Educational polygon „Skills lab”

Simulatori i simulacija postali su sastavni i nezamjenjiv dio medicinske edukacije i istraživanja. U većini medicinskih učilišta Zapadne Europe i SAD-a postoje specijalizirane učionice za učenje određenih medicinskih vještina pomoću simulatora i simulacije, koje se ne mogu u potpunosti savladati tijekom boravka na odgovarajućim odjelima, odnosno za vrijeme kliničke nastave. Jedan od zasigurno najvažnijih segmenta u edukaciji studenata medicine i drugih zdravstvenih grana je kardiopulmonalna reanimacija. Zbog specifične važnosti i nemogućnosti učenja ovih postupaka na bolesnicima, neophodno je omogućiti studentima i polaznicima tečajeva oživljavanja uvježbavanje navedenih postupaka na sofisticiranim modelima (tzv. „lutke ili modeli”) u prostoru ili učionici isključivo namijenjenima toj namjeni. Takav edukacijski poligon za uvježbavanje postupaka kardiopulmonalnog oživljavanja (CPR) ustrojen je 2001. godine pod imenom „Kabinet vještina„. Danas u svijetu postoji sve veća potreba za ovakvim centrima edukacije koji uključuju prilagodbu i potrebama „medicinskih laika„, tj. nemedicinskog osoblja, kako bi se educirao širok krug koji će biti u mogućnosti pružiti prvu i potrebnu pomoć na samom mjestu događaja.Simulators and simulations have become an integral and indispensable part of medical education and research. Specialized educational polygons for training of certain medical skills using simulators and simulations, which cannot be fully mastered during stay at clinical departments or during clinical teaching, exist in most medical schools and university hospitals in Western Europe and USA. One of the most important segments in the education of medical students and other health care professionals is cardiopulmonary resuscitation (CPR). Because of specific importance and inability to learn CPR procedures on patients, it is necessary to enable students and course trainees education on sophisticated models (called „dolls or models”) in classroom exclusively created for this purpose. Such educational polygon, for training of cardiopulmonary resuscitation procedures, was established in 2001. In Rijeka and was named „Skills lab”. Today in the world there is an increasing need for simulation training centers that are maximally equipped and adapted for education of non-medical staff („medical-laics”) with a goal to educate people to be able to provide a first and necessary assistance in CPR at the scene of event

Effect of Preoperative Feeding on Gallbladder Size and Peristaltic of the Small Bowel Following Spinal Anesthesia for the Hip Surgery

The main aim of our study was to determine the influence of preoperative feeding with clear carbohydrate rich drink (PreOp 200 mL) on peristaltic of the small intestine and gallbladder size early after the orthopedic surgery in spinal anesthesia. Clinical study includes 120 patients with fracture of femoral neck or pertrochanteric fracture. All patients were randomized in two groups, sixty patients, PreOp group, consumed carbohydrate drink two hours before surgery. Other 60 patients, Control group, represent patients who fasted overnight. After surgery, patients were submitted to ultrasound examination for measurement of the small bowel motions and gallbladder size. Four quadrants (up-right, up-left, down-right and down-left) of the abdomen were examined, each one in duration of 30 seconds. The results show that the length of the gallbladder is considerably different across the two groups; 5.866 cm in the PreOp group and 7.178 cm in the Control group (p=0.00). The width, however, differed somewhat less (PreOp group 2.437 cm, Control group 2.735 cm) and the statistically significant difference can be observed at 7% level (p=0.073). We found no statistically significant relationship between PreOp and Control group variables of each abdominal quadrant (lowest p>0.087). Accordingly, the means of the variables were found statistically significantly different between groups (p>0.05). In conclusion our study showed that the preoperative feeding of the patients undergoing orthopedic surgery in spinal anesthesia shortens the length but not the width of the gallbladder when compared with overnight fasting patients and also clearly enhance motility of the small bowel in all four quadrant of the abdomen

Epidemiology of Prostate Cancer in the Mediterranean Population of Croatia – A Thirty-Three Years Retrospective Study

