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Maletic A, Dumic-Cule I, Zic R, Milosevic M. Impact of Hair Transplantation on Quality of Life. Aesthetic Plast Surg 2024; 48:1825-1830. [PMID: 38123846 DOI: 10.1007/s00266-023-03781-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Alopecia is defined as partial or complete hair loss. The most common form is androgenetic alopecia, which occurs in both men and women. Despite the nonsurgical options available for treatment, the only permanent solution is hair transplantation. Hair loss has been shown to have significant psychological consequences associated with loss of self-confidence, poor self-image and difficulties in social functioning. We aim to examine the effect of hair transplantation on quality of life and psychosocial functioning. METHODS Forty-eight patients with androgenetic alopecia were enrolled in this two-center prospective study and underwent hair transplantation by the Follicular Unit Extraction method. Different questionnaires were used to assess their quality of life and other psychosocial parameters before and after hair transplantation. RESULTS According to SF-36 Physical and Mental Health Score patients showed significant improvement in life quality after hair transplantation. Diener's Life Satisfaction Scale (DASS-21) revealed increased life satisfaction after the procedure. Stress and anxiety DASS-21 subscales showed significantly reduced results; while, the DASS-21 depression scale and MSPSS were not significantly changed. CONCLUSION Taken together, quality of life and psychosocial functioning increased after hair transplantation. Structured abstract is required. Please provide.I insert name of paragraphs within abstract as follows: background, methods, results, conclusion Level of Evidence II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
| | - Ivo Dumic-Cule
- University North, 104 brigade 3, 42000, Varaždin, Croatia.
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Rado Zic
- Department of Plastic Surgery, University Hospital Dubrava, Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 3, 10000, Zagreb, Croatia
| | - Milan Milosevic
- School of Medicine, University of Zagreb, Salata 3, 10000, Zagreb, Croatia
- Department of Environmental Health and Occupational and Sports Medicine, Andrija Stampar School of Public Health, Rockfellerova 4, 10000, Zagreb, Croatia
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Krause T, Cholewa D, Liniger B, Berger S, Milosevic M. Torsion of an Accessory Liver Lobe in a Newborn. European J Pediatr Surg Rep 2024; 12:e7-e10. [PMID: 38230267 PMCID: PMC10789581 DOI: 10.1055/s-0043-1778663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/10/2023] [Indexed: 01/18/2024] Open
Abstract
Accessory liver lobes are rare. We present the rare case of torsion of an accessory liver lobe in a neonate. A 13-day-old newborn presented with failure to thrive and hematemesis without fever. The initial workup with sonography, magnetic resonance imaging, and upper gastrointestinal study was suspicious of a duplication cyst, most likely in the posterior wall of the stomach. Laboratory and radiological findings were not suggesting a choledochal cyst. We performed a laparotomy with resection of the 3.2 × 2.1 × 1.1 cm mass. Intraoperatively, the cystic formation extended from of the liver bed up to the lesser curvature of the stomach. The mass was attached to the left liver lobe with fibrous bands. Histopathology revealed necrotic liver parenchyma with patent viable biliary ducts, indicative of an accessory liver lobe that underwent torsion in the perinatal period. The postoperative course and follow-up (6 months so far) were uneventful. To our knowledge, this is the youngest described patient in the literature with an accessory liver lobe torsion and the second case report concerning this entity in a neonate. It presents an extremely rare differential diagnosis in symptomatic neonates with a cystic mass in the upper abdomen.
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Affiliation(s)
- Tobias Krause
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Dietmar Cholewa
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Benjamin Liniger
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Steffen Berger
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
| | - Milan Milosevic
- Department of Pediatric Surgery, Inselspital Universitätsspital Bern, Bern, Switzerland
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Madzar T, Masina T, Zaja R, Kastelan S, Cvetkovic JP, Brborovic H, Dvorski M, Kirin B, Barisic AV, Cehok I, Milosevic M. Overtraining Syndrome as a Risk Factor for Bone Stress Injuries among Paralympic Athletes. Medicina (Kaunas) 2023; 60:52. [PMID: 38256312 PMCID: PMC10819479 DOI: 10.3390/medicina60010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: In this review, we have explored the relationship between overtraining syndrome (OTS) and bone stress injuries among paralympic athletes. OTS is a complex condition that arises from an imbalance between training volume, nutrition, and recovery time, leading to significant negative effects on paralympic athlete's performance and overall well-being. On the other hand, bone stress injuries occur when abnormal and repetitive loading is applied to normal bone, resulting in microdamage accumulation and potential. The prevalence of overtraining syndrome and bone stress injuries among athletes highlights the need for a better understanding of their relationship and implications for prevention and management strategies. Methods: A literature review from the PubMed, Web of Science, and Google Scholar databases including the MeSH keywords "overtraining syndrome", "bone", and "paralympic athletes". Results: Studies have consistently shown that athletes engaged in endurance sports are particularly susceptible to overtraining syndrome. The multifactorial nature of this condition involves not only physical factors, but also psychological and environmental determinants. In addition, the diagnosis and management of OTS and bone stress injuries present challenges in clinical practice. Conclusions: Currently, there are no definitive biochemical markers for overtraining syndrome. The diagnosis is based on a combination of subjective measures such as questionnaires, symptoms checklists, and objective biomarkers, including hormone levels, inflammatory markers, and imaging studies. However, these diagnostic approaches have limitations regarding their specificity and sensitivity.
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Affiliation(s)
| | - Tonci Masina
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
| | - Roko Zaja
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
| | - Snjezana Kastelan
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
| | - Jasna Pucarin Cvetkovic
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
| | - Hana Brborovic
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
| | - Matija Dvorski
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
| | - Boris Kirin
- Croatian Paralympic Committee, Savska Cesta 137, 10000 Zagreb, Croatia; (B.K.); (A.V.B.)
- General County Hospital Bjelovar, Antuna Mihanovica 8, 43000 Bjelovar, Croatia
| | - Andreja Vukasovic Barisic
- Croatian Paralympic Committee, Savska Cesta 137, 10000 Zagreb, Croatia; (B.K.); (A.V.B.)
- General County Hospital Bjelovar, Antuna Mihanovica 8, 43000 Bjelovar, Croatia
| | - Ivan Cehok
- Department of Nursing, University North, 104 Brigade 3, 42000 Varazdin, Croatia;
| | - Milan Milosevic
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia; (T.M.); (R.Z.); (S.K.); (J.P.C.); (H.B.); (M.D.)
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Vazanic D, Kurtovic B, Balija S, Milosevic M, Brborovic O. Predictors, Prevalence, and Clinical Outcomes of Out-of-Hospital Cardiac Arrests in Croatia: A Nationwide Study. Healthcare (Basel) 2023; 11:2729. [PMID: 37893803 PMCID: PMC10606582 DOI: 10.3390/healthcare11202729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) remains a pivotal health challenge globally. In Croatia, there has been a knowledge gap regarding the prevalence, predictors, and outcomes of OHCA patients. This study aims to determine the prevalence, prediction, and outcomes of OHCA patients in Croatia. METHODS An extensive one-year analysis was performed on all OHCA treated by the Emergency Medical Service in Croatia, based on the Utstein recommendations. Data were extracted from Croatian Institute of Emergency Medicine databases, focusing on adult individuals who experienced sudden cardiac arrest in out-of-hospital settings in Croatia. RESULTS From 7773 OHCA cases, 9.5% achieved spontaneous circulation pre-hospital. Optimal outcomes corresponded to EMS intervention within ≤13 min post-arrest onset AUC = 0.577 (95% CI: 0.56-0.59; p < 0.001) and female gender OR = 1.81 (95% CI: 1.49-2.19; p < 0.001). Northern Croatia witnessed lower success rates relative to the capital city Zagreb OR = 0.68 (95% CI: 0.50-0.93; p = 0.015). CONCLUSIONS Early intervention by EMS, specifically within a 13-min period following the onset of a cardiac arrest, significantly enhances the probability of achieving successful OHCA outcomes. Gender differences and specific initial heart rhythms further influenced the likelihood of successful outcomes. Regional disparities, with reduced success rates in northern Croatia compared to the City of Zagreb, were evident.
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Affiliation(s)
- Damir Vazanic
- Croatian Institute of Emergency Medicine, 10000 Zagreb, Croatia;
- Department of Nursing, Catholic University of Croatia, 10000 Zagreb, Croatia
- University of Applied Health Sciences, 10000 Zagreb, Croatia;
| | - Biljana Kurtovic
- University of Applied Health Sciences, 10000 Zagreb, Croatia;
- Faculty of Health Studies, University of Rijeka, 51000 Rijeka, Croatia
| | - Sasa Balija
- Croatian Institute of Emergency Medicine, 10000 Zagreb, Croatia;
| | - Milan Milosevic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.M.); (O.B.)
| | - Ognjen Brborovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia; (M.M.); (O.B.)
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Han K, Zou J, Zhao Z, Baskurt Z, Zheng Y, Barnes T, Croke JM, Fyles A, Gladwish AP, Lecavalier-Barsoum M, Lukovic J, Marchand EL, Milosevic M, Taggar A, Bratman SV, Leung EW. Clinical Validation of HPV ctDNA for Early Detection of Residual Disease Following Chemoradiation in Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 117:S7-S8. [PMID: 37784556 DOI: 10.1016/j.ijrobp.2023.06.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Despite chemoradiation (CRT), 30-40% of patients with locally advanced cervical cancer relapse. Most cases are caused by human papilloma virus (HPV), and HPV circulating tumor DNA (ctDNA) may identify patients at highest risk of relapse. Our previous pilot study showed that detectable HPV ctDNA at the end of CRT is associated with inferior progression-free survival (PFS) using digital polymerase chain reaction (dPCR), and that a next generation sequencing approach (HPV-seq) may outperform dPCR. We hypothesized that HPV ctDNA may identify cervical cancer patients at increased risk of relapse following CRT and aimed to prospectively validate HPV ctDNA as a tool for early detection of residual disease. MATERIALS/METHODS This prospective, multicenter validation study accrued 70 patients with HPV+ stage IB-IVA cervical cancer treated with definitive CRT from 2017-2022. Patients underwent phlebotomy at baseline, end of, 4-6 weeks and 3 months post CRT for HPV ctDNA levels. HPV genotyping was performed on the baseline plasma sample using HPV-seq. HPV genotype-specific DNA levels in plasma were quantified using both dPCR and HPV-seq. PFS was estimated using the Kaplan-Meier method and compared using the log rank test. Multivariable Cox regression analyses incorporating stage and HPV ctDNA detectability assessed independent prognostic factors associated with PFS. RESULTS At the time of abstract, results for 67 patients were available. The majority had squamous histology (84%) and stage IIB (36%) or IIIC1 (25%) disease. HPV genotyping using HPV-seq revealed 54% (36/67) of cases harboring HPV-16, and 46% harboring other HPV types: 15 HPV-18; 5 HPV-59; 2 HPV-31; 2 HPV-33; 2 HPV-52; 1 each HPV-39, HPV-45, HPV-53, HPV-58, and HPV-82. With a median follow up of 2.2 (range 0.4 - 5.2) years, there were 21 PFS events. Most recurrences (14/21) were distant and/or paraaortic; 4 local and nodal/distant; 2 pelvic nodal; and 1 local. Patients with detectable HPV ctDNA on dPCR at the end of, 4-6 weeks and 3 months post CRT had significantly worse 2-year PFS compared to those with undetectable HPV ctDNA (78 vs 52%, p = 0.04; 82 vs 26%, p < 0.001; and 80 vs 23%, p = < 0.001, respectively). HPV-seq showed similar results (87 vs 55%, p = 0.02; 81 vs 45%, p = 0.003; and 84 vs 31%, p = < 0.001, respectively). On multivariable analyses, detectable HPV ctDNA on dPCR and HPV-seq remained independently associated with inferior PFS (see table). CONCLUSION HPV-seq enables HPV genotyping directly from plasma in locally advanced cervical cancer. Persistent HPV ctDNA following CRT is independently associated with inferior PFS in this prospective validation study. HPV ctDNA testing can be used to identify, as early as at the end of CRT, patients at high risk of recurrence in future treatment intensification trials.
