Veterinary medicine - Repository of PHD, master's thesis
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Autonomic nervous system education in Europe: EAN/EFAS/INUS survey on curricula and skills in autonomic medicine of European neurology residents and consultants
No full textBackground and purpose: Centers for training in autonomic nervous system (ANS) disorders are not widely available and the recent coronavirus 2019 pandemic temporarily reduced training opportunities in autonomic medicine across European countries. Here we evaluated the current state of education, clinical skills and postgraduate educational preferences on ANS disorders of European neurology residents and consultants.
Methods: A 23-item questionnaire was developed and distributed online amongst European neurology residents and consultants via mailing lists of the European Academy of Neurology. The questions assessed demographics, current training opportunities and learning preferences in ANS disorders. Six multiple-choice questions were used to self-evaluate knowledge of ANS disorders.
Results: In all, 285 individuals answered the survey (60% female, mostly 25-34 years of age). All respondents considered clinical autonomic skills necessary for good clinical neurological practice, and 92% would like to increase their ANS knowledge. Female respondents and those who trained in Southern/Eastern/Greater Europe more frequently judged ANS skills important for clinical practice than male respondents (p = 0.012) and respondents from Northern/Western Europe (p = 0.011). Female and younger respondents felt less confident in managing ANS disorders (p = 0.001 and p < 0.001, respectively). Respondents below 45 years of age (p < 0.001) and those with lower confidence in managing ANS disorders (p = 0.004) were more likely to recommend that ANS education is embedded in the residency curriculum.
Conclusions: Most European neurology residents and consultants reported a need for more autonomic education, with additional gender, age and regional differences. These findings underscore the importance of increasing the educational content on autonomic medicine in European medical and postgraduate curricula
A white paper from the FEBS Education and Training Conference: challenges, opportunities, and action plans for transforming molecular life sciences education
No full textThe inaugural FEBS Education and Training Conference (ETC) was held in Türkiye, in 2024. This first‐ever Molecular Life Sciences Education Conference in Europe was organized by the FEBS Education and Training Committee and it was a groundbreaking event that brought together educators and scientists to explore how to enhance education and training in molecular life sciences. The conference explored a wide range of critical themes, for example—digital revolution, active learning and student engagement, multidisciplinary teaching and learning, transitions and inclusivity in education, students' self‐assessment, and self‐regulated learning. The discussions and presentations underscored the pressing need for transformation in how academics and researchers approach teaching and learning. Such shift is driven by rapid technological advancements, societal shifts, and the evolving demands of the scientific landscape. This document synthesizes key insights, discussions, and recommendations from the conference and proposes actionable strategies for all stakeholders in the field—institutions, educators and students—to address current challenges in education and training in molecular life sciences
Uloga imunih semaforina u nealkoholnoj masnoj bolesti jetre i sepsis - plan upravljanja istraživačkim podacima
No full textThe impact of iodine intake on functional parameters of the thyroid in pregnant women
No full textIstraživanje je proučavalo utjecaj unosa joda na funkciju i volumen štitnjače (Tvol) u trudnica na području Zagreba. Unos joda je određen mjerenjem koncentracije joda u urinu (UIC). Cilj istraživanja bio je utvrditi unos joda i utjecaj dodatnog unosa joda putem dodataka prehrani u trudnica u svim trimestrima trudnoće na funkciju i Tvol, vrijednost tireoglobulina (Tg) kao biljega unosa joda u trudnoći i utjecaj morfoloških promjena štitnjače na njegovu vrijednost. Hipoteza istraživanja je da trudnice koje ne uzimaju dodatke prehrani s jodom imaju niže vrijednosti UIC, niže koncentracije slobodnog tiroksina (FT4), više koncentracije tireotropina (TSH) i Tg-a u serumu i veći Tvol. Istraživanje je obuhvatilo 91 trudnicu koje su uzimale i 100 trudnica koje nisu uzimale dodatke prehrani s jodom. Medijan UIC u trudnica koje nisu uzimale dodatke prehrani s jodom iznosio je 158 μg/L, a koje su uzimale 169 μg/L, što je dostatan unos joda u obje skupine i cjelokupnom uzorku. Trudnice koje nisu uzimale dodatke prehrani s jodom imale su statistički značajno niže vrijednosti FT4, a