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The classification of vascular lesions is complex. There is a slight overlap between reactive, developmental and benign vascular tumours, and some conditions defy precise classification. This review follows the most recent World Health Organization (WHO) classification of cutaneous vascular tumors and provides the framework for a systematic study, incorporating as many recent advances in molecular and immunohistochemical diagnostics as possible at this moment in time.

Responsible research and innovation, or RRI, is a concept that aims to bring together society and science for a better future. There are six key elements of RRI: public engagement, gender equality, science education, open access, ethics and governance. Higher Education Institutions and Responsible Research and Innovation (HEIRRI) project aimed to bring the concept of RRI into the educational system. Using state-of-the-art review of good practices, HEIRRI team developed 10 training programs on RRI for different higher education institution educational levels, including a summer school and a massive open online course (MOOC). We conducted pilot of the trainings and evaluated participants’ experiences. Satisfaction with HEIRRI training programs on responsible research and innovation was high, both for participants and for the trainers, and trainings raised awareness of RRI. Participants’ feedback was used to identify areas that need improvement and provided for recommendations for final versions of the HEIRRI training programs. In order to equip researchers with skills to recognize and apply RRI values, RRI should be included in their education. HEIRRI training is suitable for a range of different disciplines, including forensic science, and is free to use and adjust for specific contexts (available from: https://rri-tools.eu/heirri-training-programmes). KEY POINTSRRI aims to make research inclusive, responsible, reflexive and to foster integrity of researchersHEIRRI project developed a toolbox of engaging activities for introduction of RRI concepts in higher educationHEIRRI training can be used to introduce RRI at all levels of higher education and members of the publicHEIRRI training is suitable for a range of different disciplines, including forensic science, and is free to use and adapt

Background It is known that drug shortages represent a major challenge for all stakeholders involved in the process, but there is little evidence regarding insights into patients′ awareness and perspectives. This study aimed to investigate the patients-perceived drug shortages experience and their view on outcomes in different European hospital settings. Furthermore, we wanted to explore information preferences on drug shortages. Methods A retrospective, cross sectional, a mixed method study was conducted in six European hospital settings. One hospital (H) from each of this country agreed to participate: Bosnia and Herzegovina (H-BiH), Croatia (H-CR), Germany (H-GE), Greece (H-GR), Serbia (H-SE) and Poland (H-PO). Recruitment and data collection was conducted over 27 months from November 2017 until January 2020. Overall, we surveyed 607 patients which completed paper-based questionnaire. Questions related to: general information (demographic data), basic knowledge on drug shortages, drug shortages experienced during hospitalization and information preferences on drug shortage. Differences between hospital settings were analyzed using Chi-squared test or Fisher’s exact test. For more complex contingency tables, Monte Carlo simulations (N = 2000) were applied for Fisher’s test. Post-hoc hospital-wise analyses were performed using Fisher’s exact tests. False discovery rate was controlled using the Bonferroni method. Analyses were performed using R: a language and environment for statistical computing (v 3.6.3). Results 6 % of patients reported experiences with drug shortages while hospitalized which led to a deterioration of their health. The majority of affected patients were hospitalized at hematology and/or oncology wards in H-BiH, H-PO and H-GE. H-BiH had the highest number of affected patients (18.1 %, N = 19/105, p N = 1/100, p = 0.001). In addition, 82.5 %, (N = 501/607) of respondents wanted to be informed of alternative treatment options if there was a drug shortage without a generic substitute available. Majority of these patients (66.4 %, N = 386/501) prefer to be informed by a healthcare professional. Conclusions Although drug shortages led to serious medical consequences, our findings show that most of the patients did not perceive shortages as a problem. One possible interpretation is that good hospital management practices by healthcare professionals helped to mitigate the perceived impact of shortages. Our study highlights the importance of a good communication especially between patients and healthcare professionals in whom our patients have the greatest trust.

Background Our objective was to assess the effects of COVID‐19 antiepidemic measures and subsequent changes in the function of the health care system on the number of newly diagnosed breast cancers in the Republic of Croatia. Subjects, Materials, and Methods We performed a retrospective, population‐ and registry‐based study during 2020. The comparator was the number of patients newly diagnosed with breast cancer during 2017, 2018, and 2019. The outcome was the change in number of newly diagnosed breast cancer cases. Results The average monthly percent change after the initial lockdown measures were introduced was −11.0% (95% confidence interval − 22.0% to 1.5%), resulting in a 24% reduction of the newly diagnosed breast cancer cases in Croatia during April, May, and June compared with the same period of 2019. However, during 2020, only 1% fewer new cases were detected than in 2019, or 6% fewer than what would be expected based on the linear trend during 2017–2019. Conclusion It seems that national health care system measures for controlling the spread of COVID‐19 had a detrimental effect on the number of newly diagnosed breast cancer cases in Croatia during the first lockdown. As it is not plausible to expect an epidemiological change to occur at the same time, this may result in later diagnosis, later initiation of treatment, and less favorable outcomes in the future. However, the effect weakened after the first lockdown and COVID‐19 control measures were relaxed, and it has not reoccurred during the second COVID‐19 wave. Although the COVID‐19 lockdown affected the number of newly diagnosed breast cancers, the oncology health care system has shown resilience and compensated for these effects by the end of 2020. Implications for Practice It is possible to compensate for the adverse effects of COVID‐19 pandemic control measures on breast cancer diagnosis relatively promptly, and it is of crucial importance to do it as soon as possible. Moreover, as shown by this study's results on the number of newly diagnosed breast cancer cases during the second wave of the pandemic, these adverse effects are preventable to a non‐negligible extent., This article assesses the effects of COVID‐19 on the number of newly diagnosed breast cancer patients in the Republic of Croatia.

Nonalcoholic fatty liver disease is a condition defined by fat accumulation in hepatocytes not promoted by excessive alcohol consumption. It is highly prevalent and is strongly associated with insulin resistance, metabolic syndrome, and diabetes type II. Insulin resistance plays a crucial role in the multifactorial etiopathogenesis of this condition leading to accumulation of free fatty acids in the liver cells, thus causing lipotoxicity, inflammation, and fibrosis. In this review, we will focus on currently known pathogenesis of nonalcoholic fatty liver disease. Numerous investigation strategies are available to establish the diagnosis, from biochemical markers and ultrasound to various molecular and advanced imaging techniques and liver biopsy. Prevention is crucial. However, effective and promising therapies are strongly demanded.