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Affiliation(s)
- K Han
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - J Zou
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Z Zhao
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Z Baskurt
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Y Zheng
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - T Barnes
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J M Croke
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Fyles
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A P Gladwish
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Royal Victoria Hospital, Barrie, ON, Canada
| | | | - J Lukovic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - E L Marchand
- Hopital Maisonneuve-Rosemont, Montreal, QC, Canada
| | - M Milosevic
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - A Taggar
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - S V Bratman
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - E W Leung
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Mihaljevic MZ, Petricevic M, Konosic S, Svetina L, Urlic M, Starcevic Z, Krzelj K, Milosevic M, Kalamar V, Gasparovic H, Biocina B. The Association between Glycosylated Hemoglobin Level and Platelets Reactivity in Patients with Diabetes Mellitus Undergoing Elective Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2023; 71:469-482. [PMID: 35752164 DOI: 10.1055/s-0042-1748768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Diabetic patients tend to have increased platelet reactivity after coronary artery bypass grafting (CABG). The aim of this study was to determine the association between hemoglobin A1c (HbA1c) values and platelet reactivity and to evaluate the consequent impact on clinical outcomes in patients undergoing CABG. METHODS This prospective observational trial consecutively enrolled 225 diabetic patients undergoing CABG, between February 2014 and October 2018. HbA1c levels and platelet function (multiple electrode aggregometry [MEA]) were analyzed the day before surgery and on postoperative day 4 (POD 4). Patients were divided into two groups according to the HbA1c value: HBA1c < 7% and HbA1c ≥ 7%. RESULTS Significantly higher postoperative ASPI (platelet function test based on arachidonic acid) and ADP (platelet function test based on adenosine diphosphate) test values were observed at POD 4 compared with preoperative values (ASPI test: p < 0.001; ADP test: p < 0.001). The prevalence of preoperative aspirin resistance (AR) was 46.4% relative to 57.2% after surgery showing consistent increase in postoperative AR by approximately 10%. In addition, the prevalence of AR in the HbA1c < 7% group was higher by 10% compared with the HbA1c ≥ 7% group, both before and after surgery. We did not demonstrate differences in clinical outcomes between the HbA1c groups. CONCLUSION Perioperative assessment of platelet reactivity in diabetic patients detects those with AR who may be at increased risk of adverse ischemic events. A personalized approach guided by MEA and administration of early and more potent antiaggregation therapy after CABG can be beneficial in this group of patients.
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Affiliation(s)
- Martina Zrno Mihaljevic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Mate Petricevic
- Department of Cardiac Surgery, University Department of Health Studies, University of Split, UHC Zagreb, Split, Croatia
| | - Sanja Konosic
- Department of Anesthesiology, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lucija Svetina
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Marjan Urlic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Zrinka Starcevic
- Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia
| | - Kristina Krzelj
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Milan Milosevic
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Viktor Kalamar
- Department of Thoracic Surgery, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery, University Clinical Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
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Busic-Pavlek I, Dumic-Cule I, Kovacevic L, Milosevic M, Delimar P, Korsa L, Marusic Z, Prutki M. Calcium-Sensing Receptor Expression in Breast Cancer. Int J Mol Sci 2023; 24:11678. [PMID: 37511437 PMCID: PMC10380606 DOI: 10.3390/ijms241411678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/14/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The calcium-sensing receptor (CaSR) plays a crucial role in maintaining the balance of calcium in the body. Altered signaling through the CaSR has been linked to the development of various tumors, such as colorectal and breast tumors. This retrospective study enrolled 79 patients who underwent surgical removal of invasive breast carcinoma of no special type (NST) to explore the expression of the CaSR in breast cancer. The patients were categorized based on age, tumor size, hormone receptor status, HER2 status, Ki-67 proliferation index, tumor grade, and TNM staging. Immunohistochemistry was conducted on core needle biopsy samples to assess CaSR expression. The results revealed a positive correlation between CaSR expression and tumor size, regardless of the tumor surrogate subtype (p = 0.001). The expression of ER exhibited a negative correlation with CaSR expression (p = 0.033). In contrast, a positive correlation was observed between CaSR expression and the presence of HER2 receptors (p = 0.002). Increased CaSR expression was significantly associated with lymph node involvement and the presence of distant metastasis (p = 0.001 and p = 0.038, respectively). CaSR values were significantly higher in the patients with increased Ki-67 (p = 0.042). Collectively, higher CaSR expression in breast cancer could suggest a poor prognosis and treatment outcome regardless of the breast cancer subtype.
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Affiliation(s)
- Iva Busic-Pavlek
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Split, Spinciceva 1, 21000 Split, Croatia
| | - Ivo Dumic-Cule
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
- Department of Nursing, University North, 104 Brigade 3, 42000 Varazdin, Croatia
| | - Lucija Kovacevic
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Milan Milosevic
- Department of Environmental Health and Occupational and Sports Medicine, Andrija Stampar School of Public Health, Rockfellerova 4, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
| | - Petra Delimar
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Lea Korsa
- Clinical Department of Pathology and Cytology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Zlatko Marusic
- Clinical Department of Pathology and Cytology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Maja Prutki
- Clinical Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, Salata 3, 10000 Zagreb, Croatia
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Sulentic V, Vrca A, Milic S, Klupka Saric I, Milosevic M, Placko Vrsnak D, Mandic I. Influence of weather regime and local geomagnetic activity on the occurrence of epileptic seizures. Epilepsy Res 2023; 193:107164. [PMID: 37187038 DOI: 10.1016/j.eplepsyres.2023.107164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 04/02/2023] [Accepted: 05/05/2023] [Indexed: 05/17/2023]
Abstract
Epilepsy is a common neurologic disease and presents a major public health problem. Patients with epilepsy have unexpected occurrence of seizures with many triggered by existing triggering factors such as alcohol, stress etc. Other potential triggers include certain weather or atmospheric parameters and local geomagnetic activity. We have analyzed the impact of atmospheric parameters grouped in 6 grouped weather types or weather regimes and the local geomagnetic activity through the K - index. In the prospective study, we analyzed a total of 431 seizures over a 17-month period. In the results obtained, we found that the most severely common weather regime grouped type of weather was radiation and then precipitation regime. It was also found that grouped weather types of weather regimes had more impact on generalized than focal epileptic seizures. Local geomagnetic activity had no direct effect on the occurrence of epileptic seizures. Those results confirm the thesis how the impact of certain external factors is complex and that the further study is required in that respect.
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Affiliation(s)
- Vlatko Sulentic
- Department of Neurology, University Hospital Center Zagreb, School of Medicine, University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - Andjelko Vrca
- Department of Neurology, Clinical Hospital "Dubrava", Av. Gojka Suska 6, 10000 Zagreb, Croatia; School of Medicine, University of Mostar, 88000 Mostar, Bosnia and Herzegovina
| | - Simona Milic
- Department of Neurology, General Hospital "Dr. Josip Bencevic", A. Stampara 42, 35000 Slavonski Brod, Croatia.
| | - Inge Klupka Saric
- Department of Neurology, School of Medicine, University of Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina
| | - Milan Milosevic
- University of Zagreb, School of Medicine, Andrija Stampar School of Public Health, Department for Environmental Health, Occupational and Sports Medicine, Rockfeller street 4, 10000 Zagreb, Croatia
| | | | - Igor Mandic
- Department of Geophysics, Faculty of Science, University of Zagreb, Horvatovac 95, 10000 Zagreb, Croatia
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Scott A, Weersink M, Liu Z, Milosevic M, Croke J, Fyles A, Lukovic J, Rink A, Beiki-Ardakani A, Borg J, Xie J, Chan K, Ballantyne H, Skliarenko J, Conway J, Gladwish A, Weersink R, Han K. Comparing Dosimetry of Locally Advanced Cervix Cancer Patients Treated with 3 vs. 4 Fractions of MRI-Guided Brachytherapy. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Mitera G, Tsang D, Wright P, Sussman J, Craig T, Thompson R, Tyldesley S, Foxcroft S, Goddard K, Greenland J, Koul R, McCurdy B, Milosevic M, Morneau M, Morrison A, Pan L, Pantarotto J, Rutledge R, Warde P, Patel S. First Pan-Canadian Consensus Recommendations for Proton Beam Therapy Access in Canada. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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11
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Jelicic P, Ferenc T, Mrzljak A, Jemersic L, Janev-Holcer N, Milosevic M, Bogdanic M, Barbic L, Kolaric B, Stevanovic V, Vujica M, Jurekovic Z, Pavicic Saric J, Vilibic M, Vilibic-Cavlek T. Insights into hepatitis E virus epidemiology in Croatia. World J Gastroenterol 2022; 28:5494-5505. [PMID: 36312833 PMCID: PMC9611701 DOI: 10.3748/wjg.v28.i37.5494] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/15/2022] [Accepted: 09/16/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis E virus (HEV) is an emerging virus of global health concern. The seroprevalence rates differ greatly according to geographic region and population group.
AIM To analyze the seroprevalence of HEV in exposed (animal-related professions) and nonexposed populations, as well as solid organ and hematopoietic stem cell transplant patients.
METHODS Forestry workers (n = 93), hunters (n = 74), and veterinarians (n = 151) represented the exposed population. The general population (n = 126) and pregnant women (n = 118) constituted the control group. Transplant patients included liver transplant recipients (LTRs) (n = 83), kidney transplant recipients (KTRs) (n = 43), and hematopoietic stem cell transplant recipients (HSCRs) (n = 39). HEV immunoglobulin G antibodies were detected using the enzyme-linked immunosorbent assay and confirmed by the immunoblot test.
RESULTS The HEV seroprevalence significantly differed between groups: Veterinarians 15.2%, hunters 14.9%, forestry workers 6.5%, general population 7.1%, and pregnant women 1.7%. In transplant patients, the seropositivity was highest in LTRs (19.3%), while in KTRs and HSCRs, the seroprevalence was similar to the general population (6.9% and 5.1%, respectively). A significant increase in seropositivity with age was observed from 2.9% in individuals less than 30 years to 23.5% in those older than 60 years. Sociodemographic characteristics (sex, educational level, area of residence, and number of household members), eating habits (game meat, offal, and pork products consumption), and environmental and housing conditions (drinking water supply, type of water drainage/sewer, waste disposal, domestic animals) were not associated with HEV seropositivity. However, individuals who reported a pet ownership were more often seropositive compared to those who did not have pet animals (12.5% vs 7.0%).