Prostate cancer is a major public health problem of the male population in all the developed countries1. This non-skin cancer is the foremost one facing man today. Prostate cancer has become the second leading cause of cancer death2. In this study we investigated changes in the prostate carcinoma incidence and manifestation during a thirty-three years period. The study included 1,226 cases of prostate cancer diagnosed from 1972 to 2005 in the Primorsko-Goranska County, Croatia. The age-adjusted incidence of prostate cancer increased from 1.69 per 100,000 men annually in 1972 to 137.58 per 100,000 men annually in 2005, which is an 81.4-fold increase. The percentage of patients with bone metastases on the first medical examination decreased from 1972 (75%) to 2005 (15%). The most of the patients with bone metastases at the first medical examination were between 30 and 50 years old. Early detection measures, such as prostate specific antigen testing and transrectal ultrasound guided prostate biopsy combined with the raised public awareness of the disease, most probably resulted in an increase of incidence

Influence of Insolation on Osteoporosis Progression in Androgen Deprived Nonmetastatic Prostate Cancer Patients

Prostate cancer is a major public health problem in all the developed countries. Increasing numbers of men with nonmetastatic prostate cancer are receiving long-term androgen deprivation therapy (ADT). ADT is associated the loss of bone mineral density and a increased risk of bone fractures. The standard recommendations for male bone health include above all optimizing calcium and vitamin D intake, and exercise. Vitamin D3 is an essential factor in the maintenance of bone health and calcium homeostasis. The main supply of vitamin D3 is obtained through photosynthesis in the skin. The aim of this study was to investigate the influence of insolation on osteoporosis progression in androgen deprived nonmetastatic prostate cancer patients. We divided our androgen deprived prostate cancer patients in 2 groups. The first group (A) consists of 224 patients with insolation rate less then 3h per week. The second group (B) consists of 174 patients with insolation rate greater then 10h per week. With a questionnaire we determined, that patients from both groups were 70 to 80 years old, body mass index was 25–30 kg/m2, androgen deprivation was 4–6 years and received no vitamin D supplements. In the group A 21.86% suffered pathologic fractures do to osteoporosis. In the group B 10.92% patients suffered from osteoporotic bone fractures. The risk for pathological bone fractures is significantly greater in the group A. In conclusion higher insolation in androgen deprived nonmetastatic prostate cancer patients significantly decreases the osteoporosis progression and the risk of pathologic bone fractures

