THE VARIABILITY OF MULTI-DRUG RESISTANCE ABCB1 GENE IN THE ROMA POPULATION FROM CROATIA

When overexpressed, a large transmembrane P-glycoprotein, the product of the ABCB1 gene, is a notable impediment to brain-targeted therapies (like antiepileptics) and chemotherapies. Some of the genetic biomarkers with evidence of multi-drug resistance in ABCB1 ― rs1045642, rs1128503, and rs3213619 ― were analyzed in 440 subjects, members of three socio-culturally different Roma (Gypsy) groups of Croatia. Minor allele frequencies (MAFs) of rs1045642 and rs1128503 were the highest in the Balkan Roma (63.6% and 69.4%, respectively) when compared to the Baranja (52.3% and 62.5%) and the Međimurje Roma (48.8% and 54.5%) (p=0.0005 and p=0.0011, respectively). rs3213619 was monomorphic in the Međimurje group, while its MAFs in other two Roma groups were very low (<1.9%). The distribution of five detected haplotypes (four in the Međimurje group) significantly differed between the Roma subpopulations (p<0.0001), just like the frequencies of diplotypes (p=0.0008). At a global scale, the positive relationship between genetic and geographic distances between the 21 investigated populations indicates isolation by spatial distance. However, this is not true for the relationship between Roma and other populations due to their population history. The analyzed ABCB1 loci indicate genetic distinctiveness of the Roma population

Enhanced Recovery in Thoracic Surgery: A Review

The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program

Enhanced Recovery after Vascular Surgery

The beginnings of the enhanced recovery after surgery (ERAS) program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients