Veterinary medicine - Repository of PHD, master's thesis
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Analysis of risk factors and outcome in patients with severe aortic stenosis
No full textUvod: Aortalna stenoza (AS) jest progresivna bolest koja najčešće zahvaća stariju populaciju. Povezana je s visokim mortalitetom i morbiditetom stoga ju je nužno što ranije prepoznati kako bi se započelo odgovarajuće liječenje i poboljšali klinički ishodi. Hipoteza istraživanja je kako prisutnost kardiovaskularnih čimbenika rizika i komorbiditeta u bolesnika s teškom aortalnom
stenozom, negativno utječe na klinički tijek bolesti i preživljenje bolesnika s teškom aortalnom stenozom.
Ispitanici i metode: Provedeno retrospektivno kohortno istraživanje obuhvatilo je 477 pacijenata s dijagnozom teške AS koji su liječeni na Klinici za bolesti srca i krvnih žila Kliničkog bolničkog centra Zagreb u razdoblju od rujna 2020. godine do svibnja 2024. godine. Pacijente s teškom aortalnom stenozom smo na temelju procijenjene brzine glomerularne filtracije (eGFR) podijelili u
4 skupine i usporedili na temelju demografskih osobina, čimbenika rizika, kliničkih stanja i metoda liječenja.
Rezultati: Od 477 bolesnika s teškom AS (medijan dobi: 80. godina [74.-84.0]) 53.7% su bile žene. ITM je iznosio 27.1 kg/m2
[24.2-30.8]. Pri usporedbi standardnih kardiovaskularnih čimbenika rizika između skupina, pacijenti s najlošijom renalnom funkcijom (eGFR <30) su imali najveći udio arterijske hipertenzije (100%) i šećerne bolesti (44.7%) kao što je očekivano. Od svih
bolesnika s teškom AS, njih 39.6% je imalo FA sa statistički značajnom učestalošću pojavljivanja u skupinama s eGFR <60 (p<0.001). Logističkom regresijom je dobivena statistički značajna negativna asocijacija između učestalosti fibrilacije atrija i renalne funkcije (OR 0.987, 95 % CI 0.979-0.996, p=0.003). Logistička regresija anemije i eGFR-a je pokazala statistički značajnu negativnu asocijaciju (OR 0.976, 95 % CI 0.967-0.985, p<0.001). Najveći postotak bolesnika s teškom AS je bio liječen metodom zamjene aortalne valvule (79.7%). U jednogodišnjem praćenju bolesnika s teškim AS, ukupni mortalitet je iznosio 17.4% pri čemu su bolesnici liječeni konzervativnom metodom u usporedbi s TAVI/SAVR imali statistički niže preživljenje (log-rank p<0.001).
Zaključak: Bolesnici s teškom degenerativnom AS i lošijom bubrežnom funkcijom, imaju veću učestalost AH, anemije i FA. Bolesnici liječeni metodom zamjene aortalne valvule imaju bolje preživljenje nego bolesnici liječeni konzervativnim pristupom.Introduction: Aortic stenosis (AS) is a progressive disease that commonly affects the elderly population. It is associated with high mortality and morbidity; therefore, it is essential to recognize it as early as possible to initiate adequate treatment and improve clinical outcomes. This study hypothesizes that the presence of cardiovascular risk factors and comorbidities in patients with severe aortic valve stenosis negatively affects the clinical course of the disease and the survival of these patients.
Subjects and methods: Retrospective cohort study included 477 patients diagnosed with severe AS who were hospitalized at the Department of Cardiovascular Diseases of the University Hospital Centre Zagreb from September 2020 to May 2024. Patients with severe aortic stenosis were divided into 4 groups according to estimated glomerular filtration rate (eGFR) and compared based on demographic characteristics, risk factors, clinical conditions, and treatment methods.