THE ROLE OF Nrf2 TRANSCRIPTION FACTOR IN PREVENTION OF SPINAL CORD ISCHEMIA REPERFUSION INJURY IN RAT

CILJ ISTRAŽIVANJA. Ispitati da li tijekom ishemijsko-reperfuzijske (IR) ozljede kralježnične moždine dolazi do ekspresije i aktivacije Nrf2 transkripcijskog faktora, u kojim stanicama se eksprimira te da li aktivnost Nrf2 signalnog puta ovisi o dužini trajanja reperfuzije. Ispitati da li mangan porfirin (MnP) djeluje neuroprotektivno putem Nrf2 i NFkB transkripcijskih faktora. MATERIJAL I METODE. Korišten je eksperimentalni model IR ozljede kralježnične moždine klemanjem abdominalne aorte u trajanju 45 minuta u štakora. MnP je davan prije operativnog zahvata i svakih 12 sati nakon zahvata. Životinje su žrtvovane nakon 1, 6, 48 ili 168 sati nakon reperfuzije. Neurološki status je ocjenjivan svih 7 dana. Spektrofotometrijom su mjerenje razine oštećenja lipida i proteina te razina antioksidativnih enzima. Western blotom mjerili smo razine ekspresije SOD1, SOD2, GSH-Px, Nrf2, HO-1, NF-kB. Metodom PCR-a analizirana je ekspresija mRNA HO-1, Gclc i CAT. Imunofluorescentnom metodom prikazana je lokalizacija i intenzitet ekspresije Nrf2, NF-kB, NeuN, ChaT, GFAP, Iba1 i PLP1. REZULTATI. Neurološki status je bio značajno bolji nakon 48 i 168 sati davanjem MnP. MnP je značajno snizio razinu produkata lipidne peroksidacije i sadržaja karboniliranih proteina nakon 48 i 168 sati od reperfuzije. Također značajno je povisio aktivnost SOD enzima u prvih 6 sati dok je aktivnost GPx enzima bila povećana i do 48 sati. IR ozljeda značajno povećava ekspresiju Nrf2 proteina u nuklearnoj frakciji u prvih 6 sati dok MnP ne mijenja njegovu ekspresiju. Ciljni protein Nrf2 puta, HO-1 je značajno povećan i nakon 48 sati. Povećan je nivo ekspresije mRNA HO-1, Gclc i CAT molekula. MnP značajno smanjuje ekspresiju NFkB proteina u nuklearnoj frakciji u prvih 6 sati. Histomorfološka analiza je pokazala ekspresiju Nrf2 proteina u CHaT pozitivnim neuronima prednjeg roga sive tvari. Prosječni intenzitet Nrf2 ekspresije raste s dužinom trajanja reperfuzije i direktno je ovisan o IR ozljedi. MnP snižava broj astrocita posebno u prednjem funikulu bijele tvari 6 i 48 sati od reperfuzije. Analizom NF-kB ekspresije i aktivacije pokazali smo da se NFkB eksprimira u astrocitima u ovisnosti o IR ozljedi kao i o vremenu trajanja reperfuzije. MnP je značajno snizio broj stanica s NFkB pozitivnom jezgrom. ZAKLJUČAK. IR ozljeda potiče ekspresiju i aktivaciju Nrf2 proteina ovisno o trajanju reperfuzije. MnP djeluje protektivno smanjujući ekspresiju NF-kB proteina u nuklearnoj frakciji.AIM. To investigate whether Nrf2 expression and activation occurs during ischemia – reperfusion injury of spinal cord, in which cells the Nrf2 expression is observed and does the Nrf2 signalling pathway activity depends on the time of reperfusion. To investigate whether manganese porphyrin (MnP) presents neuroprotective effects through transcription factors Nrf2 and NF-kB. MATERIAL AND METHODS. The study was conducted on experimental model of spinal cord IR injury by clamping abdominal aorta during 45 min in rats. MnP was administered just before the surgery and every 12 h post surgery. The animals were sacrificed after 1, 6, 48 and 168 h of reperfusion. Neurologic score was evaluated during 7 days. Spectrophotometric measurement of lipid peroxidation products, protein carbonyl content and levels of antioxidant enzyme activity were performed. Using Western blot levels of expression of SOD1, SOD2, GSH-Px, Nrf2, HO-1 and NF-kB were measured. The expressions of mRNA HO-1, Gclc and CAT were analyzed by PCR method. Immunofluorescent analysis was used to show localization and intensity of expression of Nrf2, NF-kB, NeuN, ChaT, GFAP, Iba1 and PLP1. RESULTS. The neurologic score was significantly better during 48 and 168 h of reperfusion in group with MnP treatment. MnP significantly decreased the levels of lipid peroxidation products and the protein carbonyl content during 48 and 168 h of reperfusion. Also MnP significantly increased the activity of SOD enzymes during 6 h of reperfusion, while the activity of GPx enzyme was increased even during 48 h of reperfusion. IR injury significantly increased expression of Nrf2 protein in nuclear fraction during 6 h of reperfusion while MnP does not effect Nrf2 expression. Nrf2 signalling pathway target protein, HO-1, was significantly increased even during 48 h of reperfusion. Also the level of mRNA HO-1, Gclc and CAT expression was increased. MnP significantly decreased expression of NF-kB protein in nuclear fraction during 6 h of reperfusion. Histological analysis revealed Nrf2 expression in CHaT positive neurons localized in anterior horn of grey matter. Mean intensity of Nrf2 expression increased with the longer reperfusion time and was directly dependant on IR injury. MnP decreased astrocyte number in anterior funiculus of white matter during 6 and 48 h of reperfusion. By analysing NF-kB expression and activation we showed that NF-kB was expressed in astrocytes depending on IR injury as well as on time of reperfusion. MnP significantly decreased number of cells with nuclear positive NF-kB expression. CONCLUSION. IR injury induces expression and activation of Nrf2 protein depending on time of reperfusion. MnP acts protective by decreasing expression of NF-kB protein in nuclear fraction

