Klinička prehrana i kolorektalni karcinom

Cachexia-anorexia syndrome, characterized by anorexia and loss of adipose tissue and skeletal muscle mass, is common feature in majority of patients with cancer, especially in cancer localized in gastrointestinal tract. Malnutrition is recognized as a negative prognostic factor in patients with colorectal cancer. Malnutrition in cancer patients reduces response to specific oncological therapy, slows down recovery after surgical treatment, leads to impairement of quality of life and decreases survival. It is considered that developement of cancer cachexia is a multifactorial process, however inflammation plays a major role. Therefore, targeting inflammation may represent an effective strategy to prevent/treat cachexia. Treatment should be patient-tailored and based on a multimodal approach.Kaheksija-anoreksija sindrom je karakteriziran anoreksijom i gubitkom masnog tkiva i skeletne mišićne mase. Sindrom je prisutan u većine onkoloških bolesnika, osobito u bolesnika s tumorima probavnog sustava. Odavno je prepoznato kako malnutricija predstavlja negativni prognostički faktor kod bolesnika s kolorektalnim karcinomom. Malnutricija u onkoloških bolesnika dovodi do slabijeg odgovora na specifičnu onkološku terapiju, sporijeg oporavka nakon kirurških zahvata, do smanjenja kvalitete života, ali i sveukupnog preživljenja. Istraživanja su pokazala kako je tumorska kaheksija multifaktorijalan proces. Međutim, smatra se kako glavnu ulogu u patogenezi tumorske kaheksije ima upala. Stoga je upravo djelovanje na upalni proces potencijalni terapijski cilj u liječenju, odnosno prevenciji kaheksije. Liječenje tumorske kaheksije trebalo bi biti individualizirano i temeljeno na multimodalnom pristupu

Klinička prehrana i kolorektalni karcinom

Cachexia-anorexia syndrome, characterized by anorexia and loss of adipose tissue and skeletal muscle mass, is common feature in majority of patients with cancer, especially in cancer localized in gastrointestinal tract. Malnutrition is recognized as a negative prognostic factor in patients with colorectal cancer. Malnutrition in cancer patients reduces response to specific oncological therapy, slows down recovery after surgical treatment, leads to impairement of quality of life and decreases survival. It is considered that developement of cancer cachexia is a multifactorial process, however inflammation plays a major role. Therefore, targeting inflammation may represent an effective strategy to prevent/treat cachexia. Treatment should be patient-tailored and based on a multimodal approach.Kaheksija-anoreksija sindrom je karakteriziran anoreksijom i gubitkom masnog tkiva i skeletne mišićne mase. Sindrom je prisutan u većine onkoloških bolesnika, osobito u bolesnika s tumorima probavnog sustava. Odavno je prepoznato kako malnutricija predstavlja negativni prognostički faktor kod bolesnika s kolorektalnim karcinomom. Malnutricija u onkoloških bolesnika dovodi do slabijeg odgovora na specifičnu onkološku terapiju, sporijeg oporavka nakon kirurških zahvata, do smanjenja kvalitete života, ali i sveukupnog preživljenja. Istraživanja su pokazala kako je tumorska kaheksija multifaktorijalan proces. Međutim, smatra se kako glavnu ulogu u patogenezi tumorske kaheksije ima upala. Stoga je upravo djelovanje na upalni proces potencijalni terapijski cilj u liječenju, odnosno prevenciji kaheksije. Liječenje tumorske kaheksije trebalo bi biti individualizirano i temeljeno na multimodalnom pristupu