Results: Of the 477 patients with severe AS, with a median age of 80 years [74-84.0], 53.7% were women. The BMI was 27.1 kg/m² [24.2-30.8]. When comparing standard cardiovascular risk factors between groups, patients with the lowest renal function (eGFR <30) had the highest proportion of arterial hypertension (100%) and diabetes (44.7%), as expected. Of all patients with severe AS, 39.6% had atrial fibrillation, with a statistically significant frequency of occurrence in the groups with eGFR <60 (p<0.001). Logistic regression showed a statistically significant negative association between the frequency of atrial fibrillation and renal function (OR 0.987, 95% CI 0.979–0.996, p = 0.003). Logistic regression of anemia and eGFR showed a statistically significant negative association (OR 0.976, 95% CI 0.967–0.985, p < 0.001).
Conclusion: In patients with severe degenerative AS and reduced renal function, there was a higher incidence of arterial hypertension, anemia, and atrial fibrillation. Patients treated with aortic valve replacement have better survival than those treated with a conservative approach
Noninvasive diagnostics and monitoring of ulcerative colitis
No full textUlcerozni kolitis (eng. ulcerative colitis, UC) je kronična idiopatska upalna bolest crijeva (engl. inflammatory bowel disease, IBD) obilježena relapsno-remitirajućim tijekom. Obzirom da se dijagnostika i praćenje bazira većinom na endoskopiji, koja je invazivan i za pacijenta neugodan postupak, postoji rastući interes za primjenu neinvazivnih alata. U ovom radu analizirane su najvažnije neinvazivne metode za dijagnostiku i praćenje UC, s naglaskom na kliničku primjenu serumskih i fekalnih biomarkera te intestinalnog ultrazvuka (engl. intestinal ultrasound, IUS). Kroz pregled najnovijih smjernica (ECCO-ESGAR, AGA) i recentne literature, raspravljena je osjetljivost, specifičnost i prognostička vrijednost markera poput CRP-a, fekalnog kalprotektina (FC), laktoferina, lipokalina-2 i protutijela povezanih s upalnim bolestima crijeva. Posebna pažnja posvećena je ulozi IUS-a dijagnostici, praćenju terapijskog odgovora i posebnim kliničkim situacijama poput trudnoće i teškog akutnog kolititsa. Rad također naglašava važnost treat-to-target (T2T) pristupa te identificira izazove i otvorena pitanja vezana za standardizaciju vremenskih okvira evaluacije, međuindividualne razlike i troškovnu učinkovitost neinvazivnih metoda. Cilj rada bio je prikazati mogućnosti i ograničenja neinvazivnih strategija u suvremenom pristupu bolesnicima s ulceroznim kolitisom.Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease (IBD) characterized by a relapsing-remitting course. Given the reliance on endoscopy for diagnosis and monitoring, which is an invasive and often uncomfortable procedure, there is growing interest in implementing non-invasive tools. This thesis explores the most relevant non-invasive methods for the assessment and follow-up of UC, focusing on the clinical application of serum and faecal biomarkers, as well as intestinal ultrasound (IUS). Drawing on the latest international guidelines (ECCO-ESGAR, AGA) and recent literature, the work examines the sensitivity, specificity, and prognostic value of markers such as CRP, faecal calprotectin (FC), lactoferrin, lipocalin-2 and IBD-related antibodies. Special attention is given to the role of IUS in diagnosis, treatment monitoring and in specific clinical contexts such as pregnancy and acute severe colitis. The thesis also highlights the importance of the treat-to-target (T2T) approach and addresses current challenges and unresolved questions, including the timing of assessments, inter-individual variability, and cost-effectiveness of non-invasive strategies. The aim was to provide a comprehensive overview of the opportunities and limitations of non- invasive approaches in the modern management of patients with ulcerative colitis
Diabetic kidney disease
