Based on a vast number of worldwide studies concerning driving behavior and traffic safety, lack of drivers' attention and distraction is recognized as two of the most critical factors for road ...safety. While roadside advertising is often identified as a potential source of distraction, it has received less attention compared to other types of distractions such as texting or calling while driving. Young drivers, 18 - 25 years old, seem to invest more resources interacting with roadside advertising, suggesting a lower capacity to discriminate between relevant and irrelevant driving information. Combined with lesser driving experience, susceptibility to roadside distractions such as advertising signs, static or changeable, can increase traffic safety risks involving young drivers. Therefore, this study focused on the impact of roadside advertising signs on young drivers, specifically on their cognitive workload while driving in an urban environment cluttered with roadside billboards. The research has been conducted by simultaneously using driving simulator, wireless mobile EEG device for the measurement of the brain's electrical activity, and mobile ETG (eye-tracking glasses) for the measurement of eye movement while driving. The research included 20 young drivers 18-25 years old. Research results from EEG device showed statistically significant difference in young drivers' cognitive workload related to roadside advertising, with higher cognitive workload while driving in an environment including billboards. Research results from the simulator showed statistically significant driving speed change-drivers accelerating while driving through environment saturated with roadside billboards. Research results from ETG and questionnaire showed three common features of the static roadside billboards that draw more of driver's attention: bigger billboards (mega-boards), well-known brands, and provocative design.
Background
Pancreatic fistula after pancreaticoduodenectomy is one of the most severe complications with mortality rates as high as 45%, and the prediction of most severe form of fistula (grade C) is ...crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. It has been found that the amount of abdominal fat may predict grade C postoperative pancreatic fistula. In this study, we analysed the value of retrorenal fat thickness in the prediction of grade C pancreatic fistula.
Methods
A total of 140 patients who underwent pancreaticoduodenectomy were retrospectively analysed. Retrorenal fat thickness and intra‐abdominal fat, expressed as total fat area, visceral fat area and subcutaneous fat area, were determined from computed tomography slices using the known range of attenuation values (−190 to −30). Blood loss, operating time, pancreatic texture and main pancreatic duct diameter as well as body mass index were also analysed.
Results
Retrorenal fat thickness (P = 0.0004), duct diameter (P = 0.0008), subcutaneous fat area (P = 0.023) and total fat area (P = 0.014) were found to be significant predictors of grade C pancreatic fistula.
Conclusion
Although retrorenal fat tissue thickness may seem robust, it is a simple measure that can be used to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.
Prediction of the most severe form of postoperative pancreatic fistula is crucial for successful management of patients who are to undergo cephalic pancreatoduodenectomy. Measurement of retrorenal fat tissue thickness is a simple measure that may help to predict the most severe grade of pancreatic fistula after pancreaticoduodenectomy.
To assess the diagnostic value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in lung cancer (LC). We compared the ratios between healthy participants and all LC ...patients, as well patients with different pathohistological LC subtypes.
We retrieved the data on neutrophil, lymphocyte, and platelet levels in 449 patients with different pathohistological LC subtypes (non-small cell LC, small-cell LC, atypical or metastatic LC, neuroendocrine, and sarcomatoid carcinoma) and 47 healthy controls. NLR and PLR were calculated by dividing the absolute number of neutrophils or platelets with the absolute number of lymphocytes.
There were significant differences in both NLR and PLR (P<0.001) between all LC patients and the control group, but there were no differences between patients with different LC subtypes. Reciever operating characteristics analysis for NLR showed the optimal cut-off value of 2.71, with a sensitivity of 77.05% and specificity of 87.23%. The optimal cut-off value for PLR was 182.31, with a sensitivity of 51.09% and specificity of 91.49%.
The results showed that the NLR and PLR may have added value in the early diagnosis of LC, but further research is needed to confirm these results.
Malignant brain tumors are among the most aggressive
human neoplasms. One of the most common and severe symptoms that patients with these malignancies experience is sleep disruption. Disrupted sleep ...is known to
have significant systemic pro-tumor effects, both in patients with other types of cancer and those with malignant
brain lesions. We therefore provide a review of the current
knowledge on disrupted sleep in malignant diseases, with
an emphasis on malignant brain tumors. More specifically,
we review the known ways in which disrupted sleep enables further malignant progression. In the second part of
the article, we also provide a theoretical framework of the
reverse process. Namely, we argue that due to the several possible pathophysiological mechanisms, patients with
malignant brain tumors are especially susceptible to their
sleep being disrupted and compromised. Thus, we further
argue that addressing the issue of disrupted sleep in patients with malignant brain tumors can, not just improve
their quality of life, but also have at least some potential
of actively suppressing the devastating disease, especially when other treatment modalities have been exhausted.
Future research is therefore desperately needed.
Postoperative pancreatic fistula (POPF) is one of the most severe complications after cephalic pancreaticoduodenectomy, with mortality as high as 30%. Risk scores may help predict the risk of POPF. ...Multiple external validations substantially improve generalized clinical acceptability of a scoring system.
The aim of this study was to externally validate previously described fistula risk score in the prediction of clinically relevant POPF.
All patients who underwent pancreaticoduodenectomy for any indication during a 5-year period were prospectively analyzed. A total of 132 patients were analyzed.
Of the 132 patients, 44 (33.3%) developed pancreatic fistula, including 12.9% biochemical leaks, 7.6% grade B fistula, and 12.9% grade C fistula. Cut-off point of 4.5 was determined to best separate patients who developed clinically relevant POPF with area under curve of 78% (p = .00003). Sensitivity and specificity for the prediction of clinically relevant POPF with the cut-off value of 4.5 was 70.4 and 74.3%, respectively. Positive predictive value with cut-off value 4.5 was 57.8%, and negative predictive value was 83.4%.
