General and Teaching Hospital Celje

Ljubljana, Slovenia

General and Teaching Hospital Celje

Ljubljana, Slovenia
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Celan D.,University of Maribor | Palfy M.,University of Maribor | Bracun D.,University of Zagreb | Turk Z.,University of Maribor | And 2 more authors.
Collegium Antropologicum | Year: 2012

The purpose of the first part of the study was to establish the variability of repeated measurements in different measuring conditions. In the second part, we performed in a large number of patients, a measurement of thoracic kyphosis and lumbar lordosis and compared them to age, gender, and level of nourishment. In the first part, measurements were performed on a plastic model of the back of a patient with a rigid and a normal spine. In the second part, 250 patients participated in the study (126 men and 124 women). For measuring spinal curvatures we used an apparatus for laser triangulation constructed at the Faculty of Mechanical Engineering, University of Ljubljana. A comparison of 30 repeated measurements was shown as the average value±2 SD which included 95% of the results. Thirty repeated readings of one 3D measurement: thoracic kyphosis 41.2°±0.6°, lumbar lordosis 4.4°±1.2°; 30 measurements on a plastic model: thoracic kyphosis 36.8°±1.2°, lumbar lordosis 30.9°±2.0°; 30 measurements on a patient with a rigid spine: thoracic kyphosis 41.5°±2.4°, lumbar lordosis 4.0°±1.8°; 30 measurements on a patient with a normal spine: thoracic kyphosis 48.8°±7.4°, lumbar lordosis 21.1°±4.4°. The average size of thoracic kyphosis in 250 patients was 46.8° (SD 10.1°) and lumbar lordosis 31.7° (SD 12.5°). The angle size was statistically significantly correlated to gender (increased thoracic kyphosis and lumbar lordosis in women) and body mass index (increased thoracic kyphosis and lumbar lordosis in more nourished patients). Age was not significantly correlated to the observed angles. During measurements of the spinal angles it was important to pay attention to relaxation and the patient's position as well as to perform more measurements providing the average value. The age and the level of nourishment influence the size of the sagittal spinal angles. In the observed sample the effect of age was not confirmed.


Movrin I.,University of Maribor | Vengust R.,University of Ljubljana | Komadina R.,General and Teaching Hospital Celje
Archives of Orthopaedic and Trauma Surgery | Year: 2010

Introduction: It is still controversial whether adjacent level compression fractures after balloon kyphoplasty (BK) and vertebroplasty (VP) should be regarded as the consequence of stiffness achieved by augmentation with bone cement or if the adjacent level fractures are simply the result of the natural progression of osteoporosis. The purpose of this study was to evaluate the adjacent level fracture risk after BK as compared with VP and to determine the possible dominant risk factor associated with new compression fractures. Materials and methods: 73 consecutive patients with painful vertebral compression fractures (VCFs) were enrolled in a prospective nonrandomized study. BK was performed in 46 patients (51 vertebral bodies) and VP in 27 patients (32 vertebral bodies). The first patient's visit was before the operative procedure, when clinical and radiographical examinations were done. The follow-up visits, considered in the analysis, were on the first day and after 1 year, postoperatively. Results: In 1 year, 3 out of 46 patients (6.5%) treated with BK, and 2 out of 27 patients (7.4%) treated with VP sustained adjacent level fracture. More patients with a BMD higher or equal to 3.0 experienced a new fracture than those with a BMD less than 3.0 (odds ratio = 13.00; 95% confidence interval: 1.35-124.81), and the risk for adjacent level fractures decreased significantly when the postoperative kyphotic angle was less than 9° compared with that of higher or equal to 9° (odds ratio = 12.00; 95% confidence interval: 1.25-114.88). Conclusion: Our results indicate that BK and VP are methods with a low risk of adjacent level fractures. The most important factors for new VCFs after a percutaneous augmentation procedure are the degree of osteoporosis and altered biomechanics in the treated area of the spine due to resistant kyphosis. These results suggest that the adjacent vertebrae would fracture eventually, even without the procedure. BK and VP offer a comparable rate of pain relief. © 2010 Springer-Verlag.


