Skin cancer and its treatmentKristjan Orthaber
, Matevž Pristovnik
, Kristijan Skok
, Barbara Perić
, Uroš Maver
, 2017, pregledni znanstveni članek
Opis: The life expectancy in the Western world is increasing for a long time, which is the courtesy of a higher life standard, a more thorough hygiene, and, of course, the progress of modern medicine. Nevertheless, one of the illnesses that still proves to be a great challenge regardless of the recent advancements in medicine is cancer. Skin cancer is, according to theWorld Health Organization, the most common malignancy for the white population.The beginning of the paper offers a brief overview of the latest available information concerning epidemiology, aetiology, diagnostics, and treatment options for skin cancer, whereas the rest of the article deals with modern approaches to skin cancer treatment, highlighting recent development of nanotechnology based treatment approaches. Among these, we focus especially on the newest nanotechnological approaches combined with chemotherapy, a field which specialises in target specificity, drug release control, and real time monitoring with the goal being to diminish unwanted side effects and their severity, achieving a cheaper treatment and a generally more efficient chemotherapy. The field of nanotechnology is a rapidly developing one, judging by already approved clinical studies or by new theranostic agents that combine both the therapeutic and diagnostic modalities.
Ključne besede: skin cancer, treatment, nanotechnology, nanotechnological methods
Objavljeno: 14.06.2017; Ogledov: 126; Prenosov: 11
Celotno besedilo (1,56 MB)
Age-related differences in percentages of regulatory and effector T lymphocytes and their subsets in healthy individuals and characteristic STAT1/STAT5 signalling response in helper T lymphocytesMarija Holcar
, Aleš Goropevšek
, Alojz Ihan
, Tadej Avčin
, 2015, izvirni znanstveni članek
Opis: The dynamic process of the development of the immune system can in itself result in age-related immune malfunctions. In this study, we analysed lymphocyte subsets in the peripheral blood of 60 healthy donors, divided into groups of children, adolescents, and adults, focusing on effector (Teff) and regulatory (Treg) T lymphocytes and STAT1/STAT5 signalling response in helper T lymphocytes (Th) in adults, using flow cytometry. Our results demonstrate a decrease in the percentage of total Tregs and an increase in the percentage of total Teffs with age and a consequential immense increase in the Teff/Treg ratio. The increase of Teffs was most apparent in Th1, Th1Th17, and Th17CD161- subsets. Significant Th lymphocyte STAT1 expression differences were observed between children and adolescents, which were associated with the decrease in activated Tregs. Higher expression of STAT1 was found in FoxP3hi than in FoxP3low Th lymphocytes, while significant IL-2 induced STAT5 phosphorylation differences were found among the subsets of Th lymphocytes in adults. Our study demonstrates age-related changes in circulating Teff and Treg, as well as significant differences in STAT5/STAT1 signalling among FoxP3+ Th lymphocytes, providing new advances in the understanding of immunosenescence.
Ključne besede: T lymphocytes, age-related differences, immune system
Objavljeno: 14.06.2017; Ogledov: 109; Prenosov: 9
Celotno besedilo (2,39 MB)
Intermittent chemotherapy and erlotinib for nonsmokers or light smokers with advanced adenocarcinoma of the lungMatjaž Zwitter
, Mirjana Rajer
, Viljem Kovač
, Izidor Kern
, Martina Vrankar
, Uroš Smrdel
, 2011, izvirni znanstveni članek
Opis: Background. Intermittent application of chemotherapy and tyrosine kinase inhibitors may avoid antagonism between the two classes of drugs. This hypothesis was tested in a Phase II clinical trial. Patients and Methods. Eligible patients were nonsmokers or light smokers, chemo-naïve, with metastatic adenocarcinoma of the lung. Treatment: 4 to 6 cycles of gemcitabine 1250 mg/m2 on days 1 and 4, cisplatin 75 mg/m2 on day 2, and erlotnib 150 mg daily on days 5–15, followed by erlotinib as maintenance. Results. 24 patients entered the trial. Four pts had grade 3 toxicity. Complete remission (CR) and partial remission (PR) were seen in 5 pts and 9 pts, respectively (response rate 58%). Median time to progression (TTP) was 13.4 months and median overall survival (OS) was 23 months. When compared to patients with negative or unknown status of EGFR mutations, 8 patients with EGFR gene activating mutations had significantly superior experience: 4 CR and 4 PR, with median TTP 21.5 months and OS 24.2 months (P < .05). Conclusions. Intermittent schedule with gemcitabine, cisplatin and erlotinib has mild toxicity. For patients who are positive for EGFR gene activating mutations, this treatment offers excellent response rate, time to progression and survival.