CONCLUSION The results of this study showed that individuals in professional contact with animals and LTRs are at higher risk for HEV infection. In addition, age is a significant risk factor for HEV seropositivity.
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Affiliation(s)
- Pavle Jelicic
- Department of Environmental Health, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Thomas Ferenc
- Department of Radiology, Merkur University Hospital, Zagreb 10000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Lorena Jemersic
- Department of Virology, Croatian Veterinary Institute, Zagreb 10000, Croatia
| | - Natasa Janev-Holcer
- Department of Environmental Health, Croatian Institute of Public Health, Zagreb 10000, Croatia
- Department of Social Medicine and Epidemiology, Faculty of Medicine University of Rijeka, Rijeka 51000, Croatia
| | - Milan Milosevic
- Department of Occupational and Environmental Health, Andrija Stampar School of Public Health, Zagreb 10000, Croatia
| | - Maja Bogdanic
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
| | - Ljubo Barbic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb 10000, Croatia
| | - Branko Kolaric
- Department of Gerontology and Social Medicine, Andrija Stampar Teaching Institute of Public Health, Zagreb 10000, Croatia
| | - Vladimir Stevanovic
- Department of Microbiology and Infectious Diseases with Clinic, Faculty of Veterinary Medicine University of Zagreb, Zagreb 10000, Croatia
| | - Mateja Vujica
- Institute of Emergency Medicine of Krapina-Zagorje County, Krapina 49000, Croatia
| | - Zeljka Jurekovic
- Department of Nephrology, Merkur University Hospital, Zagreb 10000, Croatia
| | | | - Maja Vilibic
- Department for Social Psychiatry, Psychotherapy and Psychodiagnostics, University Clinical Hospital Center “Sestre Milosrdnice”, Zagreb 10000, Croatia
| | - Tatjana Vilibic-Cavlek
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
- Department of Virology, Croatian Institute of Public Health, Zagreb 10000, Croatia
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Sef D, Kovacevic M, Jernej B, Novacic K, Slavica M, Petrak J, Medved I, Milosevic M. Immunohistochemical analysis of MMP-9 and COX-2 expression in carotid atherosclerotic plaques among patients undergoing carotid endarterectomy: A prospective study. J Stroke Cerebrovasc Dis 2022; 31:106731. [PMID: 36075131 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Matrix metalloproteinase-9 protein (MMP-9) and cyclooxygenase-2 (COX-2) proteins may have a role in remodelling of atherosclerotic plaques. We analysed and compared the radiological, histological and immunohistochemical characteristics of carotid atherosclerotic plaques between symptomatic and asymptomatic patients who underwent carotid endarterectomy (CEA). METHODS This prospective single-blinded study included 31 patients (70 [64-75] years, 58% males, 42% symptomatic) who underwent CEA and a total of 155 carotid plaque sections that were analysed. Preoperative assessment and multimodality diagnostic imaging with magnetic resonance imaging (MRI) or computed tomography angiography (CTA), histological and immunohistochemical analyses of carotid plaques including the expression of MMP-9 and COX-2 proteins were performed. RESULTS Symptomatic and asymptomatic patients did not significantly differ in respect to preoperative characteristics. Unstable plaques were detected in 12/13 (92.3%, p = 0.020) symptomatic patients using MRI or CTA. There was no perioperative mortality and perioperative outcomes were comparable in both groups. A significantly higher expression of MMP-9 in macrophages was observed among symptomatic patients (p = 0.020). ROC curve analysis showed statistically significant associations of both the higher intensity of COX-2 staining in CD68 PG-M1 positive macrophages (area under the curve [AUC]=0.701, p = 0.014) and higher MVD (AUC=0.821, p < 0.001) within the plaque with cerebrovascular symptoms. The expression of COX-2 and the intensity of COX-2 staining in macrophages within the unstable carotid plaques detected by preoperative MRI or CTA were significantly higher (76.1% vs. 40.0%, p = 0.038; 76.2% vs. 30.0%, p = 0.01, respectively). CONCLUSIONS Advanced non-invasive multimodality diagnostic imaging including MRI or CTA is reliable in differentiating unstable from stable carotid plaques. High expression of MMP-9 and COX-2 in macrophages within the symptomatic plaque is associated with increased risk of cerebrovascular complications. TRIAL REGISTRATION This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Miljenko Kovacevic
- Department of Vascular Surgery, University Hospital Centre Rijeka, Rijeka, Croatia, EU
| | - Bojan Jernej
- Polyclinic for Radiology and Neurology "Dijagnostika 2000", Zagreb, Croatia, EU
| | - Karlo Novacic
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia, EU
| | - Marko Slavica
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, Zagreb, Croatia, EU
| | - Jelka Petrak
- University of Zagreb, School of Medicine, Zagreb, Croatia, EU
| | - Igor Medved
- Department of Cardiac Surgery, University Hospital Centre Rijeka, Rijeka, Croatia, EU
| | - Milan Milosevic
- University of Zagreb, School of Medicine, Zagreb, Croatia, EU; Andrija Stampar School of Public Health, Zagreb, Croatia, EU
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Stojic J, Petrosanec M, Milosevic M, Boban M. The attitude and knowledge of medical students regarding dementia. Acta Neurol Belg 2022; 122:625-630. [PMID: 35429287 DOI: 10.1007/s13760-022-01939-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/20/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Due to the growing number of older people with dementia (PWD) worldwide, there is an urgent need to improve undergraduate medical education on dementia and skills of future health professionals to provide the best quality care for PWD. The study aimed to determine attitudes and knowledge regarding dementia among medical students. METHODS This cross-sectional, survey-based study included 231 final-year medical students who completed the paper-and-pencil questionnaire with seven categories of questions including two dementia knowledge tests. RESULTS Students have relatively neutral attitudes towards working with PWD and a rather poor theoretical knowledge in the dementia knowledge exam. Students showed the best theoretical knowledge about the symptoms of Alzheimer's disease, while their knowledge was poor in the field of differential diagnoses, epidemiology, and pathogenesis of Alzheimer's disease. One in 11 sixth-year medical students has never had contact with a person with dementia. The opinion of most students was that they should have spent more time with PWD during their medical education and that there are too few classes in the field of dementia at the School of Medicine. The dementia knowledge test with 23 Multiple-Choice Questions showed a higher internal consistency compared to the Alzheimer's Disease Knowledge Scale. CONCLUSION There is an urgent need to increase the interest and improve attitudes and knowledge towards dementia for all future health care professionals from the earliest student days to provide the best care for PWD.
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14
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Abdovic S, Colic M, Stemberger Maric L, Cuk M, Hizar I, Milosevic M. Overactivity index: A noninvasive and objective outcome measure in overactive bladder in children. J Pediatr Urol 2022; 18:352.e1-352.e7. [PMID: 35474164 DOI: 10.1016/j.jpurol.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Reports showed that observing detrusor overactivity (DO) and maximum cystometric capacity (MCC) may guide rational pharmacotherapy. Since urodynamic studies (UDS) are challenging for both patients and the healthcare system, a non-invasive objective prognostic marker is preferable. OBJECTIVES To investigate the value of the overactivity index (OI), a non-invasive measure calculated from the frequency-volume chart (FVC), for predicting the presence of symptoms and abnormal UDS in children with non-neurogenic OAB. STUDY DESIGN This was a prospective interventional study on a consecutive sample of 92 children with urgency treated with anticholinergics and standard urotherapy. Data from history, physical examination, bladder diaries, kidneys and bladder ultrasonography, uroflow, urinalysis, urine culture, and UDS was collected at baseline, and after 3 and 6 months. Binary logistic regression was used to evaluate noninvasive parameters as predictors of Overactive Bladder Symptom Score (OABSS) total score >2 and DO and/or small MCC defined as <65% of expected bladder capacity (EBC) for age. OI was calculated as (1 - (median (all voided volumes in FVC in ml))/(0.65 ∗ EBC in ml)) ∗ 100. RESULTS At baseline, 26 patients (36.1%) had DO and small MCC, while 21 patients (29.2%) only had DO. In 18 patients (25.0%) only small MCC was found. Seven patients had normal findings and 20 did not perform a urodynamic study. OI ≥ 23 returned as a single significant predictor of OABSS >2 (OR 7.97, 95% 1.97-32.22, p = 0.004) in multivariate regression (R2 = 30.8%; AUC = 0.86). OI correlated with "urgency episodes over two weeks" and MCC/EBC with medium (r = 0.45) and large effect (r = -0.56), respectively, p = 0.001. DISCUSSION A strong correlation of OI and MCC/EBC ratio is useful, as rise in MCC is predictive of a positive outcome. Also, calculating the OI is more practical than performing UDS. This could contribute to the use of OI as a predictive marker for starting (or continuing) anticholinergic treatment (when OI ≥ 23) or for maintaining urotherapy alone (when OI < 23) in children with OAB. The limitations were lack of external validation of OI, a 37-49% drop-off rate for follow-up visits at 3 and 6 months, respectively, and not performing UDS on all participants at every follow-up visit. CONCLUSIONS OI was found to be a significant predictor of the presence of OAB symptoms and correlated with the number of urgency episodes. It could estimate how much MCC differs from EBC.
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Affiliation(s)
- Slaven Abdovic
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Zagreb, Croatia.
