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Association of triiodothyronine levels with prostate cancer histopathological differentiation and tumor stage
No full textBackground/Aim: The aim of this study was to determine the association between total triiodothyronine (T3), free fraction of thyroxin (FT4), and thyrotropin (TSH) levels with prostate cancer histopathological features. Patients and Methods: Blood samples from 140 patients with prostate cancer were analyzed preoperatively and stratified according to postoperative histopathological differentiation. The first group (N=62) included patients with prostate cancer Grade Groups (GG) 1-2, while the second group (N=63) included patients with prostate cancer GG 3-5. Results: T3 levels were significantly higher in patients with prostate cancer GG 3-5 (p=0.047). There was no significant difference in the FT4 and TSH levels between the two groups (p=0.680 and 0.801, respectively). T3 levels were positively correlated with tumor percentage involvement (TPI) (p=0.002), and pT stage (p=0.047) on definitive pathology. Conclusion: Higher T3 levels are associated with several indicators of prostate cancer histopathological aggressiveness
Povezanost subkliničke inzulinske rezistencije a autoimunim biljezima štitne žlijezde u eutiroidnih ispitanika
No full textHashimoto thyroiditis is characterized by anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin (anti-Tg) antibodies that gradually lead to thyroid cell destruction. As hypothyroidism has been associated with insulin resistance (IR), we aimed to investigate whether IR is associated with thyroid antibody presence and whether the degree of IR correlates with their concentration in euthyroid individuals. A total of 164 non-diabetic, euthyroid individuals, average age 34 years, were included in the study, divided into two groups according to Hashimoto thyroiditis and underwent 5-hour oral glucose tolerance test. The degree of IR was evaluated by the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR). The Hashimoto thyroiditis group had higher HOMA-IR (p=0.003) and lower glucose levels (p=0.04). HOMA-IR correlated positively with anti-TPO (p<0.001). Linear logistic regression revealed that anti-TPO concentration increased by 18.13 (p=0.001) with each HOMA-IR unit. IR might trigger thyroid antibody production and Hashimoto thyroiditis development, which needs to be evaluated in further larger scale follow up studies.Hashimotov tireoidits obilježavaju anti-TPO i anti-Tg antitijela koja postupno dovode do uništenja stanica štitne žlijezde. Kako se hipotireoza povezuje s inzulinskom rezistencijom (IR) cilj ovoga istraživanja bio je ispitati postoji li povezanost IR s prisutnošću tireoidnih antitijela te je li stupanj IR povezan s koncentracijom autoantitijela u eutiroidnih ispitanika. U istraživanje je bilo uključeno 164 eutiroidnih ispitanika bez šećerne bolesti koji su podijeljeni u dvije skupine ovisno o prisutnosti Hashimotova tireoiditisa. Svi ispitanici podvrgnuti su 5-satnom testu opterećenja glukozom. Stupanj IR izračunat je standardiziranom metodom HOMA-IR (engl. Homeostatic Model Assessment of Insulin Resistance). Skupina ispitanika s Hashimotovim tireoiditisom imala je više vrijednosti HOMA-IR (p=0,003), ali i nižu koncentraciju glukoze (p=0,04). HOMA-IR pozitivno je korelirao s anti-TPO (p<0,001). Linearna logistička regresija pokazala je da koncentracija anti-TPO poraste za 18,13 (p=0,001) sa svakom jedinicom porasta HOMA-IR. IR je mogući okidač za razvoj autoantitijela štitnjače i razvoj Hashimotove bolesti, što treba evaluirati u budućim prospektivnim istraživanjima
Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients: post-hoc analysis of LAS VEGAS study
No full textBackground: Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients.
Methods: Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs.
Results: Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (VT) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH20. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs.
Conclusions: Neurosurgical patients are ventilated with low VT and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs
CD44 expression in human skin: high expression in irritant and allergic contact dermatitis and moderate expression in psoriasis lesions in comparison with healthy controls
No full textBackground: Previous research using animal models demonstrated that CD44 expression may contribute to directing inflammatory cells into skin lesions during inflammation development in allergic contact dermatitis (ACD).