više vrijednosti Tg-a i Tvol (p˂0.05). Tireoglobulin je koristan biljeg unosa joda u trudnoći. Difuzne promjene štitnjače značajno povećavaju razinu Tg-a u serumu. Nije utvrđena korelacija Tg-a i ostalih ispitivanih prametara štitnjače.The study investigated the impact of iodine intake on thyroid function (TF) and thyroid volume (Tvol) in pregnant women from Zagreb. Iodine status was determined by measurement of urinary iodine concentration (UIC). The aim of the study was to asess iodine intake and the impact of iodine supplementation (IS) in pregnant women in all trimesters of pregnancy on TF and Tvol, the value of Thyroglobulin (Tg) as potential biomarker of iodine intake in pregnancy as well as the influence of morphological changes on Tg measurement. It is hypothesized that pregnant women without IS have lower UIC values, lower free thyroxine (FT4), higher thyrotropin (TSH) and higher serum Tg concentrations, as well as higher Tvol. We enrolled 91 pregnant women with IS and 100 pregnant women without IS. Median UIC was 158 μg/L in pregnant women without IS, and 169 μg/L in pregnant women with IS, indicating sufficient iodine intake in both groups as well as in overall sample. Pregnant women without IS had significantly lower FT4, and higher Tg and Tvol values (p˂0.05). Thyroglobulin is a valuable biomarker of iodine intake in pregnancy. Diffuse thyroid pattern increases Tg values. There was no correlation between Tg and other thyroid parameters
Role of neural stem cells on mitophagy regulation after ishemic damage of cells of the neural tissue
No full textJedan od najčešćih uzroka invalidnosti u ljudskoj populaciji je nagli manjak kisika i glukoze koji je posebice štetan tijekom perinatalnog perioda, a naziva se hipoksijsko ishemijska encefalopatija. U središtu tog patofiziološkog zbivanja su mitohondriji čiji nagli poremećaj rada dovodi do niza negativnih posljedica na stanicu, a često i do stanične smrti. Stoga se ovo istraživanje fokusiralo na utjecaj hipoksijsko-ishemijske ozljede na strukturu i metabolizam mitohondrija te na aktivnost autofagije i mitofagije u nezrelim stanicama živčanog sustava. Nakon uspostave in vitro modela HIE, što je uključilo i analizu akutne citotoksičnosti, pokazali smo kako nagli manjak kisika i glukoze negativno djeluje na površinu, duljinu i razgranatost mitohondrija. Također, korištenje vlastitog razvijenog algoritma omogućilo nam je kvantifikaciju fragmentacije mitohondrija, za koju je pokazano kako ovisi o stupnju diferencijacije stanica živčanog sustava. Istovremeno smo uočili povećane razine superoksidnih aniona, hiperpolarizaciju membrane mitohondrija te povećanu mitofagiju. S ciljem pronalaženja novih terapijskih pristupa, nezrele stanice živčanog sustava oštećene akutnim manjkom kisika i glukoze su bile tretirane živčanim matičnim stanicama ili njihovim egzosomima gdje je uočeno smanjene razine superoksidnih aniona drugog dana diferencijacije, kao i stanične smrti i autofagije petnaestog dana diferencijacije. Iz rada se zaključuje kako ŽMS i njeni egzosomi djeluje protektivno na zrelije stanice SŽS-a.One of the most common causes of disability is a sudden lack of oxygen and glucose that causes hypoxic ischemic encephalopathy which is particulary harmful for the organism during perinatal development. Mitochondria are in the center of this event, whose malfunction leads to a series of negative consequences and cell death. This research focused on the influence of hypoxic-ischemic injury (HIE) on the structure and metabolism of mitochondria, and on autophagy and mitophagy in immature cells of CNS. After the establishment of an in vitro model of HIE, which included the analysis of acute cytotoxicity, we found that lack of oxygen and glucose has a negative effect on the surface, length and branching of mitochondria. Our own developed algorithm enabled us to quantify mitochondrial fragmentation, which is depended on the degree of cell differentiation. We also observed an increased level of superoxide anions, hyperpolarization of the mitochondrial membrane, and increased mitophagy. With the aim of finding new therapeutic approaches, immature cells of CNS damaged by HIE were treated with NSCs or their exosomes after which reduced level of superoxide anions on the second and cell death and autophagy on the fifteenth day of differentiation was detected. This research indicates that NSCs and its exosomes acts protective on more matured cells of CNS
Medicinski prekid trudnoće
No full textAbortions and stillbirths result from complex maternal and fetal factors, including genetics, hormones, immune and environment. Spontaneous abortions, or miscarriages, occur before 20 weeks, while stillbirths, or Intrauterine Fetal Demise, happen after 20 weeks, with causes ranging from maternal conditions like advanced age to fetal issues like chromosomal abnormalities.