| | - Merima Colic
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Lorna Stemberger Maric
- Pediatric Infectious Diseases Department, University Hospital for Infectious Diseases "dr. Fran Mihaljevic", Zagreb, Croatia; University of Zagreb School of Medicine, Croatia
| | - Martin Cuk
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Iva Hizar
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Zagreb, Croatia
| | - Milan Milosevic
- University of Zagreb School of Medicine, Croatia; Andrija Stampar School of Public Health, Zagreb, Croatia
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15
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Stevanovic N, Markovic V, Milosevic M, Djurdjevic A, Stajic J, Milenkovic B, Nikezic D. Correlations between track parameters in a solid-state nuclear track detector and its diffraction pattern. Radiat Phys Chem Oxf Engl 1993 2022. [DOI: 10.1016/j.radphyschem.2022.109986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Milosevic M, Brborovic H, Žaja R, Masina T, Bislimovska D, Stoleski S, Mijakoski D. Work Engagement, Job Demands and Burnout among Croatian Health Care Workers during the Coronavirus Disease 2019 Pandemic. Saf Health Work 2022. [PMCID: PMC8817380 DOI: 10.1016/j.shaw.2021.12.1267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Mijakoski D, Atanasovska A, Bislimovska D, Brborovic H, Kezunovic LC, Milosevic M, Minov J, Önal B, Pranjic N, Rapas L, Stoleski S, Vangelova K, Žaja R, Karadzinska-Bislimovska J. Burnout and its predictors during pandemic in health workers from South-East European countries. Saf Health Work 2022. [PMCID: PMC8817370 DOI: 10.1016/j.shaw.2021.12.1675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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18
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Sef D, Milosevic M, Ostric M, Mestrovic T, Jernej B, Kovacic S, Kovacevic M, Skrtic A, Vidjak V. The role of magnetic resonance imaging and the expression of MMP-9 protein in the analysis of carotid atherosclerotic plaques in patients undergoing carotid endarterectomy: a prospective pilot study. Rev Cardiovasc Med 2021; 22:1611-1620. [PMID: 34957802 DOI: 10.31083/j.rcm2204167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 09/01/2023] Open
Abstract
Components of carotid atherosclerotic plaque can be analysed preoperatively by non-invasive advanced imaging modalities such as magnetic resonance imaging (MRI). The expression of matrix metalloproteinase-9 protein (MMP-9), which has a potential role in remodelling of atherosclerotic plaques, can be analysed immunohistochemically. The aim of the present prospective pilot study is to analyse histological characteristics and expression of MMP-9 in carotid plaques of patients undergoing carotid endarterectomy (CEA) and to investigate the correlation with preoperative clinical symptoms and MRI features. Preoperative clinical assessment, MRI imaging, postoperative histological and immunohistochemical analyses were performed. Fifteen patients with symptomatic (7/15; 47%) and asymptomatic carotid artery stenosis undergoing CEA were included. Among symptomatic patients, 5 (71%) had recent stroke and 2 (29%) had recent transient ischaemic attack with a median timing of 6 weeks (IQR: 1, 18) before the surgery. Both groups did not significantly differ in respect to preoperative characteristics. Prevalence of unstable plaque was higher in symptomatic than asymptomatic patients, although it was not significant (63% vs. 37%, p = 0.077). The expression of MMP-9 in CD68 cells within the plaque by semiquantitative analysis was found to be significantly higher in symptomatic as compared to asymptomatic patients (86% vs. 25% with the highest expression, p = 0.014). The average microvascular density was found to be higher and lipid core area larger among both symptomatic patients and unstable carotid plaque specimens, although this did not reach statistical significance (p = 0.064 and p = 0.132, p = 0.360 and p = 0.569, respectively). Our results demonstrate that MRI is reliable in classifying carotid lesions and differentiating unstable from stable plaques. We have also shown that the expression of MMP-9 is significantly higher among symptomatic patients undergoing CEA.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, The Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, EC1A 7BE London, UK
| | - Milan Milosevic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Andrija Stampar School of Public Health, 10000 Zagreb, Croatia
| | - Marin Ostric
- Department of Cardiac Surgery, University Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Tomislav Mestrovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Vascular Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Bojan Jernej
- Polyclinic for Radiology and Neurology "Dijagnostika 2000", 10000 Zagreb, Croatia
| | - Slavica Kovacic
- Department of Radiology, University Hospital Centre Rijeka, 51000 Rijeka, Croatia
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Miljenko Kovacevic
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Vascular Surgery, University Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Anita Skrtic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Pathology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Vinko Vidjak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
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Matic T, Novak M, Braovac D, Vinkovic M, Cicak AM, Milosevic M, Galic S, Cvitkovic M, Rubic F, Ille V, Plesko S. Characteristics, Risk Factors and Predictors for Candidemia in the Pediatric Intensive Care Unit at the University Hospital Centre Zagreb in Croatia: A 9-Year Retrospective Study. Pediatr Infect Dis J 2021; 40:981-986. [PMID: 34108407 DOI: 10.1097/inf.0000000000003225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Candidemia is one of the leading causes of bloodstream infections in the pediatric intensive care unit (PICU). The aim of this study was to define characteristics and risk factors for candidemia in the PICU setting and propose a predictive model to identify the patients at risk. METHODS This was a retrospective matched case-control study in the PICU during a 9-year period. Patients with candidemia were studied and matched with control patients without candidemia. Univariate analysis was performed for potential risk factors and multivariate analysis was conducted to determine the prediction score for candidemia. RESULTS Forty-two cases of candidemia were matched with 84 control patients. Candida parapsilosis was the most common (71.4%) species. Risk factors independently associated with candidemia were: the use of >2 antibiotics in a maximum period of 4 weeks before the candidemia (odds ratio [OR]: 10.59; 95% confidence interval [CI]: 2.05-54.83), a previous bacterial infection in a maximum period of 4 weeks before the candidemia (OR: 5.56; 95% CI: 1.44-21.5) and the duration of PICU stay of >10 days (OR: 4.22; 95% CI: 1.02-17.41). The proposed predictive scoring system has a sensitivity of 95.24%, specificity of 76.12%, OR 64.0, 95% CI 14.2-288.6, the positive predictive value of 66.67% and the negative predictive value of 96.97%. CONCLUSIONS Previously reported risk factors for candidemia have been confirmed and some new have been detected. The presented scoring system can help identify patients who would benefit from prophylactic antifungal therapy.
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Affiliation(s)
- Toni Matic
- From the Department of Pediatrics, University Hospital Centre Zagreb.,University of Zagreb School of Medicine
| | - Milivoj Novak
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Duje Braovac
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Maja Vinkovic
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Ana Marija Cicak
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Milan Milosevic
- University of Zagreb School of Medicine.,Andrija Stampar Teaching Institute of Public Health
| | - Slobodan Galic
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Miran Cvitkovic
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Filip Rubic
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Vanja Ille
- From the Department of Pediatrics, University Hospital Centre Zagreb
| | - Sanja Plesko
- University of Zagreb School of Medicine.,Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, Zagreb, Croatia
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Scott A, Polo A, Zubizarreta E, Aidoo C, Milosevic M, Rodin D. Access to Radiotherapy in Ghana: A Geospatial Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Madariaga Urrutia A, Bonilla L, King I, Garg S, Bowering V, Dhani N, Milosevic M, Han K, Lajkosz K, Karakasis K, Ghiassi P, Siman S, Rouzbahman M, Downs G, Park N, Sheen C, Udagani S, Stockley T, Oza A, Lheureux S. 805P Clinically actionable alterations in adolescents and young adults (AYA) with gynaecological cancers. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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22
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Prenc E, Pulanic D, Pucic-Bakovic M, Ugrina I, Desnica L, Milosevic M, Pirsl F, Mitchell S, Rose J, Vrhovac R, Nemet D, Lauc G, Pavletic SZ. Significant Associations of IgG Glycan Structures With Chronic Graft-Versus-Host Disease Manifestations: Results of the Cross-Sectional NIH Cohort Study. Front Immunol 2021; 12:633214. [PMID: 34335560 PMCID: PMC8317462 DOI: 10.3389/fimmu.2021.633214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 06/28/2021] [Indexed: 12/05/2022] Open
Abstract
Chronic graft-versus-host disease (cGvHD) is a systemic alloimmune and autoimmune disorder and a major late complication of allogeneic hematopoietic stem cell transplantation (alloHSCT). The disease is characterized by an altered homeostasis of the humoral immune response. Immunoglobulin G (IgG) glycoprotein is the main effector molecule of the humoral immune response. Changes in IgG glycosylation are associated with a number of autoimmune diseases. IgG glycosylation analysis was done by the means of liquid chromatography in the National Institutes of Health (NIH) cohort of 213 cGvHD patients. The results showed statistically significant differences with regards to cGvHD NIH joint/fascia and skin score, disease activity and intensity of systemic immunosuppression. ROC analysis confirmed that IgG glycosylation increases specificity and sensitivity of models using laboratory parameters and markers of inflammation associated with cGvHD (eosinophil count, complement components C3 and C4 and inflammation markers: albumin, CRP and thrombocyte count). This research shows that IgG glycosylation may play a significant role in cGvHD pathology. Further research could contribute to the understanding of the disease biology and lead to the clinical biomarker development to allow personalized approaches to chronic GvHD therapy.
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Affiliation(s)
- Ema Prenc
- Fidelta Ltd., Translational Research and Alliances, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Drazen Pulanic
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Ivo Ugrina
- Genos Ltd., Zagreb, Croatia.,Faculty of Science, University of Split, Split, Croatia
| | - Lana Desnica
- Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Milan Milosevic
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Environmental and Occupational Health and Sports, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Filip Pirsl
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sandra Mitchell
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Jeremy Rose
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
| | - Radovan Vrhovac
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Damir Nemet
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Internal Medicine, Division of Hematology, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | - Steven Z Pavletic
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, United States
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Milosevic M, Rodin D. SP-0049 Using health economics to make the case for brachytherapy – HALYS, QALYS and DALYS. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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24
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Abdovic S, Cuk M, Hizar I, Milosevic M, Jerkovic A, Saraga M. Pretreatment morning urine osmolality and oral desmopressin lyophilisate treatment outcome in patients with primary monosymptomatic enuresis. Int Urol Nephrol 2021; 53:1529-1534. [PMID: 33774753 DOI: 10.1007/s11255-021-02843-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the association between urine osmolality (Uosm) in patients with primary monosymptomatic enuresis (PMNE) and response to desmopressin (dDAVP) lyophilisate. METHODS This was a prospective cohort study that included 419 children with enuresis seen in outpatient clinic between October 2017 and October 2019. Patient workup included symptom checklist, 48 h frequency/volume chart, kidney and bladder ultrasound, uroflow, urinalysis and culture, spot urine Ca/creatinine, and first-morning Uosm. Patients < 5 years, with secondary enuresis, or loss of follow-up were excluded. Oral dDAVP lyophilisate was recommended to all with PMNE and normal bladder capacity. After 1 month of therapy, initial success was assessed according to ICCS. Significant predictor variables for complete response were identified and analyzed using correlation coefficients and binary logistic regression. RESULTS There were 48 patients with PMNE who received dDAVP and were followed for treatment success. Partial and complete responses were achieved for 14 (29.2%) and 20 cases (41.7%), respectively. Older age and lower Uosm were found to be significantly in favor of complete response to dDAVP lyophilisate, P = 0.007 and 0.033, respectively. ROC analysis determined the Uosm of ≤ 814 mOsm/kg as a cut-off value for complete success (sensitivity 65% and specificity 75%, AUC = 68.2%). The odds ratio for complete success for selected cut-off value was 5.57 (95% CI 1.588-19.551, P = 0.007). CONCLUSION High pretreatment morning Uosm (> 814 mOsm/kg) might be suggestive of an alternative treatment to dDAVP lyophilisate in PMNE because of the higher risk of treatment failure.
