SUMMARYParalysis of the facial nerve represents an exceptional functional, social and cos- metic problem for the patient. Loss of function directly leads to the inability to protect the eyes, as well as oral competence, while indirectly affecting breathing and verbal communication. Patients often encounter social stigmatization and isolation, which is direct consequence of the loss of mimic function and disfiguration that is necessary for everyday nonverbal communication. Thus, the quality of life is strongly impaired, and patients are prone to developing depression. The primary goal of reanimation is establishment of facial tone at rest, mimic function, and symmetry. The method of choice is directly dependent on the time elapsed from the onset of paralysis. Facial reanimation methods can be divided into static and dynamic. In reanimation procedures, we usually divide the face into thirds. Procedures for reanimation of the upper third of the face include oculoplastic procedures, which are divided according to the place of intervention into procedures aimed at the eyebrow, upper and lower eyelid. Static methods predominate here, i.e., endoscopic eyebrow lifting, tightening of the upper eyelid, and tightening of the lower eyelid. Procedures for reanimation of the lower third of the face are mainly based on restoring oral competence and smile, therefore the method of choice is dynamic reanimation. Direct repair of the nerve either by direct anastomosis or interposition provides the best results. In the absence of the proximal part of the facial nerve, and functional distal branches, local motor nerves and/or cross facial nerve graft (CFNG) are used as a source. In the case of long-term paralysis of the facial nerve (>2 years), muscle tissues are used in reanimation using local or innervated free flaps. Of the local muscle flaps, we most often use the minimally invasive temporalis tendon transfer (MIT3) method. The gracilis free flap is most often used in younger patients who desire to achieve a more accentuated smile, and the procedure can be performed in one or two acts. Reanimation of the face is an often neglected but extremely important procedure that should provide the patient with partial function resumption while significantly improving the quality of life.

Melanoma has emerged as a significant global health issue in recent decades, especially in countries with a predominantly fair-skinned population.Well recognized risk factors for melanoma include exposure to ultraviolet radiation, fair skin phototypes and a familial predisposition to malignant skin conditions.Although smoking is a well-known carcinogen, its impact on melanoma has been under-researched and is not routinely assessed during melanoma patient examinations.Existing studies suggest a correlation between smoking and adverse prognostic factors in melanoma, such as increased tumor thickness, ulceration and lymph node metastasis, leading to higher mortality rates independent of age, sex and disease stage.Surprisingly, some studies report a negative correlation between smoking and melanoma incidence, particularly in men, highlighting the need for further investigation.In light of the detrimental effects of smoking on melanoma prognosis, it is recommended to routinely assess smoking status -including former smoking habits -during initial evaluation and follow-up, and offer the patient support in quitting.Recognizing smoking as one of the key modifiable risk factors for cutaneous melanoma could be useful in reducing the disease's impact and improving its outcome in these patients.

The radial nerve anatomical positioning as it wraps around the distal portion of the humeral shaft in contact with the bone is the reason for its high incidence of injury during fracture. Traumatic radial neuropathy regresses spontaneously, but in certain cases surgical intervention may be necessary to achieve neurological recovery. The aim of this study was to present our experience in the treatment of radial nerve injuries associated with humeral shaft fracture. We performed a retrospective study of 20 cases of radial nerve injury after humeral fracture, all of which were managed surgically. We evaluated several factors such as neurological status, electromyoneurography results, time of treatment, surgical techniques, type of radial nerve surgery performed, and clinical outcomes. Our primary outcome measure was the incidence of traumatic radial neuropathy, while secondary outcome was focused on nerve recovery. Out of 166 operations for humeral shaft fractures performed during a ten-year period, 20 patients were identified for this study. The average age of patients was 32 (±22) years. The largest number of fractures (83%) were initially stabilized by open reduction. The fractures were in the mid third of the shaft in 11 (55%) cases and in distal third in 9 (45%) cases. Primary nerve injury was present in 15 (75%) patients, while iatrogenic radial nerve injury occurred in 5 (25%) patients. The mean DASH score was 9±15, with 90% of patients regaining their previous level of physical activities. In conclusion, in a shaft humeral fracture, radial nerve lesion symptoms may be seen and resolve in most cases. If neurological symptoms do not improve, electromyoneurography can be employed to assess the degree of nerve damage. Surgical intervention is indicated if there is no functional recovery after three months of conservative management.