No full textDijabetička bolest bubrega vodeći je uzrok završnog stadija kronične bubrežne bolesti i jedan od glavnih čimbenika morbiditeta i mortaliteta među osobama sa šećernom bolešću. Patogeneza uključuje kombinirano djelovanje dugotrajne hiperglikemije, oksidativnog stresa, hemodinamskih poremećaja, kronične upale te epigenetskih promjena koje potiču fibrozu i gubitak funkcionalnih nefrona. Novija istraživanja ukazuju i na važnu ulogu lipotoksičnosti, osobito nakupljanja lizofosfatidilkolina u bubrežnim stanicama, što pridonosi oštećenju tubula i progresiji bolesti. Iako se bolest tradicionalno smatrala isključivo mikrovaskularnom komplikacijom, danas se sve više promatra kao heterogeni sindrom s izraženom glomerularnom, tubulointersticijskom i vaskularnom komponentom. Dijagnoza se postavlja temeljem kliničkih parametara, najčešće na temelju prisutnosti patološke albuminurije i/ili snižene procijenjene brzine glomerularne filtracije, uz isključenje drugih uzroka bubrežne bolesti. Međutim, sve je više bolesnika s neproteinuričnim fenotipom bolesti, osobito među starijim osobama i bolesnicima s tipom 2 šećerne bolesti, što zahtijeva dodatne dijagnostičke pristupe. Biopsija bubrega može biti ključna u diferencijalnoj dijagnozi kod atipične kliničke slike, ali se ne provodi rutinski zbog invazivnosti postupka. Terapija dijabetičke bolesti bubrega usmjerena je na usporavanje progresije oštećenja i smanjenje kardiovaskularnog rizika. Uz kontrolu glikemije, arterijskog tlaka i lipida, sve veću ulogu imaju novije terapije, uključujući inhibitore natrij-glukoza kotransportera tipa 2 i nesteroidne antagoniste mineralokortikoidnih receptora. Unatoč terapijskim naprecima, značajan broj bolesnika napreduje prema završnom stadiju bubrežne bolesti koji zahtijeva nadomjesnu bubrežnu terapiju, poput dijalize ili transplantacije. Zbog izrazite heterogenosti kliničkih oblika, nepredvidive progresije i ograničenih terapijskih opcija, dijabetička bolest bubrega ostaje velik izazov moderne medicine. Potrebno je razvijati nove biomarkere za rano otkrivanje bolesti i individualizirati terapijske pristupe utemeljene na molekularnim i genetskim obilježjima bolesnika.Diabetic kidney disease is the leading cause of end-stage chronic kidney disease and a major contributor to morbidity and mortality among individuals with diabetes mellitus. Its pathogenesis involves the combined effects of prolonged hyperglycemia, oxidative stress, hemodynamic disturbances, chronic inflammation and epigenetic modifications that promote fibrosis and nephron loss. Recent studies have highlighted the important role of lipotoxicity, particularly the accumulation of lysophosphatidylcholine in renal cells, which contributes to tubular injury and disease progression. Although traditionally considered a purely microvascular complication, diabetic kidney disease is increasingly recognized as a heterogeneous syndrome with significant glomerular, tubulointerstitial, and vascular involvement. Diagnosis is based on clinical parameters, most commonly the presence of pathological albuminuria and/or a reduced estimated glomerular filtration rate, after exclusion of other causes of kidney disease. However, an increasing number of patients present with a non-proteinuric phenotype, especially among older adults and individuals with type 2 diabetes, requiring broader diagnostic strategies. Kidney biopsy can be essential for differential diagnosis in atypical cases, though its use is limited due to its invasive nature. Treatment of diabetic kidney disease aims to slow the progression of renal impairment and reduce cardiovascular risk. In addition to controlling blood glucose, blood pressure, and lipid levels, newer therapies are gaining prominence, including sodium-glucose co-transporter 2 inhibitors and non-steroidal mineralocorticoid receptor antagonists. Despite therapeutic advancements, a significant proportion of patients continue to progress to end-stage renal disease requiring renal replacement therapy such as dialysis or kidney transplantation. Due to the pronounced heterogeneity of clinical presentations, unpredictable progression, and limited therapeutic options, diabetic kidney disease remains a major challenge in modern medicine. There is a critical need for the development of novel biomarkers for early detection and the implementation of individualized treatment strategies based on the molecular and genetic characteristics of each patient
Impact of different endometrial preparation on the outcome of the transfer of cryopreserved embryos
No full textKrioprezervacija embrija i tehnika transfera odmrznutih embrija (FET, engl. frozen embryo
transfer) postali su neizostavan dio suvremenih postupaka potpomognute oplodnje (ART).