Gastrointestinal Complications of NSAIDs and Anticoagulants

Kronična sistemska terapija neselektivnim antireumatskim (NSAR) lijekovima koja se rabi za liječenje različitih stanja, od boli, vrućice i upale pa sve do primarne i sekundarne prevencije kardiovaskularnih i cerebrovaskularnih bolesti, povezana je s različitim neželjenim učincima, od kojih je najčešća gastropatija. Pažljiva procjena rizičnih čimbenika od razvoja gastrointestinalnih komplikacija povezanih s uzimanjem NSAR (visoka dob, istodobno uzimanje antikoagulansa, kortikosteroida ili acetilsalicilne kiseline, prijašnja anamneza peptičkih ulceracija) nužna je prije započinjanja terapije NSAR-om. Za sada postoje dva pristupa u prevenciji gastrointestinalnih komplikacija povezanih s kroničnom upotrebom NSAR-a: primjena COX-2-selektivnih inhibitora ili terapija neselektivnim NSAR-om uz jedan od gastroprotektivnih lijekova (misoprostol, inhibitor protonske pumpe (IPP), visoke doze antagonista H2-receptora). Za cijeljenje ulkusa povezanih s upotrebom NSAR-a preporučuje se primjena IPP-a. Akutno gastrointestinalno krvarenje komplikacija je kod bolesnika koji dugotrajno uzimaju antikoagulantnu terapiju, a istodobna upotreba NSAR-a povećava rizik od krvarenja.The use of chronic oral or systemic nonselective nonsteroidal anti-inflammatory drugs (NSAID) to treat various conditions, from pain, fever and inflammation to primary and secondary prophylaxis of cardiovascular and cerebrovascular diseases, is associated with a wide range of symptomatic adverse events, the most frequent and serious of which is gastropathy. A careful assessment of patients’ risk factors (high age, concomitant anticoagulants, steroids and aspirin therapy and previous history of peptic ulceration) for developing NSAIDrelated gastrointestinal complications should be undertaken prior to initiation of any NSAIDs. There are two main approaches to the prevention of gastrointestinal complications related to chronic NSAID use: COX-2 specific inhibitor therapy or nonselective NSAID therapy with one of the gastroprotective agents (misoprostol, proton-pump inhibitors (PPI), high doses of H2 antagonist). A PPI should be used for healing of NSAID-associated ulcers. Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy, and the concomitant use of NSAIDs increases the risk of bleeding

Gastrointestinal Complications of NSAIDs and Anticoagulants

Kronična sistemska terapija neselektivnim antireumatskim (NSAR) lijekovima koja se rabi za liječenje različitih stanja, od boli, vrućice i upale pa sve do primarne i sekundarne prevencije kardiovaskularnih i cerebrovaskularnih bolesti, povezana je s različitim neželjenim učincima, od kojih je najčešća gastropatija. Pažljiva procjena rizičnih čimbenika od razvoja gastrointestinalnih komplikacija povezanih s uzimanjem NSAR (visoka dob, istodobno uzimanje antikoagulansa, kortikosteroida ili acetilsalicilne kiseline, prijašnja anamneza peptičkih ulceracija) nužna je prije započinjanja terapije NSAR-om. Za sada postoje dva pristupa u prevenciji gastrointestinalnih komplikacija povezanih s kroničnom upotrebom NSAR-a: primjena COX-2-selektivnih inhibitora ili terapija neselektivnim NSAR-om uz jedan od gastroprotektivnih lijekova (misoprostol, inhibitor protonske pumpe (IPP), visoke doze antagonista H2-receptora). Za cijeljenje ulkusa povezanih s upotrebom NSAR-a preporučuje se primjena IPP-a. Akutno gastrointestinalno krvarenje komplikacija je kod bolesnika koji dugotrajno uzimaju antikoagulantnu terapiju, a istodobna upotreba NSAR-a povećava rizik od krvarenja.The use of chronic oral or systemic nonselective nonsteroidal anti-inflammatory drugs (NSAID) to treat various conditions, from pain, fever and inflammation to primary and secondary prophylaxis of cardiovascular and cerebrovascular diseases, is associated with a wide range of symptomatic adverse events, the most frequent and serious of which is gastropathy. A careful assessment of patients’ risk factors (high age, concomitant anticoagulants, steroids and aspirin therapy and previous history of peptic ulceration) for developing NSAIDrelated gastrointestinal complications should be undertaken prior to initiation of any NSAIDs. There are two main approaches to the prevention of gastrointestinal complications related to chronic NSAID use: COX-2 specific inhibitor therapy or nonselective NSAID therapy with one of the gastroprotective agents (misoprostol, proton-pump inhibitors (PPI), high doses of H2 antagonist). A PPI should be used for healing of NSAID-associated ulcers. Acute gastrointestinal bleeding is a severe complication in patients receiving long-term oral anticoagulant therapy, and the concomitant use of NSAIDs increases the risk of bleeding

