Scintigrafija z indij-111-DTPA-oktreotidom pri bolnikih s karcinoidom

Background. The aim of the study was the evaluation of clinical utility and comparison of 111 In-DTPA- octreotide receptor scintigraphy (SRS) with conventional imaging modalities (CIM) in the detection of carcinoid tumor. Patients and methods. Fourteen patients with pathohistologically proven diagnosis of carcinoid tumor and one patient with clinical suspicion of carcinoid tumor were investigated by SRS. SRS was performed for localization of primary tumor, recurrence or estimation of spread of the disease after CIM had been completed. Whole body scans and single photon emission computed tomography (SPECT) were acquired 6 and 24 h after the application of radiopharmaceutical. The intensity of nonspecific radiopharmaceutical uptake in the bowel was assessed semiquantitatively by a score using whole body scans. Results. The evaluation was done for patients and for tumor sites. The sensitivity, specificity, and positive and negative predictive values for patient evaluation were 89 %,100 %,100 % and 80 %, respectively for both CIM and SRS, whereas for tumor sites, these parameters were 69 % 100 %,100 % and 82 % for CIM, and 88%,100%,100% and 92 % for SRS. Intensity score of nonspecific 111In-octreotide bowel accumulation was 0.92 and 2.01 for 6 and 24h scans respectively (p < 0.01). Conclusion. 111In-octreotide scintigraphy should be included in the diagnostic algorithm for the patients with clinical suspicion of carcinoid and for the assessment of patients with proven carcinoid tumor.Izhodišča. Študijo smo izvedli z namenom, da ocenimo klinično uporabnost scintigrafije somatostatinskih receptorjev z indij-111-DTPA-oktreotidom (SRS) ter jo primerjamo s konvencionalnimi načini slikovne preiskave pri bolnikih s karcinoidom. Bolniki in metode. Štirinajst bolnikov s patohistološko potrjenimkarcinoidom in enega bolnika s klinično ugotovljenim karcinoidom smo preiskali s SRS. Preiskavo SRS smo izvedli po konvencionalni slikovni preiskavi in z njo poskušali lokalizirati primarni tumor in ugotoviti ponovitev ali razsoj bolezni. Scintigrafijo celotnega telesa in računalniško tomografijo z emisijo posameznih elektronov (SPECT) smo opravili 6 in 24 ur povbrizganem radiofarmacevtskem sredstvu. Intenzivnost nespecifičnega kopičenja radiofarmacevtskega sredstva v črevesu smo ocenili semikvantitativnos scintigrafijo celotnega telesa. Rezultati. Intenzivnost kopičenja smo ocenili glede na bolnike in glede na lokalizacijo tumorja. Pri bolnikih je občutljivost znašala 89%, specifičnost 100%, pozitivne in negativne napovedne vrednosti pa so bile 100% in 80% tako pri konvencionalnem načinu slikovne preiskave kot pri SRS. Pri ocenjevanju lokalizacije tumorja sobili zgornji parametri naslednji: slikanje celotnega telesa: občutljivost 69%, specifičnost 100%, pozitivne in negativne napovedne vrednosti 100% in 82%SRS: občutljivost 88%, specifičnost 100%, pozitivne in negativne napovedne vrednosti 100% in 92%. Intenzivnost nespecifičnega kopičenja 111-indija-oktreotida v črevesju je bila pri slikah, posnetih po 6. urah 0,92 in pri slikah, posnetih po 24 urah, 2,01 (p < 0,01). Zaključki. SRS bi morala biti vključena v diagnostični algoritem pri bolnikih, pri katerih je bil karcionoid ugotovljen le klinično in tudi pri bolnikih s potrjeno diagnozo karcionoida

Damage to Residual Trees in Thinning of Broadleaf Stand by Mechanised Harvesting System

