Kirurgija raka debelog crijeva s obzirom na razlike u prognozi između desnostranih i lijevostranih tumora

Human colon is derived from the embryological midgut and hindgut resulting in the developement of the right and left colon respectively. Right-sided and left-sided colon cancers are not differentiated only based on the embryological origin, anatomical position and clinical manifestations, but there are also numerous studies which prove that heterogeneous genotype features exsist in right and left-sided colon cancers,with distinguishing types of chromosome and microsatellite instability and gene expression patterns. Accumulating evidence suggests that gut microbiota, which differs in right and left colon, also plays an important role in the development of colon cancer. Although the systemic oncologic treatment has changed recently for disseminated left and right colon cancer, the current surgical treatment of both cancer locations for stages I-III follows the same principles of radical surgical oncology and should be executed in the same manner.Ljudsko debelo crijevo nastaje iz embriološkog srednjeg i stražnjeg crijeva, odakle se formira desno- i lijevostrano debelo crijevo. Desno- i lijevostrani zloćudni tumori debelog crijeva ne razlikuju se samo prema embrionalnom podrijetlu, anatomoskoj lokalizaciji i kliničkim manifestacijama, nego i prema heterogenim genotipskim značajkama, s različitim vrstama kromosomskih i mikrosatelitskih nestabilnosti te različitim uzrocima ekspresije gena, što je i dokazano brojnim studijama. Sve veći broj istraživanja sugerira da i crijevna mikrobiota, koja je različita u desnom i lijevom debelom crijevu, također igra značajnu ulogu u razvoju zloćudnih tumora debelog crijeva. Iako se sistemno onkološko liječenje za metastatski prošireni karcinom debelog crijeva nedavno promijenilo, ovisno da li je primarna lokalizacija desno- ili lijevostrani karcinom debelog crijeva, sadašnje kirurško liječenje za stadije I-III slijedi principe radikalnog onkološkog liječenja i trebalo bi biti isto za obje lokacije karcinoma debelog crijeva

Comparative Energy Consumption Analysis of the Hybrid Diesel Train and the Hybrid Fuel Cell Train

This paper compares train energy consumption of hybrid diesel-electric multiple unit (HDEMU) to hydrogen fuel-cell multiple unit (HFCMU). In the simulation, the parameters of the DMU HŽ7022 train were used for the train model created in Matlab/Simulink environment. Since the train is powered by three diesel engines in original design, it was hybridized by removing one engine and adding a battery and a supercapacitor. For comparison, a train model was made with fuel cells that have rated power of two existing diesel engines, and it was hybridized with a battery and a supercapacitor, as in the simulation with the hybridization of diesel engines. The results are presented by comparing energy consumption for both trains. In addition, voltages, electric current values and power loads of power sources are shown. As the sustainability of the system, the SOC (State of Charge) values of both the battery and the supercapacitor are presented

SIMULACIJA VUČNIH SVOJSTAVA LOKOMOTIVE HŽ 185 NA TERETNOM VLAKU U PROGRAMSKOME PAKETU MATLAB/SIMULINK

Cilj rada jest izraditi simulacijski model teretnog vlaka koji će olakšati proračun vučnih svojstava tijekom izvlačenja tereta. Željeznički prijevoznici trebaju izračunati ubrzanja i brzine vlakova kako bi isplanirali svoje vozne redove. Opisana su vučna svojstva lokomotive i simulacijski model vlaka. Svojstva i modeli aproksimirani su simulacijom u MATLAB/Simulinku. Bombardierova lokomotiva TRAXX AC2 korištena je u simulaciji samo za usporedbu. Istraživanje pokazuje rezultate ubrzanja i brzine vlaka te ovisnost između brzine, nagiba željezničke pruge i mase vučenog vlaka. Treba napomenuti da način kretanja lokomotive uvelike ovisi o odnosu ukupnog otpora vlaka i vučne sile lokomotive. Simulacijski model može se primijeniti na svako vučno željezničko vozilo i može olakšati proračun brzine vlaka, nagiba željezničke pruge i mase vučenog vlaka

Otpust iz bolnice nakon elektivne nekomplicirane laparoskopske kolecistektomije: može li se skratiti poslijeoperacijski boravak u bolnici?

