搜索结果：Polish

Monoclonal antibodies (mAbs) targeting the Calcitonin Gene-Related Peptide (CGRP) pathway are safe and effective treatments for migraine prevention. However, the high cost of these novel therapies has led to reimbursement policies requiring patients to try multiple traditional preventives before access. Here, we evaluate the real-world effectiveness of onabotulinumtoxinA (BoNT-A) as first-line treatment and describe the sequential transition to anti-CGRP monoclonal antibodies in patients who did not achieve sufficient response, within the Polish chronic migraine treatment program. In this retrospective cohort study, we included 94 patients with chronic migraine who received BoNT-A treatment according to the PREEMPT protocol every 3-4 months for 12 months as first-line treatment. Headache diaries and documentation were used to evaluate reductions in monthly headache days (MHD) and MIDAS scores. Patients were divided into two subgroups based on their response after three BoNT-A administrations: insufficient response (&#x2264;&#x2009;50% reduction in MHD) and sufficient response (>&#x2009;50% reduction in MHD). We included 94 patients (93.62% female, age range 22-66 years). Following three BoNT-A injection cycles, 70 patients (74.47%) did not achieve the &#x2265;&#x2009;50% response threshold and were sequentially transitioned to fremanezumab per programme protocol. In the insufficient response group, MHD decreased from 18.26&#x2009;&#xb1;&#x2009;4.46 to 13.90&#x2009;&#xb1;&#x2009;4.64 days (t(69)&#x2009;=&#x2009;15.49, p&#x2009;<&#x2009;0.001), representing a 23.9% reduction, while MIDAS scores decreased from 93.77&#x2009;&#xb1;&#x2009;41.80 to 61.69&#x2009;&#xb1;&#x2009;35.56 (t(69)&#x2009;=&#x2009;10.22, p&#x2009;<&#x2009;0.001, 34.2% reduction). In the sufficient response group (n&#x2009;=&#x2009;24, 25.53%), MHD decreased from 17.83&#x2009;&#xb1;&#x2009;1.95 to 7.83&#x2009;&#xb1;&#x2009;1.83 days after 3 injections (56.1% reduction, t(23)&#x2009;=&#x2009;31.97, p&#x2009;<&#x2009;0.001), and further to 4.13&#x2009;&#xb1;&#x2009;1.77 days after 5 injections (76.7% reduction, t(22)&#x2009;=&#x2009;32.59, p&#x2009;<&#x2009;0.001). Pearson's correlation analysis revealed moderate positive correlation between MHD and MIDAS after 3 injections (r&#x2009;=&#x2009;0.392, p&#x2009;<&#x2009;0.001), which weakened substantially after 5 injections (r&#x2009;=&#x2009;0.082, p&#x2009;=&#x2009;0.691). Baseline MIDAS scores were numerically higher in the sufficient response group (116.62&#x2009;&#xb1;&#x2009;61.12 vs. 93.77&#x2009;&#xb1;&#x2009;41.80, t(92)&#x2009;=&#x2009;2.04, p&#x2009;=&#x2009;0.044); however, given the outcome-dependent nature of group allocation, this difference should not be interpreted causally or as a prognostic marker. For patients who did not experience sufficient improvement after the third BoNT-A administration, treatment was changed to fremanezumab. Our real-world data demonstrate that 74.47% of patients with chronic migraine did not achieve the &#x2265;&#x2009;50% MHD reduction threshold after three onabotulinumtoxinA injections, supporting the current Polish therapeutic algorithm that allows sequential transition to anti-CGRP monoclonal antibodies for insufficient responders.

In heart failure (HF), patients' quality of life (QoL) is influenced not only by cardiac function but also by coexisting conditions. Despite the widespread use of QoL assessments, the role of patient-related factors as determinants of QoL remains not fully elucidated. This study aims to assess the relative impact of different factors on QoL in HF patients, also its impact on mortality in this group. The study was based on the national registry - HEart failuRe ObsErvational Study of the Polish Cardiac Society, where QoL was assessed at baseline (Kansas City Cardiomyopathy Questionnaire [KCCQ]-12), and follow-up data on all-cause mortality were obtained. Adjusted linear regression was used to identify factors associated with KCCQ-12. The study included 1397 patients with a mean KCCQ-12 score = 47.92 (28.65-72.92). Higher New York Heart Association class had consistently significantly lower values of all KCCQ-12 domains and KCCQ-12 overall score (85 [69-93] vs. 65 [46-79] vs. 35 [23-49] vs. 21 [10-38]; all P <0.001). Hospitalized patients had significantly lower KCCQ-12 overall score, with a significant difference between patients hospitalized for HF or non-cardiac reasons and patients hospitalized for other cardiac conditions. Apart from visit type, individual factors, cardiovascular conditions, and non-cardiac conditions were independently associated with KCCQ-12. KCCQ-12 also significantly influenced all-cause mortality (hazard ratio per 1 point increase = 0.976; 95% confidence interval, 0.970-0.981; P <0.001). Individual factors with both cardiac and non-cardiac comorbidities are independently associated with QoL in patients with HF. The KCCQ-12 integrates all of these factors and may serve as a simple, easily accessible tool for prognostic assessment.

