An Evaluation of The Host Response to An Interspinous Process Device Based on A Series of Spine Explants: Device for Intervertebral Assisted Motion (DIAM®)

Background: The objective of this study was to evaluate the host response to an interspinous process device [Device for Intervertebral Assisted Motion (DIAM®)] based on a series of nine spine explants with a mean post-operative explant time of 35 months. Methods: Explanted periprosthetic tissues were processed for histology and stained with H&E, Wright-Giemsa stain, and Oil Red O. Brightfield and polarized light microscopy were used to evaluate the host response to the device and the resultant particulate debris. The host response was graded per ASTM F981-04. Quantitative histomorphometry was used to characterize particle size, shape, and area per ASTM F1877-05. The presence or absence of bone resorption was also evaluated when bony tissue samples were provided. Results: Periprosthetic tissues demonstrated a non-specific foreign body response composed of macrophages and foreign body giant cells to the DIAM® device in most of the accessions. The foreign body reaction was not the stated reason for explantation in any of the accessions. Per ASTM F981-04, a “very slight” to “mild” to “moderate” chronic inflammatory response was observed to the biomaterials and particulate, and this varied by tissue sample and accession. Particle sizes were consistent amongst the explant patients with mean particle size on the order of several microns. Osteolysis, signs of toxicity, necrosis, an immune response, and/or device related infection were not observed. Conclusions: Cyclic loading of the spine can cause wear in dynamic stabilization systems such as DIAM®. The fabric nature of the DIAM® device’s polyethylene terephthalate jacket coupled with the generation of polymeric particulate debris predisposes the device to a foreign body reaction consisting of macrophages and foreign body giant cells. Although not all patients are aware of symptoms associated with a foreign body reaction to a deeply implanted device, surgeons should be aware of the host response to this device

Sudden infant death syndrome

Uvod: Sindrom nenadne nepričakovane smrti dojenčka je definiran kot nenadna nepričakovana smrt dojenčka do starosti enega leta. Tovrstne smrti ne moremo pripisati določenemu vzroku smrti. V preteklosti je bila pojavnost tega sindroma večja, z enostavnimi ukrepi pa se je zmanjšala. Najbolj učinkovit ukrep za preprečevanje tega sindroma je spanje dojenčka na hrbtu. Dejanski razlog za pojav tega sindroma pa še dandanes ni znan. Namen: Namen diplomskega dela je podrobno predstaviti sindrom, predstaviti dejavnike tveganja in preprečevanja, predstaviti žalovanje ob izgubi otroka, prvo pomoč, forenzično preiskavo, izpostaviti problematiko pomanjkanja znanja na temo nenadne nepričakovane smrti dojenčkatako s strani zdravstvenih delavcev kot tudi laične populacije. Metode dela: V diplomskem delu je uporabljena deskriptivna metoda delapregled aktualne literature v slovenskem in angleškem jeziku. Zbiranje literature je potekalo od novembra 2016 do oktobra 2018. Literatura je bila iskana v naslednih podatkovnih bazah: CINAHL, Medline (Pub Med) in v bazi COBIB.SI. Rezultati: V preučenih raziskavah so bili primarni vzroki smrti sledeči: deljenje postelje z materjo, predmeti v bližini dojenčka med spanjem, lokacija spanja in položaj spanja dojenčka. Lastnosti matere so pomemben dejavnik tveganja za pojav sindroma, kajenje npr. močno vpliva na pojavnost sindroma. Pomembno k preprečevanju pojavnosti sindroma prispeva tudi znanje zdravstvenih delavcev na temo sindroma. Razprava in sklep: Sindrom predstavlja nenadno nepričakovano smrt navidezno zdravega dojenčka, mlajšega od enega leta. Kljub preiskavi vzroka smrti, podrobni anamnezi, pregledu zdravstvene kartoteke in obdukciji, ostaja vzrok smrti neznan. Z ustreznim ravnanjem in ukrepi lahko preprečimo pojav nenadne nepričakovane smrti dojenčka. Kljub zloglasnemu programu »Back to sleep« pa sindrom ostaja vodilni razlog smrti dojenčkov v ZDA.Introduction: Sudden infant death syndrome is defined as unexpected death of an infant up to one year of age. We cannot determine a specific cause of this kind of death. In the past, the incidence of the syndrome was higher, but it was reduced by implementing some simple measures. The most efficient measure for preventing sudden infant death syndrome is putting a child on their back to sleep. However, the actual cause of the syndrome is not known to this day. Purpose: The purpose of the thesis is to present in detail the sudden infant death syndrome, the risk factors and preventive measures, to present grieving at a loss of a child, first aid and forensic investigation. Its purpose is also to point out the issue of lack of knowledge from the field of sudden infant death syndrome among the healthcare workers and nonprofessional population. Methods: Descriptive method was used for this thesis: researching current literature in Slovene and English. Collecting the literature took place from November 2016 to October 2018. The following databases were used for searching: CINAHL, Medline (Pub Med) and COBIB.SI. Results: The studied researches showed the following as the primary causes of the death: sharing bed with the mother, objects close to the infant at the time of sleeping, location during sleeping and the sleeping position of the infant. The characteristics of the mother are a significant risk factor for the occurrence of sudden infant death syndrome, smoking for instant can have a significant influence. Discussion and conclusion: Sudden infant death syndrome is a sudden unexpected death of a seemingly healthy infant up to one year of age. The cause of death remains unknown although there is an investigation of the cause of death, a detailed medical history is available, the medical record is inspected carefully and in spite of an autopsy. We can prevent the occurrence of sudden infant death syndrome with appropriate actions and measures. In spite of the infamous »Back to sleep program« sudden infant death syndrome remains the leading cause of infant mortality in the USA