Ključne besede: smokers, nonsmokers, cancer treatment, lung cancer, chemotherapy, erlotinib
Objavljeno: 14.06.2017; Ogledov: 146; Prenosov: 2
Celotno besedilo (2,30 MB)
Single nucleotide polymorphisms as prognostic and predictive factors of adjuvant chemotherapy in colorectal cancer of stages I and IIMatej Horvat
, Uroš Potočnik
, Katja Repnik
, Rajko Kavalar
, Borut Štabuc
, 2016, pregledni znanstveni članek
Opis: Colorectal cancer (CRC) is a highly heterogeneous disease regarding the stage at time of diagnosis and there is special attention regarding adjuvant chemotherapy in unselected patients with stage I and stage II. The clinicohistologically based TNM staging system with emphasis on histological evaluation of primary tumor and resected regional lymph nodes remains the standard of staging, but it has restricted sensitivity resulting in false downward stage migration. Molecular characteristics might predispose tumors to a worse prognosis and identification of those enables identifying patients with high risk of disease recurrence. Suitable predictive markers also enable choosing the most appropriate therapy. The current challenge facing adjuvant chemotherapy in stages I and II CRC is choosing patients with the highest risk of disease recurrence who are going to derive most benefit without facing unnecessary adverse effects. Single nucleotide polymorphisms (SNPs) are one of the potential molecular markers that might help us identify patients with unfavorable prognostic factors regarding disease initiation and recurrence and could determine selection of an appropriate chemotherapy regimen in the adjuvant and metastatic setting. In this paper, we discuss SNPs of genes involved in the multistep processes of cancerogenesis, metastasis, and the metabolism of chemotherapy that might prove clinically significant.
Ključne besede: single nucleotide polymorphism, colorectal cancer, adjuvant chemotherapy
Objavljeno: 14.06.2017; Ogledov: 101; Prenosov: 6
Celotno besedilo (1,27 MB)
Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with recurrent variceal hemorrhagePeter Popović
, Andrej Zore
, Katarina Šurlan Popović
, Manca Garbajs
, Pavel Skok
, 2013, izvirni znanstveni članek
Opis: Purpose.The purpose of this study was to determine the incidence and predictors of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) in the elective treatment of recurrent variceal hemorrhage. Methods. Seventy patients were treated with elective TIPS and fifty-six patients with ET. Median observation time was 46.28 months in the TIPS group and 42.31 months in the ET group. Results. 30 patients (42.8%) developed clinically evident portosystemic encephalopathy in TIPS group and 20 patients (35.6%) in ET group. The difference between the groups was not statistically significant (P=0.542; X2 test). The incidence of new or worsening portosystemic encephalopathy was 24.3% in TIPS group and 10.7% in ET group. Multivariate analysis showed that ET treatment (P=0.031), age of >65 years (P=0.022), pre-existing HE (P=0.045), and Childs class C (P=0.051) values were independent predictors for the occurrence of HE. Conclusions. Procedure related HE is a complication in a minority of patients treated with TIPS or ET. Patients with increased age, preexisting HE, and higher Child-Pugh score should be carefully observed after TIPS procedure because the risk of post-TIPS HE in these patients is higher.
Ključne besede: veins, dilated veins, rebleeding, portacaval encephalopathy, liver, cirrhosis, portal hypertension, transjugular intrahepatic portosystemic shunt
Objavljeno: 14.06.2017; Ogledov: 149; Prenosov: 13
Celotno besedilo (1,18 MB)
Quantitative evaluation of growth plates around the knees of adolescent soccer players by diffusion-weighted magnetic resonance imagingZmago Krajnc
, Mitja Rupreht
, Matej Drobnič
, 2015, izvirni znanstveni članek
Opis: Purpose. To quantitatively evaluate growth plates around the knees in adolescent soccer players utilizing the diffusion-weighted MR imaging (DWI). Methods. The knees and adjacent growth plates of eleven 14-year-old male soccer players were evaluated by MRI before (end of season´s summer break) and after two months of intense soccer training. MRI evaluation was conducted in coronal plane by PD-FSE and DWI. All images were screened for any major pathological changes. Later, central growth plate surface area (CGPSA) was measured and the apparent diffusion coefficient (ADC) values were calculated in two most central coronal slices divided into four regions: distal femur medial (DFM), distal femur lateral (DFL), proximal tibia medial (PTM), and proximal tibia lateral (PTL). Results. No gross pathology was diagnosed on MRI. CGPSA was not significantly reduced: DFM 278 versus 272, DFL 265 versus 261, PTM 193 versus 192, and PTL 214 versus 210. ADC decrease was statistically significant only for PTM: DFM 1.27 versus 1.22, DFL 1.37 versus 1.34, PTM 1.13 versus 1.03 (p=0.003), and PTL 1.28 versus 1.22. Conclusions. DWI measurements indicate increased cellularity in growth plates around knees in footballers most prominent in PTM after intense training. No detectable differences on a standard PD-FSE sequence were observed.