PLACE OF BIOLOGIC THERAPY IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASES AND ASSESSMENT OF ITS EFFICACY

Biološka terapija (infliksimab i adalimumab) u upalnim bolestima crijeva temelji se na IgG1 anti-TNF monoklonalnim antitijelima sa snažnim protuupalnim učincima u podlozi kojih je apoptoza upalnih stanica. Neupitno je, a to proizlazi iz većine dosadašnjih studija i meta-analiza, da se radi o učinkovitoj terapiji u prvom redu za liječenje Crohnove bolesti (CB), ali i ulceroznog kolitisa u različitim kliničkim situacijama. Za sada postoji najviše podataka o učinkovitosti infliksimaba (IFX), ali istraživanja su pokazala kako i drugi anti-TNF lijekovi, prije svega adalimumab i certolizumab imaju slične učinke. Potrebna su daljnja istraživanja kako bi se utvrdila uloga certolizumab pegola u CB i adalimumaba u ulceroznom kolitisu. Važnu ulogu u primjeni biološke terapije ima procjena njene djelotvornosti te odnosa koristi-štetnosti koji se procjenjuju na osnovi redovitih pregleda. U slučaju izostanka odgovora (primarna i sekundarna nereaktivnost) preostaje povećanje doze, skraćenje intervala davanja lijeka te zamjena drugim biološkim lijekom.Biological therapy (infliximab and adalimumab) in inflammatory bowel diseases is based on the IgG1 anti-TNF monoclonal antibodies with potent anti-inflammatory effects whose main mechanism of action is thought to be the induction of inflammatory cell apoptosis. Unquestionably, which arises from the most recent studies and meta-analysis, anti-TNF angents are an effective therapy primarily for the treatment of Crohn’s disease, but also ulcerative colitis, in different clinical situations. Infliximab has the most extensive clinical trial data, but other biological agents, such as adalimumab and certolizumab pegol appear to have similar benefits. In terms of future research, more long-term data are needed for both certolizumab pegol in Crohn’s disease and adalimumab in ulcerative colitis. Important role in the application of biological therapy is assessing its effectiveness and cost-benefit relationships that are estimated by regular follow-up. In the absence of response (primary and secondary) therapeutical options are dose increase, giving the drug in shorter intervals and substitution with other biological drug

PLACE OF BIOLOGIC THERAPY IN THE TREATMENT OF INFLAMMATORY BOWEL DISEASES AND ASSESSMENT OF ITS EFFICACY

Biološka terapija (infliksimab i adalimumab) u upalnim bolestima crijeva temelji se na IgG1 anti-TNF monoklonalnim antitijelima sa snažnim protuupalnim učincima u podlozi kojih je apoptoza upalnih stanica. Neupitno je, a to proizlazi iz većine dosadašnjih studija i meta-analiza, da se radi o učinkovitoj terapiji u prvom redu za liječenje Crohnove bolesti (CB), ali i ulceroznog kolitisa u različitim kliničkim situacijama. Za sada postoji najviše podataka o učinkovitosti infliksimaba (IFX), ali istraživanja su pokazala kako i drugi anti-TNF lijekovi, prije svega adalimumab i certolizumab imaju slične učinke. Potrebna su daljnja istraživanja kako bi se utvrdila uloga certolizumab pegola u CB i adalimumaba u ulceroznom kolitisu. Važnu ulogu u primjeni biološke terapije ima procjena njene djelotvornosti te odnosa koristi-štetnosti koji se procjenjuju na osnovi redovitih pregleda. U slučaju izostanka odgovora (primarna i sekundarna nereaktivnost) preostaje povećanje doze, skraćenje intervala davanja lijeka te zamjena drugim biološkim lijekom.Biological therapy (infliximab and adalimumab) in inflammatory bowel diseases is based on the IgG1 anti-TNF monoclonal antibodies with potent anti-inflammatory effects whose main mechanism of action is thought to be the induction of inflammatory cell apoptosis. Unquestionably, which arises from the most recent studies and meta-analysis, anti-TNF angents are an effective therapy primarily for the treatment of Crohn’s disease, but also ulcerative colitis, in different clinical situations. Infliximab has the most extensive clinical trial data, but other biological agents, such as adalimumab and certolizumab pegol appear to have similar benefits. In terms of future research, more long-term data are needed for both certolizumab pegol in Crohn’s disease and adalimumab in ulcerative colitis. Important role in the application of biological therapy is assessing its effectiveness and cost-benefit relationships that are estimated by regular follow-up. In the absence of response (primary and secondary) therapeutical options are dose increase, giving the drug in shorter intervals and substitution with other biological drug