SIGNIFICANCE OF THE PROBLEM: The diagnosis of acute viral myocarditis is one of the diagnoses most difficult to make in cardiology and medicine in general. Echocardiography and cardiomagnetic resonance play a crucial role in the clinical diagnosis and the serum titer of antiviral antibodies to cardiotropic viruses is still unjustifiably used for the diagnosis of myocarditis in everyday practice. RESEARCH OBJECTIVES: To analyze the frequency and significance of echocardiographic parameters in the diagnosis of clinically suspected acute viral myocarditis, to determine the role of antiviral antibody titer (AVA) dynamics for the diagnosis of myocarditis and to compare viral serology and echocardiographic function versus echocardiographic function. METHODOLOGY: A retrograde transverse study was performed in the ten-year period from 2006. to 2015, where 126 consecutive patients from the database of the Office of Internal medicine ''Dr. Bastać'' were analyzed, with a working diagnosis of clinically suspected viral myocarditis. They were clinically, ECG, echocardiographically and serologically monitored for 4 to 8 weeks due to the dynamics of AVA titer. The examined group (A) was divided into subgroups: A1 with elevated AVA class IgM titer in 43 (32%) subjects and subgroup A2 without elevated IgM titer in 83 (68%) patients. The control group of healthy (B) of 103 subjects was comparable.Statistical processing was done in the EXCELL database via descriptive statistics, Student's-T test and Chi2 test. RESULTS: 126 patients had clinically suspected myocarditis (≥2 ESC criteria). Diastolic left ventricular dysfunction in 39/126 (31%) patients was the dominant echocardiographic criterion for clinically suspected myocarditis. Reduced ejection fraction (EF

Contains fulltext : 244079.pdf (Publisher’s version ) (Closed access) BACKGROUND: The incidence, geographical distribution and clinical relevance of different nontuberculous mycobacteria (NTM) in Croatia are well described. There are few data on the risk factors for developing NTM pulmonary disease (NTM-PD) in this setting. METHODS: We conducted a retrospective cohort study on all Croatian residents with NTM isolated from respiratory samples in the period from 2006 to 2015 with follow-up to 2018. The American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines were used to establish NTM-PD diagnosis. Clinical, radiological and treatment data were collected from hospital records. RESULTS: Risk analysis calculations were made on the 439 isolation episodes that were classified as definitive NTM-PD (n = 137) or no disease (n = 302). Female gender, presence of bronchiectasis, low BMI and long-term systemic corticosteroid treatment were independent risk factors associated with NTM-PD. Hemoptysis and malaise were presenting symptoms independently associated with NTM-PD. Chronic obstructive pulmonary disease (COPD) and low/moderate dose inhaled corticosteroid (ICS) treatment were not associated with NTM-PD. High dose ICS treatment was a significant risk factor for developing NTM-PD (aOR = 4.73, CI 1.69-13.23 p = 0.003). CONCLUSION: The NTM-PD patients in Croatia are similar to those in other published cohorts in terms of their characteristics and risk factors. The significant dose-dependent association between ICS use and NTM-PD adds to the body of evidence suggesting that high dose ICS use is associated with NTM-PD.

For many years, tourism scholars have been investigating tourism development issues and disseminating their research results through papers published in academic journals Although there is evidence that their viewpoints are in discrepancy with the viewpoints of tourism practitioners, these inconsistencies were rarely investigated and juxtaposed As the global health pandemic caused by COVID-19 stopped travel and tourism all over the world, it created time for both groups of tourism experts to reflect on the various opportunities and challenges that the tourism sector will face in the future Using the qualitative research design, the authors had the chance to collect, analyse and discuss the views of tourism experts on the recovery phase and possible changes to tourism in Croatia Data was obtained through semi structured interviews of tourism practitioners from public and private sectors, and through literary review of published opinion papers by international scholars The aim of the research was focused on the comparison of their views on the short-term recovery of tourism, as well as the long-term possibilities to transform the sector towards a more sustainable and more inclusive sector that is able to utilize the regional competitive advantages in the best possible way The research results revealed more similarities regarding the attitudes on the recovery during short-term period, as opposed to more dissimilarity on the long-term future of tourism in Croatia According to the research results, the future of tourism would benefit from the experience and knowledge of both groups combined – practitioners and scholars © 2020 Institute for Tourism All rights reserved

Conflicts of interest (COIs) in healthcare are increasingly discussed in the literature, yet these relationships continue to influence healthcare. Research has consistently shown that financial COIs shape prescribing practices, medical education and guideline recommendations. In 2009, the Institute of Medicine (IOM, now the National Academy of Medicine) published Conflicts of Interest in Medical Research, Practice, and Education—one of the most comprehensive reviews of empirical research on COIs in medicine. Ten years after publication of theIOM’s report, we review the current state of COIs within medicine. We also provide specific recommendations for enhancing scientific integrity in medical research, practice, education and editorial practices.