Technological measures in the production and storage of table grapes

Pridelava namiznega grozdja se je v zadnjih letih na svetu zelo povečala, in sicer s 15,7 mio ton leta 2014 na več kot 27 mio ton leta 2018. V Sloveniji pridelava namiznega grozdja skorajda ni vredna omembe, kljub primernim okoljskim, tehnološkim in trženjskim razmeram. Pridelava kakovostnega namiznega grozdja zahteva veliko ročnega dela in dosledno izvajanje tehnoloških ukrepov, kot so razlistanje, redčenje mladik, grozdov in grozdnih jagod, gnojenje, varstvo ter namakanje in postavitev zaščitnih folij ali mrež. Trgatev namiznega grozdja lahko za posamezno sorto poteka v več obhodih. Parametri, ki jih je pred trgatvijo namiznega grozdja potrebno upoštevati, so v veliki meri povezani z vizualnimi in senzoričnimi lastnostmi, kot tudi z refraktometričnimi meritvami topne suhe snovi, saj mora grozdje za užitno zrelost dosegati vsaj 16 °Brix. Pakiranje grozdja poteka tako, da se le-tega najprej ohladi na 4 °C, očisti se neustrezne jagode in grozde najpogosteje zapakira v papirnato ali kartonsko embalažo v kombinaciji s spužvo. Namizno grozdje je po trgatvi precej kvarljivo, zato se ga skladišči na temperaturi 0 °C in 95 % relativni zračni vlažnosti. V preteklosti se je za obvladovanje razvoja bolezni na grozdju med skladiščenjem uporabljalo SO2, ki pa se ga zaradi negativnih vplivov na kakovost grozdja, zdravje ljudi in stanje opreme, postopoma nadomešča z UV obdelavo, ki v odmerku 3,6 kJ/m2 na 4 °C nima pomembnega vpliva na kemične lastnosti grozdja. Tudi z O3, ki je perspektivno protimikrobno sredstvo za podaljšanje trajanja skladiščenja in obstojnosti namiznega grozdja, s CO2, ki je učinkovit za nadzor nad preprečevanjem propadanja grozdja ter s pakiranjem v kontrolirano atmosfero, s čimer bi se lahko preprečilo rjavenja pecljevine, ter ohranilo vizualne in senzorične lastnosti grozdja.The table grape production has significantly increased in the last years – from 15.7 million tonnes in year 2014 to more than 27 million tonnes in 2018. In Slovenia, the production of table grapes is insignificant, although the environmental, technological and market conditions are suitable. The production of high-quality table grapes demands a lot of manual work and consistent an implementation of technical measures, such as leaf removal, shoot thinning, grape cluster thinning, fertilization, spraying, irrigation and setting plastic foil or nets for protection. Harvesting of table grape at certain grapevine cultivar requires several grape pickings. Parameters that must be considered are largely connected to visual and sensory profiles, as well as to the refractometer measurements of the total soluble solids – for the edible ripeness, grapes must have at least 16 °Brix. For packing, the grapes must first be cooled down to 4 °C and all inadequate berries have to be removed. Afterwards, they are packed in a paper or cardboard package, which is combined with a piece of sponge. After the harvest, table grape tends to rot very easily, therefore have to be stored at 0 °C and at the relative air humidity of 95 %. In the past, SO2 was used to control the development of the diseases on stored grapes. However, it has been gradually replaced by UV-treatment, since SO2 has negative impacts on the grape quality, human health and the condition of the equipment. At a 3.6 kJ/m2 dose at 4 °C, UV-treatment has no visible impact on the chemical properties of the grapes. SO2 can also be replaced by O3 – a prospective antimicrobial substance, used to prevent the decaying of the grapes, or by packing in a controlled environment, which prevents the stems from turning brown and preserves the visual and sensory profiles of the grapes