The discussion talks about pregnancy termination methods, particularly medical abortion, which employs medications for safer induction. In the first trimester, a mifepristone and misoprostol combination effectively induce abortion by blocking progesterone action and inducting uterine contraction. While misoprostol alone is an alternative, it's slightly less effective, often requiring more follow-up procedures. Its advantages are the easiness of use and cost-effectiveness, make it preferable, especially in resource-limited settings where Mifepristone is often absent.
For second-trimester abortions, both medical and surgical methods are available, with some favoring surgical methods for safety. However, medications can still be used, sometimes in combination with surgery. Third-trimester abortions typically necessitate surgical procedures like dilation and evacuation due to associated risks.
While abortion induction carries risks like cramping and bleeding, severe complications are rare but necessitate immediate attention. Examples include incomplete abortion, infection, excessive bleeding, and uterine rupture, especially in scarred uteruses. The debate on abortion worldwide involves a mix of ethical and legal viewpoints, with laws varying from strict to more tolerant. Over time, these laws have changed due to moral concerns and safety issues. Currently, around 60% of people live in places where abortion is allowed for various reasons. Despite progress in some areas, obstacles remain, affecting discussions and access to reproductive healthcare globally. This thesis will provide an overview about indications for termination of pregnancy, methods for TOP with focus on medical aspect, complications of the procedures and eventually legal and ethical part with concentration on abortion laws.Pobačaji i mrtvorođenja rezultat su složenih čimbenika koji se odnose na majku i fetus, uključujući genetiku, hormone, imunološki sustav i okoliš. Spontani pobačaji, ili spontani pobačaji, događaju se prije 20. tjedna, dok se mrtvorođenja, ili intrauterina fetalna smrt, događaju nakon 20 tjedana, s uzrocima koji variraju od majčinih stanja poput napredne dobi do fetalnih problema poput kromosomskih abnormalnosti.
Rasprava govori o metodama prekida trudnoće, posebno medicinskom pobačaju, koji koristi lijekove za sigurnije izazivanje. U prvom tromjesečju, kombinacija mifepristona i misoprostola učinkovito izaziva pobačaj blokirajući djelovanje progesterona i inducirajući kontrakcije maternice. Iako je misoprostol sam kao alternativa, nešto manje učinkovit, često zahtijeva više postupaka praćenja. Njegove prednosti su jednostavnost korištenja i ekonomičnost, što ga čini poželjnim, posebno u resursno ograničenim okruženjima gdje Mifepriston često nedostaje.
Za pobačaje u drugom tromjesečju dostupne su i medicinske i kirurške metode, pri čemu neki preferiraju kirurške metode zbog sigurnosti. Međutim, lijekovi se i dalje mogu koristiti, ponekad u kombinaciji s kirurgijom. Pobačaji u trećem tromjesečju obično zahtijevaju kirurške postupke poput dilatacije i evakuacije zbog povezanih rizika.
Iako indukcija pobačaja nosi rizike poput grčeva i krvarenja, ozbiljne komplikacije su rijetke, ali zahtijevaju hitnu pažnju. Primjeri uključuju nepotpuni pobačaj, infekciju, prekomjerno krvarenje i rupturu maternice, posebno u ožiljnim maternicama.
Rasprava o pobačaju diljem svijeta uključuje mješavinu etičkih i pravnih gledišta, pri čemu se zakoni razlikuju od strožih do tolerantnijih. Tijekom vremena, ti su se zakoni mijenjali zbog moralnih briga i sigurnosnih problema. Trenutno, oko 60% ljudi živi na mjestima gdje je pobačaj dopušten iz različitih razloga. Unatoč napretku u nekim područjima, prepreke ostaju, utječući na rasprave i pristup reproduktivnoj zdravstvenoj skrbi globalno.
Ova teza pružit će pregled indikacija za prekid trudnoće, metoda za prekid trudnoće s naglaskom na medicinski aspekt, komplikacija postupaka i konačno pravno-etičkog dijela s koncentracijom na zakone o pobačaju
Reduced Corticosteroid Exposure Is Safe and Does Not Reduce Disease Control among Hodgkin Lymphoma Patients Treated with Escalated BEACOPP (eBEACOPP)
No full textBackground and Objectives: eBEACOPP is the most effective chemotherapy regimen for younger patients with early unfavorable (EU) and advanced-stage (AS) Hodgkin lymphoma (HL), albeit with significant toxicities. The 14-day/cycle prednisone course contributes to side effects, including osteoarticular events like avascular bone necrosis (AVN). Our center has been using eBEACOPP since 2009 for AS and 2014 for EU patients. In 2016, we reduced prednisone treatment to 7–10 days to lessen AVN risk. We analyzed the effects of this approach.