Diplomski rad istražuje različite protokole pripreme endometrija u FET ciklusima (prirodni,
programirani i stimulirani ciklusi) te njihove učinke na reproduktivne i perinatalne ishode, uz
dodatnu analizu prednosti FET-a u odnosu na svježe prijenose embrija.
Usporedbom metoda pripreme endometrija ustanovljeno je da prirodni ciklusi (s ovulacijom i
prisutnošću žutog tijela) imaju povoljniji sigurnosni profil, osobito u pogledu nižeg rizika od
preeklampsije, hipertenzije i prijevremenog poroda. Kod anovulatornih žena, stimulirani
ciklusi, osobito oni stimulirani letrozolom, pokazuju bolje ishode trudnoće i nižu stopu
spontanih pobačaja u odnosu na programirane cikluse. Programirani (HRT) ciklusi, iako
logistički fleksibilniji i s manjom stopom otkazivanja, povezani su s većim rizicima kod žena
koje prirodno ovuliraju, uključujući povišenu incidenciju preeklampsije i veću porođajnu masu.
FET ciklusi općenito nadmašuju svježe prijenose u većini ključnih pokazatelja: veća je stopa
živorođenosti i kliničke trudnoće, manji je rizik od sindroma hiperstimulacije jajnika (OHSS)
te su neonatalni ishodi povoljniji. Međutim, FET se povezuje i s višim rizikom od makrosomije,
što može utjecati na porod i neonatalnu skrb.
U području krioprezervacije, vitrifikacija kao metoda brzog zamrzavanja pokazuje superiornost
u odnosu na sporo zamrzavanje – s višim stopama preživljavanja stanica, boljom morfologijom
nakon odmrzavanja i većom kliničkom učinkovitošću.
Iako dostupni podaci upućuju na jasne prednosti pojedinih protokola u određenim
populacijama, studije često pate od metodoloških ograničenja poput malih uzoraka i
heterogenih protokola. Stoga je potrebna dodatna standardizacija i provođenje velikih
randomiziranih istraživanja kako bi se oblikovale jasne kliničke preporuke.Cryopreservation of embryos and the technique of frozen embryo transfer (FET) have become
essential components of modern assisted reproductive technologies (ART). This thesis explores
different protocols for endometrial preparation in FET cycles (natural, programmed and
stimulated) and their impact on reproductive and perinatal outcomes, along with an analysis of
the advantages of FET over fresh embryo transfers.
Comparison of endometrial preparation methods reveals that natural cycles (with ovulation and
the presence of the corpus luteum) are associated with a better safety profile, especially in terms
of reduced risk of preeclampsia, hypertension and preterm birth. In anovulatory women,
stimulated cycles – particularly those stimulated by letrozole – show better pregnancy outcomes
and lower miscarriage rates compared to programmed cycles. Programmed (HRT) cycles,
although more flexible and less prone to cancellation, have been linked to increased maternal
risks in ovulatory women, including a higher incidence of preeclampsia and increased birth
weight.
FET cycles generally outperform fresh embryo transfers in most key outcomes: they yield
higher live birth and clinical pregnancy rates, lower the risk of ovarian hyperstimulation
syndrome (OHSS), and are associated with better neonatal outcomes. However, FET is also
linked to an increased risk of macrosomia, which may affect delivery and neonatal care.
In the field of cryopreservation, vitrification – a rapid freezing technique – demonstrates
superiority over slow freezing, with significantly higher cell survival rates, better post-warming
morphology, and improved clinical outcomes.
Although current data support specific protocols for particular patient populations, existing
studies often suffer from methodological limitations, such as small sample sizes and
heterogeneous protocols. Therefore, further standardization and large-scale randomized trials
are needed to establish clear clinical guidelines
The effectiveness of yoga practice during pregnancy on labour course and birth outcome
No full textUvod: Sve veći broj porođaja carskim rezom (CR) globalni je izazov u suvremenom porodništvu. Taj porast nije popraćen boljim ishodima novorođenčadi i majki. Prevencija neopravdanog primarnog carskog reza postaje prioritet. Ovo istraživanje ispituje učinkovitost i sigurnost vježbanja joge u trudnoći i njezinu povezanost s perinatalnim ishodom.
