Utjecaj stresne hiperglikemije na bolnički ishod akutne egzacerbacije kronične opstruktivne plućne bolesti [Impact of stress hyperglycemia on hospital outcome of acute exacerbation of chronic oobstructive pulmonary disease]

Impact of stress hyperglycemia on outcomes from acute exacerbations of COPD (AECOPD) has not been established. The aim of the research is to determine the impact of stress hyperglycemia (blood glucose > 6,9 and 7,8 mmol/L postprandial) on intrahospital mortality, length of hospitalization and specific clinical parameters. We enrolled 272 non-diabetics hospitalized in General Hospital Zabok for AECOPD in one year period and divide them in 2 groups according to glucose levels in venous plasma at admission. After corticosteroid therapy each group was further stratified according to glycemia after 24 hours and before discharge. Beside main aims, we evaluated impact on lung function changes, CRP level, sputum culture, the presence of radiological pneumonia and need for mechanical ventilation. Results showed that 113 patients (41,5%) had stress hyperglycemia at admission and statistically significant higher average glucose levels (9,7 vs 5,7 mmol/l). Fatal outcome happened in 8,1 % cases and it was three times more often between patients with stress hyperglycemia (13,3 % vs 4,4%), independent of age, sex, FEV1 and COPD severity or duration . The relative risk (RR) of death or long inpatient stay was significantly increased in patients with stress hyperglycemia. For each 1 mmol/L increase in blood glucose the absolute risk of adverse outcome increased by 1,23 (95% CI. 1,04 to 1,46, p =0,015). Glucose levels at admission were much higher in non-survivors than survivors (9,65 vs 6,35 mmol/L). Length of hospital stay was longer in patients with stress hyperglycemia (9 vs 7 days, p= 0,001), so was the incidence of pneumonia (29,2% vs 10,1%, p<0,001). In patients with steroid hyperglycemia, glucose levels significantly increased (5,2 vs 8 mmol/L), but without significant correlation to mortality or number of hospital days. Stress hyperglycemia in non-diabetic patients with acute exacerbation of COPD is negative prognostic factor of intra-hospital outcome. This research acquired new knowledge about impact of stress hyperglycemia on outcome of AECOPD and hopefully will stimulate further studies about stricter glycemic control that could possibly contribute to a better treatment outcome of these patients

Autologous blood coagulum is a physiological carrier for BMP6 to induce new bone formation and promote posterolateral lumbar spine fusion in rabbits

In the present study, we describe autologous blood coagulum (ABC) as a physiological carrier for BMP6 to induce new bone formation. Recombinant human BMP6 (rhBMP6), dispersed within ABC and formed as an autologous bone graft substitute (ABGS), was evaluated either with or without allograft bone particles (ALLO) in rat subcutaneous implants and in a posterolateral lumbar fusion (PLF) model in rabbits. ABGS induced endochondral bone differentiation in rat subcutaneous implants. Coating ALLO by ABC significantly decreased the formation of multinucleated foreign body giant cells (FBGCs) in implants, as compared with ALLO alone. However, addition of rhBMP6 to ABC/ALLO induced a robust endochondral bone formation with little or no FBGCs in the implant. In rabbit PLF model, ABGS induced new bone formation uniformly within the implant resulting in a complete fusion when placed between two lumbar transverse processes in the posterolateral gutter with an optimum dose of 100-μg rhBMP6 per ml of ABC. ABGS containing ALLO also resulted in a fusion where the ALLO was replaced by the newly formed bone via creeping substitution. Our findings demonstrate for the first time that rhBMP6, with ABC as a carrier, induced a robust bone formation with a complete spinal fusion in a rabbit PLF model. RhBMP6 was effective at low doses with ABC serving as a physiological substratum providing a permissive environment by protecting against foreign body reaction elicited by ALLO

Povezanost kliničkih, laboratorijskih i termografskih nalaza u bolesnika s ulceroznim kolitisom [Association between clinical, laboratory and thermographic findings in patients with ulcerative colitis]