Cystic Fibrosis – results of CFTR modulators in Croatia

Cistična fibroza najčešća je nasljedna bolest, koja skraćuje životni vijek, a uzrokuje je defekt u genu za transmembranski regulator provodljivosti cistične fibroze (eng. cystic fibrosis transmembrane regulator – CFTR). Poremećena je homeostaza elektrolita, što se očituje simptomima u više organskih sustava. Plućne manifestacije, s kroničnim infekcijama, upalom i, na kraju, respiratornim zatajenjem, ostaju i dalje najvažnija prijetnja životnom vijeku bolesnika. Do prije jednog desetljeća bilo je dostupno samo simptomatsko liječenje. Od 2012. g. dostupno je liječenje tzv. modulatorima CFTR-proteina i njihovim kombinacijama za osobe s cističnom fibrozom koje nose različite varijante CFTR-gena. Pojavom tih lijekova uvelike se promijenila perspektiva i kvaliteta života ljudi s cističnom fibrozom, ali postavljeni i novi izazovi u vezi s dugoročnim komplikacijama, pitanje eventualnog smanjenja konvencionalnog liječenja, ali i financiranja terapije, koja je mnogim bolesnicima nedostupna. Iznesene su bazične spoznaje o cističnoj fibrozi i funkciji CFTR-proteina, klasifikaciji varijanata CFTR-gena, mogućnostima liječenja CFTR-modulatorima te osnovni ishodi liječenja bolesnika s cističnom fibrozom u Hrvatskoj, gdje se ta terapija primjenjuje od jeseni 2021. godine.Cystic fibrosis, the most frequent lifespan shortening hereditary disease in Caucasians, is caused by a defect in the CFTR (cystic fibrosis transmembrane regulator) gene. Disturbed electrolyte homeostasis leads to the development of different symptoms in multiple organs. Pulmonary manifestations with chronic infections and inflammation result in respiratory failure and remain the most important life-shortening factor. Until recently only symptomatic treatment was available. In year 2012. a new treatment approach with small molecules that modulate the CFTR protein was introduced. Different combinations of CFTR modulators are applicable to certain patients carrying different variants of the CFTR gene. CFTR modulators made a huge difference in the quality of life and perspectives of people with cystic fibrosis. At the same time, new challenges emerged regarding long term complications and possible reduction of conventional treatment options, as well as financial issues that are an obstacle to the use of these drugs for many patients. This paper brings basic insight into cystic fibrosis, the function of CFTR protein, the classification of CFTR gene variants and possibilities of treatment with CFTR modulators as well as basic outcomes of CFTR modulators treatment in Croatia, where this therapy was introduced in autumn 2021

Ball Detection Using Deep Learning Implemented on an Educational Robot Based on Raspberry Pi

RoboCupJunior is a project-oriented competition for primary and secondary school students that promotes robotics, computer science and programing. Through real life scenarios, students are encouraged to engage in robotics in order to help people. One of the popular categories is Rescue Line, in which an autonomous robot has to find and rescue victims. The victim is in the shape of a silver ball that reflects light and is electrically conductive. The robot should find the victim and place it in the evacuation zone. Teams mostly detect victims (balls) using random walk or distant sensors. In this preliminary study, we explored the possibility of using a camera, Hough transform (HT) and deep learning methods for finding and locating balls with the educational mobile robot Fischertechnik with Raspberry Pi (RPi). We trained, tested and validated the performance of different algorithms (convolutional neural networks for object detection and U-NET architecture for sematic segmentation) on a handmade dataset made of images of balls in different light conditions and surroundings. RESNET50 was the most accurate, and MOBILENET_V3_LARGE_320 was the fastest object detection method, while EFFICIENTNET-B0 proved to be the most accurate, and MOBILENET_V2 was the fastest semantic segmentation method on the RPi. HT was by far the fastest method, but produced significantly worse results. These methods were then implemented on a robot and tested in a simplified environment (one silver ball with white surroundings and different light conditions) where HT had the best ratio of speed and accuracy (4.71 s, DICE 0.7989, IoU 0.6651). The results show that microcomputers without GPUs are still too weak for complicated deep learning algorithms in real-time situations, although these algorithms show much higher accuracy in complicated environment situations