Aim: The aim of this paper is to define and discuss a new and emerging sub-discipline of special education, namely special education for individuals with mental disorders. Materials and Methods: This paper is based on a narrative review and theoretical analysis of selected Polish and international literature from the fields of special education, psychiatry, and social sciences. The analysis included monographs and peer-reviewed articles addressing adult education, intellectual disability, autism spectrum disorders, and mental disorders, with particular emphasis on schizophrenia and affective disorders. A critical and comparative analysis of theoretical concepts and paradigmatic changes, especially the development of community-based models of care, was conducted. Mental disorders constitute an important cause of disability in adulthood and create a new area of interest for special education. The development of community psychiatry and community mental health centers opens opportunities for special educators to work with adults with mental disorders as community therapists, social skills trainers, or recovery assistants. However, the establishment of this professional role requires legal regulations and interdisciplinary cooperation. Conclusions: Special education pedagogy for people with mental disorders constitutes a new and essential subdiscipline of special education. The expansion of community psychiatry creates structural opportunities for the development of professional roles within this field. Whether community therapists evolve into formally recognized special educators for persons with mental disorders will depend on future legislative solutions, the engagement of universities in developing specialized training programs, and close cooperation between educators and psychiatrists.

Independent postmarket clinical evidence for newly introduced inguinal meshes remains limited. We conducted a&#xa0;multicenter prospective observational study to assess early safety and effectiveness of fixation-free SWING-Mesh in transabdominal preperitoneal (TAPP)&#xa0;/&#xa0;totally extraperitoneal (TEP) repair. We aimed to assess early (3-month) safety and effectiveness of fixation-free SWING-Mesh use in TAPP/TEP repair. A&#xa0;prospective cohort study was conducted in 20 Polish centers, of which 1 was excluded after central monitoring. Consecutive adults underwent elective TAPP or TEP repair with the&#xa0;unfixed polypropylene SWING-Mesh. Exclusion criteria comprised emergency surgery, bowel resection, contraindications to laparoendoscopic repair, and large direct M3 hernias. Recurrence, complications, unplanned visits&#xa0;/&#xa0;interventions and pain (as per the&#xa0;Visual Analog Scale [VAS]) at&#xa0;discharge, 7-10 days, 30 days, and 3 months postoperatively were recorded. The&#xa0;unit of analysis was the&#xa0;operated groin (case). We analyzed 294 cases in a&#xa0;total of 283 patients at&#xa0;a mean (SD) age of 51.9 (15.9) years, 84.4% of which were men. TAPP repair was performed in 86.4%, and TEP procedure in 13.6% of the&#xa0;patients. There were no instances of hernia recurrence by 3 months postsurgery. Pain decreased over time (P&#xa0;<&#x2060;0.001): mean (SD) VAS score of 1.8 (1.4) at&#xa0;discharge, 1 (1.2) at&#xa0;7-10 days, 0.5 (1.1) at&#xa0;30 days, and 0.5 (1) at&#xa0;3 months postoperatively. At&#xa0;3 months after the&#xa0;procedure, 78.5% of the&#xa0;individuals reported a&#xa0;VAS score of 0, and 3.1%, a&#xa0;score equal to or greater than&#xa0;4. Complication rates were below 10% at&#xa0;each time point and were mostly minor; 6.9% or fewer patients required an&#xa0;unplanned visit or intervention by 3 months postoperatively. Fixation-free SWING-Mesh use in TAPP/TEP repair was associated with favorable early outcomes. Twelve-month follow-up will report long-term recurrence and chronic pain.