SUMMARYOne of the most common diseases in vascular surgery is peripheral arterial disease, the last stage of which is critical limb ischemia. It is characterized by rest pain or tissue loss. In most cases, after revascularization, and due to gangrenous changes, it is necessary to perform amputation of a part of the lower limb. After amputation, the wound is bandaged with dressings. In conducting this pilot study, some patients were bandaged with platelet rich fibrin (PRF) in combination with dressings, while the others were treated only with dressings. PRF is a biologic material that is received from blood of the patient. All patients included in the trial had at least 2 out of 3 traversable blood vessels in the lower leg before treatment and underwent femoropopliteal bridging with prosthesis. Patients treated with PRF after revascularization had an average of 5 weeks of wound healing, in contrast to patients treated only with dressings, whose mean wound healing was 8.5 weeks and a proportion of these patients ended up with an extended amputation level. After the study, it is concluded that this type of treatment can be safely used in the treatment of vascular pathology.

SUMMARYThe prevalence of relapses in advanced squamous cell head and neck cancer (SCHNC) is significant, and so is treatment morbidity. There is persistent need for reliable biomarkers in order to better personalize treatment. The purpose of the present study was to evaluate prognostic significance of focal adhesion kinase (FAK) and CD8 expression in human papillomavirus (HPV) negative SCHNC treated with radiotherapy. FAK and CD8 expression was evaluated by immunohistochemical staining. A total of 62 tissue samples were assessed. High expression of FAK was determined in 37.1% and high expression of CD8 in 25.8% of study patients. Patients with high expression of FAK had significantly more relapses than patients with low FAK expression (p=0.04). FAK and CD8 expression had no significant impact on overall survival (OS) (p=0.44 and p=0.48, respectively) and relapse free survival (RFS) (p=0.21 and p=0.31, respectively). However, patients with high expression of FAK and low expression of CD8 had the worst 5-year OS (38.7%) and 5-year RFS (44.3%). Patients with low expression of FAK had significantly less relapses. The prognostic role of FAK and CD8 expression in SCHNC patients treated with radiotherapy was not proven.

SUMMARYExercise causes considerable changes in the number and function of immune cells and hormones in circulation. The aim of this study was to assess the impact of training regime on immune and inflammatory markers and parameters of complete blood count, thyroid function and tumor markers, immediately after intense, mostly anaerobic training in elite karate athletes. There are no similar studies that would determine changes in the concentration of tumor markers immediately after intense exercise. Study population included seven elite trained athletes, members of the Croatian National Karate Kata female team and Kata male team. Our data provided evidence that the white blood cell and segmented neutrophil granulocyte counts were significantly decreased and lymphocytes significantly increased with no major changes in interleukin-6 immediately after anaerobic exercise. We also noticed a strong increase of thyrotropin and no significant change in the levels of tumor markers. It was concluded that immune response and thyroid hormone status were in correlation with exercise duration and intensity. According to our results, a larger study is needed to define the impact of training and interrelation between sports and laboratory medicine as a perfect combination in terms of discovering new mechanisms and biochemical strategies in training of elite athletes.

The aim of this study was to determine the relationship between demographic characteristics, initial laboratory data and comorbidities with prognosis in inpatients followed up for coronavirus disease 2019 (COVID-19) and to create a new model for predicting mortality risk. In this multicenter, retrospective cohort study, patient demographic and clinical data were recorded at the first patient admission to the hospital. The primary outcome was to evaluate the relationship of demographic characteristics, laboratory parameters and comorbidities with mortality. Parameters found to be associated with mortality in univariate analyses were also evaluated with multivariate analyses and a final model was established. In the final model, the presence of chronic obstructive pulmonary disease (COPD) (OR: 3.177, 95% CI: 1.574-6.413), age (OR: 1.056, 95%CI: 1.034-1.078), lactate dehydrogenase (LDH) (OR: 1.002, 95%CI: 1.001-1.003), troponin (OR: 1.052, 95% CI: 1.007-1.099), D-dimer (OR: 1.012, 95%CI: 1.002-1.021), and C-reactive protein (CRP)/albumin ratio (OR: 1.278, 95%CI: 1.145-1.427) were found to be associated with mortality. The model accurately predicted mortality with a sensitivity of 82.6% and specificity of 77.7%. COPD, age, LDH, troponin, D-dimer, and CRP/albumin ratio were determined as factors associated with mortality. Assessment of these parameters at the time of admission of inpatients, classifying patients as high risk, and adopting early and appropriate treatment approaches may help in the management of patients.

