Can Croatia Join Europe as Competitive Knowledge-based Society by 2010?

The 21st century has brought important changes in the paradigms of economic development, one of them being a shift toward recognizing knowledge and information as the most important factors of today. The European Union (EU) has been working hard to become the most competitive knowledge-based society in the world, and Croatia, an EU candidate country, has been faced with a similar task. To establish itself as one of the best knowledge-based country in the Eastern European region over the next four years, Croatia realized it has to create an education and science system correspondent with European standards and sensitive to labor market needs. For that purpose, the Croatian Ministry of Science, Education, and Sports (MSES) has created and started implementing a complex strategy, consisting of the following key components: the reform of education system in accordance with the Bologna Declaration; stimulation of scientific production by supporting national and international research projects; reversing the “brain drain” into “brain gain” and strengthening the links between science and technology; and informatization of the whole education and science system. In this comprehensive report, we describe the implementation of these measures, whose coordination with the EU goals presents a challenge, as well as an opportunity for Croatia to become a knowledge-based society by 2010.     

Rotation of the Sacrum During Bellyboard Pelvic Radiotherapy

Patients with cervical, uterine, and rectal carcinomas are usually treated in the prone position using the bellyboard positioning device. Specific and uncomfortable prone position gives rise to uncertainties in the daily set-up of patients during the treatment. During investigation of translational movements, rotational movements of the pelvis are observed and investigated. The film portal imaging is used to discover patient positioning errors during treatment. We defined the rotational set-up errors by angle deviations of the sacrum. Thirty-six patients were included in the study; 15 patients were followed during the whole treatment and 21 during the first 5 consecutive treatment days. The image acquisitions were completed in 84%. Systematic and random positioning errors were analyzed in 725 images. Approximately half of the patients had adjusted to the bellyboard in the first few fractions, with sacrum angles remaining the same for the rest of the treatment. The other half had drifts of the sacrum angle during the whole treatment. The rotation of the sacrum during treatment ranged up to 14°, causing the usual set-up verification and correction procedure to result in errors up to 15 mm. Rotational movements of the patient pelvis during bellyboard pelvis radiotherapy can introduce considerable patient position error.     

Pharmacogenetic screening for drug therapy: from single gene markers to decision making in the next generation sequencing era

Pharmacogenetics has substantially added to our understanding of the variability of drug response. A number of single gene markers have been established and are ready to use in clinical practice. Here we review the validity and utility of markers in a number of genes (CYP2D6, CYP2C19, CYP2C9, VKORC1, TPMT, UGT1A1, OATP1B1, KRAS and HLA locus) for therapy decisions. As drug response is a complex trait in the majority of cases, most of the identified functional variants will only explain a limited part of the variability of drug response. In this sense, a phenotype is the product of many low-penetrance variations. Technical progress has not only improved the cost-effectiveness of screening for single gene markers, but offers the possibility of generating vast amounts of genome-wide single nucleotide polymorphism (SNP) or sequence data for each patient. The latest challenge is to incorporate these amounts of data into pharmacogenetic decision support. We discuss here the challenges associated with choosing the correct therapy for patients who present to their physicians with personal genome data.     

Development of the Croatian model of organ donation and transplantation

During the past ten years, the efforts to improve and organize the national transplantation system in Croatia have resulted in a steadily growing donor rate, which reached its highest level in 2011, with 33.6 utilized donors per million population (p.m.p.). Nowadays, Croatia is one of the leading countries in the world according to deceased donation and transplantation rates. Between 2008 and 2011, the waiting list for kidney transplantation decreased by 37.2% (from 430 to 270 persons waiting for a transplant) and the median waiting time decreased from 46 to 24 months. The Croatian model has been internationally recognized as successful and there are plans for its implementation in other countries. We analyzed the key factors that contributed to the development of this successful model for organ donation and transplantation. These are primarily the appointment of hospital and national transplant coordinators, implementation of a new financial model with donor hospital reimbursement, public awareness campaign, international cooperation, adoption of new legislation, and implementation of a donor quality assurance program. The selection of key factors is based on the authors'' opinions; we are open for further discussion and propose systematic research into the issue.Transplantation is a widely accepted and successful life-saving treatment providing the best therapeutic benefit for hundreds of thousands of patients (1). Unfortunately, many people die while awaiting an organ transplant. A global shortage of organs available for transplantation raises many bioethical concerns, including the dilemma how to allocate limited resources to an unlimited number of needs and thus offer a fair and equal access to organ transplantation to all patients. Great efforts have been made to increase organ donation worldwide, but with only a moderate success in most of the countries. In contrast with this general trend, Croatia has recently experienced a boom in organ donation and transplantation. In 2011, Croatia had the highest rates of utilized cadaveric donors, kidney transplantations, and liver transplantations in the world (2-5) (Figure 1).Open in a separate windowFigure 1The number of kidney transplantations and the number of patients on the waiting list in Croatia between 2008 and 2011.Remarkably, only one decade ago, Croatia was lagging far behind other European countries with a low donation rate (2.7 donors per million population [p.m.p.] in 2000). The continuous improvement of the organization of the Croatian transplant program resulted in a steadily growing donor rate, which reached the highest level in 2011, with 33.6 utilized donors p.m.p (2). We analyzed the factors that might have contributed mostly to this great success.     