The aim of the study was to reevaluate the safety and feasibility of discharge 24 h after elective uncomplicated laparoscopic cholecystectomy. Since the introduction of laparoscopic cholecystectomy in our hospital, the minimum postoperative stay was considered to be two days based on surgeons’ experience. The study included 337 operations performed by 21 surgeons during 2016 in the Sestre milosrdnice University Hospital Centre. Conversion to open technique and cases of acute cholecystitis were excluded, while 15 patients had insufficient postoperative data. The mean length of stay was 2.38 (range 1 to 6) postoperative days, median two postoperative days. Serious complications involving suspected drain bile leakage and postoperative hemorrhage occurred in two (0.59%) patients, both in the first 24 h following surgery. One patient required emergency laparotomy on the first postoperative day. Readmission rate was 1.2%. The postoperative minor complication rate was 42 of 337 (12.46%); these included wound infections, urinary tract infections, symptoms included in postcholecystectomy syndrome, etc. The onset of these complications was mostly after postoperative day 3. The data obtained suggest that discharge on the first postoperative day after elective uncomplicated laparoscopic cholecystectomy should be considered safe and can be practiced in our hospital.Cilj studije bio je reevaluirati sigurnost i izvodljivost otpusta bolesnika u prva 24 sata nakon elektivnih laparoskopskih kolecistektomija. Od uvođenja laparoskopske metode u našoj ustanovi, prema iskustvu kirurga smatralo se kako je minimalni poslijeoperacijski boravak 2 dana. Studija je obuhvatila 337 operacija koje je proveo 21 kirurg u 2016. godini u KBC “Sestre milosrdnice”. Isključeni su slučajevi konverzije u otvorene operacije kao i slučajevi akutnog kolecistitisa. Kod 15 bolesnika nije bilo dovoljno podataka o poslijeoperacijskom tijeku. Prosjek poslijeoperacijskog boravka bio je 2,38 (1 do 6) dana, medijan je bio 2 dana. Ozbiljne komplikacije u vidu suspektnog curenja žuči i poslijeoperacijskog krvarenja pojavile su se kod dvoje (0,59%) bolesnika; oba slučaja dogodila su se unutar 24 sata od operacije. Kod jednog bolesnika indicirana je hitna reoperacija prvog poslijeoperacijskog dana. Stopa ponovnog prijma u bolnicu bila je 1,2%. Manje poslijeoperacijske komplikacije dogodile su se kod 42 (12,46% operiranih) bolesnika; ove komplikacije uključivale su infekcije rane, uroinfekcije, simptome postkolecistektomijskog sindroma itd. Ove komplikacije događale su se uglavnom nakon 3. poslijeoperacijskog dana. Prikupljeni podaci ukazuju na to da se otpust prvog poslijeoperacijskog dana nakon elektivne nekomplicirane laparoskopske kolecistektomije može smatrati sigurnim i provoditi tu praksu u našoj ustanovi

Usporedba vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije anastomoze nakon kirurgije debeloga crijeva

In colorectal surgery, anastomotic leakage is a serious complication, leading to higher postoperative morbidity and mortality. The aim of this study was to evaluate the accuracy of serum and intraperitoneal C-reactive protein (CRP) in early diagnostics of anastomotic leakage on the first four postoperative days after colorectal surgery. From January to October 2019, fifty-nine patients with colorectal carcinoma were operated on, with formation of primary anastomosis. Anastomotic leakage was diagnosed in eight patients. Comparing the levels of serum and intraperitoneal CRP, our study showed that serum CRP was a better predictor of anastomotic leakage. Serum CRP levels lower than 121 mg/L on postoperative day 4 were predictive of good healing of anastomosis.U kirurgiji debelog crijeva dehiscencija crijevne anastomoze je ozbiljna komplikacija koja dovodi do povećanja pobola i smrtnosti nakon operativnog zahvata. Cilj ove studije bio je utvrditi točnost serumskog i intraperitonealnog C-reaktivnog proteina u ranoj dijagnostici dehiscencije crijevne anastomoze u prva četiri poslijeoperacijska dana nakon operacije debelog crijeva. Od siječnja do kolovoza 2019. godine operirano je 59 bolesnika s rakom debelog crijeva uz uspostavu primarne crijevne anastomoze. Kod osam bolesnika dijagnosticirana je dehiscencija crijevne anastomoze. Uspoređujući vrijednosti serumskog i intraperitonealnog C-reaktivnog proteina naša studija je pokazala da je serumski C-reaktivni protein bolji biljeg u predviđanju dehiscencije crijevne anastomoze. Vrijednosti serumskog C-reaktivnog proteina manje od 121 mg/L četvrtog poslijeoperacijskog dana pokazatelj su dobrog cijeljenja anastomoze