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Affiliation(s)
- S Abdovic
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Klaiceva 16, 10000, Zagreb, Croatia.
| | - M Cuk
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Klaiceva 16, 10000, Zagreb, Croatia
| | - I Hizar
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Klaiceva 16, 10000, Zagreb, Croatia
| | - M Milosevic
- Andrija Stampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - A Jerkovic
- Department of Pediatric Nephrology, Children's Hospital Zagreb, Klaiceva 16, 10000, Zagreb, Croatia
| | - M Saraga
- Department of Pediatric Nephrology, University Hospital Center Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
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Pauk M, Kufner V, Rumenovic V, Dumic-Cule I, Farkas V, Milosevic M, Bordukalo-Niksic T, Vukicevic S. Iron overload in aging Bmp6‑/‑ mice induces exocrine pancreatic injury and fibrosis due to acinar cell loss. Int J Mol Med 2021; 47:60. [PMID: 33649802 PMCID: PMC7910010 DOI: 10.3892/ijmm.2021.4893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
The relationship between hemochromatosis and diabetes has been well established, as excessive iron deposition has been reported to result in impaired function of the endocrine and exocrine pancreas. Therefore, the objective of the present study was to analyze the effects of iron accumulation on the pancreata and glucose homeostasis in a bone morphogenetic protein 6-knockout (Bmp6−/−) mouse model of hemochromatosis. The sera and pancreatic tissues of wild-type (WT) and Bmp6−/− mice (age, 3 and 10 months) were subjected to biochemical and histological analyses. In addition, 18F-fluorodeoxyglucose biodistribution was evaluated in the liver, muscle, heart, kidney and adipose tissue of both animal groups. The results demonstrated that 3-month-old Bmp6−/− mice exhibited iron accumulation preferentially in the exocrine pancreas, with no signs of pancreatic injury or fibrosis. No changes were observed in the glucose metabolism, as pancreatic islet diameter, insulin and glucagon secretion, blood glucose levels and glucose uptake in the liver, muscle and adipose tissue remained comparable with those in the WT mice. Aging Bmp6−/− mice presented with progressive iron deposits in the exocrine pancreas, leading to pancreatic degeneration and injury that was characterized by acinar atrophy, fibrosis and the infiltration of inflammatory cells. However, the aging mice exhibited unaltered blood glucose levels and islet structure, normal insulin secretion and moderately increased α-cell mass compared with those in the age-matched WT mice. Additionally, iron overload and pancreatic damage were not observed in the aging WT mice. These results supported a pathogenic role of iron overload in aging Bmp6−/− mice leading to iron-induced exocrine pancreatic deficiency, whereas the endocrine pancreas retained normal function.
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Affiliation(s)
- Martina Pauk
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
| | - Vera Kufner
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
| | - Viktorija Rumenovic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
| | - Ivo Dumic-Cule
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
| | - Vladimir Farkas
- Molecular Biology Department, Rudjer Boskovic Institute, HR‑10000 Zagreb, Croatia
| | - Milan Milosevic
- Andrija Stampar School of Public Health, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
| | - Tatjana Bordukalo-Niksic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
| | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, School of Medicine, University of Zagreb, HR‑10000 Zagreb, Croatia
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Wasserman D, Bindman D, Nesbitt AD, Cash D, Milosevic M, Francis PT, Chaudhuri KR, Leschziner GD, Ferini-Strambi L, Ballard C, Eccles A, Rosenzweig I. Striatal Dopaminergic Deficit and Sleep in Idiopathic Rapid Eye Movement Behaviour Disorder: An Explorative Study. Nat Sci Sleep 2021; 13:1-9. [PMID: 33447113 PMCID: PMC7802085 DOI: 10.2147/nss.s267037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/02/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is increasingly recognised as an important precursor disease state of alpha-synucleinopathies. This parasomnia is characterized by a history of recurrent nocturnal dream enactment behaviour, loss of skeletal muscle atonia, and increased phasic muscle activity during REM sleep. Neuroimaging studies of striatal dopamine transporter uptake tracer signaling suggest increasing dopaminergic deficit across the continuum of the alpha-synucleinopathies, with early sleep dysfunction suggestive of early caudate dysfunction. Henceforth, we set out to investigate the relationship between early sleep changes and the striatal dopaminergic availability in iRBD. METHODS Twelve patients with iRBD, who had undergone a video polysomnography and a neuroimaging assessment of striatal dopamine transporter (DaT) uptake tracer signaling, and 22 matched controls who had similarly undergone a video polysomnography were retrospectively identified. Data were statistically analyzed to identify altered sleep parameters and correlate them with striatal dopamine transporter uptake tracer signaling. RESULTS The iRBD patients exhibited an increased number of periodic limb movements during sleep (P=0.001), compared to 22 age-matched healthy subjects. In addition, several significant links were found between regional DaT-uptakes and sleep architecture. Correlational analyses suggested a strong positive association between sleep fragmentation and dopamine deficiency in left caudate (r=-0.630, P=0.028), whilst an increased uptake in the whole striatum was strongly linked to the sleep efficiency, and to a lesser degree to the length of sleep duration. DISCUSSION To the best of our knowledge, this is the first demonstration of a close relationship between dopaminergic availability in striatum and the quality of sleep in iRBD. Taken together, our exploratory findings suggest that subtle but functionally significant striatal changes in early stages of iRBD may contribute to the further shaping of sleep architecture.
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Affiliation(s)
- Danielle Wasserman
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Dorothea Bindman
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Alexander D Nesbitt
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Headache Group, Department of Clinical Neurosciences, King's College Hospital NHS Foundation Trust, London, UK
| | - Diana Cash
- BRAIN, Department of Neuroimaging, King's College London, London, UK
| | - Milan Milosevic
- School of Public Health "Andrija Stampar", University of Zagreb School of Medicine, Zagreb, Croatia
| | - Paul T Francis
- Wolfson Centre for Age-Related Diseases, King's College London, London, UK
| | - K Ray Chaudhuri
- Movement Disorders Unit, King's College Hospital, Department of Clinical and Basic Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, Parkinson Foundation Centre of Excellence, King's College London, London, UK
| | - Guy D Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Luigi Ferini-Strambi
- Sleep Disorders Center, Department of Clinical Neurosciences, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Amy Eccles
- Department of Nuclear Medicine, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Sleep Disorders Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Bujan Kovac A, Petelin Gadze Z, Rados M, Krbot Skoric M, Mrak G, Nemir J, Milosevic M, Hajnsek S. Brain MRI post-processing with MAP07 in the preoperative evaluation of patients with pharmacoresistant epilepsy - Croatian single centre experience. Clin Neurol Neurosurg 2020; 201:106426. [PMID: 33341458 DOI: 10.1016/j.clineuro.2020.106426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/04/2020] [Accepted: 12/05/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study aimed to determine the role of brain MRI post-processing method MAP07 (Morphometric Analysis Program) in detecting epileptogenic brain lesions in patients with pharmacoresistant epilepsy (PE). MAP07 is a sophisticated diagnostic program that offers several morphometric maps and facilitates the detection and localization of hippocampal sclerosis (HS), focal cortical dysplasias (FCD), and other types of cortical malformations, which could be undetected by conventional visual MRI analysis (CVA). METHODS 120 patients aged > 16 years with PE have been recruited. 3 T MRI was performed according to epilepsy imaging protocol followed by image postprocessing with a fully automated MATLAB script, MAP07, by applying SPM5 algorithms. Statistical analysis was performed in IBM SPSS Statistics, version 25.0. RESULTS Analysis in our patients showed a high sensitivity of MAP07 with low specificity and with a high proportion of false-positive patients. After MRI analysis, out of 120 patients, 32 were found to have no structural abnormalities by conventional visual analysis in whom after MAP07 in 5 patients structural lesions were found (in one HS, in one FCD, in two perinatal vascular lesions, and in one hippocampal hyperintensity). There was a quite high overall coincidence of the findings of MAP07 and MRI for the detection of FCD, HS, perinatal ischemia/chronic vascular lesions, heterotopias, and polymicrogyria (kappa coefficient above 0.700). CONCLUSIONS MAP07 analysis is a useful, additional, and automated method that may guide re-evaluation of MRI by highlighting suspicious cortical regions, as a complementary method to CVA, by enhancing the visualization of cortical malformations and lesions.
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Affiliation(s)
- Andreja Bujan Kovac
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated Partner of the ERN EpiCARE, Zagreb, Croatia.
| | - Zeljka Petelin Gadze
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated Partner of the ERN EpiCARE, Zagreb, Croatia
| | - Milan Rados
- Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Magdalena Krbot Skoric
- Department of Neurology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Referral Centre of the Ministry of Health of the Republic of Croatia for Epilepsy, Affiliated Partner of the ERN EpiCARE, Zagreb, Croatia; University of Zagreb, Faculty of Electrical Engineering and Computing, Zagreb, Croatia
| | - Goran Mrak
- Department of Neurosurgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Affiliated Partner of EUROCAN, Zagreb, Croatia
| | - Jakob Nemir
- Department of Neurosurgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Affiliated Partner of EUROCAN, Zagreb, Croatia
| | - Milan Milosevic
- Andrija Stampar School of Public Health, Department for Environmental Health, Occupational and Sports Medicine, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Sanja Hajnsek
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Stokovic N, Ivanjko N, Erjavec I, Milosevic M, Oppermann H, Shimp L, Sampath KT, Vukicevic S. Autologous bone graft substitute containing rhBMP6 within autologous blood coagulum and synthetic ceramics of different particle size determines the quantity and structural pattern of bone formed in a rat subcutaneous assay. Bone 2020; 141:115654. [PMID: 32977068 DOI: 10.1016/j.bone.2020.115654] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 01/10/2023]
Abstract
Bone morphogenetic proteins (BMPs) are potent osteoinductive agents for bone tissue engineering. In order to define optimal properties of a novel autologous bone graft substitute (ABGS) containing rhBMP6 within the autologous blood coagulum (ABC) and ceramic particles as a compression resistant matrix (CRM), we explored the influence of their amount, chemical composition and particle size on the quantity and quality of bone formation in the rat subcutaneous assay. Tested ceramic particles included tricalcium phosphate (TCP), hydroxyapatite (HA) and biphasic calcium phosphate ceramic (BCP), containing TCP and HA in 80/20 ratio of different particle sizes (small 74-420 μm, medium 500-1700 μm and large 1000-4000 μm). RhBMP6 was either mixed with ABC or lyophilized on CRM prior to use with ABC. The experiments were terminated on day 21 and implants were analysed by microCT, histology and histomorphometry. Addition of CRM to ABGS containing rhBMP6 in ABC significantly increased the amount of newly formed bone and the optimal CRM/ABC ratio was found to be around 100 mg/500 μL. MicroCT analyses revealed that all tested ABGS formulations induced an extensive new bone formation and there were no differences between the two methods of rhBMP6 application as determined by the bone volume. However, the particle size played a significant role in the quantity and quality of newly formed bone. ABGS containing small particles induced new bone forming a dense trabecular network, cortical bone at the rim, bone and bone marrow in apposition to and in between ceramic particles. ABGS containing medium and large particles also resulted in new bone on the surface of particles as well as inside the pores. Histomorphometric analysis revealed that the ceramics particle size correlated with the quality of trabecular pattern of newly formed bone, bone/bone marrow ratio as observed in apposition and between particles, and the ratio between the cortical and trabecular bone. By employing rat subcutaneous implant assay, we showed for the first time that the size of synthetic ceramics particles affected the osteogenesis as defined by both the quantity and quality of ectopic bone.
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Affiliation(s)
- Nikola Stokovic
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Croatia
| | - Natalia Ivanjko
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Croatia
| | - Igor Erjavec
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Croatia
| | - Milan Milosevic
- Department for Environmental Health, Occupational and Sports Medicine, Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | | | | | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia; Scientific Center of Excellence for Reproductive and Regenerative Medicine, Croatia.
