Characteristics of immune cells of weaned pigs treated with isoflurane and nitrous oxide

U ovom doktorskom radu svinja je uzeta kao svjetski priznati model u biomedicinskim istraživanjima u cilju utvrđivanja mogućih štetnih učinaka anestetika izoflurana i permanentnog plina dušikovog oksidula na staničnu imunost nakon njihove višednevne ponovljene primjene. Provedeno je prospektivno, randomizirano, kontrolirano istraživanje koje je uključilo 28 prasadi dobrog općeg stanja. Ispitivane životinje, ovisno o tretmanu izofluranom samostalno ili u kombinaciji s dušikovim oksidulom, podijeljene su u skupine. Uzorci krvi za određivanje hematoloških, biokemijskih i imunosnih pokazatelja uzeti su 0., 4., 8., 16. i 24 dana istraživanja. Na kraju istraživanja uzeti su uzorci koštane moždine, slezene, pluća i limfnog čvora te je načinjena histopatološka pretraga. Dobiveni rezultati ovih istraživanja pokazuju da izofluran te njegova kombinacija s dušikovim oksidulom, u prasadi anestezirane tijekom 24 dana, imaju imunosupresijski učinak, odnosno smanjuju udjele subpopulacija (CD4+, CD8+, CD21+ i CD45+) limfocita u svinja. Međutim, u prasadi anestezirane dušikovim oksidulom i kisikom bez dodatka izoflurana tijekom 24 dana, na kraju istraživanja nije zabilježen njihov štetni učinak na stanični imunosni sustav. Dobiveni rezultati predstavljaju znanstveno utemeljenu preporuku da izofluran te njegovu kombinaciju s dušikovim oksidulom treba s oprezom upotrebljavati za potrebe višednevne anestezije na modelu domaće svinje kao i u humanoj medicini prilikom opetovanih anestezija s istim protokolom osobito u pacijenata gdje je primarna bolest već narušila imunosni sustav.In this doctoral thesis pig is taken as a globally recognized model in biomedical research in order to identify potential adverse effects of anesthetics isoflurane and nitrous oxide permanent gas on cellular immunity after their multi-day repeated administration. This prospective, randomized, controlled trial involved 28 piglets in good general condition. Tested animals, depending on the treatment with isoflurane alone or in combination with the nitrogen oxide, were divided into groups. Blood samples for determination of hematologic, biochemical and immune parameters were taken at days 0, 4, 8, 16 and 24 of study. At the end of the study samples were taken from bone marrow, spleen, lung and lymph node and underwent histopathological examination. The results of these studies suggest that isoflurane and its combination with nitrogen oxide in pigs anesthetized for 24 days, have immunosuppressive effect or reduce stakes cell populations cellular immunity pigs (CD4+, CD8+, CD21+ and CD45+). However, in anesthetized piglets with nitrogen oxide and oxygen without addition of isoflurane for 24 days, at the end of the study was not recorded their harmful effect on the cellular immune system of animals. The results confirmed the initial hypothesis. The resulting immune indicators are a scientifically based recommendation that isoflurane and its combination with nitrogen oxide for the purpose of chronic anesthesia on a model of domestic pigs should be used with caution, especially if there is already a compromised immunity