Ključne besede: soccer, adolescent, quantitative magnetic resonance, knee
Objavljeno: 14.06.2017; Ogledov: 111; Prenosov: 5
Celotno besedilo (1,92 MB)
Predictors of mortality and prehospital monitoring limitations in blunt trauma patientsVitka Vujanović
, Tine Pelcl
, Matej Strnad
, Miljenko Križmarić
, Vesna Borovnik Lesjak
, 2015, izvirni znanstveni članek
Opis: This study aimed at determining predictors of in-hospital mortality and prehospital monitoring limitations in severely injured intubated blunt trauma patients. We retrospectively reviewed patients' charts. Prehospital vital signs, Injury Severity Score (ISS), initial Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), arterial blood gases, and lactate were compared in two study groups: survivors (n=40) and nonsurvivors (n=30). There were no significant differences in prehospital vital signs between compared groups. Nonsurvivors were older (P=0.006), with lower initial GCS (P<0.001) and higher ISS (P<0.001), along with higher lactate (P<0.001) and larger base deficit (BD; P=0.006 ), whereas RTS (P=0.001) was lower in nonsurvivors. For predicting mortality, area under the curve (AUC) was calculated: for lactate 0.82 (P<0.001), for ISS 0.82 (P<0.001), and for BD 0.69 (P=0.006). Lactate level of 3.4mmol/L or more was 82% sensitive and 75% specific for predicting in-hospital death. In a multivariate logistic regression model, ISS (P=0.037), GCS (P=0.033), and age (P=0.002) were found to be independent predictors of in-hospital mortality. The AUC for regression model was 0.93 (P<0.001). Increased levels of lactate and BD on admission indicate more severe occult hypoperfusion in nonsurvivors whereas vital signs did not differ between the groups.
Ključne besede: vital signs, nonsurvivors, survivors
Objavljeno: 14.06.2017; Ogledov: 108; Prenosov: 11
Celotno besedilo (1,30 MB)
Usefulness of the patient information leaflet (PIL) and information on medicines from professionalsTonka Poplas-Susič
, Janko Kersnik
, Zalika Klemenc-Ketiš
, 2014, izvirni znanstveni članek
Opis: Background: The Patient information leaflet (PIL) is an important source of information for every patient. Little is known about whether patients read the PIL and whether it contains useful information. Other sources of drug-related information are professionals (a family practitioner, a pharmacist and a nurse). Informing patients on drugs improves their compliance. The aim of the study was to identify the usefulness of PIL from the perspective of the patient, to assess professionals as a source of drug-related information and to suggest changes that can improve informing and therefore patients' compliances.
Methods: Four focus group interviews were conducted across different primary health care centres in the North East of Slovenia. Focus groups were composed of randomly selected patients (in total 20) who were willing to express their views on PILs, on other drug information sources and on possible improvements. A qualitative analysis of the data was based of the transcription of the audiotapes.
Results: Patients read the PILs selectively. They were most interested in side effects, contraindications and the purpose of the prescribed drug. Participants reported that the language in PILs is too scientific. In the case they do not understand PILs or they recognise some of the side effects, a majority of participants decide to contact a family physician first, and less frequently a pharmacist or a nurse. A family physician is considered to be the most trustworthy source of information and patients think that pharmacists could play a more active role in patients% education.
Conclusion: Current PILs offer enough partial information to patients but need some improvements in terms of better legibility and access to the most crucial information. PIL does not enable a comprehensive information with respect to patient%s health status. Most reliable source of information is considered to be a family practitioner. Pharmacists could play a more active role in the education of patients.