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Durdevic D, Vlahovic T, Pehar S, Miklic D, Oppermann H, Bordukalo-Niksic T, Gavrankapetanovic I, Jamakosmanovic M, Milosevic M, Martinovic S, Sampath TK, Peric M, Grgurevic L, Vukicevic S. A novel autologous bone graft substitute comprised of rhBMP6 blood coagulum as carrier tested in a randomized and controlled Phase I trial in patients with distal radial fractures. Bone 2020; 140:115551. [PMID: 32730930 DOI: 10.1016/j.bone.2020.115551] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 12/26/2022]
Abstract
Bone morphogenetic proteins (BMPs) are known to induce new bone formation in vivo but treating trabecular bone defects with a BMP based therapeutic remains controversial. Here, we evaluated the safety and efficacy of a novel Autologous Bone Graft Substitute (ABGS) comprised of recombinant human BMP6 (rhBMP6) dispersed within an autologous blood coagulum (ABC) as a physiological natural carrier in patients with a closed distal radial fracture (DRF). We enrolled 32 patients in a randomized, standard of care (SoC) and placebo (PBO) controlled, double-blinded Phase I First in Human (FiH) clinical trial. ABGS was prepared from peripheral blood as 250 μg rhBMP6/mL ABC or PBO (1 mL ABC containing excipients only) and was administered dorsally via a syringe injection into the fracture site following closed fracture fixation with 3 Kirschner wires. Patients carried an immobilization for 5 weeks and were followed-up for 0 to 26 weeks by clinical examination, safety, serial radiographic analyses and CT. During the 13 weeks follow-up and at 26 weeks post study there were no serious adverse reactions recorded. The results showed that there were no detectable anti-rhBMP6 antibodies in the blood of any of the 32 patients at 13- and 26-weeks following treatment. Pharmacokinetic analyses of plasma from patients treated with ABGS showed no detectable rhBMP6 at any time point within the first 24 h following administration. The CT image and radiographic analyses score from patients treated with AGBS showed significantly accelerated bone healing as compared to PBO and SoC at 5 and 9 weeks (with high effect sizes and P = 0.027), while at week 13 all patients had similar healing outcomes. In conclusion, we show that intraosseous administration of ABGS (250 μg rhBMP6/mL ABC) into the distal radial fracture site demonstrated a good tolerability with no serious adverse reactions as well as early accelerated trabecular bone healing as compared to control PBO and SoC patients.
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Affiliation(s)
- Dragan Durdevic
- Clinical Hospital Center "Sisters of Mercy", Clinic of Traumatology, Draskoviceva 19, 10000 Zagreb, Croatia
| | - Tomislav Vlahovic
- Clinical Hospital Center "Sisters of Mercy", Clinic of Traumatology, Draskoviceva 19, 10000 Zagreb, Croatia
| | - Sanja Pehar
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Salata 11, 10000 Zagreb, Croatia
| | - Dina Miklic
- Clinical Hospital Center "Sisters of Mercy", Clinic of Traumatology, Draskoviceva 19, 10000 Zagreb, Croatia
| | - Hermann Oppermann
- Genera Research, Svetonedeljska 2, Kalinovica, 10436, Rakov Potok, Croatia
| | - Tatjana Bordukalo-Niksic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Salata 11, 10000 Zagreb, Croatia
| | - Ismet Gavrankapetanovic
- University Clinical Center Sarajevo, Clinic of Orthopedics and Traumatology, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Mehmed Jamakosmanovic
- University Clinical Center Sarajevo, Clinic of Orthopedics and Traumatology, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina
| | - Milan Milosevic
- School of Public Health "Andrija Stampar", University of Zagreb School of Medicine, Rockefellerova 4, 10000 Zagreb, Croatia
| | | | | | - Mihaela Peric
- Department for Intracellular Communication, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Salata 2, 10000 Zagreb, Croatia
| | - Lovorka Grgurevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Salata 11, 10000 Zagreb, Croatia
| | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Salata 11, 10000 Zagreb, Croatia.
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Khoja L, Hurst N, Weiss J, Liu Z, Laframboise S, Clarke B, Han K, Milosevic M, Fyles A, Dhani N, Croke J. Vulvar Carcinoma: Patterns Of Practice And Clinical Outcomes From A Large Academic Cancer Centre. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Chiari C, Grgurevic L, Bordukalo-Niksic T, Oppermann H, Valentinitsch A, Nemecek E, Staats K, Schreiner M, Trost C, Kolb A, Kainberger F, Pehar S, Milosevic M, Martinovic S, Peric M, Sampath TK, Vukicevic S, Windhager R. Recombinant Human BMP6 Applied Within Autologous Blood Coagulum Accelerates Bone Healing: Randomized Controlled Trial in High Tibial Osteotomy Patients. J Bone Miner Res 2020; 35:1893-1903. [PMID: 32543706 PMCID: PMC7689741 DOI: 10.1002/jbmr.4107] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 06/02/2020] [Accepted: 06/07/2020] [Indexed: 12/11/2022]
Abstract
Bone morphogenetic proteins (BMPs) are potent osteogenic proteins that induce new bone formation in vivo. However, their effect on bone healing in the trabecular bone surfaces remains challenging. We evaluated the safety and efficacy of recombinant human BMP6 (rhBMP6) applied within an autologous blood coagulum (ABC) in a surgically created wedge defect of the proximal tibia in patients undergoing high tibial osteotomy (HTO) for varus deformity and medial osteoarthritis of the knee. We enrolled 20 HTO patients in a randomized, placebo-controlled, double-blinded phase I/II clinical trial. RhBMP6/ABC (1.0 mg/10 mL ABC prepared from peripheral blood) or placebo (10 mL ABC containing excipients) was administered into the tibial wedge defects. Patients were followed for 0 to 24 months by clinical examination (safety) and computed tomography (CT) and serial radiographic analyses (efficacy). The results show that there were no detectable anti-rhBMP6 antibodies in the blood of any of the 20 patients at 14 weeks after implantation. During the 24 months of follow-up, there were no serious adverse reactions recorded. The CT scans from defects of patients treated with rhBMP6/ABC showed an accelerated bone healing compared with placebo at 9 weeks (47.8 ± 24.1 versus 22.2 ± 12.3 mg/cm3 ; p = 0.008) and at 14 weeks (89.7 ± 29.1 versus 53.6 ± 21.9 mg/cm3 ; p = 0.006) follow-up. Radiographic analyses at weeks 6 and 24 and months 12 and 24 suggested the advanced bone formation and remodeling in rhBMP6/ABC-treated patients. In conclusion, we show that rhBMP6/ABC at a dose of 100 μg/mL accelerated bone healing in patients undergoing HTO without serious adverse events and with a good tolerability compared with placebo alone. Overall, for the first time, a BMP-based osteogenic implant was examined against a placebo for bone healing efficacy in the trabecular bone surface, using an objective bone mineral density measurement system. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Catharina Chiari
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Lovorka Grgurevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Tatjana Bordukalo-Niksic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - Elena Nemecek
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Kevin Staats
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Schreiner
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Carmen Trost
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Kolb
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Sanja Pehar
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Milan Milosevic
- Department of Environmental and Occupational Health and Sports, School of Public Health, "Andrija Stampar,", University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Mihaela Peric
- Department for Intracellular Communication, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Centre for Translational and Clinical Research, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
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Milosevic M, Edwards J, Tsang D, Dunning J, Shackcloth M, Batchelor T, Coonar A, Hasan J, Davidson B, Marchbank A, Grumett S, Williams N, Macbeth F, Farewell V, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer: updated analysis of 93 randomized patients - control survival is much better than previously assumed. Colorectal Dis 2020; 22:1314-1324. [PMID: 32388895 PMCID: PMC7611567 DOI: 10.1111/codi.15113] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
AIM Lung metastases from colorectal cancer are resected in selected patients in the belief that this confers a significant survival advantage. It is generally assumed that the 5-year survival of these patients would be near zero without metastasectomy. We tested the clinical effectiveness of this practice in Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), a randomized, controlled noninferiority trial. METHOD Multidisciplinary teams in 14 hospitals recruited patients with resectable lung metastases into a two-arm trial. Randomization was remote and stratified according to site, with minimization for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, number of metastases and carcinoembryonic antigen level. The trial management group was blind to patient allocation until after intention-to-treat analysis. RESULTS From 2010 to 2016, 93 participants were randomized. These patients were 35-86 years of age and had between one and six lung metastases at a median of 2.7 years after colorectal cancer resection; 29% had prior liver metastasectomy. The patient groups were well matched and the characteristics of these groups were similar to those of observational studies. The median survival after metastasectomy was 3.5 (95% CI: 3.1-6.6) years compared with 3.8 (95% CI: 3.1-4.6) years for controls. The estimated unadjusted hazard ratio for death within 5 years, comparing the metastasectomy group with the control group, was 0.93 (95% CI: 0.56-1.56). Use of chemotherapy or local ablation was infrequent and similar in each group. CONCLUSION Patients in the control group (who did not undergo lung metastasectomy) have better survival than is assumed. Survival in the metastasectomy group is comparable with the many single-arm follow-up studies. The groups were well matched with features similar to those reported in case series.
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Affiliation(s)
- M. Milosevic
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - J. Edwards
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - D. Tsang
- Basildon and Thurrock University Hospitals NHS Foundation TrustBasildonUK
| | - J. Dunning
- South Tees Hospitals NHS Foundation TrustThe James Cook University HospitalMiddlesbroughUK
| | - M. Shackcloth
- Liverpool Heart And Chest Hospital NHS Foundation TrustLiverpoolUK
| | - T. Batchelor
- Bristol Royal InfirmaryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Coonar
- Royal Papworth Hospital NHS Foundation TrustCambridgeUK
| | - J. Hasan
- The Christie NHS Foundation TrustManchesterUK
| | - B. Davidson
- Division of SurgeryRoyal Free London NHS Foundation TrustUCLLondonUK
| | - A. Marchbank
- Derriford HospitalUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - S. Grumett
- The Royal Wolverhampton NHS TrustNew Cross HospitalWolverhamptonUK
| | - N.R. Williams
- Surgical & Interventional Trials Unit (SITU)University College LondonLondonUK
| | - F. Macbeth
- Centre for Trials ResearchCardiff UniversityCardiffUK
| | | | - T. Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
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Grgurevic L, Erjavec I, Gupta M, Pecin M, Bordukalo-Niksic T, Stokovic N, Vnuk D, Farkas V, Capak H, Milosevic M, Bubic Spoljar J, Peric M, Vuckovic M, Maticic D, Windhager R, Oppermann H, Sampath TK, Vukicevic S. Autologous blood coagulum containing rhBMP6 induces new bone formation to promote anterior lumbar interbody fusion (ALIF) and posterolateral lumbar fusion (PLF) of spine in sheep. Bone 2020; 138:115448. [PMID: 32450340 DOI: 10.1016/j.bone.2020.115448] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
In the present study, we evaluated an autologous bone graft substitute (ABGS) composed of recombinant human BMP6 (rhBMP6) dispersed within autologous blood coagulum (ABC) used as a physiological carrier for new bone formation in spine fusion sheep models. The application of ABGS included cervical cage for use in the anterior lumbar interbody fusion (ALIF), while for the posterolateral lumbar fusion (PLF) sheep model allograft devitalized bone particles (ALLO) were applied with and without use of instrumentation. In the ALIF model, ABGS (rhBMP6/ABC/cage) implants fused significantly when placed in between the L4-L5 vertebrae as compared to control (ABC/cage) which appears to have a fibrocartilaginous gap, as examined by histology and micro CT analysis at 16 weeks following surgery. In the PLF model, ABGS implants with or without ALLO showed a complete fusion when placed ectopically in the gutter bilaterally between two decorticated L4-L5 transverse processes at a success rate of 88% without instrumentation and at 80% with instrumentation; however the bone volume was 50% lower in the instrumentation group than without, as examined by histology, radiographs, micro CT analyses and biomechanical testing at 27 weeks following surgery. The newly formed bone was uniform within ABGS implants resulting in a biomechanically competent and histologically qualified fusion with an optimum dose in the range of 100 μg rhBMP6 per mL ABC, while in the implants that contained ALLO, the mineralized bone particles were substituted by the newly formed remodeling bone via creeping substitution. These findings demonstrate for the first time that ABGS (rhBMP6/ABC) without and with ALLO particles induced a robust bone formation with a successful fusion in sheep models of ALIF and PLF, and that autologous blood coagulum (ABC) can serve as a preferred physiological native carrier to induce new bone at low doses of rhBMP6 and to achieve a successful spinal fusion.
