Karcinomi glave i vrata povezani su sa značajnim morbiditetom i mortalitetom unatoč napretku u liječenju posljednjih
desetljeća. Multidisciplinarni pristup liječenju ovih bolesti stoga je od iznimne ...važnosti i postaje zlatni standard. Tumori
glave i vrata također ugrožavaju relevantne strukture gornjeg aerodigestivnog trakta, uključujući funkcije kao što su glas, govor,
gutanje i disanje. Oštećenje ovih funkcija može značajno utjecati na kvalitetu života. Stoga je naše istraživanje ispitivalo
ne samo ulogu kirurga glave i vrata, onkologa i radioterapeuta, već i važnost sudjelovanja različitih drugih kliničkih profesija
poput anesteziologa, psihologa, nutricionista, stomatologa i logopeda u radu multidisciplinarnog tima (MDT). Njihovo
sudjelovanje rezultira značajnim poboljšanjem kvalitete života bolesnika. Također predstavljamo svoja iskustva u organizaciji
i radu MDT-a u sklopu Centra za tumore glave i vrata KBC-a Zagreb.
•Virtual reality is a novel medium for artistic creation.•We explored the potential of VR for art therapy.•Expert art therapists experienced the VR art therapy medium.•Qualitative analysis revealed ...domains of VR medium pertinent to art therapy.•VR art therapy poses novel opportunities and challenges to the field.
Recent advances in technology have enabled the creation of immersive digital environments commonly known as Virtual Reality (VR). The current study explored the potential of artistic creation in VR for art therapy (VRAT) from the perspective of expert art therapists. Seven expert art therapists participated in this study, all of whom experimented with creating visual art in VR and as observers. After the VR experience, a semi-structured interview was conducted to assess central aspects of their experience both as creators and as observers. The interviews were analyzed according to the principles of Thematic Analysis. Four main themes emerged from the findings: (1) The user experience of creation in VR. (2) The qualities of the VR material and medium. (3) The VR environment as a therapeutic setting. (4) The relevance of the VR medium for art therapy. The results indicated that the therapists foresee substantial potential in the novel VR medium for art therapy and highlighted further research directions needed to determine how the virtual medium can be used to treat real world problems.
SHORT CERVIX – WHAT NOW? Faris Mujezinović
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Letnik:
78
Journal Article
Recenzirano
Odprti dostop
Background: It is possible to predict preterm delivery (PD) before 34 weeks by ultrasound measurement of uterine cervical length (CL). This is the reason why this screening method is more frequently ...used in clinical practice. Methods: I extracted from PubMed database Crane’s sistematic review and articles about association of CL with PD and instructions what is necessary to take into consideration and what to do in case of a short cervix. Results: Majority of studies suggested CL of 25 mm as a cut-off point for selecting pregnancy as high risk for PD. Minority of studies also used 15 mm as a cut-off point. This inconsistency in selecting an unique cut-off point, as some authors showed, is a result of ignoring gestational age when measurement of CL is made. CL is usually measured until 24 weeks of pregnancy and value of US measurement of CL made later in pregnancy or role of follow-up measure- ments are still unclear. In cases with threatened preterm labour where CL is measured there was 66 % reduction of unnecessary tocolysis. US measurement of CL is of a little value if there is a progressive dilatation of cervix (Bishop score > 6). Shirodkar cerclage in women with short cervix does not reduce the risk for PD. Vaginal progesteron causes a 50 % decrease of incidence of PD in women with short cervix (CL < 15 mm). We do not know which form of vaginal progesteron is most effective. Progesteron is uneffective in women with PD in previous pregnancy and CL > 25 mm. Conclusions: US measurement of CL becomes reliable criteria for detecting pregnancies with increased risk for PD before 34 weeks of pregnancy. It enables individual risk calculation for PD with consideration of other risk factors.