Endoskopsko liječenje pseudociste gušterače

Pancreatic pseudocyst, the most common cystic lesion of the pancreas, may occur as a consequence of acute or chronic pancreatitis, pancreatic trauma, or obstruction of the pancreatic duct. Symptomatic, complicated, or enlarging pseudocysts require therapy that can be endoscopic (transmural and transpapillary drainage), percutaneous, or surgical. We present a patient with pancreatic pseudocyst treated by blinded endoscopic transgastric puncture and stenting after an unsuccessful attempt at endoscopic transpapillary drainage, suggesting that this simple approach is safe and effective in a selected group of patients.Pseudocista gušterače kao najčešće cistično oštećenje gušterače može nastati kao posljedica akutnog ili kroničnog pankreatitisa, traume gušterače ili opstrukcije gušteračnog kanala. Simptomatične, komplicirane ili pseudociste koje se povećavaju zahtijevaju liječenje koje može biti endoskopsko (transmuralna i transpapilarna drenaža), perkutano ili kirurško. Prikazuje se bolesnica s pseudocistom gušterače liječenom endoskopskom transgastričnom punkcijom naslijepo i postavljanjem stenta nakon neuspjelog pokušaja endoskopske transpapilarne drenaže. Ukazuje se na to da je ovaj jednostavan pristup siguran i učinkovit u odabranoj skupini bolesnika

Adjusted Blood Requirement Index as Indicator of Failure to Control Acute Variceal Bleeding

Aim: To estimate the clinical value of adjusted blood requirement index (ABRI) in relation to other criteria for failure of variceal bleeding control proposed at Baveno consensus workshops and to evaluate ABRI as an early predictor of occurrence of other Baveno criteria and identification of possible predictors of unfavorable ABRI. Methods: We retrospectively analyzed the data on 60 patients admitted to the hospital due to acute variceal bleeding. Number of treatment failures according to Baveno II-III and Baveno IV definitions and criteria was compared. We tested the ABRI’s predictability of other Baveno IV and Baveno II-III criteria. Logistic regression analysis was performed to ascertain independent variables that predict ABRI≥0.75. Results: Failure to control variceal bleeding occurred in 40 of 60 patients according to Baveno II-III criteria, and in 35 of 60 patients according to Baveno IV criteria. Excluding the criterion of “transfusion of 2 units of blood or more (over and above the previous transfusions)”and ABRI criterion, failure to control variceal bleeding was observed in 17 and 14 of 60 patients, respectively. Congruence of ABRI with other criteria was present in about two-thirds of the cases. ABRI≥0.75 was associated with increased risk of positive other Baveno criteria,particularly modified Baveno II-III (odds ratio [OR] 4.10; 95% confidence interval [CI], 1.11-15.05) and Baveno IV without ABRI (OR 4.37; 95% CI, 1.04-18.28). Independent predictors of ABRI≥0.75 identified in logistic regression analysis were male sex (P<0.001) and higher hematocrit values (P=0.004). Conclusion: We found low congruence between ABRI and other Baveno criteria. It seems that criteria related to the quantity of blood transfusions are not reliable indicators of treatment failure

Patofiziološke osnove i indikacijsko područje primjene lasera male snage u liječenju akutne i kronične boli

Primjena lasera male snage u liječenju akutne i kronične boli datira unatrag 30 godina. Cilj su ovog članka opis spoznaja o mehanizmima djelovanja lasera na bol te upute za njegovu učinkovitiju primjenu u terapiji pojedinih bolnih stanja. Prema zadanim ključnim riječima, pregledali smo literaturu na engleskom i hrvatskom jeziku objavljenu od 1988. do 2018. godine u bazama Scopus, Medline, Embase, Web of Science i Cochrane Library. Izdvojeni su i citirani radovi primjereni ciljevima ovoga kratkog pregleda. Iako patofiziološki učinci laserske zrake na oštećeno tkivo nisu potpuno poznati ni danas, dosadašnje spoznaje upućuju na biostimulativne efekte koji potiču brže saniranje i regeneraciju oštećenih tkiva poboljšanjem dopreme energenata i kisika u stanice, smanjenje upalne komponente i edema, a time i smanjenje boli te oporavak funkcije. Velik je broj objavljenih kliničkih studija koje dokazuju djelotvornost lasera u terapiji različitih bolnih stanja, ali brojne dobro dizajnirane randomizirane studije pokazale su da su ti učinci često na razini placeba ili usporedivi s učinkom drugih metoda u fizikalnoj terapiji. Poseban problem u istraživanju čini velika paleta laserskih uređaja čije sonde isporučuju zrake različitih valnih duljina, od 600 do 1000 nm, u širokom rasponu snage od 5 do 500 mW te različitih modaliteta emitiranja, od kontinuiranoga do pulsirajućega. Da bismo postigli biostimulativno djelovanje na oštećeno tkivo, ono mora primiti odgovarajuću količinu energije od 1 do 2 J/cm2 pri akutnim stanjima odnosno od 4 do 8 J/cm2 kod kroničnih stanja. Da bi primjena lasera bila djelotvorna komplementarna metoda liječenja boli, moraju se optimizirati parametri valne duljine, snaga sonde i modalitet emitiranja