Diferencijacija Pseudomonas i Stenotrophomonas vrsta izolovanih iz riba primenom molekularnih metoda i MALDI-TOF metode

For the purpose of precise antibiotic susceptibility testing it is necessary to clearly distinguish Pseudomonas and Stenotrophomonas genera, considering acquired resistance of Pseudomonas species, as well as the intrinsic resistance of Stenotrophomonas species. This is why in the identification of the 51 isolates originated from fish, the following methods were used: standard PCR, 16S rRNA gene sequencing, and MALDI-TOF. The results of the standard PCR test, 16S rRNA gene sequencing and MALDI-TOF analysis confirmed 35 strains to belong to the Pseudomonas genus. Standard PCR test and VITEK MS device confirmed that 10 strains belong to Stenotrophomonas maltophilia species. Three strains were positive in both standard PCR tests for Pseudomonas and Stenotrpohomonas. 16S rRNA gene sequencing identified these 3 strains to be 99% Pseudomonas sp. and 99% Stenotrophomonas sp. VITEK MS first identified these three strains as 99% Stenotrophomonas, and in the repeated identification it identified them as 99% Pseudomonas. MALDI TOF/TOF 4800 Plus device identified these strains as Stenotrophomonas. Three strains were negative in both standard PCR tests for Pseudomonas and Stenotrpohomonas. 16S rRNA gene sequencing identified these 3 strains to be 99% Pseudomonas sp. and 99% Stenotrophomonas sp. VITEK MS first identified these three strains as 99% Stenotrophomonas, and in the repeated identification it identified them as 99% Pseudomonas. MALDI TOF/TOF 4800 Plus device identified these strains as Stenotrophomonas. Although modern test methods that have very high specificity (PCR, 16S rRNA gene Pseudomonas and Stenotrophomonas species for 6 isolates could not be reached using the above mentioned methods.S obzirom na značaj stečene rezistencije Pseudomonas vrsta, kao i na intrinzičnu rezistenciju Stenotrophomonas vrsta, a u cilju preciznog ispitivanja osetljivosti na antibiotike, neophodna je jasna diferencijacija pripadnika ovih rodova bakterija. U tom cilju su u identifikaciji 51 izolata poreklom od riba korišćene metode: standardni PCR, 16S rRNA sekvenciranje gena, MALDI-TOF. Rezultati standardnog PCR testa, 16S rRNA sekvenciranja gena i MALDI-TOF analize su za 35 sojeva potvrdili pripadnost rodu Pseudomonas. Standardnim PCR testom i primenom aparata VITEK MS utvrđeno je da 10 sojeva pripada vrsti Stenotrophomonas maltophilia. U 16S rRNA sekvenciranju gena 3 soja koja su bila pozitivna u oba standardna PCR testa identifikovana su kao 99% Pseudomonas sp. i 99% Stenotrophomonas sp. VITEK MS je ova tri soja u prvoj identifikaciji identifikovao kao 99% Stenotrophomonas, a u ponovljenoj identifikaciji kao 99% Pseudomonas. Ti sojevi su na aparatu MALDI TOF/TOF 4800 Plus bili identifikovani kao Stenotrophomonas. U 16S rRNA sekvenciranju gena tri soja koja su bila negativna u oba standardna PCR testa su identifikovana kao 99% Pseudomonas sp. i 99% Stenotrophomonas sp. Aparat VITEK MS je ova tri soja identifikovao u jednoj identifikaciji kao 99% Stenotrophomonas, a u drugoj identifikaciji 99% kao Pseudomonas. Ti sojevi su na aparatu MALDI TOF/ TOF 4800 Plus bili identifikovani kao Stenotrophomonas. Iako su u ovom istraživanju korišćene savremene metode ispitivanja koje imaju vrlo visoku specifičnost (PCR, 16s rRNK sequencing, MALDI TOF) precizna diferencijacija Pseudomonas i Stenotrophomonas vrsta nije mogla biti postignuta