The aim of this study was to comprehensively evaluate how close-to-nature forest management influences species richness of plant in comparison to protected forests. We adopted a multi-scale framework integrating local (alpha), regional (gamma), and spatial turnover (beta) diversity, allowing us to disentangle contrasting species richness responses that may emerge depending on the scale of observation. Data from 671 plots were analysed to assess species richness of plant in protected forest areas and in close-to-nature managed forests of the Polish Western Carpathians. The forest communities within the study area are predominantly Carpathian beech-fir forests (Abies alba-Fagus sylvatica). To assess the effects of forest structure and management on local diversity, generalized additive models (GAMs) were applied. Analyses of gamma and beta diversity were conducted separately using rarefaction and turnover metrics, in accordance with the multi-scale framework of the study. Our results demonstrate that differences in plant diversity between management regimes depend strongly on the spatial scale of analysis. Managed forests exhibited higher plot-level (alpha) diversity. The enhanced local diversity in managed forests appears to be associated primarily with management-induced structural openness and vertical complexity rather than forest maturity per se. In contrast, protected forests supported higher gamma diversity and substantially greater beta diversity, reflecting stronger species turnover and the persistence of rare and specialist taxa associated with long-term continuity and environmental heterogeneity. Overall, our findings support close-to-nature forest management as an important component of multifunctional forestry, capable of conserving plant diversity when appropriately tailored to local ecological conditions. At the same time, they reaffirm the irreplaceable role of protected forests in maintaining regional biodiversity. Effective conservation strategies should therefore integrate both approaches, explicitly accounting for biodiversity patterns across multiple spatial scales.

Obstacles encountered by downstream migrating European eels during their spawning migration are among the primary causes of their population decline. River regulation and hydrotechnical infrastructure play a crucial role in this process. Fish reaching migration barriers often interrupt their journey, while those passing through hydroelectric turbines frequently suffer fatal injuries. Using acoustic telemetry, the downstream migration of silver eels from a large lake complex in northern Poland was tracked. Along their route, the fish encountered small hydropower plant (SHP) equipped with Kaplan turbines. Of the tagged eels, 25% did not reach the dam, and an additional 47% stopped in the reservoir. Only 28% of the eels passed through the turbines, of which 7% died during passage. In total, 26% of the eels reached the Polish border-the downstream limit of the tracking range, located 41&#xa0;km from the release point. Using a GLM model, we demonstrated the significance of morphological parameters such as the ocular index (EI) and total body length (TL) on the migration time after passing through the SHP. Larger EI and TL reduced migration time.

Obesity is a major global health issue associated with comorbidities, such as type 2 diabetes mellitus (T2DM) and cardiovascular disease. Bariatric surgery is effective, but its outcomes vary. Obstetric history may influence results, as pregnancy induces lasting metabolic and hormonal changes, though current evidence remains unclear. This study aimed to evaluate whether preoperative pregnancy history affects weight loss outcomes after bariatric surgery. A retrospective multicenter analysis was conducted within the Maternal Outcomes of Bariatric Surgery and Pregnancy Study project, including 1399 women from 11 Polish bariatric centers. The participants were divided into 2 groups: women with a history of pregnancy (n=1061) and nulliparous women (n=338). Primary outcomes included percentage of total weight loss (%TWL), percentage of excess weight loss (%EWL), and overall weight reduction. Women with prior childbirth were older (42 vs 32.5 y; P <&#x2060;0.001) and more frequently had T2DM (22% vs 12%; P <&#x2060;0.001) and hypertension (44.9% vs 23.4%; P <&#x2060;0.001) than the nulliparous participants. Median postoperative body mass index (BMI) was similar in both groups (29 kg/m&#xb2;), but weight loss differed considerably. Women with childbirth history achieved lower %TWL (28.57% vs 33.85%; P <&#x2060;0.001) and %EWL (72.17% vs 78.44%; P =0.001), as compared with those who never gave birth. Multivariate regression identified age, preoperative BMI, hypertension, and dyslipidemia as independent factors affecting weight loss. Women with a history of childbirth achieve poorer weight loss outcomes after bariatric surgery; however, it is not an independent factor influencing bariatric results.