INTRODUCTION: The aim of this paper was to describe the diagnostic potential of thermography in surveillance and as a noninvasive biomarker of disease activity in patients with extensive ulcerative colitis. MATERIAL AND METHODS: 30 patients with active extensive colitis and 30 healthy subjects where enrolled in the study. Patients where prospectively followed and treated for 6 months. All of the participants where subject to infrared thermography at enrollment but UC patients were screened once more after 6 months. Thermographic criteria (Tsred ROI 1 – 4) where compared among the two groups of participants but also compared to standard clinical, laboratory and endoscopic markers of disease activity. RESULTS: higher temperatures were observed among patients with active ulcerative colitis compared to healthy subjects as well as in patients with active disease compared to those in remission after 6 months. Statistically significant correlation was observed between average abdominal temperatures and clinical (Mayo score), laboratory (FC, CRP) and endoscopic findings (Mayo ESS) in patients with ulcerative colitis. CONCLUSION: This paper depicts static abdominal thermography as a potential noninvasive tool for screening and surveillance of patients with extensive ulcerative colitis

The use of infrared technology as a novel approach for studies with female laboratory animals

Aim To determine the changes in skin temperature and brown adipose tissue (BAT) activity throughout the estrous cycle as well as the regularity of the estrous cycle in mice. ----- Methods We assessed the differences in the duration of the estrous cycle and its phases between 3- and 8-month-old female mice (n = 18). Skin temperature and BAT activity were measured by infrared technology and compared with human menstrual cycle. ----- Results Young and old female mice did not differ significantly in the estrous cycle length. However, young animals had longer diestrus and shorter proestrus phase. In contrast with women, mice showed age-dependent changes in body temperature and BAT activity during the estrus cycle. ----- Conclusion Establishing the pattern of temperature and BAT activity changes could be used to determine the estrous cycle phase before performing experiments without disturbing the animal. However, since the regulation of BAT activity during the estrous cycle was age-dependent, very complex, and varied significantly from women, further studies are needed to develop a non-invasive method for determining the phase of the estrous cycle

Targeted prostate biopsy using a cognitive fusion of multiparametric magnetic resonance imaging and transrectal ultrasound in patients with previously negative systematic biopsies and non-suspicious digital rectal exam

Aim: To compare cognitive fusion targeted and systematic prostate biopsy in patients with repeated negative systematic biopsy but persistent clinical suspicion for prostate cancer. ----- Methods: The study enrolled 63 patients with at least one previously negative systematic biopsy who underwent targeted prostate biopsy using multiparametric magnetic resonance imaging (mpMRI) and transrectal ultrasound (TRUS) in addition to standardized systematic biopsy from July 2016 to May 2018. Multiparametric MRI was performed with 3 Tesla device by uro-radiologists experienced in prostate cancer. Lesions with Prostate Imaging Reporting and Data System 3, 4, and 5 were considered suspicious. Targeted biopsies were performed with cognitive fusion of TRUS and mpMRI. ----- Results: Prostate cancer detection, using either targeted or systematic biopsy, was 60.32%. Targeted biopsies were positive in 52.38% and systematic biopsies in 47.62% of patients. The median highest percentage of cancer involvement per biopsy core was significantly higher in targeted cylinders. The biopsies obtained by using the two techniques did not significantly differ in Gleason score. ----- Conclusion: Cognitive targeted prostate biopsy based on mpMRI presents a valuable addition to systematic biopsy in patients with repeated negative systematic biopsies but persistent clinical suspicion of prostate cancer

Application of a system dynamics model in forecasting the supply and age distribution of physicians

Aim: To predict the future supply and age distribution of physicians with a simulation model, which can be used as an advising tool for policymakers who decide on enrollment and specialization training (ST) quotas at the national level. ----- Methods: A simulation model was created using the system dynamics (SD) method. Changes in the number of physicians and their age distribution were projected in the context of the expected future changes of the Croatian population under different scenarios covering the period from 2017 to 2041. ----- Results: The two scenarios showed that Croatia would not face physician shortage in the future. The scenario 1 projected that Croatia would certainly reach the current European Union (EU) average of 360 physicians per 100 000 inhabitants by 2021, and that this figure would increase to 430 per 100 000 inhabitants by 2041. The scenario 2 suggested a similar trend, with Croatia reaching the current EU average by 2021 and the number of physicians increasing to 451 per 100 000 inhabitants by 2041. Both scenarios indicated that the Croatian physicians' age distribution will recover in favor of younger age groups of specialists. ----- Conclusion: There is no need to increase the enrollment into the medical schools to ensure sufficient number of physicians per capita in Croatia, but it is necessary to keep the recently reached level of 550 licenses for ST per year. The developed dynamic model is available online and can be adapted to the analysis of different scenarios in different health care system

The association between clinical and laboratory findings of bullous pemphigoid and dipeptidyl peptidase-4 inhibitors in the elderly: a retrospective study

