Initiation of insulin therapy in patients with type 2 diabetes: An observational study

The aim of the study was to assess the initiation of insulin therapy in patients with type 2 diabetes using health claims data on prescription medicines. The study evaluated time to insulin initiation and prescribing patterns of other antidiabetic medicines before and after insulin initiation. Five years after starting non-insulin antidiabetic therapy, 6.4 % of patients were prescribed insulin, which is substantially lower compared to other similar studies. Among all patients who initiated insulin therapy in 2013, 30 % did not continue any other antidiabetic therapy. However, this proportion was lowered to 20 % in 2018. Before insulin initiation in 2018, metformin was prescribed in only 67 % of patients and sulfonylureas in 78 % of patients. Moreover, metformin and sulfonylureas were discontinued after insulin initiation in 26 and 37 % of patients, resp. More attention should be paid to the continuation of oral antidiabetics, particularly metformin, after insulin initiation

Renal AA amyloidosis leading to early diagnosis and treatment of takayasu arteritis: a case report and review of the literature

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Medication adherence and health-related quality of life among patients with chronic obstructive pulmonary disease

This study evaluated medication adherence and health-related quality of life (HRQoL) of Slovenian patients with chronic obstructive pulmonary disease (COPD) and examined the factors associated with HRQoL. Demographic and therapy information was collected from 65 patients through interviews. The St. George’s Respiratory Questionnaire and the Morisky Medication Adherence Scale were used to evaluate HRQoL and adherence, resp. A multiple linear regression model was used to assess the association between the factors and HRQoL. The mean St. George’s Respiratory Questionnaire score (range 0–100, with higher scores indicating lower HRQoL) was 41.4. COPD affected patients’ daily activities more than their social and psychological functioning. Slightly more than 53 % of the patients were optimally adherent, while 12 % were non-adherent. Patients with lower HRQoL had a larger number of medications for concomitant diseases, experienced COPD exacerbation in the last year, and had less education. No statistically significant correlation was found between medication adherence and HRQo

Nezakoniti dokazi: Teorijske i praktične dvojbe u svjetlu prakse Europskog suda za ljudska prava

U početnom dijelu rada izlažu se temeljni teorijski sadržaji vezani za vrste, podrijetlo i svrhu dokaznih zabrana. U nastavku slijedi osvrt na dokazne zabrane u njemačkoj kaznenoprocesnoj teoriji, zakonodavstvu i praksi. U središnjem dijelu rada raspravlja se o dokazima čija uporaba dovodi do povrede prava na pravičan postupak propisanog čl. 6. Europske konvencije za zaštitu ljudskih prava i temeljnih sloboda. S time u vezi ispituje se kada do ocjene Europskog suda za ljudska prava o postojanju povrede prava na pravičan postupak dovodi upotreba dokaza pribavljenog povredom čl. 3. Konvencije, a kada je ta ocjena rezultat ispitivanja pravičnosti postupka kao cjeline. U posebnom se poglavlju ispituju slučajevi povrede čl. 6. Konvencije poticanjem na kazneno djelo i primjenom „posebnih istražnih metoda“. Slijedi analiza mehanizama izvršenja presuda Europskog suda za ljudska prava, koja je u kontekstu nezakonitih dokaza osobito relevantna zbog mogućnosti obnove kaznenog postupka. U završnom se dijelu rada o nezakonitim dokazima raspravlja iz perspektive Zakona o kaznenom postupku, pri čemu se osobito uzima u obzir recentna sudska praksa. U sklopu navedenog u zasebnim se odlomcima razmatraju procesne posljedice korištenja nezakonitih dokaza i pojedine kategorije nezakonitih dokaza prema čl. 10. st. 2., nakon čega se raspravlja o odvagivanju interesa kaznenog progona i povrede prava predviđenom u čl. 10. st. 3. Zakona o kaznenom postupku. U zaključku se iznose i prijedlozi de lege ferenda

Management of Extranodal Marginal Zone Lymphoma: Present and Upcoming Perspectives