Mobile element insertions (MEIs) disrupting coding sequences are rare but clinically significant mutations that are often missed by standard next-generation sequencing (NGS) workflows. Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant tumour predisposition syndrome caused by pathogenic variants in the MEN1 gene. Patients included in this study were referred for genetic testing of hereditary cancer syndromes. In a validation of our NGS-based copy number variant detection pipeline, four cases showed discrepancies between NGS and multiplex ligation-dependent probe amplification (MLPA) results. Further investigation using soft-clipped read analysis and the MEI detection tool Scramble revealed an Alu insertion in the MEN1 gene. Long-read whole genome sequencing (LR-WGS) was used for validation and complete characterisation of the variant. Additionally, 2014 retrospective NGS samples were analysed with Scramble. Relatives of probands were tested with MLPA and PCR. Positive samples were analysed with Sanger sequencing. The apparent exon 2 deletion detected by MLPA was shown to be a false positive caused by an Alu insertion within the probe binding site. LR-WGS confirmed the pathogenic variant (MEN1:c.143_144insAlu) and resolved its complete sequence. Screening of the retrospective cohort revealed no additional MEIs. Altogether, we identified 10 affected individuals from two Polish families carrying hereditary MEN1:c.143_144insAlu, which segregates with MEN1 syndrome. We report a novel pathogenic Alu insertion in the MEN1 gene, which is associated with MEN1 syndrome. Our findings underscore the importance of incorporating MEI detection into routine diagnostics. It also emphasises the necessity of interpreting single-exon MLPA deletions cautiously, as recommended in the MLPA protocol.

Colorectal cancer (CRC) is a major health concern globally, with lymph node metastasis being a key factor in its spread. The lymph node ratio (LNR), defined as the ratio of pathologically positive lymph nodes to the total number of examined nodes, has been proposed as a prognostic marker in CRC. However, data from prospective cohort studies remain limited. This study aimed to evaluate the association between LNR and overall survival (OS) in patients with colon cancer in a prospective multicentre cohort. A prospective cohort study was conducted across seven Polish surgical centers enrolling 445 patients with primary colon cancer. The study collected survival data until September 30, 2022, focusing on patients aged 18-75 years eligible for radical surgery. Preoperative assessments included demographic information, Body Mass Index (BMI) and histopathological evaluation according to AJCC 8th edition. Surgical complications were graded using the Clavien-Dindo scale. The association between OS and LNR was analysed using a multivariable Cox proportional hazards model adjusting for selected clinical and surgical covariates. In the multivariable Cox model, LNR, BMI, and grade III or higher postoperative complications were independently associated with overall survival. For LNR, a 0.1-unit increase was associated with a 26% increase in the hazard of death (hazard ratio 1.26, 95% CI 1.07-1.48; p&#x2009;=&#x2009;0.006). In this prospective multicentre cohort, lymph node ratio was associated with overall survival in patients with colon cancer, alongside body mass index and the severity of postoperative complications. These findings suggest that LNR may represent a clinically relevant prognostic marker and warrant further investigation in studies specifically designed to compare its prognostic performance with established nodal staging systems.

Ensuring food safety while advancing sustainability is increasingly recognised as a dual imperative for modern food systems. However, the interconnection between food safety and sustainability at the retail and food service levels remains underexplored. This study is aimed at assessing and comparing the prevailing food safety practices (FSP) and sustainability practices (SUST) among grocerants, which are hybrid outlets combining grocery retail and restaurant functions, in Ghana, Poland, and India. A structured 28-indicator observational checklist (14 FSP and 14 SUST indicators) was applied during unannounced audits of 150 grocerants. The analysis revealed significant cross-country differences in compliance levels for both sections. Polish grocerants achieved comparatively the highest mean scores, reflecting advanced hygiene management and proactive SUST, whereas Ghanaian and Indian outlets exhibited moderate compliance. Cluster analysis identified three groups representing low-, transitional-, and high-maturity stages of sustainable food safety performance. Grocerants with stronger food safety compliance also demonstrated higher sustainability engagement, suggesting an association between the two domains. The findings highlight differences in regulatory enforcement and managerial commitment across various contexts, contributing to the development of the concept of sustainable food safety management, which links hygiene compliance with environmental and social responsibility in emerging retail formats.