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Affiliation(s)
- Lovorka Grgurevic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Igor Erjavec
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Munish Gupta
- Department of Orthopedic Surgery, Washington University, St. Louis, MO 63110, USA
| | - Marko Pecin
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Tatjana Bordukalo-Niksic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Nikola Stokovic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Drazen Vnuk
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Vladimir Farkas
- Division of Molecular Biology, Rudjer Boskovic Institute, 10000 Zagreb, Croatia
| | - Hrvoje Capak
- Department of Radiology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Milan Milosevic
- Department of Environmental and Occupational Health and Sports, School of Public Health "Andrija Stampar", University of Zagreb School of Medicine, Rockefellerova 4, 10000 Zagreb, Croatia
| | - Jadranka Bubic Spoljar
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Mihaela Peric
- Center for Translational and Clinical Research, School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Mirta Vuckovic
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Drazen Maticic
- Clinics for Surgery, Orthopedics and Ophthalmology, School of Veterinary Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Reinhard Windhager
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | | | | | - Slobodan Vukicevic
- Laboratory for Mineralized Tissues, Center for Translational and Clinical Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia.
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Polsek D, Cash D, Veronese M, Ilic K, Wood TC, Milosevic M, Kalanj-Bognar S, Morrell MJ, Williams SCR, Gajovic S, Leschziner GD, Mitrecic D, Rosenzweig I. The innate immune toll-like-receptor-2 modulates the depressogenic and anorexiolytic neuroinflammatory response in obstructive sleep apnoea. Sci Rep 2020; 10:11475. [PMID: 32651433 PMCID: PMC7351955 DOI: 10.1038/s41598-020-68299-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/16/2020] [Indexed: 12/19/2022] Open
Abstract
The increased awareness of obstructive sleep apnoea’s (OSA) links to Alzheimer’s disease and major psychiatric disorders has recently directed an intensified search for their potential shared mechanisms. We hypothesised that neuroinflammation and the microglial TLR2-system may act as a core process at the intersection of their pathophysiology. Moreover, we postulated that inflammatory-response might underlie development of key behavioural and neurostructural changes in OSA. Henceforth, we set out to investigate effects of 3 weeks’ exposure to chronic intermittent hypoxia in mice with or without functional TRL2 (TLR2+/+, C57BL/6-Tyrc-Brd-Tg(Tlr2-luc/gfp)Kri/Gaj;TLR2−/−,C57BL/6-Tlr2tm1Kir). By utilising multimodal imaging in this established model of OSA, a discernible neuroinflammatory response was demonstrated for the first time. The septal nuclei and forebrain were shown as the initial key seed-sites of the inflammatory cascade that led to wider structural changes in the associated neurocircuitry. Finally, the modulatory role for the functional TLR2-system was suggested in aetiology of depressive, anxious and anorexiolytic symptoms in OSA.
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Affiliation(s)
- Dora Polsek
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), De Crespigny Park, Box 089, London, SE5 8AF, UK.,University of Zagreb School of Medicine, Croatian Institute for Brain Research, Zagreb, Croatia
| | - Diana Cash
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), De Crespigny Park, Box 089, London, SE5 8AF, UK.,BRAIN, Department of Neuroimaging, KCL, London, UK
| | | | - Katarina Ilic
- University of Zagreb School of Medicine, Croatian Institute for Brain Research, Zagreb, Croatia
| | | | - Milan Milosevic
- School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Svjetlana Kalanj-Bognar
- University of Zagreb School of Medicine, Croatian Institute for Brain Research, Zagreb, Croatia
| | - Mary J Morrell
- The National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Srecko Gajovic
- University of Zagreb School of Medicine, Croatian Institute for Brain Research, Zagreb, Croatia
| | - Guy D Leschziner
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), De Crespigny Park, Box 089, London, SE5 8AF, UK.,Department of Neurology, Guy's and St Thomas' Hospital (GSTT) and Clinical Neurosciences, KCL, London, UK.,Sleep Disorders Centre, GSTT, London, UK
| | - Dinko Mitrecic
- University of Zagreb School of Medicine, Croatian Institute for Brain Research, Zagreb, Croatia
| | - Ivana Rosenzweig
- Sleep and Brain Plasticity Centre, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), De Crespigny Park, Box 089, London, SE5 8AF, UK. .,Sleep Disorders Centre, GSTT, London, UK.
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Milosevic M, Wendland N, Lee RE, Gregory BW. The Usefulness of Spectroscopic Simulations. Appl Spectrosc 2020; 74:305-313. [PMID: 31746219 DOI: 10.1177/0003702819893689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This article presents a method for extracting the optical constants of homogeneous isotropic materials using the infrared spectra of that material. The method is based on using the harmonic oscillator model of molecular polarizability to obtain optical constants, then calculating the spectrum, comparing the calculated spectrum to an experimental spectrum of the material, and adjusting the model parameters until a close fit between the spectra is obtained. Corrections that need to be made to the experimental spectra in order to remove instrumental distortions are also briefly described. The remainder of the article centers on describing how the optical constants can be used to simulate spectra of that material in different experimental arrangements and the benefits that spectral simulations afford to experimentalists.
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Affiliation(s)
| | - Nils Wendland
- Department of Chemistry and Biochemistry, Samford University, Birmingham, AL, USA
| | - Robert E Lee
- Department of Chemistry and Biochemistry, Samford University, Birmingham, AL, USA
| | - Brian W Gregory
- Department of Chemistry and Biochemistry, Samford University, Birmingham, AL, USA
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Kang J, Tsai CC, Hasegawa H, Morris-Paterson T, Higgins S, Crum W, Gnoni V, Green D, Gunasinghe C, Nesbitt A, Williams S, Milosevic M, Ashkan K, Goadsby P, Leschziner G, Harridge S, Rosenzweig I. The effect of hyper-buoyancy floatation (HBF), a model of simulated microgravity, on sleep and cognitive function in humans. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.1091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Velec M, Tadic T, Xie J, Moseley J, Patel T, Milosevic M, Fyles A, Han K, Croke J. Deformable Dose Accumulation for Hybrid CBCT-MRI Guided Adaptive Radiotherapy for Cervix Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tadic T, Croke J, Xie J, Stanescu T, Letourneau D, Bissonnette J, Breen S, Simeonov A, Dickie C, Hill C, Li W, Ellis C, Winter J, Velec M, Fyles A, Han K, Jaffray D, Milosevic M. In-Room MRI for Adaptive Radiotherapy for Cervical Cancer Using an Integrated MR-Guided Radiation Therapy System. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Petricevic M, Knezevic J, Biocina B, Mikus M, Konosic L, Rasic M, Milosevic M, Rotim C, Madzar T, Rotim A, Gasparovic H, Goerlinger K. Association among Clopidogrel Cessation, Platelet Function, and Bleeding in Coronary Bypass Surgery: An Observational Trial. Thorac Cardiovasc Surg 2019; 69:630-638. [PMID: 31362327 DOI: 10.1055/s-0039-1693122] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study sought to determine (1) the association between the length of preoperative clopidogrel discontinuation, blood loss, and transfusion requirements and (2) whether preoperative platelet function testing predicts excessive postoperative bleeding in patients undergoing coronary artery bypass grafting (CABG) surgery. METHODS In this retrospective analysis, patients undergoing CABG were divided into three groups with regard to the period between preoperative clopidogrel cessation and surgery: group 1 (n = 94, ≤3 days), group 2 (n = 100, 4-5 days), and group 3 (n = 83, 6-7 days), respectively. Impedance aggregometry (Multiplate) with arachidonic acid (ASPI) test assay (used for platelets stimulation) and adenosine diphosphate (ADP) test (used for platelets stimulation) was performed before the surgery. Primary outcome was 24 hours chest tube output (CTO) and transfusion requirements (red blood cell concentrate [RBCC], platelet concentrate [PC], fibrinogen concentrate [FC], and fresh-frozen plasma [FFP]) were considered as secondary outcomes. RESULTS CTO during 24 hours was significantly higher in group 1 as compared with groups 2 and 3, respectively (p = 0.003). Considering secondary outcomes, RBCC (p = 0.043), PC (p = 0.001), FC (p = 0.003), and FFP (p = 0.010) were more frequently transfused in group 1 as compared with groups 2 and 3, respectively. Multiple electrode aggregometry ASPI and ADP tests were significantly correlated with the 24-hour CTO (ASPI test-rho = -0.258, p < 0.001; ADP test-rho = -0.164, p = 0.007). A significant correlation was observed between clopidogrel-free interval and 24-hour CTO (rho = -0.200, p < 0.001). Receiver-operating characteristics (ROC) curve analysis revealed cutoff values to delineate bleeding tendency (ASPI test ≤ 25 area under the aggregation curve [AUC], ADP test ≤63 AUC, and clopidogrel-free interval ≤3 days). CONCLUSION Excessive postoperative bleeding occurred less frequently if the period between clopidogrel discontinuation and surgery was longer than 3 days, as compared with shorter waiting time. Inadequate recovery of the platelets function following clopidogrel cessation in preoperative period was associated with increased bleeding risk. Platelet function testing was found to be a useful tool for postoperative bleeding management in our hands.
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Affiliation(s)
- Mate Petricevic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Jadranka Knezevic
- University Hospital Center Mostar, University of Mostar School of Medicine, Mostar, Bosnia and Herzegovina
| | - Bojan Biocina
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mislav Mikus
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Lucija Konosic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Mario Rasic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Milan Milosevic
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | - Cecilija Rotim
- Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia
| | | | - Ante Rotim
- University of Osijek School of Medicine, Osijek, Croatia
| | - Hrvoje Gasparovic
- Department of Cardiac Surgery, University Hospital Center Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Klaus Goerlinger
- Klinik fur Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, and TEM International GmbH, Munich, Germany
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Milosevic M. SP-0150 Using functional imaging as a guidance and decision tool in radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30570-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kojic M, Milosevic M, Simic V, Geroski V, Ziemys A, Filipovic N, Ferrari M. Smeared multiscale finite element model for electrophysiology and ionic transport in biological tissue. Comput Biol Med 2019; 108:288-304. [PMID: 31015049 DOI: 10.1016/j.compbiomed.2019.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/22/2019] [Accepted: 03/23/2019] [Indexed: 10/27/2022]
Abstract
Basic functions of living organisms are governed by the nervous system through bidirectional signals transmitted from the brain to neural networks. These signals are similar to electrical waves. In electrophysiology the goal is to study the electrical properties of biological cells and tissues, and the transmission of signals. From a physics perspective, there exists a field of electrical potential within the living body, the nervous system, extracellular space and cells. Electrophysiological problems can be investigated experimentally and also theoretically by developing appropriate mathematical or computational models. Due to the enormous complexity of biological systems, it would be almost impossible to establish a detailed computational model of the electrical field, even for only a single organ (e.g. heart), including the entirety of cells comprising the neural network. In order to make computational models feasible for practical applications, we here introduce the concept of smeared fields, which represents a generalization of the previously formulated multiscale smeared methodology for mass transport in blood vessels, lymph, and tissue. We demonstrate the accuracy of the smeared finite element computational models for the electric field in numerical examples. The electrical field is further coupled with ionic mass transport within tissue composed of interstitial spaces extracellularly and by cytoplasm and organelles intracellularly. The proposed methodology, which couples electrophysiology and molecular ionic transport, is applicable to a variety of biological systems.
