Novel advances in diagnosis and treatment of necrotizing enterocolitis

Nekrotizirajući enterokolitis (NEC) je devastirajuća bolest koju je ujedno teško liječiti u učinkovito predvidjeti njen razvoj. Ovaj rad daje kratki uvod u etiologiju NEC-a i njegovu epidemiologiju. Na to se nastavlja karakterizacija patologije i patogeneze, zajedno sa simptomatologijom, kliničkim, radiološkim i biokemijskim metodama otkrivanja. Na uvod se nadovezuje pregled novih metoda otkrivanja. Većina njih se fokusira na pronalaženje specifičnih biljega u krvi, ali razvijaju se i novi, manje invazivni postupci. Oni su navedeni sljedećim redoslijedom: interleukini, proteini koji vežu masne kiseline, žučne kiseline, kalprotektin, klaudin i neinvazivne metode temeljene na praćenju elektrofizioloških promjena u tijelu. Još značajniji broj istraživanja usmjeren je na pronalaženje novih načina liječenja i prevencije NEC-a. Nove moguće metode i tehnike liječenja koje su opisane uključuju: inzulinu sličan čimbenik rasta, oligosaharide ljudskog mlijeka, obitelj epidermalnog faktora rasta, transformirajući faktor rasta β, enzim alkalnu fosfatazu, vitamin A, obitelj trefoil faktora, masne kiseline razgranatih lanaca, eritropoetin, kisik i ozon. Poseban naglasak je stavljen na ulogu majčinog mlijeka kao izvora velikog broja čimbenika korisnih u prevenciji i liječenju NEC-a. Cilj ovoga članka je dati sažeti opis NEC-a i detaljnu analizu recentnih istraživanja novih metoda detekcije i liječenja te bolesti.Necrotizing enterocolitis (NEC) is a devastating disease that is difficult to treat, and it is especially difficult to effectively predict its development. This paper gives a brief introduction to the etiology of NEC and its epidemiology, followed by a characterization of the pathology and pathogenesis, as well as symptomatology, clinical, radiological, and biochemical methods of detection. The introduction is followed by the rewie of detection methods. Most of them are focused on finding specific blood markers, but there are also a lot of novel and less invasive procedure being developed. They are listed as follows: interleukins, fatty acid binding proteins,bile acids, calprotectin, claudin, and noninvasive methods based upon tracking electrophysiologycal changes in the body. Many more studies were aimed at finding new ways of treatment and prevention. New possible treatment methods and techniques are briefly described: insulin-like growth factor, human milk oligosaccharides, epidermal growth factor family, transforming growth factor β, an enzyme – alkaline phosphatase, vitamin A, trefoil factor family, branch chain fatty acids, erythropoietin, oxygen, and ozone. Particular emphasis is given to the role of maternal milk as a source of many of biochemical factors in prevention and even treatment of NEC. The goal of this article is to give a brief review of what NEC is and to present a thorough analysis of recent developments in screening for and treatment of the disease

Necrotizing enterocolitis of infants – new treatment possibilities

Necrotizing enterocolitis (NEC) of infants is a devastating disease that is both difficult to treat and to effectively predict its development. Its occurrence and progression are associated with a plethora of possible causes. That is why, in recent years, many studies were made with the intent of finding efficient new ways of treatment and prevention. Some of those were designed to study and isolate specific factors found in maternal milk and others were more focused on testing synthetic molecules or natural remedies. The etiology of NEC and its epidemiology followed by a characterization of the pathology and pathogenesis, as well as symptomatology, clinical, radiological, and biochemical methods of detection. New possible treatment methods and techniques are briefly described: insulin-like growth factor, human milk oligosaccharides, epidermal growth factor family, transforming growth factor β, an enzyme – alkaline phosphatase, vitamin A, trefoil factor family, branch chain fatty acids, erythropoietin, oxygen, and ozone. Particular emphasis is given to the role of maternal milk as a source of many of biochemical factors in prevention and even treatment of NEC. Further investigations are needed to decrease the incidence and severity as well as to improve the chances of NEC patients

