Croatian Medical Journal最新文献

Aim: To determine the rate of and predictive factors for postacute in-hospital survival of older adults after successful weaning from extremely prolonged mechanical ventilation (e-PMV).

Methods: This pilot retrospective study involved patients who were weaned from e-PMV in Bayit Balev Geriatric and Rehabilitation Center, Maccabi Health Services, Bat Yam, Israel between January 2010 and May 2022. In-hospital survival was measured.

Results: Out of 488 patients (of all ages) treated in our geriatric rehabilitation center (GRC) during the study period, only 181 patients aged 65 years and older were conscious and were candidates for weaning from e-PMV. Seventy-three patients (40.3%) were weaned and therefore recruited to this study. Six patients (8.2%) were weaned but died before discharge. Out of the 67 (91.8%) who were alive and weaned, 18 (24.7%) were decanulated and discharged to their homes, and the remaining 49 (75.3%) were weaned and discharged from our GRC with tracheostomy canula to other long-term care institutions. Univariate analysis showed that in-hospital survival was significantly dependent on age and the presence of tracheomalacia, both in a time-independent and time-dependent manner. In a time-dependent (adjusted) multivariate analysis, there were no independent predictive factors for in-hospital mortality.

Conclusions: A dedicated GRC team can wean a substantial number of patients after e-PMV and return them to their community and even homes.

Aim: To evaluate the effect of 5 alpha-reductase inhibitor (5-ARI) treatment on prostate cancer detection by multiparametric magnetic resonance imaging (mpMRI).

Methods: We retrospectively collected data on 429 patients who underwent mpMRI before prostate biopsy in the Urology Department of Giresun University Training and Research Hospital between March 2018 and December 2021. The patients were categorized as those who had never been treated with 5-ARI (n=359) and those who were treated with 5-ARI for more than six months (n=70). The two groups were compared in terms of age, mpMRI findings, and pathology results.

Results: The number of patients with Prostate Imaging-Reporting and Data System (PIRADS) 3 score was significantly higher in the 5-ARI group (37.1% vs 20.6%; P=0.009). The groups did not differ in terms of malignant pathological findings (48.5% in the non-5-ARI vs 47.1% in the 5-ARI group; P=0.505). The detection rates of malignant pathological findings in PIRADS 3 and PIRADS 5 patients were similar between the 5-ARI and non-5-ARI group. However, malignancy detection rate in PIRADS 4 patients was significantly higher in the non-5-ARI group (P=0.031). In the non-5-ARI group, the sensitivity was 56.4% and the specificity was 79.7%. In the 5-ARI group, the sensitivity was 84.9% and the specificity was 56.8%.

Conclusion: In patients with suspected prostate cancer, 5-ARI intake may alter lesion mpMRI characteristics and PIRADS distribution on mpMRI. 5-ARI intake should be reported to the radiologist.

Alpha-1 antitrypsin deficiency (AATD) is a rare autosomal co-dominant disease caused by mutations in the SERPINA1 gene. The alleles most frequently associated with AATD are protease inhibitors S and Z. Here, we report on a 35-year-old woman diagnosed with Kartagener's syndrome and subsequently referred for bronchiectasis testing. She was identified with a hitherto unreported AATD mutation: a heterozygous variant rs1460874866 in a previously undefined exon 4 (NM_001127701.1) of the SERPINA1 gene. Although Kartagener's syndrome is a genetic cause of bronchiectasis, patients with this syndrome are recommended to undergo AATD testing.

We systematically reviewed the current research literature to 1) investigate whether there was a difference in bone mineral density (BMD) between chronic obstructive pulmonary disease (COPD) patients and non-COPD controls, 2) determine the influence of severity and subtype of COPD on BMD, and 3) determine the risk factors for lower BMD in COPD patients. The Web of Science and PubMed databases were searched on September 25, 2023. Studies where BMD was evaluated with computed tomography (CT) or quantitative CT in patients with COPD were included in the review. We collected data on the number of COPD patients, the average age, average body mass index, average predicted forced expiratory volume in one second (%) or Global Initiative for Chronic Obstructive Lung Disease stage, the average of low attenuation areas, the use of corticosteroid therapy, the use of osteoporosis therapy, the average BMD, and the location of BMD measurement. Twelve studies met our review criteria. Although in several studies COPD was associated with a decreased BMD, most of the studies suggested that COPD, especially in its milder forms, was not strongly associated with osteopenia or osteoporosis of the thoracic and lumbar spine.

Aim: To determine the procedural characteristics, results, and long-term outcomes of the first 500 consecutive patients undergoing transcatheter aortic valve implantation (TAVI) at the MC Medicor International Center for Cardiovascular Diseases Izola (Slovenia).

Methods: Data were collected from the institutional registry. The date of death was obtained from the National BIRPIS system by using the patient's health insurance card number. The difference in 30-day mortality was assessed between two consecutive cohorts of 250 patients, patients who received self-expandable (SEV) and those with balloon-expandable (BEV) valves, and between patients ≤80 and >80 years old.

Results: Between December 2016 and September 2023, 500 patients (80±6 years, 52% men, EuroScore II, 4.09±4.11), including 3.2% with degenerated surgical prosthesis, underwent TAVI. After predilatation (57%), SEV was implanted in 87.5% and BEV in 12.5% of the patients. The mean postprocedural gradient was 10±4 mm Hg, with more than moderate regurgitation in 0.4%. Emergency cardiac/vascular surgery was performed in 1.4%, and stroke occurred in 0.8%. The new permanent pacemaker (PPM) rate decreased from 19% to 7% (P<0.001) in the second cohort, and the mean postprocedural transaortic gradient was significantly lower after SEV compared with BEV (9±4 vs 13±4 mm Hg; P<0.001). There was no difference in 30-day mortality between the first and second cohort of 250 patients (1.2% vs 1.2%; P=1.000), cohorts of 50 patients from number 0 to 500 (0% vs 2.0%; P=0.391), SEV and BEV groups (0.9% vs 1.6%; P=0.487), and patients ≤80 and >80 years old (2.0% vs 0.4%; P=0.119).

Conclusion: TAVI results in our study are comparable with international standards. PPM rate decreased over time, and postprocedural gradient was lower after SEV. Learning curve, type of valve, and patient age did not affect 30-day mortality.

Aim: To assess diagnostic and prognostic value of regulator of calcineurin 3 (RCAN3) in various malignancies.

Methods: RCAN3 expression levels were assessed across pan-cancer data sets including various molecular and immune subtypes. Receiver operating characteristic (ROC) and Kaplan-Meier curves were employed to determine the diagnostic and prognostic value of RCAN3 in pan-cancer, respectively. Enrichment analyses were used to identify RCAN3-associated terms and pathways. A special focus was placed on cervical squamous cell carcinoma and endocervical adenocarcinoma cervical cancer (CESC); we assessed the prognostic value of RCAN expression within distinct clinical subgroups and its effect on m6A modifications and immune infiltration.

Results: RCAN3 expression varied not only in different cancer types but also in different molecular and immune subtypes of cancers. RCAN3 displayed high accuracy in diagnosing and predicting cancers, and RCAN3 expression level was associated with the prognosis of certain cancers. CESC patients with a high RCAN3 level had a worse overall survival, disease-specific survival, and progression-free interval. RCAN3 expression was related to multiple m6A modifier genes and immune cells.

Conclusion: In general, RCAN3 can serve as a novel biomarker for the diagnosis and prognosis in pan-cancer, especially in CESC. It may represent a promising molecular target for developing new treatments. However, our analysis is limited to bioinformatic predictions, and further biological experiments are necessary to verify our results.