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Usporedba biomehaničkih svojstava tetiva mišića plantarisa i gracilisa za rekonstrukciju medijalnoga patelofemoralnoga ligamenta [Comparison of biomechanical properties of the plantaris and gracilis tendons for medial patellofemoral ligament reconstruction]
Get PDFThe lateral patellar dislocation represents 2-3 % of all knee injuries. Medial patellofemoral ligament (MPFL) is injured in more than 95 % of cases after a first patellar dislocation. Due to the MPFL injuries, subsequent patellar instability could happen. The MPFL reconstruction using double looped gracilis tendon autograft is most frequently conducted when surgery is indicated. However, since gracilis plays an essential role in the knee biomechanics, some drawbacks may occur. On the contrary, plantaris muscle has an insignificant role in the knee biomechanics. Although used frequently as a tendon graft, there are not so many findings regarding biomechanical properties of plantaris muscle tendon. The purpose of this research project was to investigate if the plantaris muscle tendon is suitable as a tendon graft for the MPFL reconstruction. The main assumption of the research is that a doubled looped plantaris tendon graft has comparable biomechanical properties as a doubled looped gracilis tendon graft. The biomechanical study included 30 paired doubled looped plantaris and gracilis tendon grafts taken from 15 fresh human cadavers. The author compared the research results with data on the highest value of the native MPFL maximal tensile force and confirmed the hypothesis. However, in the study, only 23.3 % of doubled looped plantaris tendon grafts were suitable for the MPFL reconstruction
Dijagnostička vrijednost ultrazvučnoga pregleda prsnoga koša u razlikovanju pleuralnih izljeva maligne i nemaligne etiologije [Diagnostic validity of thoracic ultrasound in distinguishing malignant and nonmalignant pleural effusions]
Get PDFThoracic ultrasound is a diagnostic procedure that may help in the prediction of the pleural effusion etiology. Analyzing the ultrasound characteristics of pleural effusion, visceral and parietal pleura, the best predicting parameters for malignant pleural effusion (MPI) were pleural nodularity (sensitivity of 76,19 %, specificity of 71,43 %, accuracy of 73,81 %). Using various combinations of ultrasound and macroscopic characteristics of typical MPI (nodular pleura together with hemorrhagic/sanguinolent effusion; nodular pleura together with the fibrin absence in pleural effusion; pleural thickness over 10 mm together with hemorrhagic/sanguinolent effusion) finding accuracy in prediction of MPI increased up to 82,50 %. Using integrated statistical analyses of ultrasound, macroscopic and biochemical parameters (logistic regression), the three parameters were obtained (pleural nodularity, fibrin absence, serum proteins) which were the best predictors for MPI (sensitivity of 81,58 %, specificity of 76,09 %, accuracy of 89,64 %). The best single predicting parameter for non-malignant pleural effusion (NMPI) was the fibrinous remodeling (sensitivity of 45,24 %, specificity of 90,48 %, accuracy of 67,86 %). Using various combinations of ultrasound and macroscopic characteristics of typical NMPI (clear/serous pleural effusion together with fibrinous remodeling; pleural effusion fibrinous remodeling together with absent pleural nodularity; pleural effusion fibrinous remodeling together with pleural thickness less than 10 mm), finding accuracy in prediction of NMPI increased up to 88,24 %. Based on these findings, together with results of previous studies, a simple diagnostic algorithm for lymphocytic pleural effusions was proposed
High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study
Get PDFAims: Little is known regarding initiation of insulin therapy in type 2 diabetes (T2D) in Central and South-Eastern European countries. Therefore, we conducted a survey to characterise the prescribing practices of specialist diabetes healthcare professionals in this region and assessed factors that influence clinical decision-making regarding insulin initiation in T2D.
------ Methods: A cross-sectional survey sampled 211 specialist diabetes healthcare prescribers from five Central and South-Eastern European countries (Bulgaria, Croatia, Greece, Hungary, and Slovenia). A structured questionnaire was developed which surveyed current clinical practices and influencing factors, barriers to insulin initiation, and combination therapy prescribing preferences.
----- Result: Only 9.4% (20 of out of 211 respondents) of healthcare professionals would initiate insulin therapy in T2D patients at the recommended HbA1c threshold of 7-7.9% [53-63 mmol/mol]. Large regional differences were evident in insulin initiation thresholds (≥ 9.0% [≥ 75 mmol/mol]: Bulgaria 80.8% vs. Slovenia 13.3%). Psychological distress was recorded as the major barrier to insulin initiation. Health insurance regulations were ranked more important than personal clinical experience and clinical guidelines in clinical decision-making. Information from peers was more influential than manufacturer information, clinical experience, and continuous medical education, respectively, for insulin initiation.