Meningothelioma as the predominant histological subtype of midline skull base and spinal meningioma

OBJECT: This study was undertaken to test a hypothesis that meningiomas of the midline skull base and spine are predominantly of the meningothelial histological subtype. METHODS: The cases of 794 consecutive patients who underwent resection for meningioma at the Cleveland Clinic between January 1991 and March 2004 were reviewed retrospectively. The authors analyzed the relationship between the tumors' histological subtypes and sites of origin in the 731 patients from this group who harbored tumors that were determined to be benign histologically (World Health Organization Grade I). Meningothelial meningiomas (MMs) accounted for 63.5% (464/731) of the Grade I tumors. The incidence of MM according to the site of origin was as follows: 84.9% (186/219) in the midline skull base, 58.3% (35/60) in the lateral skull base, 48.5% (183/377) in a non-skull base location, and 80% (60/75) in spinal locations. The incidence of MM in the midline skull base and spinal locations were significantly higher than in non-skull base or lateral skull base locations. CONCLUSIONS: Meningiomas of the midline neuraxis are predominantly meningotheliomas. Analysis of the increasingly available data on genetic and topographic characteristics of MMs suggests that they may represent a unique entity, contrary to the prevailing belief that all benign meningiomas are identical tumors.     

Association of oculocardiac reflex and postoperative nausea and vomiting in strabismus surgery in children anesthetized with halothane and nitrous oxide

BACKGROUND: Postoperative nausea and vomiting (PONV) occurs frequently after strabismus surgery. The controversy still exists regarding the association of PONV and the oculocardiac reflex (OCR). A recent study has proven that rocuronium attenuates OCR. If these two occurrences are dependent, it is expected that with the diminution of OCR, occurrence of PONV will also be reduced. The goal of this randomized, controlled study was to prove an association between OCR and PONV by attenuating OCR with 0.4 mg x kg(-1) of rocuronium and subsequently diminishing PONV if these occurrences are associated. METHODS: A total of 119 ASA 1 children, aged between 3 and 10, undergoing surgery of the medial rectus muscle, were randomly assigned to two groups. In group R (n = 59), 0.4 mg x kg(-1) of rocuronium was administered i.v. before intubation. Group C (controls, n = 60) received no muscle relaxant. The anesthesia was induced and maintained with halothane and N(2)O/O(2) (50/50%). Chi-squared test, Fisher's exact test, t-test, and anova were used for statistical analysis; P-value <0.05 was considered statistically significant. RESULTS: There were no differences between groups regarding patients' characteristics as well as endtidal halothane and duration of surgery and anesthesia. The occurrence of OCR was different between groups (R: 16/59, 27.1%, C: 28/60, 46.7%; P = 0.027), but not the occurrence of PONV (R: 27/59, 45.8%, C: 28/60, 46.7%; P = 0.921). There was an equal number of patients with PONV and bradycardias in both groups (R: 4/27 vs C: 4/28; P = 0.858), whereas there was different, but statistically insignificant distribution of patients (R: 3/27 vs C: 10/28; P = 0.086) with PONV and arrhythmias other than bradycardia. However, simultaneous occurrence of total OCR and PONV in the 24-h period was not different between the two groups (P = 0.964). CONCLUSIONS: Rocuronium (0.4 mg x kg(-1)) attenuates the occurrence of OCR, but with the reduced occurrence of OCR we were not able to attenuate the occurrence of PONV, therefore the association of OCR and PONV in strabismus surgery in children anesthetized with halothane and nitrous oxide remains unclear, and if there is a link between the two, it could be related to arrhythmias and not bradycardia.     

A prospective analysis of intraoperative electromyographic monitoring of posterior cervical screw fixation

OBJECTIVE: This is a prospective study of 26 patients undergoing posterior cervical spine instrumentation with lateral mass or pedicle screws to determine the correlation between intraoperative screw stimulation thresholds and the position of posterior cervical lateral mass and pedicle screws. METHODS: One hundred forty-seven posterior cervical screws (122 lateral mass screws and 25 C7 pedicle screws) in 26 patients were electrically stimulated intraoperatively and stimulation thresholds recorded. Computed tomography (CT) scans were taken postoperatively and were evaluated independently to assess screw position. Electromyographic (EMG) thresholds and CT data were compared to assess the accuracy of the EMG screw stimulation technique in detecting screw malposition. RESULTS: Intraoperative electrical stimulation was accurate in verifying screw position. A stimulation threshold of 15 mA provided a 99% positive predictive value (89% sensitivity, 87% specificity) that the screw was within the lateral mass or pedicle. Stimulation values of 10-15 mA provided a 13% predictive value (66% sensitivity, 90% specificity) that the screw was within the lateral mass or pedicle. A stimulation value of <10 mA provided a 100% predictive value that the screw was malpositioned (70% sensitivity, 100% specificity). CONCLUSIONS: Intraoperative evoked EMG monitoring is a valuable tool in posterior cervical instrumentation using lateral mass and pedicle screws. Stimulation thresholds in this study correlated with screw position. Stimulation values of >15 mA reliably predict acceptable screw position. Values between 10 and 15 mA are generally associated with acceptable screw position, although exploration is recommended. Values below 10 mA are associated with screw malposition and warrant exploration, repositioning, and possible removal.