THE ROLE OF Nrf2 TRANSCRIPTION FACTOR IN PREVENTION OF SPINAL CORD ISCHEMIA REPERFUSION INJURY IN RAT

CILJ ISTRAŽIVANJA. Ispitati da li tijekom ishemijsko-reperfuzijske (IR) ozljede kralježnične moždine dolazi do ekspresije i aktivacije Nrf2 transkripcijskog faktora, u kojim stanicama se eksprimira te da li aktivnost Nrf2 signalnog puta ovisi o dužini trajanja reperfuzije. Ispitati da li mangan porfirin (MnP) djeluje neuroprotektivno putem Nrf2 i NFkB transkripcijskih faktora. MATERIJAL I METODE. Korišten je eksperimentalni model IR ozljede kralježnične moždine klemanjem abdominalne aorte u trajanju 45 minuta u štakora. MnP je davan prije operativnog zahvata i svakih 12 sati nakon zahvata. Životinje su žrtvovane nakon 1, 6, 48 ili 168 sati nakon reperfuzije. Neurološki status je ocjenjivan svih 7 dana. Spektrofotometrijom su mjerenje razine oštećenja lipida i proteina te razina antioksidativnih enzima. Western blotom mjerili smo razine ekspresije SOD1, SOD2, GSH-Px, Nrf2, HO-1, NF-kB. Metodom PCR-a analizirana je ekspresija mRNA HO-1, Gclc i CAT. Imunofluorescentnom metodom prikazana je lokalizacija i intenzitet ekspresije Nrf2, NF-kB, NeuN, ChaT, GFAP, Iba1 i PLP1. REZULTATI. Neurološki status je bio značajno bolji nakon 48 i 168 sati davanjem MnP. MnP je značajno snizio razinu produkata lipidne peroksidacije i sadržaja karboniliranih proteina nakon 48 i 168 sati od reperfuzije. Također značajno je povisio aktivnost SOD enzima u prvih 6 sati dok je aktivnost GPx enzima bila povećana i do 48 sati. IR ozljeda značajno povećava ekspresiju Nrf2 proteina u nuklearnoj frakciji u prvih 6 sati dok MnP ne mijenja njegovu ekspresiju. Ciljni protein Nrf2 puta, HO-1 je značajno povećan i nakon 48 sati. Povećan je nivo ekspresije mRNA HO-1, Gclc i CAT molekula. MnP značajno smanjuje ekspresiju NFkB proteina u nuklearnoj frakciji u prvih 6 sati. Histomorfološka analiza je pokazala ekspresiju Nrf2 proteina u CHaT pozitivnim neuronima prednjeg roga sive tvari. Prosječni intenzitet Nrf2 ekspresije raste s dužinom trajanja reperfuzije i direktno je ovisan o IR ozljedi. MnP snižava broj astrocita posebno u prednjem funikulu bijele tvari 6 i 48 sati od reperfuzije. Analizom NF-kB ekspresije i aktivacije pokazali smo da se NFkB eksprimira u astrocitima u ovisnosti o IR ozljedi kao i o vremenu trajanja reperfuzije. MnP je značajno snizio broj stanica s NFkB pozitivnom jezgrom. ZAKLJUČAK. IR ozljeda potiče ekspresiju i aktivaciju Nrf2 proteina ovisno o trajanju reperfuzije. MnP djeluje protektivno smanjujući ekspresiju NF-kB proteina u nuklearnoj frakciji.AIM. To investigate whether Nrf2 expression and activation occurs during ischemia – reperfusion injury of spinal cord, in which cells the Nrf2 expression is observed and does the Nrf2 signalling pathway activity depends on the time of reperfusion. To investigate whether manganese porphyrin (MnP) presents neuroprotective effects through transcription factors Nrf2 and NF-kB. MATERIAL AND METHODS. The study was conducted on experimental model of spinal cord IR injury by clamping abdominal aorta during 45 min in rats. MnP was administered just before the surgery and every 12 h post surgery. The animals were sacrificed after 1, 6, 48 and 168 h of reperfusion. Neurologic score was evaluated during 7 days. Spectrophotometric measurement of lipid peroxidation products, protein carbonyl content and levels of antioxidant enzyme activity were performed. Using Western blot levels of expression of SOD1, SOD2, GSH-Px, Nrf2, HO-1 and NF-kB were measured. The expressions of mRNA HO-1, Gclc and CAT were analyzed by PCR method. Immunofluorescent analysis was used to show localization and intensity of expression of Nrf2, NF-kB, NeuN, ChaT, GFAP, Iba1 and PLP1. RESULTS. The neurologic score was significantly better during 48 and 168 h of reperfusion in group with MnP treatment. MnP significantly decreased the levels of lipid peroxidation products and the protein carbonyl content during 48 and 168 h of reperfusion. Also MnP significantly increased the activity of SOD enzymes during 6 h of reperfusion, while the activity of GPx enzyme was increased even during 48 h of reperfusion. IR injury significantly increased expression of Nrf2 protein in nuclear fraction during 6 h of reperfusion while MnP does not effect Nrf2 expression. Nrf2 signalling pathway target protein, HO-1, was significantly increased even during 48 h of reperfusion. Also the level of mRNA HO-1, Gclc and CAT expression was increased. MnP significantly decreased expression of NF-kB protein in nuclear fraction during 6 h of reperfusion. Histological analysis revealed Nrf2 expression in CHaT positive neurons localized in anterior horn of grey matter. Mean intensity of Nrf2 expression increased with the longer reperfusion time and was directly dependant on IR injury. MnP decreased astrocyte number in anterior funiculus of white matter during 6 and 48 h of reperfusion. By analysing NF-kB expression and activation we showed that NF-kB was expressed in astrocytes depending on IR injury as well as on time of reperfusion. MnP significantly decreased number of cells with nuclear positive NF-kB expression. CONCLUSION. IR injury induces expression and activation of Nrf2 protein depending on time of reperfusion. MnP acts protective by decreasing expression of NF-kB protein in nuclear fraction