TAPENTADOL THERAPY IN CHRONIC PAIN MANAGEMENT: OUR EXPERIENCE

Tapentadol je novi lijek registriran u retard obliku za umjerenu i jaku kroničnu bol koji svojim spektrom djelovanja pokriva i nociceptivnu i neuropatsku komponentu boli. Analgetski se učinak postiže djelovanjem dvaju sinergističkih mehanizama: agonističkim učinkom na mi opioidne receptore (MOR-agonizam) i inhibicijom ponovnog preuzimanja noradrenalina (NRI). Cilj: Usporediti naša iskustva o učinkovitosti i podnošljivosti tapentadola s iskustvima drugih istraživača u svijetu. Metode: U istraživanje su uključena 92 bolesnika iz naše ambulante za bol, kojima je bilo indicirano propisati tapentadol-retard u dozi od dva puta 50 mg ili višoj. Pratili smo povoljni učinak na smanjenje bolova prema vizualno-analognoj ljestvici (VAS) te vrstu i učestalost neželjenih učinaka lijeka. Bilježene su i daljnje preporuke za prilagodbu doze odnosno prekid terapije. Rezultati: Pojava povoljnog djelovanja tapentadola na smanjenje kronične boli kod različitih bolnih sindroma pokazala se u 66 %, ispitanika. Postotak nuspojava, od blažih do težih, iskazalo je 43 % bolesnika. Pedeset i četiri % korisnika tapentadola odustalo je od terapije, 37 % zbog nuspojava, 15 % zbog nezadovoljstva kontrolom boli i 2 % zbog neodobravanja obiteljskog liječnika. Zaključak: Našim istraživanjem potvrđena je dobra učinkovitost tapentadola na smanjenje boli. Nuspojave se u ukupnom broju javljaju sličnom učestalošću kao u podatcima iz literature, i to rjeđe nego kod terapije klasičnim opioidima. Uočena je visoka stopa prekida terapije što je u prvom redu pripisano pojavi neželjenih učinaka.Tapentadol is a novel analgesic registered in slow-release form for medium-intensity and intense chronic pain, which targets both the nociceptive and neuropathic component of the pain signal. It utilizes two synergistic mechanisms: MOR – mu opioid receptor agonism and NRI – norepinephrine reuptake inhibition. The goal of this study was to compare the effectiveness of pain management and tolerability of tapentadol in our clinical experience with existing reports from abroad. The study included 92 patients from our pain management clinic who were prescribed slow-release tapentadol in doses of at least 50 mg twice daily. We tracked the effectiveness of pain management recorded using the visual analog scale, as well as the appearance and type of adverse effects. Further directions for dose adjustment or discontinuation of therapy were also recorded. In our experience, 66% of patients reported a satisfactory analgesic effect. The adverse effect rate was 43%; 54% of patients discontinued tapentadol therapy, i.e. 37% due to adverse effects, 15% because of inadequate pain management, and 2% because of a negative attitude of their primary care physician. Our study confi rmed the effi cacy of pain management with tapentadol. The total adverse effect rate was comparable to reports found in the literature and was lower than with classical opioid therapy. A relatively high therapy discontinuation rate was noted primarily due to adverse effects