SUMMARYModern literature supports primary repair in a wide array of colon injury presentations. The aim of the study was to evaluate the validity of criteria for primary repair of colon injuries. The analysis involved 96 patients with colon injuries. Group 1 (62 patients) underwent the Stone and Fabian (S/F) criteria for primary repair, whereas group 2 (34 patients) underwent the following exclusion criteria for primary repair: significant peritonitis, edema/ischemia of a large area/multiple colonic segments, latent period >8 h, and intraoperative cardiorespiratory instability. The following variables were analyzed: demographic data, mechanism of injury, latent period, distribution of injuries, macroscopic intraoperative finding, and several trauma indices. The mean latent period was shorter in group 2 (1.3±1.1 h) versus group 1 (4.9±3.7 h). Primary repair was more frequent in group 2. There was no difference in the success rate of the primary procedures between the two groups according to Flint grade or S/F criteria. Primary repair is safe and recommended in the first 8 h after injury in hemodynamically and respiratory stable patients without intra-abdominal sepsis.

Fuchs endothelial corneal dystrophy (FECD) is a bilateral dystrophy of the cornea and the most common indication for corneal transplantation procedures.Currently, the clinical assessment of the disease relies on slit-lamp grading, central corneal thickness, endothelial cell analysis and high contrast visual acuity.The Visual Function and Corneal Health Status (V-FUCHS) is a paper questionnaire that measures patient-reported visual disability, unlike classic diagnostic procedures.It contains 8 questions regarding glare and daily fluctuations, and 7 questions regarding visual acuity.The English version of V-FUCHS was developed in cooperation with patients and experts in the field according to recommendations for questionnaire development.Pretesting was performed in patients in different stages of the disease.Each question in the V-FUCHS questionnaire is answered by placing a cross in one of the 5 possible answer categories on a Likert scale.The aim of this study was to translate the V-FUCHS questionnaire into Croatian and to examine its reliability.

Background: Stroke, a neurological condition, ranks as the second leading cause of death and disability worldwide, resulting in sensory, motor and cognitive impairments.Post-stroke cerebral atrophic changes in various brain regions, both ipsilesional and contralesional, carry significant clinical implications.This systematic review and meta-analysis aims to explore structural (volume and cortical thickness) and functional deficits induced by post-ischemic stroke cerebral atrophy. Methods:The review encompassed studies conducted from January 2010 to October 2021, resulting in the inclusion of 33 articles sourced from PubMed/Medline, Cochrane/EMBASE and PEDro databases.Keywords such as 'stroke', 'cortical atrophy', 'cerebral atrophy', 'motor', 'sensory' and 'cognitive disability' were utilized in the search process.Results: Notably, the temporal lobe emerged as the most commonly affected site for atrophic volume changes, followed by the thalamic areas, hippocampus, cerebellum and sensory cortex.Cortical thinning was observed in frontotemporal, inferior parietal, primary motor cortex (M1) and superior frontal gyrus regions of the stroke hemisphere.Regarding functional outcomes, gray matter volume (GMV) was found to correlate with motor function, with severe GMV atrophy hindering clinical recovery, while increased GMV was linked to better outcomes.Additionally, GMV was associated with cognitive functions.Notably, changes in total and regional brain tissue volume were observed early poststroke and continued at an accelerated rate compared to normal age-related atrophic changes.Conclusion: This underscores the potential of brain atrophy as a prognostic marker for identifying regions of structural plasticity and as a therapeutic target.