Objectives: To examine CD44 expression in patients with ACD and irritant contact dermatitis (ICD), and to compare it to patients with psoriatic lesions and healthy controls’ (HCs) skin.
Methods: This study included 200 patients comprising four groups of 50 each: ACD, ICD, psoriasis vulgaris, and HCs. CD44 expression was determined by immunohistochemical analysis using an optical microscope, and the results were visualized semiquantitatively by determining the percentage of immunoreactive cells in the epidermis, dermis, and on lymphocytes.
Results: The highest CD44 expression was found in ICD, followed by ACD, psoriasis vulgaris, and lastly, the HCs (P < .001). Epidermal CD44 expression was significantly higher in contact dermatoses (especially in ICD) compared with psoriasis and healthy skin (P < .001). Similarly, CD44 expression in the dermis and on lymphocytes was strongest in ICD, although less pronounced than in the epidermis.
Conclusions: Because significantly elevated CD44 expression in ICD might be related to its function in maintaining and preserving the skin barrier in affected patients, further research on disease pathogenesis and new treatment options is needed
Urinary troponin concentration as a marker of cardiac damage in pregnancies complicated with preeclampsia
No full textPregnant women with preeclampsia experience significant hemodynamic changes which lead to an increased myocardial workload. In response to increased demands in pregnancy, the heart muscle responds with ventricular remodeling process which involves cardiac muscle hypertrophy. Opposed to occurrence of eccentric ventricular hypertrophy in normal pregnancy, myocardial remodeling in a form of concentric hypertrophy will occur in pregnant patients with preeclampsia. Increased myocardial workload is manifested by an increased troponin release. As process of troponin degradation continue, filtration of degradation fragment through glomerular membrane occur, raising the possibility of it's detection in urine. Degradation fragments of troponin molecules are estimated to be 20 kDa with preserved immunoreactivity to high-sensitivity assays. Some of the authors suggest that serum levels of cardiac troponin I might be elevated in patients with hypertension, as well as in preeclamptic pregnant women. It is to be expected that evaluation of severity of the myocardial damage in pregnant woman with preeclampsia may be performed by measuring levels of troponin in the urine using high-sensitivity assays. Designing of urine dipstick will help to detect an early phase of myocardial involvement in preeclamptic pregnancies
Primjena elektroretinografije i optičke koherentne tomografije u bolesnika sa shizofrenijom
No full textThe use of electroretinography (ERG) and optical coherence tomography (OCT) has currently expanded beyond ophthalmology alone. The aim of this review is to present the results and knowledge acquired by these two methods in patients suffering from schizophrenia. Reviewing the studies applying ERG and OCT methods in the field of psychiatry, one can conclude that results
of the research imply morphological and functional changes of retina in patients with schizophrenia that are not consistent. However, in most studies there was reduction of the amplitude and changes in the implicit time related parameters on ERG and thinning of the retinal nerve fiber layer on OCT. Neurons in the eye use the same neurotransmitters as neurons in the basal brain structures that are most affected in schizophrenia, according to the dopamine hypothesis of schizophrenia. Unlike neurons
in the basal brain structures, the neurons in the eye are in vivo available to ERG. Using the aforementioned tests together with clinical diagnostic criteria of schizophrenia, the subgroups with different prognostic and therapeutic specificities within schizophrenia as a group of diseases might be identified more precisely.Primjena elektroretinografije (ERG) i optičke koherentne tomografije (OCT) danas nadilazi primjenu isključivo u oftalmologiji.