Kirurško liječenje sinonazalnog adenokarcinoma

Cilj rada: Prikaz slučaja uspješnog liječenja uznapredovalog sinonazalnog karcinoma isključivo kirurški, bez adjuvantne kemoradioterapije. Materijal i metode: Radi se o bolesniku rođenom 1933. godine, koji se prezentirao s učestalim epistaksama i otežanim disanjem na desnu nosnicu. Prilikom inicijalnog pregleda uočena je tumorska masa koja u potpunosti opstruira desni nosni kavum. Bolesnik je imao epiforu na desno oko. Učinjena je probatorna biopsija i PH analiza koja govori u prilog sinonazalnog adenokarcinoma neintestinalnog tipa. Učinjen je CT koji nalazi opsežan tumorski proces desnog kavuma i etmoida s parcijalnom destrukcijom septuma i medijalnog zida maksilarnog sinusa, stanjenom laminom cribriformis, bez prodora intrakranijalno, destrukcijom nazolakrimalnog kanala i zahvaćanjem medijalnog dijela dna orbite bez prodora intraorbitalno. Učinjen je endoskposki kirurški zahvat tijekom kojeg je reseciran tumorski proces do u zdravo tkivo. Tijekom zahvata bioptirano je tkivo za analizu koja potvrđuje inicijalnu patohistološku dijagnozu. Rezultat: Bolesnik je detamponiran tri dana nakon, zahvata te je sedmi dan otpušten. Prikazan je na Konziliju za tumore glave i vrata koji je, zbog uznapredovale dobi, donio odluku da se bolesnik prati po operateru. Bolesnik redovito dolazi na kontrole tijekom kojih se vidi uredan postoperativni nalaz bez znakova lokoregionalnog recidiva. Zaključak: Zbog uznapredovale dobi u velikom broju slučajeva preporuka za ovakvog bolesnika bila bi palijativno liječenje. Cilj ovoga prikaza je osvijestiti da se kirurškim liječenjem sinonazalnog karcinoma može postići bolje preživljenje i kvaliteta života, čak i u slučajevima kada postoje kontraindikacije za adjuvantnu terapiju

Revizijska rinoplastika: izazov za kirurga, katastrofa za bolesnika

Uvod: Svaki bolesnik koji ide na operaciju nosa, upoznat je s mogućnošću potrebe sekundarnog zahvata, a vjerojatnost kojega prema literaturi iznosi između 5 i 15%. Planirane rekonstrukcije nosa u dva ili više akta su rijetke, tako da sekundarna rinoplastika najčešće upućuje na neuspjeh primarne operacije. Bolesnici i metode: Analizirali smo vlastite rinoplastike u razdoblju od srpnja 2020. do siječnja 2021., kao i noviju literaturu vezanu uz učestalost i razloge za reviziju. Rezultati: U promatranom razdoblju uočili smo porast udjela revizijskih rinoplastika među ukupnim operacijama nosa. Razlozi za reviziju u skladu su s razlozima opisanim u literaturi, a dijele se na funkcionalne i estetske. Zaključak: Neovisno o uzrocima sekundarne rinoplastike, porast udjela sekundarne unutar svih rinoplastika predstavlja negativan trend. Smatramo da je bolje postavljanje indikacija i bolja informiranost bolesnika u pogledu očekivanja jedini način za smanjenje udjela revizijskih rinoplastik