----- Conclusions: Despite large regional variation, there is widespread delay of insulin initiation from specialist diabetes healthcare professionals in Central and South-Eastern Europe
Intracranial mature teratoma in an adult patient: a case report
Get PDFIntroduction: Primary intracranial teratoma is a subtype of germ cell tumors, classified into three subtypes. They occur very rarely, with only several reported individual cases in adults. ----- Case Description: We present a patient with an intermittent headache in the right frontal region. Magnetic resonance imaging (MRI) revealed a right sided high frontal parasagittal mass that compressed the falx, the right lateral ventricle, as well as the brain parenchyma. Patient underwent surgical treatment. Histopathological analysis described mature teratoma. Four months after the surgical treatment there were no signs of residual intracranial mass or relapse. ----- Discussion: Primary intracranial teratoma in adults has a nonspecific clinical presentation. MRI reveals a solitary irregular mass with multilocularity and mixed signals derived from different tissues. The patients age, biochemical markers, and patohistological analysis are necessary to confirm the diagnosis. ----- Conclusion: Teratoma treatment strategy still remains controversial. It includes radical resection whenever possible. Since the residual portion of mature teratoma may contain part of immature or malignant tissue, tumor recurrence after surgical removal is possible. Also, new tumor mass could occur at other sites intracranial after the initial one was removed. Thus, although patients usually recover, they should be followed-up for a long period of time
Health-related quality of life in Croatian general population and multiple myeloma patients assessed by the EORTC QLQ-C30 and EORTC QLQ-MY20 questionnaires
Get PDFBackground. The impact of disease and treatment on the patient's overall well-being and functioning is a topic of growing interest in clinical research and practice. The aim of this study is to obtain reference data on quality of life of Croatian general population. Further, we aim to assess the impact of the disease and its primary systemic treatment on their health related quality of life (HrQoL) in multiple myeloma (MM) patients. Patients and methods. Participants for the first part of the study were randomly selected from adult Croatian population. In the clinical part of the study MM patients were included as prospectively diagnosed within two years in two major Croatian haematological centres. The EORTC QLQ-C30 in both trials and QLQ-MY20 in MM patients only were applied for HrQoL assessment. Results. Gender, age and place of residence have great impact on quality of life scores in Croatian population. The MM patients at the time of diagnosis have lower QLQ-C30 scores for global quality of life, functional and symptom scale scores, as well as single items. The type of disease followed by the choice of therapy options are important HrQoL determinants. Conclusions. The norm values available now for Croatian population will help to interpret HrQoL for clinicians and aid in planning cancer care interventions. This study identified treatment effect consistent with those from other observational studies and provided new data on HrQoL across two different treatment choices for MM patients
The role of red yeast rice (RYR) supplementation in plasma cholesterol control: a review and expert opinion
Get PDFAssociation of serum PCSK9 levels with antibiotic resistance and severity of disease in patients with bacterial infections admitted to intensive care units
Get PDFBackground: The results of several studies have suggested that infections and sepsis, either bacterial or viral, might be associated with elevated plasma proprotein convertase subtilisin/kexin type 9 (PCSK9) levels. Since there are no data on PCSK9 levels and antibiotic resistance or the severity of disease in patients with bacterial infections in intensive care units, the aim of this study was to investigate whether any such associations exist.
----- Methods: 100 patients (46 males, mean age 67.12 ± 1.34 years) with bacterial infections who were staying in an intensive care unit (ICU) longer than 48 h but less than 7 days and who were not receiving corticosteroids were analyzed. Their serum levels of albumin, C-reactive protein, glucose, lactate, blood urea nitrogen, prothrombin (international normalized ratio), total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, PCSK9, and procalcitonin were measured. The severity of the patients' condition was assessed by using the Glasgow Coma Scale (GCS), the Sequential Organ Failure Assessment (SOFA), and the Acute Physiology and Chronic Health Evaluation II (APACHE II) scales.
----- Results: Using a hierarchical regression modeling approach, no significant association was found between PCSK9 levels and either the severity of disease (APACHE II, SOFA, and GCS) indices or resistance to antibiotics.