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Affiliation(s)
- M Kojic
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX, 77030, USA; Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400, Kragujevac, Serbia; Serbian Academy of Sciences and Arts, Knez Mihailova 35, 11000, Belgrade, Serbia.
| | - M Milosevic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400, Kragujevac, Serbia; Belgrade Metropolitan University, Tadeuša Košćuška 63, 11000, Belgrade, Serbia
| | - V Simic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400, Kragujevac, Serbia
| | - V Geroski
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400, Kragujevac, Serbia
| | - A Ziemys
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX, 77030, USA
| | - N Filipovic
- University of Kragujevac, Faculty for Engineering Sciences, Sestre Janic 6, 34000, Kragujevac, Serbia
| | - M Ferrari
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX, 77030, USA
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Abdovic S, Cuk M, Cekada N, Milosevic M, Geljic A, Fusic S, Bastic M, Bahtijarevic Z. Predicting posterior urethral obstruction in boys with lower urinary tract symptoms using deep artificial neural network. World J Urol 2018; 37:1973-1979. [DOI: 10.1007/s00345-018-2588-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022] Open
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Grabovac I, Milosevic M, Mustajbegovic J. Perceived and Experienced Discrimination and Sexual Identity Disclosure of Lesbian, Gay and Bisexual Patients in Croatia. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Han K, Welch M, Weiss J, Pintilie M, Fyles T, Milosevic M. An MRI-Based Radiomic Signature for Disease-Free Survival in Locally Advanced Cervical Cancer. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schulman D, Milosevic M, Singh P. TECHNOLOGY-ENABLED SUBJECTIVE WELLNESS OBSERVATIONS BY INFORMAL CAREGIVERS: A QUALITATIVE ANALYSIS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - P Singh
- Philips Research North America
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Ziemys A, Yokoi K, Kai M, Liu YT, Kojic M, Simic V, Milosevic M, Holder A, Ferrari M. Progression-dependent transport heterogeneity of breast cancer liver metastases as a factor in therapeutic resistance. J Control Release 2018; 291:99-105. [PMID: 30332610 DOI: 10.1016/j.jconrel.2018.10.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 12/13/2022]
Abstract
Metastatic disease is a major cause of mortality in cancer patients. While many drug delivery strategies for anticancer therapeutics have been developed in preclinical studies of primary tumors, the drug delivery properties of metastatic tumors have not been sufficiently investigated. Therapeutic efficacy hinges on efficient drug permeation into the tumor microenvironment, which is known to be heterogeneous thus potentially making drug permeation heterogeneous, also. In this study, we have identified that 4 T1 liver metastases, treated with pegylated liposomal doxorubicin, have unfavorable and heterogeneous transport of doxorubicin. Our drug extravasation results differ greatly from analogous studies with 4 T1 tumors growing in the primary site. A probabilistic tumor population model was developed to estimate drug permeation efficiency and drug kinetics of liver metastases by integrating the transport and structural properties of tumors and delivered drugs. The results demonstrate significant heterogeneity in metastases with regard to transport properties of doxorubicin within the same animal model, and even within the same organ. These results also suggest that the degree of heterogeneity depends on the stage of tumor progression and that differences in transport properties can define transport-based tumor phenotypes. These findings may have valuable clinical implications by illustrating that therapeutic agents can permeate and eliminate metastases of "less resistant" transport phenotypes, while sparing tumors with more "resistant" transport properties. We anticipate that these results could challenge the current paradigm of drug delivery into metastases, highlight potential caveats for therapies that may alter tumor perfusion, and deepen our understanding of the emergence of drug transport-based therapeutic resistance.
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Affiliation(s)
- A Ziemys
- Houston Methodist Research Institute, The Department of Nanomedicine, Houston, TX, USA.
| | - K Yokoi
- Houston Methodist Research Institute, The Department of Nanomedicine, Houston, TX, USA
| | - M Kai
- Houston Methodist Research Institute, The Department of Nanomedicine, Houston, TX, USA
| | - Y T Liu
- Houston Methodist Research Institute, The Department of Nanomedicine, Houston, TX, USA
| | - M Kojic
- Houston Methodist Research Institute, The Department of Nanomedicine, Houston, TX, USA; Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400 Kragujevac, Serbia; Serbian Academy of Sciences and Arts, Knez Mihailova 35, 11000 Belgrade, Serbia
| | - V Simic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400 Kragujevac, Serbia
| | - M Milosevic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400 Kragujevac, Serbia
| | - A Holder
- Department of Surgery, Houston Methodist, Houston, TX, USA
| | - M Ferrari
- Houston Methodist Research Institute, The Department of Nanomedicine, Houston, TX, USA
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Milosevic M, Simic V, Milicevic B, Koay E, Ferrari M, Ziemys A, Kojic M. Correction function for accuracy improvement of the Composite Smeared Finite Element for diffusive transport in biological tissue systems. Comput Methods Appl Mech Eng 2018; 338:97-116. [PMID: 30555187 PMCID: PMC6292687 DOI: 10.1016/j.cma.2018.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Modeling of drug transport within capillaries and tissue remains a challenge, especially in tumors and cancers where the capillary network exhibits extremely irregular geometry. Recently introduced Composite Smeared Finite Element (CSFE) provides a new methodology of modeling complex convective and diffusive transport in the capillary-tissue system. The basic idea in the formulation of CSFE is in dividing the FE into capillary and tissue domain, coupled by 1D connectivity elements at each node. Mass transport in capillaries is smeared into continuous fields of pressure and concentration by introducing the corresponding Darcy and diffusion tensors. Despite theoretically correct foundation, there are still differences in the overall mass transport to (and from) tissue when comparing smeared model and a true 3D model. The differences arise from the fact that the smeared model cannot take into account the detailed non-uniform pressure and concentration distribution in the vicinity of capillaries. We introduced a field of correction function for diffusivity through the capillary walls of smeared models, in order to have the same mass accumulation in tissue as in case of true 3D models. The parameters of the numerically determined correction function are: ratio of thickness and diameter of capillary wall, ratio of diffusion coefficient in capillary wall and surrounding tissue; and volume fraction of capillaries within tissue domain. Partitioning at the capillary wall - blood interface can also be included. It was shown that the correction function is applicable to complex configurations of capillary networks, providing improved accuracy of our robust smeared models in computer simulations of real transport problems, such as in tumors or human organs.
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Affiliation(s)
- M. Milosevic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia
- Belgrade Metropolitan University, Tadeusa Koscuska 63, 11000 Belgrade, Serbia
| | - V. Simic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia
| | - B. Milicevic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia
| | - E.J. Koay
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX 77030, United States
| | - M. Ferrari
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX 77030
| | - A. Ziemys
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX 77030
| | - M. Kojic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX 77030
- Serbian Academy of Sciences and Arts, Knez Mihailova 35,11000 Belgrade
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Kojic M, Milosevic M, Simic V, Koay EJ, Kojic N, Ziemys A, Ferrari M. Multiscale smeared finite element model for mass transport in biological tissue: From blood vessels to cells and cellular organelles. Comput Biol Med 2018; 99:7-23. [PMID: 29807251 DOI: 10.1016/j.compbiomed.2018.05.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/19/2018] [Accepted: 05/19/2018] [Indexed: 11/16/2022]
Abstract
One of the basic and vital processes in living organisms is mass exchange, which occurs on several levels: it goes from blood vessels to cells and organelles within cells. On that path, molecules, as oxygen, metabolic products, drugs, etc. Traverse different macro and micro environments - blood, extracellular/intracellular space, and interior of organelles; and also biological barriers such as walls of blood vessels and membranes of cells and organelles. Many aspects of this mass transport remain unknown, particularly the biophysical mechanisms governing drug delivery. The main research approach relies on laboratory and clinical investigations. In parallel, considerable efforts have been directed to develop computational tools for additional insight into the intricate process of mass exchange and transport. Along these lines, we have recently formulated a composite smeared finite element (CSFE) which is composed of the smeared continuum pressure and concentration fields of the capillary and lymphatic system, and of these fields within tissue. The element offers an elegant and simple procedure which opens up new lines of inquiry and can be applied to large systems such as organs and tumors models. Here, we extend this concept to a multiscale scheme which concurrently couples domains that span from large blood vessels, capillaries and lymph, to cell cytosol and further to organelles of nanometer size. These spatial physical domains are coupled by the appropriate connectivity elements representing biological barriers. The composite finite element has "degrees of freedom" which include pressures and concentrations of all compartments of the vessels-tissue assemblage. The overall model uses the standard, measurable material properties of the continuum biological environments and biological barriers. It can be considered as a framework into which we can incorporate various additional effects (such as electrical or biochemical) for transport through membranes or within cells. This concept and the developed FE software within our package PAK offers a computational tool that can be applied to whole-organ systems, while also including specific domains such as tumors. The solved examples demonstrate the accuracy of this model and its applicability to large biological systems.
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Affiliation(s)
- M Kojic
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX, 77030, USA; Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400 Kragujevac, Serbia; Serbian Academy of Sciences and Arts, Knez Mihailova 35, 11000, Belgrade, Serbia.
| | - M Milosevic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400 Kragujevac, Serbia
| | - V Simic
- Bioengineering Research and Development Center BioIRC Kragujevac, Prvoslava Stojanovica 6, 3400 Kragujevac, Serbia
| | - E J Koay
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - N Kojic
- Center for Engineering in Medicine and Surgical Services, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - A Ziemys
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX, 77030, USA
| | - M Ferrari
- Houston Methodist Research Institute, The Department of Nanomedicine, 6670 Bertner Ave., R7-117, Houston, TX, 77030, USA
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Yap M, Allo G, Cuartero J, Pintilie M, Kamel-Reid S, Murphy J, Mackay H, Clarke B, Fyles A, Milosevic M. Prognostic Significance of Human Papilloma Virus and p16 Expression in Patients with Vulvar Squamous Cell Carcinoma who Received Radiotherapy. Clin Oncol (R Coll Radiol) 2018; 30:254-261. [DOI: 10.1016/j.clon.2018.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/17/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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Lukovic J, Han K, Pintilie M, Chaudary N, Hill R, Fyles A, Milosevic M. OC-0149: Intratumoral heterogeneity and hypoxia gene expression signatures in cervix cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30459-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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