Fistula risk score identified low risk patients with false negative rate of 16.6%. Further external validation studies on large cohorts of patients and with wide case-mix may enable additional refinements of the score model.
Utilization of somatic healthcare services is highly predictive of the development of chronic physical illnesses and increased mortality risks. The objective of this study was to assess the ...differences in healthcare utilization among patients with schizophrenia spectrum disorders (SSD), major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) and the general population in Croatia.
We enrolled 566 Croatian participants from the general population, 282 with SSD, 178 with MDD, and 86 with PTSD. The primary outcome was a self-reported specialist consultation for non-psychiatric (e.g., somatic) causes within the previous 12 months.
Although SSD patients with chronic physical illnesses were significantly more often hospitalized for physical illness than the general population, the proportion of patients who had a specialist consultation were equal in SSD and the general population. MDD and PTSD patients had significantly higher adjusted odds for specialist consultation than the general population and SSD patients (MDD compared to SSD: OR = 2.14; 95% CI 1.27-3.59; PTSD compared to SSD: OR = 2.03; 95% CI 1.00-4.10).
SSD patients' utilization of somatic healthcare is equal to the general population, despite their increased healthcare needs. However, their utilization is lower than in MDD and PTSD patients and, therefore, probably not adequate.
The study protocol was registered at ClinicalTrials.gov ( NCT02773108 ) on May 16, 2016.
Purpose of this study was assessing of local infiltration analgesia (LIA) with levobupivacaine on the trend of acute postoperative pain and outcome in individuals who underwent rhinoplasty procedure ...and abdominoplasty performed in general anaesthesia. The research was conducted on 60 patients, of which 30 patients underwent rhinoplasty procedure and the other 30 patients underwent abdominoplasty procedure in general anaesthesia with LIA in "Bagatin" Polyclinic in the time period between 01.01.2014. and 01.01.2017. Postoperative analgesics doses on the same day of surgery were noted in 85% of participants who underwent an abdominoplasty procedure and in 45% of participants underwent rhinoplasty procedure. Patients who underwent abdominoplasty were discharged from the facility within 48 hours, while all patients who underwent rhinoplasty procedure were discharged on the same day of the surgery. During the first postoperative day patients who underwent a rhinoplasty procedure did not require analgesics, while only 3% of patients who underwent an abdominal liposuction procedure required an additional dose of analgesics. The research results had shown, when LIA was performed, the manifestation of acute postoperative pain and vomiting did not lead to prolonged stay in day surgery.
In the last decade, a growing body of research has dealt with the effects of cyberbullying on mental health of children and youth, and the results have systematically shown that cyberbullying is on ...the rise and that the mental health consequences are negative for both victims and perpetrators. Effective prevention programs for cyberbullying targeting children, youth, professionals, parents, and all those involved in upbringing are being developed and evaluated in the world, Europe and Croatia. Common features of implementing successful prevention programs that most authors agree on are the education of students, teachers, professional assistants and parents, their collaboration, the use of quality interactive educational content and knowledge of following protocols for schools in cases of electronic violence.
Stroke is the second leading cause of death and the most important cause of adult disability worldwide and in Croatia. In the past, stroke was almost exclusively considered to be a disease of the ...elderly; however, today the age limit has considerably lowered towards younger age. The aim of this study was to determine age and gender impact on stroke patients in a Croatian urban area during one-year survey. The study included all acute stroke patients admitted to our Department in 2004. A compiled stroke questionnaire was fulfilled during hospitalization by medical personnel on the following items: stroke risk factors including lifestyle habits (smoking and alcohol), pre-stroke physical ability evaluation, stroke evolution data, laboratory and computed tomography findings, outcome data and post-stroke disability assessment. Appropriate statistical analysis of numerical and categorical data was performed at the level of p < 0.05. Analysis was performed on 396 patients, 24 of them from the younger adult stroke group. Older stroke patients had worse disability at hospital discharge and women had worse disabilities at both stroke onset and hospital discharge, probably due to older age at stroke onset. Younger patients recovered better, while older patients had to seek secondary medical facilities more often, as expected. The most important in-hospital laboratory findings in young stroke patients were elevated lipid levels, while older patients had elevated serum glucose and C-reactive protein. Stroke onset in younger patients most often presented with sudden onset headache; additionally, onset seizure was observed more frequently than expected. Stroke risk factor analysis showed that women were more prone to hypertension, chronic heart failure and atrial fibrillation, whereas men had carotid disease more frequently, were more often smokers and had higher alcohol intake. Additionally, age analysis showed that heart conditions and smoking were more prevalent among older stroke patients. In conclusion, considerable differences were established between age and gender stroke patient groups, confirming the need of permanent national stroke registry and subsequent targeted action in secondary care, and prevention with education on risk factors, preferably personally tailored.
The influence of facet orientation and tropism on the process of spinal degeneration has been extensively studied during the last few decades, but there are still many controversies and conflicting ...results in this field of research. The biomechanical cause of accelerated degeneration of stabilizing structures in lower lumbar spine lies within the combination of several factors, but two most important ones are compressive load and more coronal facet orientation that offers less resistance against torsional loading. Axial rotation of lower lumbar spine is undoubtedly associated with higher strain in disc annulus, and enhanced range of secondary rotational movements may be even more significant for the progression of annular degeneration. Accordingly, more pronounced facet tropism could be having part in faster progression of disc degeneration in lower lumbar spine, as indicated by a number of recent studies. More sagittal facet orientation in patients with a higher facet osteoarthritis score at lower lumbar segments is very likely related to arthritic remodeling commonly seen in other synovial joints. There is also a possibility that it could be associated with the adaptation to partial loss of lumbar lordosis, as both coincide with advanced age.
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