Background: To obtain a complete diagnosis of preinvasive cervical lesions, the results of cytology, col- poscopy and histological biopsy are needed. Low-grade lesions (LG-SIL, CIN 1) should be ...managed conservatively because such lesions can regress. Treatment is suggested if the abnormality persists for 2 years or if the lesion worsens in grade or size. High-grade lesions (HG-SIL, CIN 2 and 3) are managed by different treatment modalities. Ablative modalities include cryocautery, electrocoagulation diathermy and laser ablation. For ablative treat- ment only ectocervical lesions with entirely visible squamocolumnar junction visible are suitable. Small localized lesions of CIN 1 and 2 may be treated by cryocautery or electroco- agulation diathermy. Lesions entering the cervical canal cannot be destroyed with certainty. Laser destroys the tissue by evaporation and coagulation, and is useful if the dysplastic areas extend into the vaginal fornices. Excision modalities including loop diathermy excision, cold-knife conization, laser cone biopsy and hysterectomy provide specimens for histology. Loop diathermy excision is currently the most common treatment modality. Cold-knife conization is performed with a scalpel. The cone can be broad and shallow or narrow and deep, depending on the location and the size of the lesion. Laser cone biopsy is relatively costly and time-consuming. Histopathology aims to assess the nature of the lesion and to determine whether it has been removed completely. Conclusions: Treatment of preinvasive lesions is not completely harmless for the patient. Complications include hemorrhage, cervical stenosis or incomplete excision. Hysterectomy should be con- sidered for a patient with CIN suffering from menorrhagia, uterine prolapse or leiomyomas as well as in cases of adenocarcinoma in situ, when the reproductive function has been completed.
Rak materničnega vratu lahko prizadene ženske v rodnem obdobju. V stadiju IB1 je mogoče pri zdravljenju rakave bolezni ohraniti rodno funkcijo ženske z radikalno trahelektomijo in odstranitvijo ...medeničnih bezgavk.To je operacija, pri kateri se odstrani maternični vrat in paracervikalno tkivo (parametriji) v kombinaciji z odstranitvijo medeničnih bezgavk, telo maternice pa se ohrani. Predstavljamo primer 32-letne nulipare z rakom materničnega vratu stadija 1B1. Bolnica je bila zdravljena radikalno z ohranitvijo rodne funkcije in je po zdravljenju rodila donošenega otroka.
Nowadays, NAND Flash technology is everywhere, since it is the core of the code and data storage in mobile and embedded applications; moreover, its market share is exploding with Solid-State-Drives ...(SSDs), which are replacing Hard Disk Drives (HDDs) in consumer and enterprise scenarios. To keep the evolutionary pace of the technology, NAND Flash must scale aggressively in terms of bit cost. When approaching ultra-scaled technologies, planar NAND is hitting a wall: both academia researchers and industry worked to cope with this issue for several decades. Then, the 3D integration approach turned out to be the definitive alternative by eventually reaching mass production. This review paper exposes several 3D NAND Flash memory technologies, along with their related integration challenges, by showing their different layouts, scaling trends and performance/reliability features.
Flash memory industry has showed remarkable steady progress during the last few years. This achievement is owed to the development of the 3D NAND Flash structures. This paper reviews the latest ...advances in the monolithic 3D integration of the NAND Flash memory. It highlights key technical challenges and uses important aspects and characteristics of various designs in order to illustrate mechanisms that overcome the technical barriers. Furthermore, the most promising solutions are marked by comparing advantages and disadvantages of different designs. Finally, future prospects and expected market demand of NAND Flash memory are addressed.
Display omitted
•The latest advances in the monolithic 3D integration of the NAND Flash memory are surveyed.•The key technical challenges and important aspects of various designs are highlighted.•The mechanisms that overcome the technical barriers are discussed.•By comparing different designs, the most promising solutions are marked.•Future prospects and expected market demand of NAND Flash memory are explained.