Healthcare documentation or nursing documentation as often used in practice is the name of an indispensable part of a patient’s medical documentation, and documentation is an integral part of a nurse’s daily work. Documenting health care in the hospital means recording data on all procedures performed, during the entire health care process for the individual, all for the purpose of systematic monitoring, planning and evaluation of the quality of health care. Nursing documentation serves as a means of communication between the team and is of great importance for the quality and continuity of health care. AIMS: 1 - To determine the existence of health care documentation in hospital health care institutions; 2 - Examine the importance and purpose of documenting health care among nurses-medical technicians; 3 - Examine the practice of nurses-medical technicians in the process of administering health care; 4 - Present quality indicators that are monitored and analyzed through health care documentation; 5 - Compare the obtained results in two examined areas. METHODS: This research was conducted in two geographically separate areas of Sarajevo and Travnik. The study involved 210 respondents, 147 nurses-technicians employed at the Clinical Center of the University of Sarajevo and 63 nurses-technicians employed at the General Hospital in Travnik. Data collection for research was carried out by exploratory and descriptive method. An original authorized questionnaire was used for the descriptive research. The questionnaire was made available to respondents in the electronic form trough Google Forms. The anonymity of the respondents was fully guaranteed. The survey was conducted in the period from July 15- August 15, 2019. RESULTS: At the Clinical Center of the University of Sarajevo (CCU), 98% of respondents use health care documentation forms on a daily basis, and at the General Hospital Travnik 77.8% of respondents. In CCU Sarajevo, respondents use more standardized forms of health care documentation, 97.6%, compared to respondents in the General Hospital Travnik, where the documenting is carries out in nursing records, 74.6%. 68% of respondents at CCU Sarajevo believe that documentation contributes to the evaluation of nursing services, while only 19% of re-spondents at General Hospital Travnik believe the same. As the most common shortcomings, the respondents state the lack of computer technology in the department in 74.3%, then adequate premises for document administration in 37.6%, the lack of forms in printed form in 32.1% and 6 or 2.3% respondents did not answer this question. In both institutions, the biggest shortcoming is the problem of computer equipment in the department, in 70.7% in CCU Sarajevo and 82.5% in General Hospital Travnik. CONCLUSIONS: The research found that over 95% of respondents use standardized health care processes in their daily practice, document health care, know the basic purpose and monitor health care indicators. More than 90% of respondents in both study groups use health care documentation to plan health care and monitor its outcomes. More than half of respondents in both study groups stated that documenting health care is a problem because it consumes a lot of time. A larger number of respondents from both groups, as many as 30%, state that they do not use the data from the health care documentation for any purpose. The lack of workers in the health care process, insufficient knowledge of information technologies, and the lack of an information system represent an aggravating circumstance in documenting the health care process., Dokumentacija zdravstvene njege ili sestrinska dokumentacija, kako se često naziva u praksi, neizostavan je dio medicinske dokumentacije pacijenta, a dokumentiranje je sastavni dio svakodnevnoga sestrinskog posla. Dokumentiranje zdravstvene njege u bolnici podrazumijeva zapisivanje podataka o svim provedenim postupcima tijekom cjelokupnog procesa zdravstvene njege za pojedinca, a sve u svrhu sustavnog praćenja stanja te planiranja i vrednovanja kvaliteta zdravstvene njege. Sestrinska dokumentacija služi kao sredstvo komunikacije između tima i od velike je važnosti za kvalitetu i kontinuitet zdravstvene njege. CILJEVI RADA: 1. Utvrditi postojanje dokumentacije zdravstvene njege u bolničkim zdravstvenim ustanovama. 2. Ispitati praksu medicinskih sestara/tehničara u procesu administriranja zdravstvene njege. 3. Prikazati indikatore kvalitete koji se prate i analiziraju putem dokumentacije zdravstvene njege. 4. Komparirati dobivene rezultate u dva ispitivana područja. METODE RADA: Ovo istraživanje provedeno je na dva geografski odvojena područja, u Sarajevu i Travniku. U istraživanju je sudjelovalo 210 ispitanika, i to 147 medicinskih sestara/tehničara zaposlenih u Kliničkom centru Univerziteta u Sarajevu i 63 medicinske sestre / medicinska tehničara zaposlena u Općoj bolnici u Travniku. Prikupljanje podataka za istraživanje provedeno je deskriptivnom metodom. Za deskriptivno istraživanje primijenjen je originalni autorski upitnik. Upitnik je ispitanicima bio dostupan u elektroničkom obliku u internetskoj aplikaciji Google Forms. Anonimnost ispitanika bila je u potpunosti zajamčena. Istraživanje je provedeno u periodu od 15. srpnja do 15. kolovoza 2019. REZULTATI ISTRAŽIVANJA:U Kliničkom centru Univerziteta u Sarajevu 98 % ispitanika svakodnevno upotrebljava obrasce dokumentacije zdravstvene njege, a u Općoj bolnici Travnik 77,8 % ispitanika. U KCU-u Sarajevo ispitanici više upotrebljavaju standardizirane obrasce dokumentacije zdravstvene njege, i to 97,6 %, u odnosu na ispitanike u Općoj bolnici u Travniku, gdje se dokumentiranje vrši u sestrinske evidencijske bilježnice, i to 74,6 %. 68 % ispitanika u KCU-u Sarajevo smatra da dokumentiranje pridonosi vrednovanju sestrinskih usluga, dok to smatra samo 19 % ispitanika iz Opće bolnice Travnik. Kao najčešće nedostatke ispitanici navode nedostatak računalne tehnike na odjelu (74,3 %), zatim neadekvatne prostorije za administriranje dokumentacije (37,6 %) te nedostatak obrazaca u tiskanom obliku (32,1 %), a na ovo pitanje nije odgovorilo šest ili 2,3 % ispitanika.U obje ustanove kao najveći nedostatak navode problem računalne opreme na odjelu, i to 70,7 % u KCU-u Sarajevo i 82,5 % u OB-u Travnik. ZAKLJUČCI: Istraživanjem je utvrđeno da više od 95 % ispitanika u svakodnevnoj praksi primjenjuje standardizirane procese zdravstvene njege, dokumentira zdravstvenu njegu, poznaje osnovnu svrhu i prati indikatore zdravstvene njege. Više od 90 % ispitanika u obje ispitivane skupine dokumentacijom zdravstvene njege kori-sti se za planiranje zdravstvene njege i praćenje njezinih ishoda.Više od polovine ispitanika u obje ispitivane skupine navelo je da im dokumentiranje zdravstvene njege predstavlja problem jer im oduzima mnogo vremena u radu. Veći broj ispitanika obje ispitivane skupine, čak 30 %, navodi da se podacima iz dokumentacije zdravstvene njege ne koriste ni u kakve svrhe. Nedostatak izvršitelja procesa zdravstvene njege, nedovoljno znanje o informacijskim tehnologijama te nepostojanje informacijskog sustava predstavlja otežavajuću okolnost u dokumentiranju procesa zdravstvene njege.

Prepublication peer review is a cornerstone of science. Overburdened reviewers invest millions of hours in this voluntary activity. In this scoping review, we aimed at identifying motivations for performing prepublication peer review of scholarly manuscripts. Original research studies investigating actual peer reviewers' motivations were included. We excluded modeling studies, studies related to other types of peer review, guidelines, peer review processes in particular journals. Medline, WoS, and Scopus were searched in February 2016, with no language or time limitations, and the search was updated in July 2019. The search yielded 5,250 records, and 382 were chosen for full text analysis, out of which 10 were appropriate for synthesis. Reference snowballing identified one eligible study. Eleven studies were appropriate for synthesis: four qualitative, four mixed qualitative/quantitative, and three qualitative studies, published from 1998 to 2018, involving 6,667 respondents. Major internal incentive was "communal obligations and reciprocity." Major external incentives were "career advancement," "being recognized as an expert," and "building relationships with journals and editors." Major disincentive was the "lack of time." Editors could incentivize peer review process by choosing highest quality articles, improving communication with peer reviewers, in order to make the process of peer review as short and efficient as possible. The gaps in research concern disincentives to review.

Background This study evaluated the prevalence ofspreading pathways in nontuberculous mycobacteria(NTM) pulmonary infections according to nodulardistribution patterns seen on chest computed tomog-raphy (CT). Methods This study included 63 patients diagnosedwith NTM lung infections who underwent CT at ourinstitution. A retrospective analysis of CT images fo-cused on the presence and distribution of nodules, presence of intrathoracic lymphadenopathy and thepredominant side of infection in the lungs. The find-ings were classified into five groups ; centrilobular(bronchogenic spread), perilymphatic (lymphangiticspread), random (hematogenous spread), combinedpattern and no nodules present. The groups werethen compared according to other CT findings. Results Among 51 (81%) patients identified with anodular pattern on chest CT, 25 (39.8%) presentedwith centrilobular, 7 (11.1%) with perilymphatic, 6(9.5%) with random and 13 (20.6%) with combinednodular patterns but located in different areas of thelungs. The right side of the lungs was predominantin 38 cases (60.3%). Intrathoracic lymphadenopa-thy was evident in 20 patients (31.7%). Significantdifferences in distributions of nodular patterns wereseen in patients infected withMycoplasma aviumcomplex(MAC) associated with centrilobular pat-tern (p= 0.0019) andM. fortuitumassociated withrandom pattern (p= 0.0004). Some of the findingswere related to perilymphatic nodules between otherisolated species of NTM (p= 0.0379). Conclusion The results of this study showed a highproportion of perilymphatic nodules and right-sidedpredominance in the upper lobe, which, combinedwith intrathoracic lymphadenopathy is highly sugges-tive of the lymphangitic spread of lung NTM infec-tions.