Enforced expression of PPP1R13L increases tumorigenesis and invasion through p53-dependent and p53-independent mechanisms.

PPP1R13L was initially identified as a protein that binds to the NF-[kappa]B subunit p65/RelA and inhibits its transcriptional activity. It also binds p53 and inhibits its action. One set of experimental findings based on over-expression of PPP1R13L indicates that PPP1R13L blocks apoptosis. Another set of experiments, based on endogenous production of PPP1R13L, suggests that the protein may sometimes be pro-apoptotic. We have used primary mouse embryonic fibroblasts (MEFs), dually transformed by H-ras and Adenovirus E1A and differing in their p53 status, to explore the effects of PPP1R13L over-expression, thus examining the ability of PPP1R13L to act as an oncoprotein. We found that over-expression of PPP1R13L strongly accelerated tumor formation by ras/E1A and also resulted in an increased metastatic potential of the tumors. PPP1R13L over-expressing cells were depleted for both p53 and active p65/RelA and we found that both p53 dependent and independent apoptosis pathways were regulated by PPP1R13L. Finally, studies with the proteasome inhibitor MG132 revealed that over-expression of PPP1R13L causes faster p53 degradation, a likely explanation for the depletion of p53. Taken together, our results show that increased levels of PPP1R13L can increase tumorigenesis and furthermore pinpoint PPP1R13L as a gene that influences metastasis

Ocena zamikov pri napotitvi, izvedbi diagnostike in prvega zdravljenja pri bolnikih z raki sečnega mehurja in ledvic v Sloveniji