Dragojevic J.,University of Ljubljana | Logar D.B.,University of Ljubljana | Komadina R.,General and Teaching Hospital Celje | Marc J.,University of Ljubljana
Archives of Medical Research | Year: 2011

Background and Aims: New data show that increased adipogenesis in bone marrow may decrease osteoblastogenesis, resulting in osteoporosis (OP). Runt-related transcription factor 2 (RUNX2) and peroxisome proliferator-activated receptor γ (PPARγ) are two main transcriptional regulators controlling osteoblastogenesis and adipogenesis from the same precursor cell in bone-the mesenchymal stem cell. Because osteoarthritis (OA) and OP present the opposing bone phenotype, our aim was to determine whether the expression of selected adipogenic genes is lower in OA compared to OP bone tissue. Methods: Bone samples were obtained from gender-matched OP (n = 54) and OA (n = 49) patients undergoing hip arthroplasty. Osteoblastogenesis and adipogenesis were estimated by gene expression analysis of RUNX2, PPARγ2 and their downstream genes. Results: In OA bone, significantly higher expression of PPARγ2 and adiponectin as well as RUNX2, osterix and osteocalcin were obtained, suggesting higher adipogenesis and osteoblastogenesis in OA than in OP. There were no differences in RUNX2/PPARγ2 and osteocalcin/adiponectin ratios between groups, suggesting similar balance of both processes. Higher perilipin 2, angiopoietin-like 4 and fatty-acid binding protein 4 mRNA levels in OP suggest activation of other transcription factors or hypoxic conditions in OP bone. Conclusions: Regulation of bone formation by RUNX2 and PPARγ2 is modified in OA compared to OP, resulting in higher osteoblastogenesis and adipogenesis in OA. Both processes are similarly balanced in OP and OA but less active in OP. © 2011 IMSS.


Trost Z.,University of Ljubljana | Trebse R.,Orthopaedic Hospital Valdoltra | Prezelj J.,University of Ljubljana | Komadina R.,General and Teaching Hospital Celje | And 2 more authors.
Bone | Year: 2010

Genetic factors influencing the pathogenesis of osteoporosis are still largely unknown. We employed genome-wide gene expression approach in order to discover novel genes involved in the pathogenesis of osteoporosis. To this end, primary cultures of osteoblasts isolated from osteoporotic and non-osteoporotic human bone tissue samples were prepared. One thousand six hundred six genes were found to be differentially expressed, indicating increased demand for protein synthesis and decreased cell proliferation rate in osteoblasts from osteoporotic tissue as compared to osteoblasts from non-osteoporotic tissue. At first, top four genes, based on the microarray data and potential role in bone metabolism, were further studied in bone tissue samples of 55 patients. PTN and COL15A1 were both downregulated in osteoporotic bone tissue (6.2- and 3.4-fold, respectively, both p < 0.05), while IBSP and CXCL2 were both upregulated (5.7-fold, p < 0.05, and 2.1-fold, p > 0.05). Further biostatistical analysis of the microarray data by gene set enrichment analysis suggested oxidative stress may have an important part in the pathogenesis of osteoporosis. Thus, secondly, we tested it by an in vitro assay on human osteosarcoma cell line cells treated with hydrogen peroxide. After 72 h of treatment with 500 μM hydrogen peroxide, the upregulation of the same genes involved in the response to oxidative stress as on the microarrays was observed: MT1G (metallothionein 1G, 22.1-fold, p < 0.05), TXNRD1 (thioredoxin reductase 1, 3.7-fold, p < 0.05), AOX1 (aldehyde oxidase 1, 24.5-fold, p < 0.05) and GSR (glutathione reductase, 4.7-fold, p < 0.05). Our results present a novel list of genes and metabolic pathways that may be associated with the pathogenesis of osteoporosis. PTN, CXCL2, COL15A1, IBSP, AOX1, MT1G, GSR and TXNRD1 are candidate genes for further studies in the assessment of the genetic susceptibility to osteoporosis. In addition, differences in protein synthesis, cell proliferation rate and response to oxidative stress may also be involved in the pathogenesis of osteoporosis. © 2009 Elsevier Inc. All rights reserved.