Background: Two checklists have recently been developed for reporting clinical practice guidelines (CPGs). The RIGHT checklist follows the reporting guidelines framework from the EQUATOR network. The AGREE checklist was developed as an extension of the AGREE tools for methodological quality of CPGs. Objective: To compare the characteristics of the RIGHT and AGREE checklists and their practical application in assessing reporting completeness for a set of CPGs. Design: Method comparison study. Main measures: Percentage completeness of reporting items on the checklists for a set of 79 CPGs (37 Croatian and 42 European) assessed by two independent assessors ; correlation plot and Bland Altman plot of reported items ; linguistic characteristics assessed using the Linguistic Inquiry and Word Count software. Key results: The two checklists have overlapping content. However, 11 of 35 items (31%) in the RIGHT checklist and 10 out of 87 items (11%) in the AGREE checklist are not covered by the other checklist. CPGs scored higher on the RIGHT than the AGREE checklist (median 43% (interquartile range (IQR) 37-46%) vs 23% (IQR 21-29%) reported items, P

A 53-year-old white man presented with a 2-month history of a painless periungual ulcerated mass on the lateral aspect of his right thumb, measuring up to 7 mm in diameter (Fig. 1a). The neurovascular function and motion range of the thumb were preserved. The mass was excised, but 2 months later, local recurrence and ipsilateral axillary lymph node metastasis were observed. Partial thumb amputation was performed, shortly followed by another local recurrence (Fig. 1b) and occurrence of pulmonary metastases, detected by multislice computed tomography. After four cycles of carboplatin and paclitaxel chemotherapy, disease progression was noted (additional liver and mediastinal metastases and an increase in the diameter of previously noted metastases). Following four cycles of second-line chemotherapy with 5-fluorouracil and cisplatin, there was no measurable therapeutic response. Unfortunately, the patient died 14 months after metastatic disease was established and 2 years after the primary diagnosis. Histopathological examination showed variably sized, partially cystic tumour nests within the dermis and subcutis, composed of solid and papillary formations covered by atypical epithelial cells (Fig. 2a, b). Lymphovascular invasion was noted and tumour tissue was also detected in the right axillary lymph node on core biopsy (Fig. 2c). There was moderate and focally severe cytological atypia, ample mitotic activity and focal central necrosis within the tumour nests. There was no communication with the epidermis and no invasion of underlying bone. Diagnosis Digital papillary adenocarcinoma (DPAC).

Linked Article: Cook et al. Br J Dermatol 2022; 186:167–173.

In this article, we suggest a blueprint for an ideal open-access repository for clinical trial data with a description of a model of such a repository using a business process analysis approach. Firstly, we suggested which features an ideal repository should have. Secondly, we used business process management software to describe the whole process, from the decision to share clinical trial data to either publication of data in a repository or discarding data. The research community, legislators and society at large should be interested in a transparent open-access repository that will host clinical trial data. We hope this work can inspire relevant stakeholders to engage in discussion about the necessity of creating such repository, and that we will witness the creation of such a repository in the near future.

Global health diplomacy (GHD) is a novel concept in health with a focus on the interactions in foreign affairs. GHD coordinates policies for improving global health, which was particularly during the COVID-19 pandemic.This study aimed to evaluate how GHD can help healthcare professionals (HCP), and identify the problems for the HCP in practice as well dilemmas to providing only emergency treatments in the pandemic lockdowns. We performed 9 semistructured interviews with participants responsible for health in the EU as members of governments and health-related sectors through purposive sampling from 12/2020 to 02/2021 via MS Teams. Interviews were conducted in English, voice recorded, and transcribed. The data analysis included coding of the transcripts, categorization of initial codes, and identification of themes using NVivo 12 software. All participants signed the informed consent. The research was approved by the University of Split Medical School ethical board. Participants agree that the global solution to this pandemic is to ensure universal access to healthcare. Global diplomatic response to the pandemic was uncoordinated. Participants stated that the pandemic hit HCPs especially hard, as they have to balance the fear about their safety and providing care. HCP are also faced with ethical and moral dilemmas regarding limiting access to healthcare. The participants agreed that the best example of a coordinated GHD effort was the centralised EU approach to securing supplies and development of a vaccine. Participants stressed the importance of the patients’ rights in the GHD. The participants discussed what can be learnt from the failures of diplomatic response to the COVID-19 and how future global crises should be handled. We identified lessons that GHD can apply to help HCP. GHD in times of COVID-19 underlines the increasing politicization of global health. As the pandemic continues, it is worth asking what GHD will look like in the aftermath of COVID-19.

Biological agents are widely used in the treatment of autoimmune rheumatic disorders. We report on serious adverse events during treatment with anti-tumor necrosis factor antibody in two of our patients with juvenile idiopathic arthritis. One patient was treated with a biological agent due to juvenile idiopathic arthritis complicated by uveitis, developing miliary tuberculosis during treatment. After treatment with antituberculotics, she recovered completely. Her underlying disease is currently in remission. Another patient was treated for juvenile spondyloarthritis and developed an inflammatory process of the central nervous system with serious neurological deficits. He was treated with high-dose corticosteroids, followed by slowly tapering doses of corticosteroids. His neurological deficits improved, but are still present. Similar cases have been described previously, but there are no recommendations how to treat arthritis afterwards in such patients. We would like to emphasize the need of developing guidelines for further treatment of arthritis after the occurrence of serious adverse effects during treatment with biological agents., Biološki lijekovi se primjenjuju u liječenju brojnih autoimunih reumatskih bolesti. U ovom članku prikazujemo dva slučaja ozbiljnih nuspojava liječenja inhibitorima čimbenika nekroze tumora (tumor necrosis factor, TNF) kod bolesnika s juvenilnim idiopatskim artritisom (JIA): bolesnice liječene zbog JIA kompliciranog razvojem uveitisa, kod koje se javila milijarna tuberkuloza tijekom liječenja. Nakon liječenja antituberkuloticima došlo je do potpunog oporavka. Njena osnovna bolest je u remisiji. Drugi bolesnik je liječen zbog juvenilnog spondiloartritisa te je razvio upalni proces središnjega živčanog sustava s ozbiljnim neurološkim posljedicama. Liječen je visokim dozama kortikosteroida koje su potom postupno snižavane. Neurološki ispadi su se dijelom poboljšali, ali su ipak još uvijek prisutni. Slični slučajevi su opisivani i ranije, ali nema preporuka kako bi trebalo liječiti artritis nakon što nastupe takve nuspojave. Željeli bismo naglasiti potrebu stvaranja smjernica za daljnje liječenje artritisa nakon pojave teških nuspojava prilikom liječenja biološkim lijekom.

Objectives The aim of the study was to evaluate the completeness of intervention description in ClinicalTrials.gov and corresponding journal articles for registered and published drug–drug interaction (DDI) trials because complete and transparent description of interventions is particularly important for DDI. Study Design and Setting Observational study of completed interventional trials on DDIs with up to two drugs within the Intervention registration element in ClinicalTrials.gov until October 2015. We used the Template for Intervention Description and Replication items to assess the quality of intervention description in both ClinicalTrials.gov Descriptive Information section and matching publications. Corresponding articles were identified in March 2019. Results The description of 1,180 drug interventions registered for 642 DDI trials mostly lacked information on the intervention provider (99.7%), adherence strategies (99.2%), procedure (83.8%), location (71.3%), and dosage form (60.7%). Generic name (82.5%), dose (70.8%), and duration of administration (65.6%) were most frequently reported. Among 51 trials that had data reported both in ClinicalTrials.gov and publication, 60.8% were in phase 1. Less than half of 96 interventions had clear and matching description of dosage form, procedure, and route of administration in both sources. Conclusion DDI trials did not sufficiently report components required for complete intervention description. Further improvements in ClinicalTrials.gov registration requirements, including phase 1 trials, and more stringent publishing requirements for essential data on drug interventions, are needed to prevent patient risk in clinical practice regarding concomitant medication use.

