Dusan Micic

Cadmium Exposure as a Putative Risk Factor for the Development of Pancreatic Cancer: Three Different Lines of Evidence

Although profoundly studied, etiology of pancreatic cancer (PC) is still rather scant. Exposure to cadmium (Cd), a ubiquitous metal associated with well-established toxic and carcinogenic properties, has been hypothesized to one putative cause of PC. Hence, we analyzed recently published observational studies, meta-analyses, and experimental animal and in vitro studies with the aim of summarizing the evidence of Cd involvement in PC development and describing the possible mechanisms. Consolidation of epidemiological data on PC and exposure to Cd indicated a significant association with an elevated risk of PC among general population exposed to Cd. Cadmium exposure of laboratory animals was showed to cause PC supporting the findings suggested by human studies. The concordance with human and animal studies is buttressed by in vitro studies, although in vitro data interpretation is problematic. In most instances, only significant effects are reported, and the concentrations of Cd are excessive, which would skew interpretation. Previous reports suggest that oxidative stress, apoptotic changes, and DNA cross-linking and hypermethylation are involved in Cd-mediated carcinogenesis. Undoubtedly, a significant amount of work is still needed to achieve a better understanding of the Cd involvement in pancreatic cancer which could facilitate prevention, diagnosis, and therapy of this fatal disease.

Influence of IL-6, TNF-α and hs-CRP on Insulin Sensitivity in Patients after Laparoscopic Cholecystectomy or Open Hernia Repair

Summary The aim of this study was to investigate the influence of IL-6, TNF-α and hs-CRP on insulin sensitivity during postoperative follow-up in patients with laparoscopic cholecystectomy (LC) or open hernia repair (OHR). 65 patients were studied: after laparoscopic cholecystectomy (LC; n=40) or open hernia repair (OHR; n=25). Glucose, insulin, hs-CRP, IL-6 and TNF-a were determined at day 0 (before the operation) and at days 1, 3 and 7 (after the operation). There were no difference between LC and OHR groups concerning age, BMI, glucose, insulin, hs-CRP, IL-6 and TNF-α at day 0. hs-CRP increased at day 1, 3 and 7 vs. day 0 (p<0.0005), without difference between groups (p=0.561). IL-6 increased at day 1 and day 3 vs. day 0 (p<0.005). IL-6 was higher at day 1 in OHR group in comparison with LC group (p=0.044). There were no differences in TNF-a levels between LC and OHR groups (p=0.056). There was increase of HOMA-IR at day 1, 3 and 7 vs. day 0 (p<0.0005) in both groups. Significantly higher increase of HOMA-IR was in OHR group compared with LC group at day 1 (p=0.045). There was a positive correlation between hs-CRP and HOMA-IR (r=0.46; p=0.025) and between IL-6 and HOMA-IR at day 1 in OHR group (r=0.44; p=0.030). Significantly higher HOMA-IR was found in OHR group compared with LC. Positive correlation between hs-CRP and IL-6 with HOMA-IR in OHR group at day 1, indicate possible influence of this mediators on impairment of insulin sensitivity.

Premature Ovarian Failure: Fertility Challenge

Premature ovarian insufficiency (POI) (also known as premature menopause) is a heterogeneous disorder of multifactorial origin defined as the occurrence of secondary amenorrhoea, hypergonadotropism (follicle-stimulating hormone above 40 IU/L) and hypoestrogenism (oestradiol below 50 pmol/L) in women under the age of 40 years.

Transsexualism: Endocrine Aspects

Harry Benjamin, the father and establisher of transsexualism, tried to describe this phenomenon as terra incognita or noli me tangere (1966), trying to explain that many doctors were blinded in the presence of a new undescribed and undiagnosed disorder [1]. Ira Pauly described one hundred transsexuals from 13 countries [2].

Veštačka stimulacija nervus-a frenikus-a nakon povrede

The phrenic nerve is a nerve that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm. It controls the diaphragm which is the primary muscle involved in breathing. Injuries of the phrenic nerve can occur after trauma such as falls, blunt trauma, after penetrating injuries or in car accidents, iatrogenic nerve injury during surgery in the neck and chest. Phrenic nerve pacing (PNP), or “diaphragm pacing”, is the application of rhythmic electrical impulses to the diaphragm, resulting in respiration for patients who would be otherwise dependent on a mechanical ventilator. Phrenic nerve stimulators are indicated for selected patients with partial or complete respiratory insufficiency” and “can be only effective if the patient has an intact phrenic nerve and diaphragm, which means in patients with spinal cord injuries, central sleep apnea and in patients with lesion of central nervous system. In contrast, trauma below C2 usually does not allow pacing, because the cell bodies of the phrenic nerves are damaged. This kind of treatment can lead to a significant improvement in the quality of life of ventilator-dependent quadriplegic individuals. It can improve pulmonary function and reduce the incidence of pulmonary infections. In addition, it improves quality of speech and olfaction which leads to much better quality of life and higher rates of social participation. We would like to demonstrate a case of a nineteen years old patient that was admitted to the ER department in Clinical Center of Serbia as an emergency case with penetrating wound injury after a gunshot wound to the neck. Data from the literature, which have been also confirmed with our individual experience suggest that the phrenic nerve pacing begins in cases that there is no recovery of nerve not earlier than three and no later than six months after the injury when the results are the most appropriate. Most patients with diaphragmatic pacemakers continue to need tracheostomies and mechanical ventilators as a back-up to their pacemakers. It is important to note that diaphragmatic pace makers only improve inspiratory function and do not target expiratory functions such as coughing and clearing secretions. Finally, the extremely high cost of the device itself, with modest results of the implementation of the device, gives a basis to observe it with great criticism, especially in countries with lower economic status.