Ključne besede: PIL, focus groups, medicines, family practitioner
Objavljeno: 10.05.2017; Ogledov: 291; Prenosov: 2
Celotno besedilo (91,61 KB)
Primerjava prednosti in slabosti takojšnje ter odložene prekinitve popkovnice pri novorojenčkuTamara Todorović
, Andraž Dovnik
, Iztok Takač
, 2015, pregledni znanstveni članek
Opis: Izhodišča: Prekinitev popkovnice pri novorojenčku je v porodništvu še vedno predmet raz- prav. Tako ločimo takojšnjo prekinitev popkovnice, ki se običajno izvede v prvih 10, 15, 30 ali celo 60 sekundah po rojstvu, in odloženo prekinitev popkovnice, ki običajno pomeni prekinitev popkovnice več kot 60 sekund ali 2–5 minut po rojstvu, ob prenehanju pulzacij popkovnice ali ob pojavu posteljice v porodnem kanalu. Takojšnja prekinitev popkovnice je ena od treh komponent aktivnega vodenja tretje porodne dobe, ki se je v modernem porodništvu uveljavilo v zadnjem stoletju, medtem ko je v nekaterih severnoevropskih državah ponekod v ZDA in Kanadi ter v razvijajočih se državah bolj aktualen fiziološki pristop.
Zaključki: V zadnjih letih se takojšnja prekinitev popkovnice v številnih smernicah vse bolj zamenjuje z odloženo prekinitvijo, saj so raziskave potrdile številne prednosti slednje. Med najpomembnejšimi prednostmi odložene prekinitve popkovnice omenjajo višjo raven hemoglobina in feritina, večje zaloge železa, zmanjšano pojavnost anemije zaradi pomanjkanja železa, boljšo kardiopulmonalno prilagoditev in daljše trajanje zgodnjega dojenja pri donošenem novorojenčku ob nespremenjeni pojavnosti poporodne krvavitve pri materi. Prednosti odložene prekinitve popkovnice se kažejo tudi pri nedonošenčkih. Kljub vsemu je potrebna previdnost zaradi možnega pojava policitemije s hiperviskoznostjo, hiperbilirubinemije in dihalne stiske.
Ključne besede: prekinitev popkovnice, tretja porodna doba, anemija, pomanjkanje železa, poporodna krvavitev
Objavljeno: 10.05.2017; Ogledov: 248; Prenosov: 7
Celotno besedilo (83,43 KB)
Pomen vodene razprave v simulacijah visoke stopnje posnemanja resničnostiIgor Karnjuš
, Miljenko Križmarić
, Damjan Zazula
, 2014, pregledni znanstveni članek
Opis: Vodena razprava (angl. debriefing) je najpomembnejši del učenja s simulacijami visoke stopnje posnemanja resničnosti, v kateri mentor pozove učeče se, da kritično ocenijo znanje in spretnosti, ki so jih pokazali med izvedbo scenarija. Kljub številnim raziskavam, ki proučujejo izobraževanje s simulacijami, je področje vodene razprave še razmeroma slabo opredeljeno. V prispevku so o sodobni literaturi povzete bistvene značilnosti vodene razprave, njene faze, tehnike in metode. Poudarjena je vloga mentorja, saj je učinkovitost vodene razrave v veliki meri odvisna ravno od njegove usposobljenosti. Podane so smernice, s katerimi mentor lahko oceni lastno uspešnost pri vodenju razprave. Prav tako je izpostavljen pomen pri kontinuiranem izobraževanju v kliničnem okolju, saj vodena razprava omogoča oceno uspešnosti izvedbe klinične obravnave in možnosti postavljanja novih strategij s ciljem doseči večjo usposobljenost zdravstvenega tima. Čeprav je vodena razprava temelj izobraževanja s simulacijami visoke stopnje posnemanja resničnosti, je tudi pomemben način učenja v kliničnem okolju. Mnogi vidiki vodene razprave so še vedno slabo raziskani, zato bo temu segmentu v prihodnosti potrebno nameniti večjo pozornost.
Ključne besede: vodena razprava, simulacije visoke stopnje posnemanja resničnosti, simulatorji bolnika, metode učenja, mentorji
Objavljeno: 10.05.2017; Ogledov: 150; Prenosov: 14
Celotno besedilo (217,23 KB)