Integration of a cobot workstation into existing production system

U ovome radu istražuje se integracija radne stanice s kobotom (kolaborativni robot) unutar već postojećeg proizvodnog sustava. Fokusira se na povećanje učinkovitosti i produktivnost proizvodnje uključujući tehničke, programerske i logističke izazove. Kroz analizu dostupnih tehnologija za suradnju čovjeka i robota te razmatranje zahtjeva proizvodnje, rad predlaže odgovarajuće strategije za usklađivanje rada robota s postojećim procesima.This paper investigates the integration of a workstation with a cobot (collaborative robot) within an existing production system. It focuses on enhancing efficiency and productivity in manufacturing, including technical, programming, and logistical challenges. Through an analysis of available technologies for human-robot collaboration and consideration of production requirements, the paper proposes appropriate strategies to align the robot's work with the existing processes

Immunohistochemical expression of connexin 43 and NEDD9 in gastric cancer

Najvažnije karakteristike karcinoma želuca su invazivnost i veliki metastatski potencijal. Sve je više dokaza da koneksini koji izgrađuju međustanična pukotinasta spojišta i NEDD9 protein igraju važnu ulogu u epitelno-mezenhimalnoj tranziciji i metastaziranju tumora različitih sijela. Cilj ovog istraživanja bio je odrediti i usporediti imunohistokemijsku izraženost koneksina 43 (Cx43) i NEDD9 u 108 uzoraka primarnog adenokarcinoma želuca (53 bez metastaza i 55 s metastazama u limfne čvorove) te korelirati njihovu izraženost s različitim kliničkim i patohistološkim parametrima. U našem istraživanju većina karcinoma nije izražavala Cx43 u epitelnoj komponenti, dok je u stromi pokazala veću izraženost (P<0,001). Izraženost Cx43 u stromi korelirala je s višim stadijem bolesti (P=0,03) i veličinom tumora (P=0,002). Većina karcinoma izražavala je NEDD9 istovremeno u epitelnoj i stromalnoj komponenti karcinoma. Izraženost NEDD9 bila je u značajnoj korelaciji s veličinom tumora (P=0,001), perineuralnom invazijom (P=0,049) te kliničkim stadijem bolesti (P<0,001). Neovisni loši prognostički čimbenici bili su jaka izraženost Cx43 u epitelu (HR 1.55, 95%CI 1.00 - 2.38, P=0.048), jaka izraženost NEDD9 u epitelu (HR 6.85, 95% CI 2.36 - 19.88, P<0.001) te viši T status (HR 1.54, 95% CI 1.07 - 2.20, P=0.019) i viši N status (HR 1.63, 95% CI 1.29 - 2.08, P<0.001). Potrebna su daljnja istraživanja na većem uzorku karcinoma želuca i njihovim metastatskim sijelima kako bi se potvrdio prognostički značaj Cx43 i NEDD9.Invasive growth and metastatic potential are considered to be the most important features of gastric cancer. Growing evidence suggests that connexins, who form intercellular gap junctions, and NEDD9 protein have an important role in epithelial-mesenchymal transition and metastasis of cancer of various primary sites. Aim of this study was to determine and correlate immunohystochemical expression of connexin 43 (Cx43) and NEDD9 in 108 samples of gastric adenocarcinoma (53 without and 55 with lymph node involvement) with various clinical and pathohystological parameters. According to our results, most cancers didn't express Cx43 in cancer cells but demonstrated expression in the stroma (P <0.001). Stromal Cx43 expression correlated both with higher disease stage (P=0.03) and size of the tumor (P=0.002). Most cancers expressed NEDD9 simultaneously in epithelial and stromal component. NEDD9 expression correlated with tumor size (P=.001), perineural invasion (P=.049) and clinical disease stage (P<.001). Increased epithelial Cx43 expression (HR 1.55, 95%CI 1.00 - 2.38, P=0.048), increased epithelial NEDD9 expression (HR 6.85, 95% CI 2.36 - 19.88, P<0.001), advanced T status (HR 1.54, 95% CI 1.07 - 2.20, P=0.019) and advanced N status (HR 1.63, 95% CI 1.29 - 2.08, P<0.001) were identified to be independent predictors of poor prognosis. These findings warrant further investigation in larger cohorts of patients with gastric cancer and various metastatic sites