Cilj ovoga pregleda je prikazati rezultate i spoznaje dobivene primjenom ovih metoda u shizofrenih bolesnika. Pregledom dosadašnjih istraživanja primjene metoda ERG-a i OCT-a u području psihijatrije možemo zaključiti da rezultati provedenih istraživanja morfoloških i funkcionalnih promjena retine u bolesnika sa shizofrenijom nisu konzistentni. Ipak, u većini istraživanja nalaze se smanjenje amplituda i promjene implicitnog vremena u ERG-u te stanjenje sloja mrežničnih živčanih vlakana na OCT-u. Kako se radi o neuronima dostupnima in vivo koji koriste iste neurotransmitere kao i neuroni u središnjim strukturama mozga koji su po dopaminskoj hipotezi shizofrenije najzahvaćeniji, primjenom spomenutih pretraga uz uobičajenu dijagnostiku shizofrenije možemo očekivati definiranje jasnijih podskupina unutar shizofrenije kao skupine bolesti koje bi imale različite prognostičke i terapijske specifičnosti
Endovaskularno liječenje intrakranijskih aneurizmi distalnih arterijskih ogranaka: ilustrativni prikaz slučajeva i uvid u dosadašnju literaturu
No full textIntracranial aneurysms located on distal arterial branches are sporadic and scarce. They account for 2%-7% of the middle cerebral artery and 0.7%-2.3% of the posterior cerebral artery aneurysms, where they mainly arise distally from the P2-related sites. Such aneurysms usually remain asymptomatic prior to rupture, making their diagnosis and management really demanding. Endovascular treatment comprising of different neurointerventional techniques is becoming the most operational up-to-date routine to approach distal cerebral branch aneurysms. In this single-institution case series, endovascular selective coiling and/or parent vessel occlusion resulted in successful and total aneurysmal exclusion from cerebral circulation, which brought good recovery. Hereby, we present an illustrative case series of distal arterial branch intracranial aneurysms, discussing their possible etiology and various endovascular management modalities. We also provide a literature retrospection concerned with this rare entity. In conclusion, due to their predisposition for rupture, distal branch intracranial aneurysms should be treated early and aggressively. We do believe that endovascular selective coil occlusion is the management method of choice, while parent vessel occlusion (with liquid embolics) is optimal when aneurysmal coiling cannot be achieved, or when distal cortical territory is well vascularized by strong collateral cerebral circulation.Intrakranijske se aneurizme distalnih arterijskih ogranaka javljaju sporadično i rijetko. One predstavljaju 2%-7% aneurizmi srednje moždane arterije i 0,7%-2,3% aneurizmi stražnje moždane arterije, gdje uglavnom nastaju na odsječku P2 i distalno od njega. Ovakve aneurizme najčešće ostaju asimptomatske i samim time neprepoznate prije nego rupturiraju, što čini njihovo dijagnosticiranje i liječenje iznimno zahtjevnim. Endovaskularno liječenje koje se sastoji od uporabe različitih neurointervencijskih tehnika postaje najučinkovitiji suvremeni rutinski pristup u opskrbi aneurizmi distalnih arterijskih cerebralnih ogranaka. U našem institucijskom prikazu slučajeva endovaskularno selektivno postavljanje zavojnica i/ili okluzija matične krvne žile rezultirali su uspješnim i potpunim isključenjem aneurizme iz moždane cirkulacije, što je osiguralo dobar oporavak bolesnika. U radu predstavljamo ilustrativni prikaz slučajeva bolesnika s intrakranijskim aneurizmama distalnih arterijskih ogranaka, raspravljajući o mogućim uzrocima njihovog nastanka i oblicima endovaskularnog liječenja. Također donosimo uvid u dosadašnju literaturu povezanu s ovom rijetkom bolesti. Zaključujemo kako bi aneurizme distalnih moždanih arterijskih ogranaka trebalo opskrbiti rano i agresivno zbog njihove sklonosti rupturi. Uvjereni smo kako je endovaskularno selektivno postavljanje zavojnica metoda izbora u liječenju, dok je okluzija matične krvne žile (pomoću tekućeg embolizacijskog sredstva) optimalna u slučaju kada nije moguće postaviti zavojnice u aneurizmatsku tvorbu, odnosno kada je distalno kortikalno područje dobro prokrvljeno snažnom kolateralnom moždanom cirkulacijom
Miksopapilarni ependimom kralježnične moždine u odraslih: prikaz osobne serije i pregled literature