Mencej-Bedrac S.,University of Ljubljana | Prezelj J.,University of Ljubljana | Komadina R.,General and Teaching Hospital Celje | Vindisar F.,General and Teaching Hospital Celje | Marc J.,University of Ljubljana
Molecular Genetics and Metabolism | Year: 2011

Our gene expression microarray data of primary cultures of osteoblasts revealed that the expression of the pleiotrophin (PTN) gene is decreased in osteoporosis. PTN is involved in osteoblasts' proliferation and differentiation, response to mechanical stimuli and cross-talk with Wnt signaling. On the basis of these findings, we studied the PTN gene as a candidate gene for genetic susceptibility to osteoporosis. The aim of the study was to evaluate the association of two PTN gene promoter polymorphisms with osteoporotic phenotype in postmenopausal women.530 postmenopausal women, 480 without and 50 with hip fracture, were genotyped for the presence of PTN gene promoter polymorphisms -1734C>T (rs161335) and -1227C>T (rs321198). Three common haplotypes, CC (14.2%), CT (42.8%) and TC (42.9%), were inferred. Bone mineral densities (BMDs) at lumbar spine and (contralateral) hip were measured. In non-osteoporotic postmenopausal women without hip fracture, the association of -1227C>T and CT haplotype with lumbar spine BMD was shown (p = 0.014 and 0.014). No other significant association of the studied genotypes and haplotypes in the PTN gene promoter with BMDs was found. Comparing age-matched postmenopausal women with and without hip fractures, no differences in frequency distributions of the studied genotypes and haplotypes was shown. For the first time we have shown that, in postmenopausal women, the PTN gene promoter polymorphism -1227C>T and CT haplotype could contribute to the genetic background of osteoporosis, but these findings need further functional and clinical confirmation. © 2011 Elsevier Inc.


Spahn D.R.,University of Zürich | Bouillon B.,Witten/Herdecke University | Cerny V.,University of Hradec Kralove | Cerny V.,Dalhousie University | And 13 more authors.
Critical Care | Year: 2013

Introduction: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.Methods: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.Results: Key changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.Conclusions: A comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond. © 2013 Spahn et al.; licensee BioMed Central Ltd.


Rossaint R.,RWTH Aachen | Bouillon B.,Witten/Herdecke University | Cerny V.,University of Hradec Kralove | Coats T.J.,University of Leicester | And 12 more authors.
Critical Care | Year: 2010

Introduction: Evidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes.Methods: The multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.Results: Key changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.Conclusions: This guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients. © 2010 Rossaint et al.; licensee BioMed Central Ltd.


PubMed | Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Brest University Hospital Center, S Camillo Hospital, General and Teaching Hospital Celje and 11 more.
Type: | Journal: Critical care (London, England) | Year: 2016

Severe trauma continues to represent a global public health issue and mortality and morbidity in trauma patients remains substantial. A number of initiatives have aimed to provide guidance on the management of trauma patients. This document focuses on the management of major bleeding and coagulopathy following trauma and encourages adaptation of the guiding principles to each local situation and implementation within each institution.The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004 and included representatives of six relevant European professional societies. The group used a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were reconsidered and revised based on new scientific evidence and observed shifts in clinical practice; new recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated. This guideline represents the fourth edition of a document first published in 2007 and updated in 2010 and 2013.The guideline now recommends that patients be transferred directly to an appropriate trauma treatment centre and encourages use of a restricted volume replacement strategy during initial resuscitation. Best-practice use of blood products during further resuscitation continues to evolve and should be guided by a goal-directed strategy. The identification and management of patients pre-treated with anticoagulant agents continues to pose a real challenge, despite accumulating experience and awareness. The present guideline should be viewed as an educational aid to improve and standardise the care of the bleeding trauma patients across Europe and beyond. This document may also serve as a basis for local implementation. Furthermore, local quality and safety management systems need to be established to specifically assess key measures of bleeding control and outcome.A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. The implementation of locally adapted treatment algorithms should strive to achieve measureable improvements in patient outcome.