MJESTO BIOLOŠKE TERAPIJE U LIJEČENJU UPALNIH BOLESTI CRIJEVA I PROCJENA NJENE DJELOTVORNOSTI

Biological therapy (infliximab and adalimumab) in inflammatory bowel diseases is based on the IgG1 anti-TNF monoclonal antibodies with potent anti-inflammatory effects whose main mechanism of action is thought to be the induction of inflammatory cell apoptosis. Unquestionably, which arises from the most recent studies and meta-analysis, anti-TNF angents are an effective therapy primarily for the treatment of Crohn’s disease, but also ulcerative colitis, in different clinical situations. Infliximab has the most extensive clinical trial data, but other biological agents, such as adalimumab and certolizumab pegol appear to have similar benefits. In terms of future research, more long-term data are needed for both certolizumab pegol in Crohn’s disease and adalimumab in ulcerative colitis. Important role in the application of biological therapy is assessing its effectiveness and cost-benefit relationships that are estimated by regular follow-up. In the absence of response (primary and secondary) therapeutical options are dose increase, giving the drug in shorter intervals and substitution with other biological drug.Biološka terapija (infliksimab i adalimumab) u upalnim bolestima crijeva temelji se na IgG1 anti-TNF monoklonalnim antitijelima sa snažnim protuupalnim učincima u podlozi kojih je apoptoza upalnih stanica. Neupitno je, a to proizlazi iz većine dosadašnjih studija i meta-analiza, da se radi o učinkovitoj terapiji u prvom redu za liječenje Crohnove bolesti (CB), ali i ulceroznog kolitisa u različitim kliničkim situacijama. Za sada postoji najviše podataka o učinkovitosti infliksimaba (IFX), ali istraživanja su pokazala kako i drugi anti-TNF lijekovi, prije svega adalimumab i certolizumab imaju slične učinke. Potrebna su daljnja istraživanja kako bi se utvrdila uloga certolizumab pegola u CB i adalimumaba u ulceroznom kolitisu. Važnu ulogu u primjeni biološke terapije ima procjena njene djelotvornosti te odnosa koristi-štetnosti koji se procjenjuju na osnovi redovitih pregleda. U slučaju izostanka odgovora (primarna i sekundarna nereaktivnost) preostaje povećanje doze, skraćenje intervala davanja lijeka te zamjena drugim biološkim lijekom

MJESTO BIOLOŠKE TERAPIJE U LIJEČENJU UPALNIH BOLESTI CRIJEVA I PROCJENA NJENE DJELOTVORNOSTI

Biological therapy (infliximab and adalimumab) in inflammatory bowel diseases is based on the IgG1 anti-TNF monoclonal antibodies with potent anti-inflammatory effects whose main mechanism of action is thought to be the induction of inflammatory cell apoptosis. Unquestionably, which arises from the most recent studies and meta-analysis, anti-TNF angents are an effective therapy primarily for the treatment of Crohn’s disease, but also ulcerative colitis, in different clinical situations. Infliximab has the most extensive clinical trial data, but other biological agents, such as adalimumab and certolizumab pegol appear to have similar benefits. In terms of future research, more long-term data are needed for both certolizumab pegol in Crohn’s disease and adalimumab in ulcerative colitis. Important role in the application of biological therapy is assessing its effectiveness and cost-benefit relationships that are estimated by regular follow-up. In the absence of response (primary and secondary) therapeutical options are dose increase, giving the drug in shorter intervals and substitution with other biological drug.Biološka terapija (infliksimab i adalimumab) u upalnim bolestima crijeva temelji se na IgG1 anti-TNF monoklonalnim antitijelima sa snažnim protuupalnim učincima u podlozi kojih je apoptoza upalnih stanica. Neupitno je, a to proizlazi iz većine dosadašnjih studija i meta-analiza, da se radi o učinkovitoj terapiji u prvom redu za liječenje Crohnove bolesti (CB), ali i ulceroznog kolitisa u različitim kliničkim situacijama. Za sada postoji najviše podataka o učinkovitosti infliksimaba (IFX), ali istraživanja su pokazala kako i drugi anti-TNF lijekovi, prije svega adalimumab i certolizumab imaju slične učinke. Potrebna su daljnja istraživanja kako bi se utvrdila uloga certolizumab pegola u CB i adalimumaba u ulceroznom kolitisu. Važnu ulogu u primjeni biološke terapije ima procjena njene djelotvornosti te odnosa koristi-štetnosti koji se procjenjuju na osnovi redovitih pregleda. U slučaju izostanka odgovora (primarna i sekundarna nereaktivnost) preostaje povećanje doze, skraćenje intervala davanja lijeka te zamjena drugim biološkim lijekom