Social media today represent a global community of different nationalities - the size of China in terms of population, and social networking sites are online venues where users can create and post content. Social networks have also become one of the most popular ways for people to socialize, connect with friends and family, purchase items and gather relevant information about current and political topics and views. The most popular and biggest social network is Facebook and its influence in every pore of our society is evident, e.g. potential misuse of its user’s data in different purpose including manipulation in political purposes. This paper will also cover the findings of a survey conducted in Croatia and Serbia about the perception of social media and social networks as a source of gathering relevant information.

Background Cochrane systematic reviews have plain language summaries (PLSs) that are translated into multiple languages, mostly by volunteers. We aimed to survey volunteer translators to find out their characteristics, motivation, and suggestions to further improve this translation project. Methods We surveyed 176 registered volunteer translators from the Cochrane Croatia PLS translation project. A 28-item survey, created for the purpose of this study, was administered via SurveyMonkey in November-December 2017. Translators received an invitation to the survey and two follow-up reminders via e-mail. Primary and secondary outcomes were the characteristics and motivation of volunteers. Results We received 106 responses (60% response rate) to the survey. The translators were on average (standard deviation) 32 ± 10 years old, they were mostly women (74%), and most of them were medical doctors (29%) or pharmacists (13%). The majority found out about the translation project from acquaintances and colleagues. Most of them indicated that they have still had high motivation for the project, but for the majority, the number of translations decreased over time. When asked what could motivate them to translate more Cochrane PLSs, or to start translating if they did not translate anything yet, the most common answers were: feedback about translation quality, reminders, a workshop for translators and Facebook group for translators. Conclusion Cochrane volunteer PLS translators are a motivated and highly educated group, but their translation output is decreasing with time. Reminders, feedback and education are interventions that should be tested to increase volunteer engagement in such initiatives.

The widespread problems with scientific fraud, questionable research practices, and the reliability of scientific results have led to an increased focus on research integrity (RI). International organisations and networks have been established, declarations have been issued, and codes of conducts have been formed. The abstract principles of these documents are now also being translated into concrete topic areas that Research Performing organisations (RPOs) and Research Funding organisations (RFOs) should focus on. However, so far, we know very little about disciplinary differences in the need for RI support from RPOs and RFOs. The paper attempts to fill this knowledge gap. It reports on a comprehensive focus group study with 30 focus group interviews carried out in eight different countries across Europe focusing on the following research question: “Which RI topics would researchers and stakeholders from the four main areas of research (humanities, social science, natural science incl. technical science, and medical science incl. biomedicine) prioritise for RPOs and RFOs?” The paper reports on the results of these focus group interviews and gives an overview of the priorities of the four main areas of research. The paper ends with six policy recommendations and a reflection on how the results of the study can be used in RPOs and RFOs.

To foster research integrity (RI), it is necessary to address the institutional and system-of-science factors that influence researchers’ behavior. Consequently, research performing and research funding organizations (RPOs and RFOs) could develop comprehensive RI policies outlining the concrete steps they will take to foster RI. So far, there is no consensus on which topics are important to address in RI policies. Therefore, we conducted a three round Delphi survey study to explore which RI topics to address in institutional RI policies by seeking consensus from research policy experts and institutional leaders. A total of 68 RPO and 52 RFO experts, representing different disciplines, countries and genders, completed one, two or all rounds of the study. There was consensus among the experts on the importance of 12 RI topics for RPOs and 11 for RFOs. The topics that ranked highest for RPOs concerned education and training, supervision and mentoring, dealing with RI breaches, and supporting a responsible research process (e.g. through quality assurance). The highest ranked RFO topics concerned dealing with breaches of RI, conflicts of interest, and setting expectations on RPOs (e.g. about educating researchers about RI). Together with the research policy experts and institutional leaders, we developed a comprehensive overview of topics important for inclusion in the RI policies of RPOs and RFOs. The topics reflect preference for a preventative approach to RI, coupled with procedures for dealing with RI breaches. RPOs and RFOs should address each of these topics in order to support researchers in conducting responsible research. Supplementary Information The online version contains supplementary material available at 10.1007/s11948-021-00322-9.

we describe the clinical and dermoscopic features of multiple BIMTs in a male and female member of a Croatian family with BAP1-associated cancer susceptibility syndrome, as well as review the literature regarding dermoscopic features of BAP1- inactivated melanocytic tumours.

Objective: There are no definitive treatment guidelines for hypertriglyceridemia (HTG)-induced acute pancreatitis (AP). The aim of this retrospective study was to evaluate the efficacy of insulin in decreasing triglyceride (TG) levels in patients with HTG-induced AP. Design: We included 17 cases of HTG-induced AP treated with continuous insulin aspart for 4 days. Patients: Fifteen patients were male, two were female. The mean TG level at admission was 56.53 ± 25.29 mmol/L. The mean APACHE II score was 10.2 ± 5.7, Ranson 4.2 ± 1.7 and Balthazar 6.5 ± 2.6, implying a severe form of the disease. Methods: In an 8- year period, 17 patients with a diagnosis of HTG- induced AP were treated with a continuous infusion of 5% dextrose and insulin aspart in an attempt to lower TG levels. TG levels were assessed on admission, the second and fourth day of therapy. The patient outcome, complications and recurrence of AP were monitored. Results: A significant reduction of TG levels was observed in all patients on Day 4. All patients survived, with one forming a giant pseudocyst as a disease complication, one needing haemodialyses treatment due to an acute kidney injury, and one developing acute respiratory distress syndrome that required mechanical ventilation for 4 days. All patients recovered completely. Conclusion: Our study showed that continuous insulin aspart infusion decreases TG levels in HTG-induced AP from a mean TG level of 56.53 mmol/L on Day 1 to 21.75 mmol/L on Day 2 and finally to 6.86 mmol/L on Day 4. We consider this therapy very efficient, safe, simple to administer and monitor.

The inflammatory phenotype of neck adipose tissue (NAT) might reflect its involvement in the pathogenesis of carotid atherosclerosis. We investigated inflammatory gene expression in the subcutaneous and the perivascular (pericarotid) adipose tissue from patients with carotid stenosis (CS) undergoing endarterectomy and a control group of patients without significant carotid atherosclerosis undergoing thyroid surgery. Only male patients were included (n = 13 in each study group). Clinical and biochemical data along with serum leptin, adiponectin, and monocyte chemoattractant protein 1 (MCP-1) were collected. Adipose tissue samples were obtained from both the subcutaneous and pericarotid compartments. Real-time polymerase chain reaction was used to measure gene expression of macrophage markers and adipokines. The CS group had higher subcutaneous and pericarotid visfatin gene expression and higher pericarotid expression of MCP-1 and CD68 genes. The ratio between pericarotid CD206 and CD68 gene expression was similar between study groups. Adiponectin gene expression in both NAT compartments did not differ between groups, but it was negatively associated with body weight. These observations suggest that NAT, and especially the pericarotid compartment, express enhanced inflammatory properties in patients with CS, but the proportion of anti-inflammatory macrophages in advanced atherosclerosis seems to be maintained.