The average annual incidence of kidney cancer in Slovenia is 370, and the incidence of bladder cancer is 320. Consortium of three research organizations: the Institute of Oncology Ljubljana, Department of Family Medicine, University of Ljubljana and the Clinical Department of Urology at the University Clinical Center Ljubljana, launched the project Comprehensive analysis of management of urological cancer patients with an assessment of possible delays in referrals, realization of diagnostics procedures and first treatment in 2017. Its main objective was to retrospectively analyse the health care of Slovenian patients with cancer of the kidney, bladder or prostate. The study included all Slovenian patients diagnosed in 2014. This article presents the results of an assessment of delays in referrals, diagnostics procedures and first treatment in bladder and kidney cancer patients. The median system interval (time from first examinations to initiation of treatment) was 35 days in patients with bladder cancer and 22 days in patients with kidney cancer. In both cases, the greatest amount of time elapsed between the first diagnostic procedures and the first specialist visit what points to a bottleneck in performing diagnostic procedures at both the primary and secondary levels of our health system.Pri nas za ledvičnim rakom na leto povprečno zboli 370 ljudi, za rakom sečnega mehurja 320. Preživetje slovenskih bolnikov in bolnic pri teh dveh oblikah raka je že vrsto let slabše od evropskega povprečja. V povezavi treh raziskovalnih organizacij, Onkološkega inštituta Ljubljana, Katedre za družinsko medicino Univerze v Ljubljani in Kliničnega oddelka za urologijo Univerzitetnega kliničnega centra Ljubljana, smo leta 2017 uvedli projekt Celostna analiza zgodnje obravnave bolnikov z urološkimi raki z oceno zamikov pri napotitvi, izvedbi diagnostike in prvega zdravljenja, v katerem smo retrospektivno analizirali zdravstveno oskrbo slovenskih bolnikov in bolnic z raki ledvic, sečnega mehurja ali prostate. V raziskavo smo vključili vse zbolele v Sloveniji leta 2014. V tem prispevku prikazujemo rezultate ocene zamikov v zdravljenju bolnikov in bolnic z rakom ledvic in rakom sečnega mehurja. Median interval zdravstvenega sistema (čas od prvih preiskav do začetka zdravljenja) je bil pri bolnikih z rakom sečnega mehurja 35 dni, pri bolnikih z ledvičnim rakom pa 22 dni. Pri obeh rakih je največ časa poteklo med prvimi diagnostičnimi postopki in prvim pregledom pri specialistu, kar nakazuje na ozko grlo pri izvedbi diagnostičnih postopkov

Assessment of possible delays in referrals, diagnostics procedures and first treatment in Slovenian bladder and kidney cancer patients

Pri nas za ledvičnim rakom na leto povprečno zboli 370 ljudi, za rakom sečnega mehurja 320. Preživetje slovenskih bolnikov in bolnic pri teh dveh oblikah raka je že vrsto let slabše od evropskega povprečja. V povezavi treh raziskovalnih organizacij, Onkološkega inštituta Ljubljana, Katedre za družinsko medicino Univerze v Ljubljani in Kliničnega oddelka za urologijo Univerzitetnega kliničnega centra Ljubljana, smo leta 2017 uvedli projekt Celostna analiza zgodnje obravnave bolnikov z urološkimi raki z oceno zamikov pri napotitvi, izvedbi diagnostike in prvega zdravljenja, v katerem smo retrospektivno analizirali zdravstveno oskrbo slovenskih bolnikov in bolnic z raki ledvic, sečnega mehurja ali prostate. V raziskavo smo vključili vse zbolele v Sloveniji leta 2014. V tem prispevku prikazujemo rezultate ocene zamikov v zdravljenju bolnikov in bolnic z rakom ledvic in rakom sečnega mehurja. Median interval zdravstvenega sistema (čas od prvih preiskav do začetka zdravljenja) je bil pri bolnikih z rakom sečnega mehurja 35 dni, pri bolnikih z ledvičnim rakom pa 22 dni. Pri obeh rakih je največ časa poteklo med prvimi diagnostičnimi postopki in prvim pregledom pri specialistu, kar nakazuje na ozko grlo pri izvedbi diagnostičnih postopkov.The average annual incidence of kidney cancer in Slovenia is 370, and the incidence of bladder cancer is 320. Consortium of three research organizations: the Institute of Oncology Ljubljana, Department of Family Medicine, University of Ljubljana and the Clinical Department of Urology at the University Clinical Center Ljubljana, launched the project Comprehensive analysis of management of urological cancer patients with an assessment of possible delays in referrals, realization of diagnostics procedures and first treatment in 2017. Its main objective was to retrospectively analyse the health care of Slovenian patients with cancer of the kidney, bladder or prostate. The study included all Slovenian patients diagnosed in 2014. This article presents the results of an assessment of delays in referrals, diagnostics procedures and first treatment in bladder and kidney cancer patients. The median system interval (time from first examinations to initiation of treatment) was 35 days in patients with bladder cancer and 22 days in patients with kidney cancer. In both cases, the greatest amount of time elapsed between the first diagnostic procedures and the first specialist visit what points to a bottleneck in performing diagnostic procedures at both the primary and secondary levels of our health system