Ispitanici i metode: Proveli smo randomizirano kontrolirano kliničko istraživanje u zdravih prvorotkinja s jednoplodnom trudnoćom s randomizacijom u prvom tromjesečju trudnoće. Istraživanje je provedeno u Sveučilišnom Kliničkom centru Maribor u Sloveniji u razdoblju od 2018. do 2023. godine. Ukupno je randomizirano 214 sudionica, 106 u skupini trudnica koje su vježbale jogu i 108 u kontrolnoj skupini. Studijska skupina izvodila je vježbe joge, dok je kontrolna skupina primala standardnu prenatalnu skrb. Vježbe joge izvodile su se jednom tjedno pod nadzorom certificiranog učitelja joge i trajale su 90 minuta. Sve trudnice iz ispitivane skupine završile su ukupno 12 vježbi joge.
Rezultati: Skupina trudnica koja je vježbala jogu imala je nižu stopu intrapartalnog carskog reza (p = 0,004) i češći spontani vaginalni porođaj (p = 0,009), dok je kontrolna skupina imala višu stopu induciranih porođaja (p = 0,032).
Zaključak: Vježbanje joge sigurna je preventiva u trudnoći koja pozitivno utječe na smanjenje stope intrapartalnog carskog reza, poboljšava proces porođaja, povećava zadovoljstvo majke i pozitivno utječe na ishod trudnoće i porođaja, bez rizika za majku i novorođenče. Vježbanje joge u trudnoći preporučuje se zdravim trudnicama.Introduction: The increasing number of cesarean deliveries (CD) is a global challenge in modern obstetrics. This increase has not been accompanied by better outcomes for newborns and mothers. The prevention of unjustified primary CDs has become a priority. This study investigates the efficacy and safety of yoga practice during pregnancy and its association with perinatal outcomes.
Subjects and methods: We conducted a randomized controlled clinical trial in healthy primiparous women with a singleton pregnancy, randomized in the first trimester of pregnancy. The research was conducted at the Maribor University Clinical Center in Slovenia from 2018 to 2023. A total of 214 participants were randomized, 106 in the yoga group and 108 in the control group. The study group performed yoga exercises, while the control group received standard prenatal care. Yoga exercises were performed once a week under the supervision of a certified yoga teacher and lasted 90 minutes. All pregnant women in the yoga group completed a total of 12 yoga sessions.
Results: The group of pregnant women who practiced yoga had a lower rate of intrapartum cesarean sections (p=0,004) and more frequent spontaneous vaginal deliveries (p=0,009), while the control group had a higher rate of induced labor (p=0,032).
Conclusion: Practicing yoga is a safe intervention during pregnancy that has a positive effect on reducing the rate of intrapartum CDs, improves the birth process, increases maternal satisfaction, and positively affects the outcome of pregnancy and childbirth without risk for the mother and newborn. Practicing yoga during pregnancy is recommended for healthy pregnant wome
Neuroscience of psychotrauma
No full textPosttraumatski stresni poremećaj (PTSP) je psihički poremećaj koji se razvija nakon
izloženosti iznimno stresnim i traumatskim događajima, poput nasilja, ratnih sukoba, nesreća
ili prirodnih katastrofa. Kliničku sliku obilježavaju simptomi poput intruzivnih sjećanja,
noćnih mora, emocionalne otupjelosti, izbjegavanja podsjetnika na traumu te stalnog osjećaja
prijetnje i pojačane pobuđenosti. Iako ne reagiraju svi jednako na traumu, brojni čimbenici,
uključujući genetiku, prethodna iskustva, podršku okoline i neurobiološku predispoziciju,
utječu na rizik razvoja PTSP-a.