Materials and Methods: We retrospectively collected data on patients who received at least two cycles of eBEACOPP for first-line HL treatment.
Results: A total of 162 patients (33 EU, 129 AS) were included. Their median age was 31 (range 19–59 years), and 88 were males. A total of 94 patients received full corticosteroid courses, and 68 received reduced corticosteroid courses. The overall response rate (ORR) was 98%. Different corticosteroid dosings had no significant effect on ORR, febrile neutropenia episodes, or hospital admissions. After a median follow-up (mFU) of 58 months, the 5yPFS for the entire cohort was 98% vs. 95% for the standard course vs. the short corticosteroids course, respectively (p = 0.37), while the 5yOS was 98% vs. 99% for the standard course vs. short corticosteroids course, respectively (p = 0.87). In AS patients intended to be treated with six eBEACOPP cycles, 5yPFS and 5yOS were 100% vs. 97% and 100% vs. 99% for standard vs. short corticosteroid courses, respectively (p = 0.56 and p = 0.17). In EU patients, 5yPFS was 97% (standard) vs. 95% (short) (p = 0.98) and 5yOS 100% vs. 93.3% (p = 0.87). Osteoarticular events were numerically lower in patients receiving the shorter prednisone course, both in the whole cohort and in the subgroup of patients treated with six cycles of eBEACOPP, but this difference failed to reach statistical significance.
Conclusions: eBEACOPP provides excellent and durable first-line disease control. Shortening the corticosteroid course does not compromise efficacy, potentially reducing toxicity. However, longer follow-ups and larger studies are needed for confirmation
Influence of the lifestyle for mental health as a risk factor on coronary heart disease
No full textKoronarna bolest srca neumorno zauzima vodeću poziciju među uzrocima smrtnosti, kako globalno, tako i u Hrvatskoj. Unatoč tome što zdravstveni sustav za liječenje srčanih bolesti u Hrvatskoj pruža usluge visoke kvalitete, ravnopravne s onima u najrazvijenijim zemljama svijeta, bolesti srca i krvnih žila i dalje predstavljaju značajan uzrok bolesti i smrtnih ishoda. Medicinska tehnologija i metode liječenja somatskih bolesti napredovale su, no incidencija srčanih oboljenja ostaje nepromijenjena kroz evolucijski razvoj čovječanstva, ukazujući na to da u borbi s ovim bolestima zdravstvenom zapuštenosti zaostajemo. Zanemarivanje zdravlja koje možemo aktivno prevenirati kroz primarnu, sekundarnu i tercijarnu prevenciju, predstavlja jedan od ključnih modificirajućih faktora. Unatoč tehničkom napretku i izvrsnosti u liječenju, koronarna bolest srca ostaje glavni uzrok morbiditeta i mortaliteta. Zanemarivanje zdravlja koje se očituje kroz nisku razinu brige o sebi, poput fizičke neaktivnosti, pretilosti, pušenja i drugih čimbenika, povećava rizik od srčanih bolesti. Suočavamo se s evolucijski novim izazovima - načinom
života i mentalnim zdravljem. Mentalno zdravlje se pokazuje kao ključan faktor zdravog života, čemu svjedoči veza između stresnih događaja i koronarne bolesti srca. To dodatno ističe važnost integriranog pristupa zdravlju koji obuhvaća mentalno blagostanje, jer kako definicija Svjetske zdravstvene organizacije navodi da je zdravlje stanje potpunog fizičkog, psihičkog i socijalnog blagostanja, a ne samo odsustvo bolesti i iznemoglosti.