Corporate bankruptcy prediction is essential for assessing companies' capacity to maintain sustainable customer relationships and service quality. This study proposes a novel CNN-based hybrid approach that transforms correlation-filtered financial features into 64&#x2009;&#xd7;&#x2009;64 grayscale images, enabling reliable identification of firms at financial risk whose deteriorating conditions could compromise their ability to maintain quality customer service and sustain long-term business relationships. The research explicitly examines the linkage between financial health indicators and customer relationship sustainability by categorizing financial features based on their operational impact on service delivery, relationship management capabilities, and long-term customer commitment fulfillment. The methodology was evaluated on a comprehensive dataset of 43,405 Polish companies (2,091 bankrupt, 41,314 healthy) using two resampling strategies: random downsampling and Synthetic Minority Oversampling Technique (SMOTE). Following correlation-based feature selection that reduced multicollinearity by eliminating features with absolute correlation coefficients exceeding 0.8, retained financial features were normalized and transformed into spatial image representations. Six classification models were implemented: Deep Neural Network (DNN), Support Vector Machine (SVM), Random Forest (RF), Decision Tree (DT), Gradient Boosting (GB), and Logistic Regression (LR), alongside five CNN-hybrid variants, evaluated using 5-fold cross-validation. SMOTE-balanced datasets demonstrated superior performance across all models. Ensemble methods achieved exceptional accuracy, with Random Forest reaching 99.99% and Gradient Boosting 99.97%. The innovative CNN-SVM hybrid model attained 99.77% accuracy with perfect ROC-AUC (1.000), providing reliable indicators for assessing firms' financial stability and their ability to invest in customer experience initiatives. Statistical analysis identified company size and working capital as the most discriminative financial indicators directly impacting customer service delivery capabilities. Customer-related metrics such as receivables turnover and collection period indicators emerged as critical predictors of relationship management effectiveness. The study contributes a novel spatial feature representation methodology enabling precise identification of companies whose financial deterioration could compromise customer service quality and relationship sustainability. These findings provide significant implications for stakeholders seeking enhanced risk assessment capabilities that consider both internal financial health and external customer relationship dynamics in bankruptcy prediction.

Balantioides coli (formerly Balantidium coli) is a ciliate protozoan causing balantidiasis in humans and non-human primates (NHPs), yet it remains underrecognized in zoological settings. Morphologically similar ciliates described as Buxtonella-like organisms have been reported in NHPs and are generally considered asymptomatic. In this study, we report symptomatic infection in mandrills (Mandrillus sphinx) and investigate the prevalence and genetic diversity of Balantioides spp. and Buxtonella-like ciliates across multiple NHP species housed in Polish zoological gardens. Faecal samples were collected from 70 individually identified NHPs representing 25 species across five facilities between October 2023 and September 2025 and examined using coproscopic methods and molecular analyses. While standard coproscopy detected ciliate cysts in 5.7% of samples, PCR identified infections in 18.6% of individuals, demonstrating substantially higher sensitivity. Balantioides coli was detected in several NHP species, whereas a Buxtonella-like organism was found exclusively in seven mandrills, five of which exhibited gastrointestinal symptoms. Phylogenetic analyses revealed a distinct lineage associated with mandrills, suggesting host specificity and previously unrecognised pathogenic potential. These findings challenge the assumption of asymptomatic carriage of Buxtonella-like ciliates and underscore the importance of molecular diagnostics for accurate detection and assessment of clinically relevant protozoan infections in captive NHP populations.

This narrative review explores the development and implementation of Coordinated Care (CC) within Primary Health Care (PHC) systems in Europe, with a focus on Poland. CC aims to provide continuous, integrated, and patient-centered care, particularly for individuals with chronic conditions. By analyzing PHC models across 13 European countries, the review highlights variations in the scope of services, roles of primary care teams, and the integration of diagnostic and specialist support. In Poland, a CC model was introduced nationally in 2022 following a successful pilot. It emphasizes enhanced roles for general practitioners, nurses, and care coordinators, and includes comprehensive consultations, individual health care plans (IHCPs), and expanded diagnostic access. Data from public sources from 2023 to 2025 show growing provider participation and improved diagnosis rates, particularly for chronic kidney disease. The Polish model demonstrates that systemic reforms based on PC team collaboration and fee-for-service financing can be a way of strengthen PHC systems by better resource utilization. While early results are promising, further evaluation is needed to assess long-term outcomes and guide adaptations in other healthcare settings.

One of the major applications of the CRISPR-Cas9 system is the visualization of DNA by using nuclease-deactivated Cas9 (dCas9), which, following complexation with a single-guide RNA (sgRNA), specifically binds to target genomic sequences without inducing DNA breaks. In this approach, either dCas9 or the sgRNA is labeled with fluorescent proteins or dyes, or they are engineered to recruit such molecules. A key advantage of CRISPR-based imaging is that genomic elements in living cells can be tracked, because of the ability to express all system components in vivo. Although CRISPR-based imaging has been successfully used to label repetitive sequences in living cells, the visualization of nonrepetitive loci remains a challenging issue. The primary obstacles are a low signal-to-noise ratio and the potential for nonspecific DNA binding by the dCas9-sgRNA complex, which can generate fluorescent puncta at off-target sites. Efficient intracellular delivery of system components and their sustained expression over time are also a major concern. Consequently, CRISPR-based imaging remains a highly time- and labor-intensive process that requires ongoing optimization. Here, we summarize recent advances in labeling nonrepetitive genomic loci, outline key challenges associated with CRISPR-based imaging, and present insights derived from our own experimental findings and research experience.