In his novel The Brother, David Albahari designs a transmedial network that relates to the breakup of Yugoslavia and the breakup of a family. The confrontation with an unknown brother, who was ...adopted by a Jewish family in Argentinian exile, lets the coordinates of morality and aesthetics get out of hand: The brother not only reveals himself as a connoisseur of the literature of Jorge Luis Borges, he also bursts into the everyday life of a country that is unprepared for him as a transsexual person. In this spectrum of literary discourse and through the experience of homophobia, of diaspora and transgender reality, memories are stimulated by photographs and aesthetic lines of escape unfold and help accepting the unknown Other.
Knjiga o življenjskih zgodbah zapornic na Slovenskem je dobrodošel prispevek k razumevanju zaporniških in z njimi povezanih kontekstov, saj v luči konkretnih situacij dopolnjuje predstave, ki jih ...oblikujejo javna občila, kazenski dosjeji, medicinski spisi in drugi dokumenti. Zgodbe zapornic bodo morda komu delovale preveč subjektivno, da bi jim dal priložnost in jim pripisal zadostno verodostojnost. Tem dvomljivcem pa lahko v isti sapi povemo, da za vsakim medijskim poročilom, medicinskim zapisom ali kazensko dokumentacijo stoji človek ali skupina ljudi, ki so prav tako subjektivni akterji svojega časa, nosilci predsodkov in različnih stopenj družbene senzibilnosti. Hvalevredno je, da so lastne predsodke do zaporniških zgodb ozavestile tudi avtorice knjige. Iz njihovih uvodnih besed, pa tudi režijskih posegov v vsaki od posameznih zgodb odzvanja, da jih je izkušnja srečevanja in pogovorov z zapornicami obogatila. Verjamem, da ima zbirka pripovedi zapornic, ki je podana v tekočem, pogovornem slogu, ogromno spoznavnega potenciala, zato jo vsakomur toplo priporočam v branje in ogled – opremljena je namreč s pomenljivimi fotografskimi vtisi, ki delujejo kot pogled skozi ključavnično luknjo zaporniških vrat.
Sarkomi mekoga tkiva relativno su rijetki zloćudni tumori koji mogu nastati u bilo kojoj anatomskoj regiji. U regiji glave i vrata leiomiosarkom je najrjeđi tip sarkoma i čini svega 1-4% sarkoma ...mekih tkiva, te je zbog toga često kasno dijagnosticiran. Najčešća lokalizacija na glavi i vratu je usna šupljina (22%), zatim sinonazalno (19%), a tek potom na koži (17%). Liječenje treba započeti detaljnim kliničkim pregledom, uz kompjuteriziranu tomografiju ili magnetsku rezonancu. Konačna dijagnoza može se postaviti tek nakon detaljne patohistološke analize. Liječenje diktiraju stadij, lokalizacija i veličina tumora, te dob bolesnika. Primarna terapija je kirurško liječenje. Preporučena je široka ekscizija s rubovima od 3 do 5 centimetara, te dubinom koja uključuje potkožno tkivo i fasciju. U ovom radu prikazujemo slučaj bolesnika kojeg smo liječili u našoj ustanovi zbog velike tumorske mase na koži vlasišta zatiljne regije. Nakon opsežne ekscizije postavili smo dijagnozu leiomiosarkoma. Bolesniku smo, unatoč primarnoj eksciziji s adekvatno širokim rubovima, nakon dvije godine dijagnosticirali lokalni recidiv s tumorskim satelitima u okolnom tkivu. Sarkomi glave i vrata pokazuju lošije ishode preživljavanja u usporedbi sa sarkomima ektremiteta, a meta-analize pokazuju da je petogodišnje preživljenje do 57%. Pravovremeno postavljanje dijagnoze ovoga rijetkog tumora, primarno kirurško liječenje i multidisciplinarni pristup, uz češću upotrebu adjuvantnog zračenja, kod nemogućnosti postizanja adekvatnih resekcijskih rubova, trebalo bi voditi do uspješnijeg liječenja i duljeg preživljavanja ovakvih bolesnika.
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