Nuclear factor erythroid 2-related factor 2 and choline acetyltransferase co-expression in rat spinal cord neurons after ischemia-reperfusion injury

Spinal cord ischemia-reperfusion injury (IRI) results in overproduction of reactive oxygen species leading to tissue oxidative stress which impacts the neuronal network in the spinal cord as well as glial cells. We investigated the expression of Nuclear factor erythroid 2-related factor 2 (Nrf2) in neurons and glial cells after occlusion of the abdominal aorta followed by IRI as well as the time-dependent expression of Nrf2 in the same cells. The experimental method of transient aortic occlusion was carried out on rats by cross-clamping of the abdominal aorta for 45 minutes. The animals used for this study were sacrificed 1 h, 6 h, and 48 h after reperfusion to determine time-related changes of Nrf2 expression, as well as changes of astrocyte activity in the spinal cord. Immunofluorescence results showed an increase in the staining intensity of Nrf2 expression in the neurons following ischemia with highest intensity 48 h post-reperfusion and an increase in a number of reactive astrocytes. Western blot analysis showed that Nrf2 protein expression increased in a cytoplasmic and nuclear fraction as early as 1 h after reperfusion and remained active 48 h after, resulting in increased expression of the main Nrf2 target gene HO-1. In conclusion, substances that enhance expression of Nrf2 may have the potential to prevent cellular damage to the spinal cord caused by IRI

Nuclear factor erythroid 2-related factor 2 and choline acetyltransferase co-expression in rat spinal cord neurons after ischemia-reperfusion injury

Spinal cord ischemia-reperfusion injury (IRI) results in overproduction of reactive oxygen species leading to tissue oxidative stress which impacts the neuronal network in the spinal cord as well as glial cells. We investigated the expression of Nuclear factor erythroid 2-related factor 2 (Nrf2) in neurons and glial cells after occlusion of the abdominal aorta followed by IRI as well as the time-dependent expression of Nrf2 in the same cells. The experimental method of transient aortic occlusion was carried out on rats by cross-clamping of the abdominal aorta for 45 minutes. The animals used for this study were sacrificed 1 h, 6 h, and 48 h after reperfusion to determine time-related changes of Nrf2 expression, as well as changes of astrocyte activity in the spinal cord. Immunofluorescence results showed an increase in the staining intensity of Nrf2 expression in the neurons following ischemia with highest intensity 48 h post-reperfusion and an increase in a number of reactive astrocytes. Western blot analysis showed that Nrf2 protein expression increased in a cytoplasmic and nuclear fraction as early as 1 h after reperfusion and remained active 48 h after, resulting in increased expression of the main Nrf2 target gene HO-1. In conclusion, substances that enhance expression of Nrf2 may have the potential to prevent cellular damage to the spinal cord caused by IRI

Cystocoele and Sensory Urgency – Our Experience

Sensory urgency appears mostly in patients with a specific or non specific cystitis, interstitial cystitis, intravesical foreign bodies, bladder carcinoma and carcinoma of the prostate, infravesical obstruction, estrogen deficiency and in some neurologic and psychiatric diseases. The aim of this study was to analyze and explain the relation between vaginal vault prolapse and sensory urgency. Clinical courses of 64 patients with cystocoele, which between 1999 and January 2006 have been treated on the Clinic of urology, University Hospital, Rijeka, Croatia, were analyzed retrospectively. On physical examination, using the International Society for Continence staging system we found that 4 (0.6%) had grade II, 29 (45.3%) had grade III, and 31 (48.4%) had grade IV cystocoele. Forty-seven (73.4%) women had urgency, for minimally 6 months to many years before the vaginal vault prolapse manifestation. In all but 3 (4.6%) an extended anterior vaginal colporaphy has been done, with only 1 (1.6%) recurrence of cystocele. It seems that sensory urgency may in fact be a predictor of cystocele