Kirurško liječenje sinonazalnog adenokarcinoma

Cilj rada: Prikaz slučaja uspješnog liječenja uznapredovalog sinonazalnog karcinoma isključivo kirurški, bez adjuvantne kemoradioterapije. Materijal i metode: Radi se o bolesniku rođenom 1933. godine, koji se prezentirao s učestalim epistaksama i otežanim disanjem na desnu nosnicu. Prilikom inicijalnog pregleda uočena je tumorska masa koja u potpunosti opstruira desni nosni kavum. Bolesnik je imao epiforu na desno oko. Učinjena je probatorna biopsija i PH analiza koja govori u prilog sinonazalnog adenokarcinoma neintestinalnog tipa. Učinjen je CT koji nalazi opsežan tumorski proces desnog kavuma i etmoida s parcijalnom destrukcijom septuma i medijalnog zida maksilarnog sinusa, stanjenom laminom cribriformis, bez prodora intrakranijalno, destrukcijom nazolakrimalnog kanala i zahvaćanjem medijalnog dijela dna orbite bez prodora intraorbitalno. Učinjen je endoskposki kirurški zahvat tijekom kojeg je reseciran tumorski proces do u zdravo tkivo. Tijekom zahvata bioptirano je tkivo za analizu koja potvrđuje inicijalnu patohistološku dijagnozu. Rezultat: Bolesnik je detamponiran tri dana nakon, zahvata te je sedmi dan otpušten. Prikazan je na Konziliju za tumore glave i vrata koji je, zbog uznapredovale dobi, donio odluku da se bolesnik prati po operateru. Bolesnik redovito dolazi na kontrole tijekom kojih se vidi uredan postoperativni nalaz bez znakova lokoregionalnog recidiva. Zaključak: Zbog uznapredovale dobi u velikom broju slučajeva preporuka za ovakvog bolesnika bila bi palijativno liječenje. Cilj ovoga prikaza je osvijestiti da se kirurškim liječenjem sinonazalnog karcinoma može postići bolje preživljenje i kvaliteta života, čak i u slučajevima kada postoje kontraindikacije za adjuvantnu terapiju

Quality of Life after the Sweedish Adjustable Gastric Band Procedure

The term »quality of life« usually describes factors that have an impact on living conditions within the society or on an individual. Generally, the term quality of life refers to the level of the welfare of individuals or group of people. Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health and as such is one of the most common pathological conditions of modern society. Almost 10–25% of adult population in Europe, 1/3 population in the USA and 20% of population in Croatia are affected by obesity5,6. In this prospective study we included 30 patients who underwent Sweedish adjustable gastric band procedure (SAGB) (Johnson & Johnson) procedures without complications during the first year of the postoperative period. Body mass index (BMI) was in female patients 40,52174 kg/m2 and in male patients 46,71429 kg/m2. Prior to the surgical procedures 13 patients (43.33%) experienced worse health conditions. Health conditions were equl in 17 patients. The treatment was ineffective in 5 patients (16.67%). In 5 patients health conditions were equal. 6 patients (20%) had good quality of life, 11 patients (36.67%) very good and only 3 patients (10%) had excellent quality of life after the procedure. We noticed body weight reduction in all patients. The quality of life was improved in all patients, except for one 28 years old woman. Body weight loss and quality of life after the procedure are in positive correlation which means that significant body weight loss leads to improved quality of life. Our conclusion is that SAGB is a quality method in obesity treatment which improves quality of life

Glycomics meets lipidomics - associations of N-glycans with classical lipids, glycerophospholipids, and sphingolipids in three European populations

Recently, high-throughput technologies have been made available which allow the measurement of a broad spectrum of glycomics and lipidomics parameters in many samples. The aim of this study was to apply these methods and investigate associations between 46 glycan and 183 lipid traits measured in blood of 2041 Europeans from three different local populations (Croatia - VIS cohort; Sweden - NSPHS cohort; Great Britain - ORCADES cohort). N-glycans have been analyzed with High Performance Liquid Chromatography (HPLC) and lipids with Electrospray Ionization Tandem Mass Spectrometry (ESI-MS/MS) covering sterol lipids, glycerolipids, glycerophospholipids and sphingolipids in eight subclasses. Overall, 8418 associations were calculated using linear mixed effect models adjusted for pedigree, sex, age and multiple testing. We found 330 significant correlations in VIS. Pearson's correlation coefficient r ranged from −0.27 to 0.34 with corresponding p-values between 1.45 × 10−19 and 4.83 × 10−6, indicating statistical significance. A total of 71 correlations in VIS could be replicated in NSPHS (r = [−0.19; 0.35], p = [4.16 × 10−18; 9.38 × 10−5]) and 31 correlations in VIS were also found in ORCADES (r = [−0.20; 0.24], p = [2.69 × 10−10; 7.55 × 10−5]). However, in total only 10 correlations between a subset of triantennary glycans and unsaturated phosphatidylcholine, saturated ceramide, and sphingomyelin lipids in VIS (r = [0.18; 0.34], p = [2.98 × 10−21; 1.69 × 10−06]) could be replicated in both NSPHS and ORCADES. In summary, the results show strong and consistent associations between certain glycans and lipids in all populations, but also population-specific correlations which may be caused by environmental and genetic differences. These associations point towards potential interactive metabolic pathways