Mlakar V.,University of El Salvador | Jurkovic Mlakar S.,University of El Salvador | Zupan J.,University of El Salvador | Komadina R.,General and Teaching Hospital Celje | And 2 more authors.
Journal of Cellular and Molecular Medicine | Year: 2015

Adrenergic stimulation is important for osteoclast differentiation and bone resorption. Previous research shows that this happens through β2-adrenergic receptor (AR), but there are conflicting evidence on presence and role of α2A-AR in bone. The aim of this study was to investigate the presence of α2A-AR and its involvement in neuro-endocrine signalling of bone remodelling in humans. Real-time polymerase chain reaction (PCR) and immunohistochemistry were used to investigate α2A-AR receptor presence and localization in bone cells. Functionality of rs553668 and rs1800544 single nucleotide polymorphism SNPs located in α2A-AR gene was analysed by qPCR expression on bone samples and luciferase reporter assay in human osteosarcoma HOS cells. Using real-time PCR, genetic association study between rs553668 A>G and rs1800544 C>G SNPs and major bone markers was performed on 661 Slovenian patients with osteoporosis. α2A-AR is expressed in osteoblasts and lining cells but not in osteocytes. SNP rs553668 has a significant influence on α2A-AR mRNA level in human bone samples through the stability of mRNA. α2A-AR gene locus associates with important bone remodelling markers (BMD, CTX, Cathepsin K and pOC). The results of this study are providing comprehensive new evidence that α2A-AR is involved in neuro-endocrine signalling of bone turnover and development of osteoporosis. As shown by our results the neurological signalling is mediated through osteoblasts and result in bone resorption. Genetic study showed association of SNPs in α2A-AR gene locus with bone remodelling markers, identifying the individuals with higher risk of development of osteoporosis. © 2015 The Authors.


PubMed | General and Teaching Hospital Celje
Type: Journal Article | Journal: European journal of trauma and emergency surgery : official publication of the European Trauma Society | Year: 2016

Osteoporosis is the most common metabolic bone disease. Recently, the paradigm for diagnosis and treatment of osteoporosis has undergone changes due to new findings on this disease. With the arrival of densitometers that could measure BMD we started using medications that block further degradation of density and repair the densitometric results. More recent findings, however, suggest that the BMD value influences the predicted success of future fracture prevention in less than 50%. The remainder is attributed to bone quality. There are a number of risk factors for osteoporotic fractures, some of greater and some of lesser significance. A small external force is necessary to cause an osteoporotic fracture; otherwise, the osteoporotic bone still does not break. The dominant factor in a fracture is therefore the fall of the elderly patient. Falls are preventable, although most are benign and injury free. Only in the recent decade have we started paying attention to the fall phenomenon, which does not only involve accidents, but is also a consequence of the normal aging process. Incidence of falls and hip fractures in residential elderly patients can be reduced with a multifactorial interdisciplinary prevention program (MIPP): Staff training Adaptation of environment Gait and mobility exercise Technical accessories Revision of pharmacotherapy (psychotropics) Hip protectors Post-fall problem-solving conferences. Mobility exercise is useful in elderly groups; however, the maintenance of mobility is not linked to a reduction of fall risk. Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of fall sufficiently to prevent a hip fracture. A number of cost-benefit studies on residential elderly patients between 2004 and 2006 proved the efficacy of MIPP and hip protectors, and some studies did so also on those patients living independently. Unfortunately, as much as 75% of women and 90% ofmen at high risk in nursing homes are not investigated, and 75% of those affected are not treated.

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