Extranodal marginal zone lymphoma (EMZL) encompasses a subgroup of non-Hodgkin lymphomas that often present with localized involvement and may manifest in a diversity of organs and tissues. EMZL pathogenesis is in some cases linked to chronic inflammation/infection, which may impose additional diagnostic and clinical challenges. The most studied and established connection is the presence of Helicobacter pylori in gastric EMZL. Due to its heterogeneity of presentation and intricate pathological features, treatment can be complex, and staging systems are decisive for the choice of therapy. Nevertheless, there is no consensus regarding the most suitable staging system, and recommendations vary among different countries. As a rule of thumb, in limited stages, a local therapy with surgery or radiation is the preferred option, and it is potentially curative. Of note, eradicating the causal agent may be an important step of treatment, especially in gastric EMZL, in which Helicobacter pylori eradication remains the first-line therapy for the majority of patients. In patients with more advanced stages, watch-and-wait is a valuable option, especially amongst those without clear indications for systemic therapy, and it may be carried on for several years. If watch-and-wait is not an option, systemic therapy may be needed. Even though several agents have been tested as monotherapy or in combination in recent years, there is no consensus regarding the first-line therapy, and decisions can vary depending on individual factors, such as age, clinical performance and stage. This review aims to discuss the several aspects of EMZL, including genetic milieu, pathogenesis and staging systems, that may influence the choice of therapy. In addition, we present a summary of evidence of several systemic therapies, compare different recommendations worldwide and discuss future perspectives and novelties in its therapy

The measuring station for electrical energy production modeling using photovoltaic technology

U ovom članku prikazana je koncepcija prototipne mjerne stanice sa fotonaponskim sustavom i dvoosnim usmjerivačem koja ujedno služi i kao mjerni i akvizicijski sustav. Mjereni podaci odnose se na podatke potrebne za modeliranje proizvodnje električne energije fotonaposnkim sustavom na određenoj lokaciji zasnovanoj na konvencionalnim analitičkim modelima. Za ovu primjenu odabran je model Liu-Jordan-Klein, pa su i mjerene veličine prilagođene ulaznim podacima tog modela. Za tako konstruiranu prototipnu mjernu stanicu puštena je u rad mjerna oprema i izmjerene su karakteristike kanala za mjerenje pojedinih veličina.The concept of prototype measurement station is presented in this paper with photovoltaic system and dual-axis directing which is also used as measuring and acquisitioning system. The measured data are referring to data necessary for modeling of photovoltaic production of electrical energy for specific location based on conventional analytical models. The Liu-Jordan-Klein model is selected for this application, and therefore all measured values are adapted to this model input data. For described prototype measurement station the measuring equipment was run in test mode and characteristics of measuring channels for each measured value is provided

Advances in Lymphoma Molecular Diagnostics

Lymphomas encompass a diverse group of malignant lymphoid neoplasms. Over recent years much scientific effort has been undertaken to identify and understand molecular changes in lymphomas, resulting in a wide range of genetic alterations that have been reported across all types of lymphomas. As many of these changes are now incorporated into the World Health Organization’s defined criteria for the diagnostic evaluation of patients with lymphoid neoplasms, their accurate identification is crucial. Even if many alterations are not routinely evaluated in daily clinical practice, they may still have implications in risk stratification, treatment, prognosis or disease monitoring. Moreover, some alterations can be used for targeted treatment. Therefore, these advances in lymphoma molecular diagnostics in some cases have led to changes in treatment algorithms. Here, we give an overview of and discuss advances in molecular techniques in current clinical practice, as well as highlight some of them in a clinical context

Edukacija i istraživanje: početni razvoj atmosferskog lagranžijanskog stohastičkog čestičnog modela ALPS

The Atmospheric Lagrangian Particle Stochastic (ALPS) dispersion model was created as an experimental student project and tested under idealized and complex atmospheric and topographic conditions. The challenge of the project was to bring current scientific technology to the direct involvement of students in the framework of problem based learning educational theory. The model simulates dispersion of a passive scalar in the atmosphere by calculating a large number of Lagrangian particle trajectories. It uses meteorological model output to obtain mean meteorological fields. The predicted turbulence kinetic energy (TKE) from a higher order turbulence closure nonhydrostatic meteorological model is used for the simulations. Idealized tests showed that ALPS is correctly responding to different static stability conditions and associating dispersion of particles according to the magnitude of turbulence, satisfying the well-mixed criterion.Atmosferski lagranžijanski stohastički čestični model ALPS napravljen je kao eksperimentalni studentski projekt. Testiran je u idealiziranim i kompleksnim atmosferskim i orografskim uvjetima. Cilj projekta bio je studente direktno uključiti u najnovije znanstvene tehnologije. Model simulira disperziju pasivnog skalara u atmosferi tako da računa lagranžijanske trajektorije velikog broja čestica. Za srednje vrijednosti meteoroloških polja koristi rezultate meteorološkog modela. Za simulacije koristi prognostičku turbulentnu kinetičku energiju (TKE) iz nehidrostatskog meteorološkog modela višeg reda zatvaranja. Idealizirani testovi pokazali su da ALPS dobro reagira na različite uvjete statičke stabilnosti i povezuje disperziju čestica u zavisnosti o jakosti turbulencije, pri tome zadovoljavajući kriterij dobre izmiješanosti