Clinical guidelines for diagnostics, treatment and monitoring of patients with testicular cancer

Rak testisa najčešći je solidni tumor u muškaraca u dobi od 15. do 34. godine. Incidencija raka testisa u svijetu udvostručena je u posljednjih 40 godina. Tumori zametnih stanica čine 95% svih tumora testisa, a podijeljeni su u dva osnovna histološka tipa: seminomi i neseminomi. Osobito značenje daje im velik postotak izlječivosti i u diseminiranoj fazi bolesti. Tom je uspjehu najviše pridonijela kemoterapija, ali kirurgija je i dalje neizostavan dio uspješnog liječenja. U znatnog dijela bolesnika danas se nastoji odrediti terapijski minimum kojim se izbjegava niz nuspojava, a dovodi do jednakog uspjeha kao i donedavno agresivniji terapijski pristup. U tekstu koji slijedi iznesene su kliničke upute radi standardizacije dijagnostike, liječenja i praćenja bolesnika s tumorima zametnih stanica testisa u Republici Hrvatskoj.Testicular tumors are the most common solid tumors in men between age 15- 34 years. The worldwide incidence of these tumors has doubled in the past 40 years. Germ cell tumors comprise 95% of malignant tumors arising in the testes and they are classified as seminoma and nonseminoma. Testicular cancer has high cure rates even in disseminated stage of disease. The chemotherapy mostly contributed to these results, but surgery is an unavoidable part of this success. In significant number of these patients treatment algorithms today have intention to offer the same cure rates with minimally aggressive therapy. The following text presents the clinical guidelines in order to standardize procedures and criteria for diagnosis, treatment, and follow-up of patients with testicular cancer in the Republic of Croatia

Genomics Meets Glycomics—The First GWAS Study of Human N-Glycome Identifies HNF1α as a Master Regulator of Plasma Protein Fucosylation

Over half of all proteins are glycosylated, and alterations in glycosylation have been observed in numerous physiological and pathological processes. Attached glycans significantly affect protein function; but, contrary to polypeptides, they are not directly encoded by genes, and the complex processes that regulate their assembly are poorly understood. A novel approach combining genome-wide association and high-throughput glycomics analysis of 2,705 individuals in three population cohorts showed that common variants in the Hepatocyte Nuclear Factor 1α (HNF1α) and fucosyltransferase genes FUT6 and FUT8 influence N-glycan levels in human plasma. We show that HNF1α and its downstream target HNF4α regulate the expression of key fucosyltransferase and fucose biosynthesis genes. Moreover, we show that HNF1α is both necessary and sufficient to drive the expression of these genes in hepatic cells. These results reveal a new role for HNF1α as a master transcriptional regulator of multiple stages in the fucosylation process. This mechanism has implications for the regulation of immunity, embryonic development, and protein folding, as well as for our understanding of the molecular mechanisms underlying cancer, coronary heart disease, and metabolic and inflammatory disorders

Revizijska rinoplastika: izazov za kirurga, katastrofa za bolesnika

Uvod: Svaki bolesnik koji ide na operaciju nosa, upoznat je s mogućnošću potrebe sekundarnog zahvata, a vjerojatnost kojega prema literaturi iznosi između 5 i 15%. Planirane rekonstrukcije nosa u dva ili više akta su rijetke, tako da sekundarna rinoplastika najčešće upućuje na neuspjeh primarne operacije. Bolesnici i metode: Analizirali smo vlastite rinoplastike u razdoblju od srpnja 2020. do siječnja 2021., kao i noviju literaturu vezanu uz učestalost i razloge za reviziju. Rezultati: U promatranom razdoblju uočili smo porast udjela revizijskih rinoplastika među ukupnim operacijama nosa. Razlozi za reviziju u skladu su s razlozima opisanim u literaturi, a dijele se na funkcionalne i estetske. Zaključak: Neovisno o uzrocima sekundarne rinoplastike, porast udjela sekundarne unutar svih rinoplastika predstavlja negativan trend. Smatramo da je bolje postavljanje indikacija i bolja informiranost bolesnika u pogledu očekivanja jedini način za smanjenje udjela revizijskih rinoplastik