We determined the prevailing ethical climate at three different schools of a single university, in order to explore possible differences in the ethical climate related to different research fields: the School of Electrical Engineering, Mechanical Engineering, and Naval Architecture ; the School of Humanities and Social Sciences ; and the School of Medicine. We used the Ethical Climate Questionnaire to survey the staff (teachers and administration) at the three schools, and used the research integrity and organizational climate (RIOC) survey for early- stage researchers at the three schools. The dominant ethical climate type perceived collectively at the three university schools (response rate 49%, n=294) was Laws and professional codes, which is associated with the cosmopolitan level of analysis and the ethical construct of principle. Individually, the same climate predominated at the schools for engineering and humanities, but the School of Medicine had the Self-interest ethical climate, which is associated with the individual level of analysis and the egoism ethical construct. In the RIOC survey (response rate 85% ; n=70), early- stage researchers from the three university schools did not differ in their perceptions of the organizational research integrity climate, or in their perceived individual, group or organizational pressures. Our study is the first, to the best of our knowledge, to show differences in perceived ethical climate at a medical school compared to other schools at a university. Further studies are needed to explore the reasons for these differences and how they translate to organizational outcomes, such as job satisfaction, commitment to the institution and dysfunctional behaviour, including research misconduct.

We analysed all journals from two Journal Citation Reports (JCR) categories: ‘Dentistry, Oral Surgery and Medicine’ and ‘Otorhinolaryngology’ published in 2018 for their policies on publishing facial photographs and actual practices of publishing these photographs in articles. We extracted the following data for each journal: JCR category, impact factor, volume, issue, instructions for authors regarding ethical issues, instructions for photograph deidentification, journals’ references to standard research and publishing policies, presence and type of published clinical images, separate informed consent for the publication of patient photograph and methods of deidentification. The sample included 103 journals, which published 568 articles with 1404 clinical images. Around a half of the journals (52%) had a policy on clinical images, however, the only predictor of having a journal policy on clinical images was reference in the policy to International Committee of Medical Journal Editors Recommendations (OR=3.00, 95% CI 1.26 to 7.14, p=0.013). Identifiable patient photographs were found in 13% (79/568) of the articles, constituting 9% (128/1404) of the total sample of images. Only 16% (13/79) of articles publishing recognisable patient facial images included a statement about consent for publication of the image. From the total sample of articles, 34% (27/79) contained deidentified but recognisable patient photographs and only 22% (6/27) of them had a statement about patient consent for photograph publication. The patients’ consent was more likely stated in the article in cases of recognisable facial images (OR=2.81, 95% CI 1.41 to 5.63, p=0.004). Journals publishing clinical research involving the face and neck region need to establish and enforce policies on publishing clinical images.

Clinical trials, systematic reviews (SRs), and trustworthy clinical practice guidelines (CPGs) are central to evidence ecosystems and evidence- based health care. Efficient and transparent measures should be in place to share information about any planned work. Prospective registration provides researchers with an open platform to post protocols and record the progress of studies. Prior registration of clinical trials and SRs has brought an opportunity to improve the transparency in methods and objectives, reduce unnecessary duplication and potential biases, and provide a more reliable evidence basis for CPGs.

This e-book and correspondent platform MyC3Place present the collection of the outcomes carried out by the partners of the C3Places Project.It explores the new dynamics of open spaces as a trusted service for community and expands our understanding on how mediated public open spaces function, paying attention to stakeholders, local context and different social groups. The e-book shows how it's possible to increase the quality of public open spaces (squares, parks, green spaces) as a community’s service, reflecting through ICT the needs of different social groups.

Background The European Charter of Patients' Rights (ECPR) presents basic patients' rights in health care. We analysed the characteristics of patients' complaints about their rights submitted through the official complaints system and to a non-governmental organization in Croatia. Methods The official system for patients’complaints in Croatia does not have a common pathway but offers different modes for addressing patient complaints. In this cross-sectional study, we analysed the reports about patients’ complaints from the official regional committees sent to the Ministry of Health. We also analysed the complaints received by the Croatian Association for the Protection of Patient’s Rights (CAPR) and mapped them to the ECPR. Results The aggregated official data from the Ministry of Health in 2017 and 2018 covered only 289 individual complaints from 10 out of 21 counties. Complaints were most frequently related to secondary and tertiary healthcare institutions and details were not provided. CAPR received a total of 440 letters, out of which 207 contained 301 complaints about violations of patients’ rights in 2017–2018. The most common complaint was the Right of Access to health care (35.3%) from the ECPR, followed by the Right to Information (29.9%) and the Right to Safety (21.7%). The fewest complaints were about the Right to Complain (1.9%), Right to Innovation (1.4%), Right to Compensation (1.4%), and Right to Preventive Measures (1.0%). Conclusions Reporting and dealing with patients’ complaints about violations of their patients’ rights does not appear to be effective in a system with parallel but uncoordinated complaints pathways. Mapping patient's complaints to the ECPR is a useful tool to assess the perception of patients’ rights and to plan actions to improve the complaints system for effective health care.

Objectives To investigate the changes in personal attitudes and behaviour before and after negative serological test results for severe acute respiratory syndrome coronavirus 2. (SARS-CoV-2) antibodies. Study Design Cross-sectional questionnaire survey. Methods A survey questionnaire was conducted with 200 industry workers (69% males and 31% females) who had previously tested negative for SARS-CoV-2 antibodies. The survey examined participants' self-reported general attitudes towards coronavirus disease 2019 (COVID-19), their sense of fear, as well as their behaviour towards protective measures before and after the testing. Results Participants perceived the disease as a severe health threat and acknowledged that the protective measures were appropriate. Respondents reported a high level of adherence to measures and low level of fear, both before and after the testing. Although these indicators were statistically significantly reduced after the test (p < 0.004), they did not result in irresponsible non-adherence behaviours. Almost all respondents attributed their application of personal protection measures to factors other than the results of serological screening. Conclusions Serological tests do not contribute to irresponsible non-adherence behaviours in an environment where protective measures are efficient. However, they may help reduce fear within society and working environments., Highlights • Effects of negative serological test results for SARS-CoV-2 on attitudes and behaviour. • High adherence to protective measures was reported before and after the test. • Low level of fear from infection was reported before and after the test. • Changes were statistically significant but did not result in irresponsible behaviour. • Participants did not attribute their behaviour to the serological test results.

Metastatic tumors to the oral cavity are uncommon, representing approximately 1% of all cases of oral malignant lesions even when a metastatic disease is present. The 53-year-old female is presented complaining of abdominal pain, weight loss, and a loose stool recurring not more than three times per day. A computed tomography (CT) scan of the abdomen showed a retroperitoneal mass expanding along the body of the pancreas. Colonoscopy and gastroscopy with a gastric mucosa biopsy showed a normal result. After laparoscopic surgery, the primary site of adenocarcinoma was not confirmed. The patient was referred to the Maxillofacial Surgery Clinic with pain, swelling, and occasional bleeding around the lower right second mollar. Immunohistochemicaly, the tumor cells were positive for Cytokeratin (CK) 19, Cytokeratin (CK) 7, and homebox protein (CDX-2), which are highly sensitive markers of pancreatobiliar cancer. Therefore, the patient was diagnosed with pancreatic carcinoma. This report describes a rare metastasis of malignant pancreatic tumor to the lower right gingiva and highlights the importance of immunohistochemical examination and how it helped identify both the origin and the nature of gingival neoplasm.