Edukacija i istraživanje: početni razvoj atmosferskog lagranžijanskog stohastičkog čestičnog modela ALPS

The Atmospheric Lagrangian Particle Stochastic (ALPS) dispersion model was created as an experimental student project and tested under idealized and complex atmospheric and topographic conditions. The challenge of the project was to bring current scientific technology to the direct involvement of students in the framework of problem based learning educational theory. The model simulates dispersion of a passive scalar in the atmosphere by calculating a large number of Lagrangian particle trajectories. It uses meteorological model output to obtain mean meteorological fields. The predicted turbulence kinetic energy (TKE) from a higher order turbulence closure nonhydrostatic meteorological model is used for the simulations. Idealized tests showed that ALPS is correctly responding to different static stability conditions and associating dispersion of particles according to the magnitude of turbulence, satisfying the well-mixed criterion.Atmosferski lagranžijanski stohastički čestični model ALPS napravljen je kao eksperimentalni studentski projekt. Testiran je u idealiziranim i kompleksnim atmosferskim i orografskim uvjetima. Cilj projekta bio je studente direktno uključiti u najnovije znanstvene tehnologije. Model simulira disperziju pasivnog skalara u atmosferi tako da računa lagranžijanske trajektorije velikog broja čestica. Za srednje vrijednosti meteoroloških polja koristi rezultate meteorološkog modela. Za simulacije koristi prognostičku turbulentnu kinetičku energiju (TKE) iz nehidrostatskog meteorološkog modela višeg reda zatvaranja. Idealizirani testovi pokazali su da ALPS dobro reagira na različite uvjete statičke stabilnosti i povezuje disperziju čestica u zavisnosti o jakosti turbulencije, pri tome zadovoljavajući kriterij dobre izmiješanosti

Vitamin D Enhances Immune Effector Pathways of NK Cells Thus Providing a Mechanistic Explanation for the Increased Effectiveness of Therapeutic Monoclonal Antibodies

Patients with diffuse large cell lymphoma who have an adequate vitamin D supply derive significantly more benefit from immuno-chemotherapy with rituximab than patients with vitamin D deficiency; this is especially true for female patients. We have already been able to show that vitamin D increases the antibody-dependent cytotoxicity (ADCC) of NK cells in a sex-dependent manner, but it is unclear how vitamin D makes NK cells more efficient. Methods: Healthy individuals with vitamin D deficiency were supplemented with vitamin D to sufficient levels. NK cells were isolated from blood samples before and after vitamin D saturation. For transcriptome analysis, we used the Affymetrix Gene-Chip 2.0™. Gene expression analysis as well as supervised and unsupervised pathway analysis were performed. Results: Among others the “NK cell-associated cytotoxicity pathway” increased after vitamin D substitution. Five IFN-α subtypes (2, 4, 6, 7 and 10) and IFN-κ were more highly expressed and are mainly responsible in these pathways. In contrast, the pathway “interferon-gamma response”, as well as other sets in cytokine production and chemotaxis showed a reduction. Toll-like receptor genes (TLR-8, TLR-7, TLR-2) were downregulated and, therefore, are responsible for the decline of these pathways. The same could be shown for the “ubiquitin-ligase” pathway. Conclusions: Increased expression of several IFN-α subtypes may explain the increased ADCC of NK cells in vitamin D-replenished and otherwise healthy subjects. Other regulators of interferon production and ADCC are compensatory upregulated in compensation, such as Toll-like receptors and those of the ubiquitin ligase, and normalize after vitamin D substitution