----- Conclusion: The results suggest that there is no association between PCSK9 levels and resistance to antibiotics or the condition of patients hospitalized in intensive care units
Regulation of survivin isoform expression by GLI proteins in ovarian cancer
Get PDFOvarian cancer (OC) is the most lethal female gynecological malignancy, mostly due to
diagnosis in late stages when treatment options are limited. Hedgehog-GLI (HH-GLI) signaling
is a major developmental pathway involved in organogenesis and stem cell maintenance, and is
activated in OC. One of its targets is survivin (BIRC5), an inhibitor of apoptosis protein (IAP) that
plays a role in multiple processes, including proliferation and cell survival. We wanted to investigate
the role of different GLI proteins in the regulation of survivin isoform expression (WT, 2α, 2B, 3B,
and Dex3) in the SKOV-3 OC cell line. We demonstrated that survivin isoforms are downregulated in
GLI1 and GLI2 knock-out cell lines, but not in the GLI3 knock-out. Treatment of GLI1 knock-out cells
with GANT-61 shows an additional inhibitory effect on several isoforms. Additionally, we examined
the expression of survivin isoforms in OC samples and the potential role of BIRC5 polymorphisms
in isoform expression. Clinical samples showed the same pattern of survivin isoform expression as
in the cell line, and several BIRC5 polymorphisms showed the correlation with isoform expression.
Our results showed that survivin isoforms are regulated both by different GLI proteins and BIRC5
polymorphisms in OC
A case report of severe recurrent varicella in an ankylosing spondylitis patient treated with adalimumab – a new side effect after 15 years of usage
Get PDFBackground: Tumor necrosis factor-α (TNF-α) antagonists, most of which are monoclonal antibodies, became a widespread treatment for autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel diseases, psoriasis, psoriatic arthritis, hidradenitis suppurativa and uveitis. Their use is based on the blockage of TNF-α, which plays an important role in granulomas formation, development of phagosomes, activation and differentiation of macrophages, immune response against viral pathogens. The multiple adverse effects of TNF-α inhibition have been identified, including a two-to four-fold increased risk of active tuberculosis and other granulomatous conditions and an increased occurrence of some other serious bacterial, fungal and certain viral infections.
----- Case presentation: A 34-year-old male patient with disseminated varicella and pneumonitis was admitted to our hospital. The diagnosis of varicella was established serologically by enzyme immunoassay (EIA) and by polymerase chain reaction confirmation of the virus in vesicular fluid. The patient has been receiving adalimumab and methotrexate for the last 3 years due to ankylosing spondylitis and was seropositive to varicella zoster virus prior to the introduction of TNF-α antagonists. Acyclovir was administered for 10 days with the resolution of clinical illness and radiological signs of pneumonitis.
----- Conclusion: Due to the use of biological agents, particularly TNF-α inhibitors, as a well-established therapy for some autoimmune diseases, new potential adverse events can be expected in the future and we wanted to point out one of them. To our knowledge this is the first case of recurrent disseminated varicella in a patient taking TNF-α antagonists
A free radical scavenger ameliorates teratogenic activity of a DNA hypomethylating hematological therapeutic
Get PDFThe spin-trap free radical scavenger N-tert-butyl-a-phenylnitron (PBN) ameliorated effects of several teratogens
involving reactive oxygen species (ROS). We investigated for the first time whether PBN could ameliorate
teratogenesis induced by a DNA hypomethylating hematological therapeutic 5-azacytidine (5azaC). At days 12
and 13 of gestation, Fisher rat dams were pretreated by an i.v. injection of PBN (40mg/kg) and 1 h later by an
i.p. injection of 5azaC (5mg/kg). Development was analyzed at gestation day 15 in embryos and day 20 in fetuses.
PBN alone did not significantly affect development. PBN pretreatment restored survival of 5azaC-treated dams’
embryos to the control level, restored weight of embryos and partially of fetuses, and partially restored crownrump
lengths. PBN pretreatment converted limb adactyly to less severe oligodactyly. PBN pretreatment restored
global DNA methylation level in the limb buds to the control level. Cell proliferation in limb buds of all 5azaCtreated
dams remained significantly lower than in controls. In the embryonic liver, PBN pretreatment normalized
proliferation diminished significantly by 5azaC; whereas in embryonic vertebral cartilage, proliferation of all
5azaC-treated dams was significantly higher than in PBN-treated dams or controls. Apoptotic indices significantly
enhanced by 5azaC in liver and cartilage were not influenced by PBN pretreatment. However, PBN significantly
diminished ROS or reactive nitrogen species markers nitrotyrosine and 8-hydroxy-2¢deoxyguanosine elevated by
5azaC in embryonic tissues, and, therefore, activity of this DNA hypomethylating agent was associated to the
activation of free radicals. That pretreatment with PBN enhanced proliferation in the liver and not in immature
tissue is interesting for the treatment of 5azaC-induced hepatotoxicity and liver regeneration