Aim: To evaluate the association between the use of dipeptidyl peptidase-4 inhibitors (DPP4I) and clinical and laboratory findings of bullous pemphigoid (BP) in patients treated at the European Reference Network - Skin Reference Centre in Croatia. ----- Methods: This retrospective study enrolled 82 patients treated for BP at the Department of Dermatovenereology, University Hospital Center Zagreb from January 2015 to December 2019. Clinical features of BP, presence of comorbidities, and laboratory findings of anti-BP antibodies and eosinophilia were analyzed in three groups of BP patients: 1) diabetes mellitus (DM) type II patients treated with DPP4I, 2) DM type II patients not treated with DPP4I, and 3) non-DM type II patients. ----- Results: The average age and anti-BP180 titer were similar in all three groups. DPP4I group had a slightly lower eosinophil level in both peripheral blood (4.89%) and biopsy specimens (87.5%), but the difference was not significant. The prevalence of inflammatory BP in DPP4I group was 76.5%. DPP4I group had significantly higher percentage of patients with chronic renal failure and dementia (52.9% and 11.8%, respectively) compared with non-DPP4I DM (14.3% and 0%, respectively) and non-DM type II patients (15.7% and 0%, respectively). ----- Conclusion: BP patients treated with DPP4I and those not treated with DPP4Is did not significantly differ in laboratory findings. However, DPP4I treatment was associated with an inflammatory subtype of BP and a higher prevalence of dementia and chronic renal failure. These findings warrant further research into the association of BP and DM with dementia and chronic renal failure

Axon morphology of rapid Golgi-stained pyramidal neurons in the prefrontal cortex in schizophrenia

Aim To analyze axon morphology on rapid Golgi impregnated pyramidal neurons in the dorsolateral prefrontal cortex in schizophrenia. ----- Methods Postmortem brain tissue from five subjects diagnosed with schizophrenia and five control subjects without neuropathological findings was processed with the rapid Golgi method. Layer III and layer V pyramidal neurons from Brodmann area 9 were chosen in each brain for reconstruction with Neurolucida software. The axons and cell bodies of 136 neurons from subjects with schizophrenia and of 165 neurons from control subjects were traced. The data obtained by quantitative analysis were compared between the schizophrenia and control group with the t test. ----- Results Axon impregnation length was consistently greater in the schizophrenia group. The axon main trunk length was significantly greater in the schizophrenia than in the control group (93.7 ± 36.6 μm vs 49.8 ± 9.9 μm, P = 0.032). Furthermore, in the schizophrenia group more axons had visibly stained collaterals (14.7% vs 5.5%). ----- Conclusion Axon rapid Golgi impregnation stops at the beginning of the myelin sheath. The increased axonal staining in the schizophrenia group could, therefore, be explained by reduced axon myelination. Such a decrease in axon myelination is in line with both the disconnection hypothesis and the two-hit model of schizophrenia as a neurodevelopmental disease. Our results support that the cortical circuitry disorganization in schizophrenia might be caused by functional alterations of two major classes of principal neurons due to altered oligodendrocyte development

The influence of therapeutic hypothermia on the outcomes of cardiac arrest survivors: a retrospective cohort study

Aim: To determine whether therapeutic hypothermia (TH) improves survival and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors. ----- Methods: This retrospective cohort study enrolled patients treated for OHCA with a return of spontaneous circulation admitted to the Cardiac Intensive Care Unit from October 2000 until March 2019. Data were collected from medical archives. Propensity score matching was used. The primary endpoint was death during hospital stay and secondary endpoint was cerebral performance category (CPC) score at discharge. ----- Results: Out of 152 patients included in the study, 58 (38.7%) underwent TH treatment. After matching (which left 70 patients in the analysis), death during hospital stay occurred less often in TH group (28.6% vs 57.1%, P=0.029), while the difference in CPC score was not significant. Cox proportional hazards model showed the predictors of death during hospital stay to be TH (hazard ratio [HR] 0.29, 95% confidence interval [CI] 0.13-0.68, P=0.004), initial Glasgow Coma Scale score of 3 (HR 7.55, 95% CI 1.44-39.63, P=0.017), and heart failure (HR 2.35, 95% CI 1.02-5.34, P=0.045). TH was not an independent predictor of CPC score. Mann-Whitney U test and linear regression model showed that TH was associated with higher gain in GCS. ----- Conclusion: TH was associated with better survival and certain variables suggesting improved neurological outcomes, suggesting that TH is a vital treatment option for comatose OHCA survivors