Thymic epithelial tumors (TETs) are rare thymic neoplasms. There are approximately 1.5 cases per million TETs per year. They are the most common anterior mediastinal tumors in adults. Due to limited activity of available treatment options novel strategies and treatment options are needed and treatment with immune checkpoint inhibitors is an attractive option. Thymic epithelial tumors have one of the lowest tumor mutational burden among all cancer in adults, but high expression of PD-L1 on tumor cells and abundant CD8+ lymphocytes provide a strong rational for implementing immune checkpoint inhibitors (ICIs) which target PD-1/PD-L1 pathway in the treatment of TETs. Few small early stage clinical trials were published so far evaluating efficacy of pembrolizumab and avelumab in thymoma and thymic carcinoma patients. Al trials showed reasonable response rates and progression-free survival. Higher PD-L1 expression was predictor of response in all trials. However, increased incidence of immune-related adverse events was seen in TET patients treated with immune checkpoint inhibitors compared to patients with other cancers. At the moment, ICIs are not standard of care for patients with TET and larger trials are needed to establish the right role of ICIs regarding efficacy and safety of these agents.

Acute crises, such as a war or a pandemic, are the ultimate tests for health care systems' resilience (temporary response to stress with change and adaptation) and antifragility (permanent benefit from change in response to stress). In this Health Policy paper, we analyse and discuss how the healthcare systems of two European countries - Bosnia and Herzegovina and Croatia - adapted to war as a man-made disaster, and how they adapted to COVID-19 pandemic twenty-five years later. These countries experienced full scale wars in recent history, which significantly changed their political and healthcare systems. This experience prepared the countries for the response to the pandemic, which coincided with two earthquakes in Croatia. We argue that healthcare systems in Croatia and Bosnia and Herzegovina are not only resilient but antifragile, and that they benefited from stressors they were exposed to. The antifragility of the two systems were primarily based on human effort - the strength, adaptability and resilience of health care professionals. We will look at lessons from the wars that were applied to the pandemic and discuss newly recognized opportunities and improvements.

Most funding agencies rely on peer review to evaluate grant applications and proposals, but research into the use of this process by funding agencies has been limited. Here we explore if two changes to the organization of peer review for proposals submitted to various funding actions by the European Union has an influence on the outcome of the peer review process. Based on an analysis of more than 75,000 applications to three actions of the Marie Curie programme over a period of 12 years, we find that the changes – a reduction in the number of evaluation criteria used by reviewers and a move from in-person to virtual meetings – had little impact on the outcome of the peer review process. Our results indicate that other factors, such as the type of grant or area of research, have a larger impact on the outcome.

ObjectivesWe validated the Croatian version of the test using multiple-choice questions (MCQs) from the Claim Evaluation Tools item bank of the Informed Health Choices project, and measured the ability of high school students to appraise health claims.Setting16 high schools from the urban agglomeration of the city of Split, Croatia.ParticipantsFinal year high school students of at least 18 years of age.Interventions18 MCQs from the item bank considered relevant for high school students were translated. After face-validity testing, the questionnaire was piloted and sent to a convenient sample of 302 high school students.Primary and secondary outcome measuresDifficulty and discrimination indices were calculated for each MCQ to determine the validity of translation and the weight of MCQs. We assessed basic metric characteristics and performed initial validation of the test. Two tests were created, the full (18 MCQs) and the short version (12 MCQs). We analysed differences in test score according to gender and school.ResultsThe response rate was 96% (75% female respondents). Metric characteristics of both tests were satisfactory (Cronbach’s α=0.71 for the full and α=0.73 for the short version). The mean score (±SD) for the full version was 11.15±3.43 and 8.13±2.76 for the short version. There were 6 easy and 12 moderately difficult questions. Questions concerning effectiveness and dissimilar comparison groups were answered correctly by fewer than 40% of students. Female students and those from grammar and health schools scored higher on both tests.ConclusionsBoth tests showed good metric characteristics and may be used for quick and reliable assessments of adolescents’ ability to appraise health claims. They may be used to identify needs and inform development of educational activities to foster critical thinking about health among adolescents.

ACKGROUND The sodium/glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like-1 receptor agonists (GLP-1RA) are antidiabetic agents effective both in hemoglobin A1c (HbA1c) reduction (with a low risk of hypoglycemia) and cardiovascular event prevention. In patients with type 2 diabetes, the add-on value of combination therapy of GLP-1RA and an SGLT-2i seems promising. AIM To investigate whether the efficacy of GLP-1RA and SGLT-2i combination observed in randomized controlled trials translates into therapeutic benefits in the Croatian population during routine clinical practice and follow-up. METHODS We included 200 type 2 diabetes patients with poor glycemic control and analyzed the effects of treatment intensification with (1) GLP-1RA on top of SGLT-2i, (2) SGLT-2i on top of GLP-1RA compared to (3) simultaneous addition of both agents. The primary study endpoint was the proportion of participants with HbA1c < 7.0% and/or 5% bodyweight reduction. Secondary outcomes included changes in fasting plasma glucose (FPG), prandial plasma glucose, low-density lipoprotein cholesterol, estimated glomerular filtration rate (eGFR), and cardiovascular (CV) incidents assessment over a follow-up period of 12 mo. RESULTS The majority of patients were over 65-years-old, had diabetes duration for more than 10 years. The initial body mass index was 39.41 ± 5.49 kg/m2 and HbA1c 8.32 ± 1.26%. Around half of the patients in all three groups achieved target HbA1c below 7%. A more pronounced decrease in the HbA1c seen with simultaneous SGLT-2i and GLP-1RA therapy was a result of higher baseline HbA1c and not the effect of initiating combination therapy. The number of patients achieving FPG below 7.0 mmol/L was significantly higher in the SGLT-2i group (P = 0.021), and 5% weight loss was dominantly achieved in the simultaneous therapy group (P = 0.044). A composite outcome (reduction of HbA1c below 7% (53 mmol/mol) with 5% weight loss) was achieved in 32.3% of total patients included in the study. Only 18.2% of patients attained composite outcome defined as HbA1c below 7% (53 mmol/mol) with 5% weight loss and low-density lipoprotein cholesterol < 2.5 mmol/L. There were no significant differences between treatment groups. No differences were observed regarding CV incidents or eGFR according to treatment group over a follow-up period. CONCLUSION Combination therapy with GLP-1RA and SGLT-2i is effective in terms of metabolic control, although it remains to be determined whether simultaneous or sequential intensification is better.

This paper presents the main characteristics of a decision-making support tool for economic and environmental assessment of enhanced geothermal systems given a particular site. The tool examines the enhanced geothermal systems projects in a holistic way considering: technology details, geothermal site characteristics, energy prices, and spatial data, social impact, and environmental impact. The tool developed under this research will be capable to 1) calculate system levelized cost of electricity for particular technology using forecasted data over the lifecycle of the technology and 2) choose the best enhanced geothermal system technology for a given site. The decisions of the tool will be obtained by a multiple-criteria decisionmaking analysis where the performance of a technology is assessed on credible criteria.