Osjetljivost i specifičnost Fenyö-Lindbergova i Teicherova sustava bodovanja u dijagnostici akutne upale crvuljka u žena

The aim of the study was to assess diagnostic accuracy (sensitivity and specificity) of Fenyö-Lindberg and Teicher scores for distinguishing patients that need immediate surgical treatment from the others, in a female population from an urban setting. The study prospectively included 130 female patients admitted to the emergency department with abdominal pain indicating acute appendicitis. The scores and parameters of validity were calculated and compared to definitive diagnosis. For Fenyö-Lindberg score of -17 or less, 84.5% sensitivity, 55.6% specificity, 87.9% positive predictive value (PPV) and 48.4% negative predictive value (NPV) were recorded. For cut-off value greater or equal to -2, there was 59.2% sensitivity, 77.8% specificity, 91% PPV and 33.3% NPV. The Receiver Operating Characteristic (ROC) curve analysis of Fenyö-Lindberg score showed that the best single cut-off value for discriminating acute appendicitis in the study population was -15. For Teicher score, values greater than -3 yielded 89.3% sensitivity and 22.2% specificity, 81.4% PPV and 35.3% NPV. In conclusion, Fenyö-Lindberg score could be used as an additional tool to exclude appendicitis and avoid unnecessary appendectomies. Teicher score may help in recognizing patients with appendicitis. None of the two scores can indicate or decline appendectomy in all cases. Scoring systems may be useful for pointing to important clinical signs and symptoms in specific subpopulations.Cilj istraživanja bio je analizirati dijagnostičku točnost (osjetljivost i specifičnost) Fenyö-Lindbergove i Teicherove bodovne ljestvice u postavljanju dijagnoze akutne upale crvuljka u ženskoj populaciji u urbanom okruženju. U studiju je prospektivno uključeno 130 bolesnica primljenih u hitnoj službi s bolovima u trbuhu i sumnjom na akutni apendicitis. Rezultati i parametri valjanosti izračunati su i uspoređeni s obzirom na konačnu dijagnozu. Za vrijednosti Fenyö-Lindbergova zbira -17 ili manje nađena je osjetljivost od 84,5%, specifičnost od 55,6%, pozitivna prediktivna vrijednost (PPV) od 87,9% i negativna prediktivna vrijednost (NPV) od 48,4%. Za vrijednosti istoga zbira većeg ili jednakog -2 utvrđena je osjetljivost od 59,2%, specifičnost od 77,8%, PPV od 91% i NPV od 33,3%. Usporedba krivulja ROC za Fenyö-Lindbergov zbir pokazala je da je najbolja pojedinačna granična vrijednost u proučavanoj populaciji u svrhu diskriminacije akutne upale crvuljka -15. Za Teicherov zbir vrijednosti veće od -3 pokazale su osjetljivost od 89,3%, specifičnost od 22,2%, PPV od 81,4% i NPV od 35,3%. U zaključku, Fenyö-Lindbergov zbir se može koristiti kao dodatni alat u isključivanju upale crvuljka i izbjegavanju nepotrebnih operacija. Teicherov zbir može pomoći u prepoznavanju bolesnica s akutnom upalom crvuljka. Niti jedan zbir se ne može koristiti kao jedino sredstvo za indiciranje ili nepoduzimanje operacije akutne upale crvuljka u svim slučajevima. Bodovni sustav može biti koristan u isticanju važnih kliničkih znakova i simptoma u pojedinim skupinama bolesnika