Immunohistochemical expression of connexin 43 and NEDD9 in gastric cancer

Najvažnije karakteristike karcinoma želuca su invazivnost i veliki metastatski potencijal. Sve je više dokaza da koneksini koji izgrađuju međustanična pukotinasta spojišta i NEDD9 protein igraju važnu ulogu u epitelno-mezenhimalnoj tranziciji i metastaziranju tumora različitih sijela. Cilj ovog istraživanja bio je odrediti i usporediti imunohistokemijsku izraženost koneksina 43 (Cx43) i NEDD9 u 108 uzoraka primarnog adenokarcinoma želuca (53 bez metastaza i 55 s metastazama u limfne čvorove) te korelirati njihovu izraženost s različitim kliničkim i patohistološkim parametrima. U našem istraživanju većina karcinoma nije izražavala Cx43 u epitelnoj komponenti, dok je u stromi pokazala veću izraženost (P<0,001). Izraženost Cx43 u stromi korelirala je s višim stadijem bolesti (P=0,03) i veličinom tumora (P=0,002). Većina karcinoma izražavala je NEDD9 istovremeno u epitelnoj i stromalnoj komponenti karcinoma. Izraženost NEDD9 bila je u značajnoj korelaciji s veličinom tumora (P=0,001), perineuralnom invazijom (P=0,049) te kliničkim stadijem bolesti (P<0,001). Neovisni loši prognostički čimbenici bili su jaka izraženost Cx43 u epitelu (HR 1.55, 95%CI 1.00 - 2.38, P=0.048), jaka izraženost NEDD9 u epitelu (HR 6.85, 95% CI 2.36 - 19.88, P<0.001) te viši T status (HR 1.54, 95% CI 1.07 - 2.20, P=0.019) i viši N status (HR 1.63, 95% CI 1.29 - 2.08, P<0.001). Potrebna su daljnja istraživanja na većem uzorku karcinoma želuca i njihovim metastatskim sijelima kako bi se potvrdio prognostički značaj Cx43 i NEDD9.Invasive growth and metastatic potential are considered to be the most important features of gastric cancer. Growing evidence suggests that connexins, who form intercellular gap junctions, and NEDD9 protein have an important role in epithelial-mesenchymal transition and metastasis of cancer of various primary sites. Aim of this study was to determine and correlate immunohystochemical expression of connexin 43 (Cx43) and NEDD9 in 108 samples of gastric adenocarcinoma (53 without and 55 with lymph node involvement) with various clinical and pathohystological parameters. According to our results, most cancers didn't express Cx43 in cancer cells but demonstrated expression in the stroma (P <0.001). Stromal Cx43 expression correlated both with higher disease stage (P=0.03) and size of the tumor (P=0.002). Most cancers expressed NEDD9 simultaneously in epithelial and stromal component. NEDD9 expression correlated with tumor size (P=.001), perineural invasion (P=.049) and clinical disease stage (P<.001). Increased epithelial Cx43 expression (HR 1.55, 95%CI 1.00 - 2.38, P=0.048), increased epithelial NEDD9 expression (HR 6.85, 95% CI 2.36 - 19.88, P<0.001), advanced T status (HR 1.54, 95% CI 1.07 - 2.20, P=0.019) and advanced N status (HR 1.63, 95% CI 1.29 - 2.08, P<0.001) were identified to be independent predictors of poor prognosis. These findings warrant further investigation in larger cohorts of patients with gastric cancer and various metastatic sites