This research was conducted to determine the cause, intensity and location of damage (stem, butt end, root collar, root) and the extent of damage to standing trees during felling and processing by an harvester and timber extraction by a forwarder (cut-to-length system). The research was conducted in the central part of the Republic of Croatia in the Management Unit (MU) “Bjelovarska Bilogora” during the thinning of Subcompartment 14b, area of 18.28 ha, in the stand of hornbeam (Carpino betuli—Quercetum roboris fagetosum Rauš 1975), age 70, and of Subcompartment 14c, area of 9.07 ha, in a stand of common beech (Carici pilosae—Fagetum Oberdorfer 1957) aged 79 years. The thinning intensity was 12.13% in Subcompartment 14b and 13.72% in Subcompartment 14c. Field measurements were carried out on sample plots—the first time in 2017 to determine the intensity and characteristics of the damage to standing trees with regard to the cause of the damage (harvester or forwarder), and the second time in 2018 to determine the overall intensity and features of the damage to standing trees after finishing harvesting operations. For all trees remaining in the stand after the harvesting operations, the following were determined: tree species, diameter at breast height (DBH), the position of the tree in the stand depending on the forest traffic infrastructure, and—if damaged—cause of damage, type of damage, the position of damage on the tree, and dimensions of damage. The intensity of the damage was expressed by the ratio of damaged and undamaged trees, with a detailed analysis of bark damage (squeezed-bark damage and peeled-bark injuries). The results of the research indicate the highest prevalence of peeled-bark injuries. In relation to the total number of standing trees, trees with peeled-bark injuries were more represented in Subcompartment 14c (39%) than in Subcompartment 14b (33%). In Subcompartment 14b, the harvester and the forwarder damaged an equal number of trees, while in Subcompartment 14c, the harvester damaged 59% of the damaged trees. In both subcompartments, an average of 83% of (peeled bark) injuries were up to 1.3 m above the ground. In both subcompartments, the most common (67%) were injuries up to 100 cm2 in size, for which many authors claim the tree can heal by itself. Given the increasing use of harvester-forwarder systems in deciduous stands and research results that indicate possible damage to standing trees, it is necessary to pay attention to all phases of planning and execution of timber harvesting operations, thus minimising negative effects

Antiproliferative activity of the Michael adducts of aroylacrylic acids and cyclic amines

Antiproliferative activity of twenty one Michael adducts of aroylacrylic acids and cyclic amines ( N -Me-piperazine, imidazole, 2-Me-imidazole, and indole) was tested toward five human tumor cell lines (HeLa, LS174, K562, FemX, MDA-MB-361) in vitro. Compounds exerted antiproliferative activity in the high to the single-digit micromolar concentrations, causing increase of the cell population fraction in S phase and apoptosis. N -Me-piperazine and imidazole derivatives of aroylacrylic acids substituted with bulky alkyl substituents (2,4-di- i -Pr-Ph-, 2,4,6-tri-Et-Ph-, or β -tetrahydronaphthyl-) showed the best potency, while indole adducts were proved as the inferior antiproliferative agents. Few compounds showed significant selectivity, tumor versus healthy cells, with selectivity index ∼60 for the most selective congener. An unbiased in silico distinction between more and less potent compounds was obtained from 3D QSAR models derived by alignment-independent GRIND-2 descriptors

( E )-4-Aryl-4-oxo-2-butenoic acid amides, chalcone–aroylacrylic acid chimeras: Design, antiproliferative activity and inhibition of tubulin polymerization

Antiproliferative activity of twenty-nine (E)-4-aryl-4-oxo-2-butenoic acid amides against three human tumor cell lines (HeLa, FemX, and K562) is reported. Compounds showed antiproliferative activity in one-digit micromolar to submicromolar concentrations. The most active derivatives toward all the cell lines tested bear alkyl substituents on the aroyl moiety of the molecules. Fourteen compounds showed tubulin assembly inhibition at concentrations <20 μM. The most potent inhibitor of tubulin assembly was unsubstituted compound 1, with IC(50) = 2.9 μM. Compound 23 had an oral LD(50) in vivo of 45 mg/kg in mice. Cell cycle analysis on K562 cells showed that compounds 1, 2 and 23 caused accumulation of cells in the G2/M phase, but inhibition of microtubule polymerization is not the principal mode of action of the compounds. Nevertheless, they may be useful leads for the design of a new class of antitubulin agents

Surgeons' perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Background: Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons' knowledge and perception of using AI-based tools in clinical decision-making processes. Methods: An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society's website and Twitter profile. Results: 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion: The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI

Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Background Shared decision-making (SDM) between clinicians and patients is one of the pillars of the modern patient-centric philosophy of care. This study aims to explore SDM in the discipline of trauma and emergency surgery, investigating its interpretation as well as the barriers and facilitators for its implementation among surgeons. Methods Grounding on the literature on the topics of the understanding, barriers, and facilitators of SDM in trauma and emergency surgery, a survey was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was sent to all 917 WSES members, advertised through the society’s website, and shared on the society’s Twitter profile. Results A total of 650 trauma and emergency surgeons from 71 countries in five continents participated in the initiative. Less than half of the surgeons understood SDM, and 30% still saw the value in exclusively engaging multidisciplinary provider teams without involving the patient. Several barriers to effectively partnering with the patient in the decision-making process were identified, such as the lack of time and the need to concentrate on making medical teams work smoothly. Discussion Our investigation underlines how only a minority of trauma and emergency surgeons understand SDM, and perhaps, the value of SDM is not fully accepted in trauma and emergency situations. The inclusion of SDM practices in clinical guidelines may represent the most feasible and advocated solutions