Kronična pseudo-opstrukcija sigmoidnog kolona - prikaz slučaja

Chronic intestinal pseudo-obstruction (CIPO) is a rare syndrome characterized by signs of intestinal obstruction lasting for 6 months or more, in the absence of a definitive cause of obstruction. We report a case of CIPO in a 49-year-old female patient with a 6-month history of ongoing irregular bowel movements, manifested as constipation and diarrhea accompanied by abdominal pain and bloated feeling. Contrast-enhanced abdominal computed tomography and magnetic resonance enterography revealed focal thickening of a segment of the lienal flexure and intermittent areas of wider and narrower caliber along the sigmoid colon. No signs of a definitive cause of obstruction were found, but evidence for dolichosigma was revealed, which was later confirmed with colonoscopy. Due to persisting symptoms, the patient agreed to elective resection of the sigmoid colon. Following the procedure, symptoms regressed with a significant improvement in the quality of life. The patient has been regularly monitored in an outpatient setting and reports absence of the symptoms since the procedure. Pathophysiology of the resected section revealed more prominent lymphatic tissue, follicular arrangement, and reactively altered germinal centers, which can suggest CIPO.Kronična intestinalna pseudo-opstrukcija (KIPO) je vrlo rijedak sindrom obilježen znakovima intestinalne opstrukcije koji traju 6 mjeseci ili duže, a u odsutnosti definitivnog jasnog uzroka. U našem prikazu slučaja radi se o 49-godišnjoj bolesnici koja je više od 6 mjeseci imala stalne nepravilne stolice koje su se manifestirale izmjenom proljeva i konstipacije, a bile su praćene nadutošću i bolovima u trbuhu. Učinjenom obradom koja je uključivala kontrastnu kompjutoriziranu tomografiju i magnetsku enterografiju kod bolesnice je utvrđeno žarišno zadebljanje segmenta lienalne fleksure i isprekidana područja šireg i užeg kalibra duž sigmoidnog kolona. Nije nađen jasni uzrok opstrukcije, ali je otkrivena anatomska varijanta dolihosigme koja je kasnije potvrđena i kolonoskopijom. Zbog vrlo izraženih dugotrajnih simptoma koji nisu regredirali na konzervativne metode liječenja bolesnica je pristala na preporučenu elektivnu resekciju sigmoidnog kolona. Nakon zahvata simptomi su se povukli uz značajno poboljšanje kvalitete života, a bolesnica se redovito prati u gastroenterološkoj ambulanti. Patohistološki nalaz reseciranog dijela sigmoidnog kolona otkrio je istaknutije limfno tkivo, folikularni raspored i reaktivno promijenjene germinativne centre, što ide u prilog dijagnoze KIPO-a

Pursuit for est microsatellites in a tetraploid model from de novo transcriptome sequencing

Available scientific literature reports very few microsatellite markers derived from tetraploid genomes using de novo transcriptome sequencing, mostly because their gain usually represents a major computational challenge due to complicated combinatorics during assembly of sequence reads. Here we present a novel approach for mining polymorphic microsatellite loci from transcriptome data in a tetraploid species with no reference genome available. Pairs of 114 bp long de novo sequenced transcriptome reads of Centaurium erythraea were merged into short contigs of 170-200 bp each. High accuracy assembly of the pairs of reads was accomplished by a minimum of 14 bp overlap. Sequential bioinformatics operations involved fully free and open-source software and were performed using an average personal computer. Out of the 13 150 candidate contigs harboring SSR motifs obtained in a final output, we randomly chose 16 putative markers for which we designed primers. We tested the effectiveness of the established bioinformatics approach by amplifying them in eight different taxa within the genus Centaurium having various ploidy levels (diploids, tetraploids and hexaploids). Nine markers displayed polymorphism and/or transferability among studied taxa. They provided 54 alleles in total, ranging from 2 to 14 alleles per locus. The highest number of alleles was observed in C. erythraea, C. littorale and a hybridogenic taxon C. pannonicum. The developed markers are qualified to be used in genetic population studies on declining natural populations of Centaurium species, thus providing valuable information to evolutionary and conservation biologists. The developed cost-effective methodology provides abundant de novo assembled short contigs and holds great promise to mine numerous additional EST-SSR-containing markers for possible use in genetics population studies of tetraploid taxa within the genus Centauriu