Neurobiološki mehanizmi PTSP-a uključuju poremećaje u funkcioniranju osi hipotalamus
hipofiza-nadbubrežna žlijezda (HHN), kao i promjene u neurotransmiterskim sustavima
(serotonin, norepinefrin, dopamin, GABA, glutamat). Utvrđena je i povećana aktivacija
amigdale, smanjena aktivnost prefrontalnog korteksa i smanjen volumen hipokampusa – sve
to doprinosi disfunkciji u procesiranju emocija, pamćenju i odgovoru na stres.
Funkcionalne promjene vidljive su i na razini moždanih mreža – osobito u središnjoj izvršnoj
mreži (CEN), mreži zadanog načina rada (DMN) i glavnoj osjetnoj mreži (SN) – što dovodi
do narušene emocionalne i kognitivne regulacije. Uz neurobiološke promjene, važnu ulogu
ima i imunološki sustav: PTSP je povezan s kroničnom upalom i povišenim razinama
proupalnih citokina, što dodatno utječe na mozak i tijelo.
Liječenje PTSP-a uključuje psihoterapiju (poput kognitivno-bihevioralne terapije, terapije
produljene izloženosti i EMDR-a), farmakološku terapiju (najčešće SSRI antidepresive) te su
u razvoju nove metode poput neuromodulacije. Ključni čimbenici oporavka uključuju ranu
dijagnozu, dostupnost podrške i individualizirani terapijski plan temeljen na razumijevanju
neurobioloških i psiholoških osnova poremećaja.Post-traumatic stress disorder (PTSD) is a mental disorder that develops after exposure to
extremely stressful and traumatic events, such as violence, war, accidents, or natural disasters.
Its clinical presentation includes intrusive memories, nightmares, emotional numbness,
avoidance of trauma-related cues, persistent hyperarousal, and a heightened sense of threat.
Although not everyone reacts the same way to trauma, various factors, including genetics,
prior experiences, environmental support, and neurobiological predisposition influence the
risk of developing PTSD.
The neurobiological mechanisms of PTSD involve dysregulation of the hypothalamic
pituitary-adrenal (HPA) axis, and alterations in neurotransmitter systems (serotonin,
norepinephrine, dopamine, GABA, glutamate). Research has shown increased activation of
the amygdala, decreased prefrontal cortex activity, and reduced hippocampal volume, all of
which contribute to dysfunction in emotional processing, memory, and stress response.
Functional changes also occur within major brain networks, particularly the central executive
network (CEN), the default mode network (DMN), and the salience network (SN), leading to
impaired emotional and cognitive regulation. Beyond neurobiology, the immune system plays
a critical role: PTSD is associated with chronic inflammation and elevated levels of pro
inflammatory cytokines, which further affect both brain function and physical health.
PTSD treatment includes psychotherapy (such as cognitive-behavioral therapy, prolonged
exposure, and EMDR), pharmacological treatment (primarily SSRIs), and new methods of
treatment are being developed, such as neuromodulation. Key recovery factors include early
diagnosis, strong social support, and personalized treatment plans grounded in a deep
understanding of the disorder’s neurobiological and psychological foundations
Association of MTHFR gene polymorphism and vegetarian diet with serum concentrations of vitamin B12, folic acid and lipid parameters
No full textPovezanost polimorfizma gena MTHFR i vegetarijanske prehrane sa serumskim koncentracijama vitamina B12, folne kiseline i lipidnih parametara
Autor: Fran Crnjac
Ovo istraživanje ispituje povezanost vegetarijanske prehrane i polimorfizma gena za metilentetrahidrofolat reduktazu (MTHFR) sa serumskim lipidnim statusom i koncentracijama vitamina B12 i folne kiseline kod ispitanika koji ne uzimaju dodatke prehrani. Cilj rada je odrediti kako vegetarijanska prehrana i MTHFR-polimorfizam utječu na ove parametre.
Metode: Uključeno je 162 ispitanika, starosti od 18 do 60 godina, koji su bili na vegetarijanskoj ili mješovitoj prehrani. Korištene su metode kao što su PCR-RFLP za genotipizaciju MTHFR, izolacija DNA, te biokemijske analize za određivanje koncentracija vitamina B12, folne kiseline i lipidnog profila.