Istraživanje utjecaja životnog stila na mentalno zdravlje kao prediktora rizika za koronarnu bolest srca cilja produbiti razumijevanje ovog složenog odnosa. Fokusirajući se na zanemarivanje zdravlja kao javnozdravstveni izazov, ovaj rad teži doprinijeti boljem poimanju veza između načina života, mentalnog zdravlja i učestalosti koronarne bolesti srca. Analizom nalaza i davanjem preporuka, namjera je ovog rada unaprijediti preventivne strategije i pridonijeti poboljšanju javnog zdravlja u području mentalnog blagostanja te kardiovaskularnih bolesti.Coronary heart disease tirelessly occupies a leading position among the causes of mortality, both globally and in Croatia. Despite the fact that the healthcare system for the treatment of heart diseases in Croatia provides high-quality services, equal to those in the most developed countries of the world, diseases of the heart and blood vessels continue to represent a significant cause of illness and death. Medical technology and methods of treating somatic diseases have advanced, but the incidence of heart diseases remains unchanged throughout the evolutionary development of humanity, indicating that we are lagging behind in the fight against these diseases due to health neglect. Neglect of health, which we can actively prevent through primary, secondary and tertiary prevention, is one of the key modifying factors. Despite technical advances and excellence in treatment, coronary heart disease remains a major cause of morbidity and mortality. Neglect of health, manifested through a low level of self-care, such as physical inactivity, obesity, smoking and other factors, increases the risk of heart disease. We face evolutionary new challenges - lifestyle and mental health. Mental health is proving to be a key factor in a healthy life, as evidenced by the link between stressful events and coronary heart disease.
This further emphasizes the importance of an integrated approach to health that includes mental well-being, because as defined by the World Health Organization, health is a state of complete physical, psychological and social well-being, and not just the absence of disease and infirmity.
Research into the influence of lifestyle on mental health as a risk predictor for coronary heart disease aims to deepen the understanding of this complex relationship. Focusing on the neglect of health as a public health challenge, this paper aims to contribute to a better understanding of the links between lifestyle, mental health and the incidence of coronary heart disease. By analyzing the findings and giving recommendations, the intention of this paper is to advance preventive strategies and contribute to the improvement of public health in the field of mental well-being and cardiovascular diseases
Guiding principles on the education and practice of theranostics
No full textPurpose: The recent development and approval of new diagnostic imaging and therapy approaches in the field of theranostics have revolutionised nuclear medicine practice. To ensure the provision of these new imaging and therapy approaches in a safe and high-quality manner, training of nuclear medicine physicians and qualified specialists is paramount. This is required for trainees who are learning theranostics practice, and for ensuring minimum standards for knowledge and competency in existing practising specialists.
Methods: To address the need for a training curriculum in theranostics that would be utilised at a global level, a Consultancy Meeting was held at the IAEA in May 2023, with participation by experts in radiopharmaceutical therapy and theranostics including representatives of major international organisations relevant to theranostics practice.
Results: Through extensive discussions and review of existing curriculum and guidelines, a harmonised training program for theranostics was developed, which aims to ensure safe and high quality theranostics practice in all countries.
Conclusion: The guiding principles for theranostics training outlined in this paper have immediate relevance for the safe and effective practice of theranostics
Competence of radiologists in cardiac CT and MR imaging in Europe: insights from the ESCR Registry
No full textRationale: To provide an overview of the current status of cardiac multimodality imaging practices in Europe and radiologist involvement using data from the European Society of Cardiovascular Radiology (ESCR) MRCT-registry.
Materials and methods: Numbers on cardiac CT and MRI examinations were extracted from the MRCT-registry of the ESCR, entered between January 2011 and October 2023 (n = 432,265). Data collection included the total/annual numbers of examinations, indications, complications, and reporting habits.
Results: Thirty-two countries contributed to the MRCT-registry, including 29 European countries. Between 2011 and 2022, there was a 4.5-fold increase in annually submitted CT examinations, from 3368 to 15,267, and a 3.8-fold increase in MRI examinations, from 3445 to 13,183. The main indications for cardiac CT were suspected coronary artery disease (CAD) (59%) and transcatheter aortic valve replacement planning (21%). The number of patients with intermediate pretest probability who underwent CT for suspected CAD showed an increase from 61% in 2012 to 82% in 2022. The main MRI indications were suspected myocarditis (26%), CAD (21%), and suspected cardiomyopathy (19%). Adverse event rates were very low for CT (0.3%) and MRI (0.7%) examinations. Reporting of CT and MRI examinations was performed mainly by radiologists (respectively 76% and 71%) and, to a lesser degree, in consensus with non-radiologists (19% and 27%, respectively). The remaining examinations (4.9% CT and 1.7% MRI) were reported by non-radiological specialties or in separate readings of radiologists and non-radiologists.
Conclusions: Real-life data on cardiac imaging in Europe using the largest available MRCT-registry demonstrate a considerable increase in examinations over the past years, the vast majority of which are read by radiologists. These findings indicate that radiologists contribute to meeting the increasing demands of competent and effective care in cardiac imaging to a relevant extent