Malignant pleural mesothelioma (MPM) is an aggressive tumor that develops from the mesothelial cells lining the pleural cavity. The most relevant risk factor is asbestos exposure. Despite therapy the median survival is poor ranging from four to 18 months. The aims and objectives of this study were to assess the clinical characteristics and survival of patients with MPM treated at UHC Zagreb. This study included 101 patients diagnosed and treated for MPM at UHC Zagreb from September 1999 to September 2012. We analyzed the overall survival (OS), progression free survival (PFS) and OS depending on histological subtype, clinical stage, age, treatment method and pleurodesis performed using the Kaplan-Meier method. Eighty-nine patients were male and 12 female with the median age of 62 years. Using the TNM staging system, 69.3% were stage IV, 26.73% were stage III and 3.96% were stage II. 73.26% of MPM were epitheloid, 4.95% sarcomatous and 20.79% were NOS (non otherwise specified) histological subtype. 14.85% of patients had surgery, 55.44% of patients received chemotherapy and 9.9% radiotherapy. Median OS was 11 months and PFS was ten months. OS by histological subtype was 11 months for epitheloid, 12.5 months for NOS and 5.5 months for sarcomatous MPM. OS by TNM stage was seven months for stage II, 17.5 months for stage III and 11 months for stage IV disease. Median OS was longer for patients younger than 65 (12 vs. 8.5 months, p=0.28), patients treated with pleurodesis (13 vs. 7.5 months, p=0.06) and patients who received chemotherapy (12.5 vs. 7.5 months, p=0.10). The overall survival and prognosis of patients with malignant pleural mesothelioma in Croatia is poor in accordance with the literature. The studied treatment methods offer only a modest survival benefit to our patients.

Counselling, coaches and collegiality — how institutions can share resources to promote best practice in science. Counselling, coaches and collegiality — how institutions can share resources to promote best practice in science.

Unmanned Aircraft Systems (UASs) have been recognized as an important resource in search-and-rescue (SAR) missions and, as such, have been used by the Croatian Mountain Search and Rescue (CMRS) service for over seven years. The UAS scans and photographs the terrain. The high-resolution images are afterwards analyzed by SAR members to detect missing persons or to find some usable trace. It is a drawn out, tiresome process prone to human error. To facilitate and speed up mission image processing and increase detection accuracy, we have developed several image-processing algorithms. The latest are convolutional neural network (CNN)-based. CNNs were trained on a specially developed image database, named HERIDAL. Although these algorithms achieve excellent recall, the efficiency of the algorithm in actual SAR missions and its comparison with expert detection must be investigated. A series of mission simulations are planned and recorded for this purpose. They are processed and labelled by a developed algorithm. A web application was developed by which experts analyzed raw and processed mission images. The algorithm achieved better recall compared to an expert, but the experts achieved better accuracy when they analyzed images that were already processed and labelled.

Medical journals must be as transparent as they require their authors to be. Disclosure of potential conflicts of interest by authors and editors is best practice and recommended by the International Committee of Medical Journal Editors (ICMJE). Most journals following ICMJE recommendations require authors to provide a declaration of interests. Very few journals, however, disclose individual editors’ COIs. Editors need to declare their own potential COIs as well as journal revenues since these might be considered to affect publication decisions.

We think CROSS has the potential to be a beneficial resource to researchers who are designing and conducting survey studies. Following CROSS before and during the survey administration could assist researchers to ensure their surveys are sufficiently reliable, reproducible, and transparent.

Primary hyperparathyroidism (PHPT) is nowadays usually diagnosed as an asymptomatic disease but it might be related with advanced end-organ damage. Parathyroid incidentaloma (PI) is the term describing enlarged parathyroid nodules that are unexpectedly discovered on surgery or by imaging performed for nonparathyroid disorders. The recognition of PI might uncover a clinically significant PHPT with the potential for surgical cure. We retrospectively reviewed patients’ records with a newly diagnosed PHPT in the last 5 years in our hospital. Among 74 retrieved patients we found 14 (18.9%) diagnosed with PHPT following the discovery of PI. Nonparametric statistical tests were used for the comparison between this PI PHPT group and the rest of our cohort. Overall thirteen PHPT patients with PIs were discovered on neck ultrasound. The median volume of these PIs was 403.2 mm3 (117–1570 mm3). One PI was found during the surgery in a patient referred for thyroidectomy at our institution. The previous presence of PHPT in this case was suggested by development of transitory hypocalcemia due to hungry bone syndrome after the surgery. The rest of PHPT patients were mostly identified by incidental laboratory findings of hypercalcemia (36.5%) or during the osteoporosis work-up (32.4%). The comparison of the PI PHPT group with other PHPT patients found a statistically similar level of PTH, calciuria and eGFR. The highest serum calcium level measured before treatment was lower in PI PHPT patients (P = 0.037), but rates of normocalcemic PHPT were comparable in both groups. The PI PHPT group had more often positive scintigraphy (P = 0.027). Differences in the occurrence of osteoporosis and urolithiasis did not reach statistical significance. The PI PHPT group was less likely to meet the international consensus criteria for surgery (P < 0.01), but the frequency of surgical management did not differ between groups. The surgical cure for PHPT was achieved in all PI PHPT patients and pathohistology of all operated PIs confirmed adenomas. PIs are still an uncommon but relevant way of revealing PHPT. In our institution the radiological suspicion for enlarged parathyroid glands is further investigated only after the positive biochemical screening for parathyroid hyperfunction. This certainly introduces a bias in our clinical data because silent PIs are disregarded, similar to bias which exists in other circumstances of discovering asymptomatic PHPT. We emphasize that all relevant laboratory parameters are checked not to miss the normocalcemic PHPT. An appropriate follow up for suspicious silent nodules should be suggested.

Given our recent discovery of somatic mutations in autism spectrum disorder (ASD)/intellectual disability (ID) genes in postmortem aged Alzheimer’s disease brains correlating with increasing tauopathy, it is important to decipher if tauopathy is underlying brain imaging results of atrophy in ASD/ID children. We concentrated on activity-dependent neuroprotective protein (ADNP), a prevalent autism gene. The unique availability of multiple postmortem brain sections of a 7-year-old male, heterozygous for ADNP de novo mutation c.2244Adup/p.His559Glnfs*3 allowed exploration of tauopathy, reflecting on a general unexplored mechanism. The tested subject exhibited autism, fine motor delays, severe intellectual disability and seizures. The patient died after multiple organ failure following liver transplantation. To compare to other ADNP syndrome mutations, immortalized lymphoblastoid cell lines from three different patients (including ADNP p.Arg216*, p.Lys408Valfs*31, and p.Tyr719* heterozygous dominant mutations) and a control were subjected to RNA-seq. Immunohistochemistry, high-throughput gene expression profiles in numerous postmortem tissues followed. Comparisons to a control brain and to extensive datasets were used. Live cell imaging investigated Tau-microtubule interaction, protecting against tauopathy. Extensive child brain tauopathy paralleled by multiple gene expression changes was discovered. Tauopathy was explained by direct mutation effects on Tau-microtubule interaction and correction by the ADNP active snippet NAP. Significant pathway changes (empirical P value ADNP showed relatively reduced expression in the ADNP syndrome cerebellum, which was also observed for 25 additional genes (representing >50% of the tested genes), including NLGN1, NLGN2, PAX6, SMARCA4, and SNAP25, converging on nervous system development and tauopathy. NAP provided protection against mutated ADNP disrupted Tau-microtubule association. In conclusion, tauopathy may explain brain-imaging findings in ADNP syndrome children and may provide a new direction for the development of tauopathy protecting drug candidates like NAP in ASD/ID.