Rezultati: Vegetarijanci su imali nižu koncentraciju glukoze, ukupnog kolesterola i LDL-kolesterola u serumu u usporedbi s ne-vegetarijancima. Serumske koncentracije vitamina B12 bile su niže kod vegetarijanaca, dok koncentracije folne kiseline nisu bile statistički značajne. Nositelji T-alela MTHFR-polimorfizma imali su više koncentracije ukupnog i LDL-kolesterola u ne-vegetarijanskoj skupini.
Zaključak: Vegetarijanska prehrana i MTHFR-polimorfizam imaju različite učinke na serumski lipidni status i koncentracije vitamina B12 i folne kiseline, što upućuje na važnost personaliziranog pristupa prehrani, posebno kod osoba s TT-genotipom.Association of MTHFR gene polymorphism and vegetarian diet with serum concentrations of vitamin B12, folic acid and lipid parameters
This study examines the relationship between vegetarian diet and MTHFR polymorphisms on serum lipid profiles and concentrations of vitamin B12 and folate in individuals not taking dietary supplements. The objective is to determine how vegetarian diet and MTHFR polymorphism affect these parameters.
Methods: The study included 162 participants aged 18 to 60, following either a vegetarian or mixed diet. Methods used included PCR-RFLP for MTHFR genotyping, DNA isolation, and biochemical analyses for determination of serum vitamin B12, folate, and lipid profiles.
Results: Vegetarians had lower serum glucose, total cholesterol, and LDL-cholesterol levels compared to non-vegetarians. Vitamin B12 levels were lower in vegetarians, while there were no significant differences in folate concentrations. Carriers of the MTHFR T-allele had higher total and LDL-cholesterol levels in the non-vegetarian group.
Conclusion: Vegetarian diet and MTHFR polymorphism have different effects on serum lipid profiles and vitamin B12 and folate levels, suggesting the importance of personalized dietary approaches, especially for individuals with the TT-genotype
Guidelines and recommendations for radiologist staffing, education and training
No full textThis article outlines the radiology-related staffing and education/training guidelines and recommendations developed by the European Commission-funded EU-REST (European Union Radiation, Education, Staffing & Training) project. The radiologist consortium partners propose the use of hour of machine/system/activity as the basic unit to calculate radiologist staffing needs. Education and training recommendations for radiologists include establishing 5 years as the standard duration of specialty training in radiology and establishing the ESR European Training Curriculum for Radiology as the European-wide standard. General recommendations for all professional groups include the maintenance of a central registry for each professional group and for relevant equipment, by each EU Member State, mandated CPD including techniques and knowledge relevant to each professional group, adoption vs adaptation of the project's recommendations. CRITICAL RELEVANCE STATEMENT: The radiology-related staffing and education/training guidelines and recommendations developed by the EU-REST project propose a novel approach to calculate radiologist staffing numbers and provide recommendations regarding radiology education and training as well as general recommendations for all professional groups covered by the project. KEY POINTS: The pros and cons of taking population, workload, equipment or bed availability numbers as parameters to calculate radiology workforce are described. The reasons why these parameters are not suitable to calculate radiologist staffing needs are explained. The proposed use of hour of machine/system/activity as the basic unit to calculate radiologist staffing needs allows for establishing an adaptable and scalable guideline. Education and training recommendations for radiologists and non-profession-specific recommendations are summarised
Neurobiology of empathy
No full textEmpatija, kao sposobnost prepoznavanja i dijeljenja tuđeg emocionalnog stanja, predstavlja temelj međuljudskih odnosa i prosocijalnog ponašanja. U medicinskoj praksi empatija nije samo poželjna osobina, već i nužan preduvjet za kvalitetnu i cjelovitu skrb o pacijentima. Cilj ovog rada bio je pokazati kompleksnu narav empatije kroz njezine neurobiološke temelje.
Na početku je detaljno analizirana definicija empatije, povijesni razvoj pojma te diferencijacija od srodnih pojmova poput emocionalne zaraze, teorije uma i suosjećanja. Empatija ima dvije komponente: afektivnu i kognitivnu. Njihovi korijeni mogu se pratiti od najprimitivnijih oblika kod životinja do složenih procesa karakterističnih za ljude.