No full textMyxopapillary ependymomas (MPE) of the spinal cord are slow-growing benign tumors most frequently found in adults between 30 and 50 years of age. They arise from the ependyma of the filum terminale and are located in the area of the medullary conus and cauda. The recommended treatment option is gross total resection, while patients undergoing subtotal resection usually require radiotherapy. Complete resection without capsular violation can be curative and is often accomplished by simple resection of the filum above and below the tumor mass. Nevertheless, dissemination and distant treatment failure may occur in approximately 30% of the cases. In this paper, we propose an original MPE classification, which is based upon our personal series report concerned with tumor location and its correlation with the extent of resection. We also provide literature review, discussing surgical technique, tumor recurrence rate and dissemination, and adjuvant treatment. In conclusion, our findings suggest that MPE management based on the proposed 5-type tumor classification is favorable when total surgical resection is performed in carefully selected patients. Yet, further studies on a much broader model is obligatory to confirm this.Miksopapilarni ependimomi (MPE) kralježnične moždine sporo su rastući, dobroćudni tumori najčešće zastupljeni u odraslih u dobi između 30 i 50 godina života. Nastaju iz ependima filuma terminale, a pretežito su smješteni u području medularnoga konusa i kaude. Kirurško uklanjanje tumora u cijelosti preporučena je metoda liječenja, dok u bolesnika u kojih to nije moguće učiniti u obzir dolazi subtotalna resekcija nakon koje je potrebno zračenje. Potpuno uklanjanje tumora uz očuvanje cjelovitosti tumorske kapsule postiže se jednostavnom resekcijom filuma terminale iznad i ispod tumorske mase, što može dovesti do izlječenja. Unatoč tomu, tumorska diseminacija uzduž neuralne osi može se javiti u oko 30% slučajeva. U ovom radu predlažemo originalnu klasifikaciju MPE koja prosuđuje smještaj tumora i obujam tumorske resekcije, a temeljena je na osobnoj seriji operiranih bolesnika. Također raspravljamo o kirurškoj tehnici, o mogućnostima recidiva i širenja ovakvih tumora, kao i o oblicima pomoćnog liječenja, koristeći se pregledom literature. Zaključujemo kako naši rezultati zagovaraju kirurško liječenje temeljeno na predloženoj originalnoj tumorskoj klasifikaciji, koje može biti uspješno u pažljivo odabranih bolesnika u kojih je tumor uklonjen u cijelosti. Naknadna istraživanja na znatno većem uzorku potrebna su za potvrdu naših rezultata
Chromogenic anti-FXa assay calibrated with low molecular weight heparin in patients treated with rivaroxaban and apixaban: possibilities and limitations
No full textIntroduction: Clinical application of rivaroxaban and apixaban does not require therapeutic monitoring. Commercial anti-activated factor X (anti-FXa) inhibition methods for all anti-FXa drugs are based on the same principle, so there are attempts to evaluate potential clinical application of heparin-calibrated anti-FXa assay as an alternative method for direct FXa inhibitors. We aimed to evaluate relationship between anti-FXa methods calibrated with low molecular weight heparin (LMWH) and with drug specific calibrators, and to determine whether commercial LMWH anti-FXa assay can be used to exclude the presence of clinically relevant concentrations of rivaroxaban and apixaban.
Materials and methods: Low molecular weight heparin calibrated reagent (Siemens Healthineers, Marburg, Germany) was used for anti-FXa activity measurement. Innovance heparin (Siemens Healthineers, Marburg, Germany) calibrated with rivaroxaban and apixaban calibrators (Hyphen BioMed, Neuville-sur-Oise, France) was used for quantitative determination of FXa inhibitors.
Results: Analysis showed good agreement between LMWH calibrated and rivaroxaban calibrated activity (κ = 0.76) and very good agreement with apixaban calibrated anti-Xa activity (κ = 0.82), respectively. Low molecular weight heparin anti-FXa activity cut-off values of 0.05 IU/mL and 0.1 IU/mL are suitable for excluding the presence of clinically relevant concentrations (< 30 ng/mL) of rivaroxaban and apixaban, respectively. Concentrations above 300 ng/mL exceeded upper measurement range for LMWH anti-FXa assay and cannot be determined by this method.
Conclusion: Low molecular weight heparin anti-FXa assay can be used in emergency clinical conditions for ruling out the presence of clinically relevant concentrations of rivaroxaban and apixaban. However, use of LMWH anti-FXa assay is not appropriate for their quantitative determination as an interchangeable method