Razvoj empatije predodređen je već u genima čovjeka te se dalje oblikuje svakodnevnim društvenim interakcijama koje utječu na funkcije i anatomske strukture mozga. Ključne anatomske strukture mozga važne za doživljaj empatije su: anteriorna insula, anteriorni cingularni korteks i specifične regije prefrontalnog korteksa. Funkcioniranje empatije omogućeno je aktivacijom zrcalnih neurona i regulirano neurokemijskim modulatorima, poput oksitocina, vazopresina, dopamina i endogenih opioida. Dodatno, značajan utjecaj na doživljaj i iskazivanje empatije ima spol preko djelovanja spolnih hormona i specifične organizacije moždanih struktura muškaraca i žena.
Na kraju, važnost empatije za svakodnevni život najbolje je ilustrirana poremećajima u kojima dolazi do disfunkcije empatije, poput psihopatije. Sve to omogućuje dublje razumijevanje empatije, ne kao statičke karakterne osobine, već kao dinamičnog neurokognitvnog procesa.Empathy, as the capacity to recognize and share the emotional states of others, forms the foundation of human social connection and prosocial behaviour. In clinical medicine, empathy is not merely a desirable trait, but a prerequisite for providing comprehensive and compassionate patient care. This paper aims to explore the complex nature of empathy through its neurobiological underpinnings.
The beginning provides an in-depth analysis of the definition of empathy, its historical development, and its differentiation from related concepts such as emotional contagion, theory of mind, and compassion. Empathy is comprised of two components: cognitive and affective. The origins of these components can be traced from primitive expressions in animals to the highly developed processes observed in humans.
The development of empathy is influenced by genetic predispositions and shaped through everyday social interactions, which modulate brain function and structure. Key brain structures involved in empathic processing include the anterior insula, anterior cingulate cortex, and specific regions of the prefrontal cortex. Normal functioning of empathy is enabled by the activation of mirror neurons and modulated by neurochemical agents such as oxytocin, vasopressin, dopamine, and endogenous opioids. Additionally, sex-related differences in hormonal activity and brain organization significantly influence the experience and expression of empathy in men and women.
Finally, the importance of empathy is further underscored by examining its dysfunction in clinical disorders, particularly psychopathy. These findings emphasize that empathy should not be viewed as a fixed personality trait, but rather as a dynamic neurocognitive process
Beyond neuromuscular activity: botulinum toxin type A exerts direct central action on spinal control of movement
No full textOvert muscle activity and impaired spinal locomotor control hampering coordinated movement is a hallmark of spasticity and movement disorders like dystonia. While botulinum toxin A (BoNT-A) standard therapy alleviates mentioned symptoms presumably due to its peripheral neuromuscular actions alone, the aim of present study was to examine for the first time the toxin's trans-synaptic activity within central circuits that govern the skilled movement. The rat hindlimb motor pools were targeted by BoNT-A intrasciatic bilateral injection (2 U per nerve), while its trans-synaptic action on premotor inputs was blocked by intrathecal BoNT-A-neutralising antitoxin (5 i.u.). Effects of BoNT-A on coordinated and high intensity motor tasks (rotarod, beamwalk swimming), and localised muscle weakness (digit abduction, gait ability) were followed until their substantial recovery by day 56 post BoNT-A. Later, (day 62-77) the BoNT-A effects were examined in unilateral calf muscle spasm evoked by tetanus toxin (TeNT, 1.5 ng). In comparison to peripheral effect alone, combined peripheral and central trans-synaptic BoNT-A action induced a more prominent and longer impairment of different motor tasks, as well as the localised muscle weakness. After near-complete recovery of motor functions, the BoNT-A maintained the ability to reduce the experimental calf spasm evoked by tetanus toxin (TeNT 1.5 ng, day 62) without altering the monosynaptic reflex excitability. These results indicate that, in addition to muscle terminals, BoNT-A-mediated control of hyperactive muscle activity in movement disorders and spasticity may involve the spinal premotor inputs and central circuits participating in the skilled locomotor performance