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Background: We aimed to determine if there was a higher incidence of small intestinal bacterial overgrowth (SIBO) in nonalcoholic fatty liver disease (NAFLD) than in patients without NAFLD. Moreover, we assessed whether patients with significant fibrosis (SF) had a higher incidence of SIBO compared to patients with non-significant or no liver fibrosis. Methods: NAFLD was diagnosed in 117 patients by using Fibroscan with a controlled attenuation parameter (CAP) as well as liver biopsy (LB). SIBO was defined by esophagogastroduodenoscopy with an aspiration of the descending duodenum. Results: Patients with nonalcoholic steatohepatitis (NASH) and those with SF on LB had a significantly higher incidence of SIBO than patients without NASH and those without SF, respectively (p

Cilj: cilj ove studije je ukazati na ulogu patohistološke analize (PHA) preparata tkiva bojenih hemalaun-eozin (HE) bojom u sudskomedicinskoj praksi. Metode: Radi se o retrospektivnoj studiji obdukcija izvršenih na Zavodu za sudsku medicinu i kriminalistiku Medicinskog fakulteta u Rijeci u periodu od 2000.-2014. Istražena je zastupljenost prirodnih prema nasilnim smrtima, te vrsta prirodnih smrti koje su kod sudskomedicinskih obdukcija najzastupljenije. Također ćemo prikazati koji udio u srčanim smrtima čine smrti uslijed ishemijske bolesti srca (IBS) te koliki je udio preminulih od infarkta miokarda (IM). Rezultati: temeljem analiziranih podataka proizlazi da se u istraživanom petnaestogodišnjem periodu odnos između nasilnih i prirodnih smrti nije značajnije mijenjao (p=0, 052) te je tijekom tog razdoblja broj obdukcija relativno konstantan. Uočen je trend porasta prirodnih u odnosu na nasilne smrti od 2010. godine. Kod prirodnih, srčane smrti su vodeći uzrok, a udio smrti uslijed ishemijske bolesti srca (IBS) u tim srčanim smrtima iznosi 87%. Od ukupnih smrti uslijed IBS-a, u provedenom istraživanju IM je zastupljen 21%. Zaključak: PHA je neizostavna kod naglih srčanih smrti (NSS) u koje, kao smrt uslijed IBS spada i IM. To je pretraga koja pomaže kada pri na obdukciji nije moguće utvrditi stvaran uzrok smrti ; pretraga koja omogućava vizualizaciju infarktom zahvaćenog srčanog mišića i unutar 24 sata od nastanka lezije (što se ne može uočiti makroskopski), te pretraga koja u sudskom postupku može otkloniti dvojbe. Osim što može potvrditi makroskopski nalaz s obdukcije, može katkad biti pretraga koja utvrđuje stvarni uzrok smrti, a kod naglih srčanih smrti ta pretraga je neizostavna. Predstavlja materijal koji se može koristiti za pregled duže vrijeme nakon smrti, za znanstvena istraživanja i edukaciju.

Biological traces found at the crime scene are of human, animal and plant origin. Among them the most commonly present are of human origin - hair, blood, sperm, saliva, sweat and tears, but also nails, teeth and bone bits. When considering biological traces as evidence, we distinguish incontestable and debatable traces. Incontestable samples are taken from suspects, alive victims and from all other people that may have been in contact with the traces or objects at the crime scene. Debatable traces are found at the scene of events, on objects or people associated with a venue or criminal offense, whose identity and role in the event is known. When taking biological traces, it is necessary to comply with the anti-contamination and safety rules regarding handling with biological material, including self-protection measures. The goal of processing biological traces that are usable as court evidence is to provide a sufficient amount of DNA, which can be used in the individualization of each biological trace. However, in addition to this analytical step by which evidence is undoubtedly drawn from the trace, biological traces can be treated with some simpler, cheaper and less reliable methods. In this review article, we also discussed the judicial significance of sperm traces. Sperm is often analyzed for crimes impingeing on sexual freedom. Hair samples can be used for toxicological analysis and to connect perpetrators to an event or victim.

With an overview of deaths by drowning - a common accident based on asphyxia, we bring a unique perspective at the newer literature, bearing in mind our students, who we hope to bring closer to this obscure and hardly accessible topic. An interest in this topic can be explained, on the one hand, by epidemiology; namely, each year a large number of people, especially children dies in water; and, on the other hand, deaths by drowning often involve a spectrum of various topics from forensic medicine. While writing this article, we tried to make a clear distinction between drowned and bodies retrieved from water, to clarify the pathophysiological sequence of events of death by drowning, and present typical pathoanatomical findings. In addition to the "classic drowning", we also show some lesser and equally interesting deaths involving submersion in water. Along with the facts listed in the international literature, we also bring the data that we have collected through the thirty-year documentation, which will make our work more interesting and valuable.

Izgladnjivanje do smrti samo je iznimno uzrok smrti u razvijenim zemljama. Međutim, ova pojava može imati daleko veći značaj ako je sudskomedicinski gledano smrt posljedica namjernog uskraćivanja hrane. U takvim slučajevima zadatak specijalista sudske medicine ili patologa je razjasniti uzrok smrti i dati stručno mišljenje o stupnju i trajanju gladi. Za procjenu proteinsko-energijske pothranjenosti razvijeno je nekoliko klasifikacijskih sustava koji se također opisuju u članku. Mnogo je faktora vezanih uz dob koji mogu dovesti do gubitka apetita i smanjenja težine, te se u preglednom članku oni i razmatraju. Sudskomedicinski su posebno interesantni slučajevi izgladnjivanja u kojima su, u sklopu pojave zlostavljanja i zanemarivanja, pogođena djeca,. Upravo takve primjere iz literature i navodimo u radu, uz osvrt na osobe starije životne dobi. Ove su osobe, zbog nerazmjera u odnosu snaga, posebno ugrožena skupina, kod koje je također najčešći tip pothranjenosti proteinsko-energijska pothranjenost., Starvation with a fatal outcome is just an exceptional cause of death in developed countries. However, this phenomenon may have far greater significance if a criminal case related-death is the consequence of deliberate denial of food. In such cases, the task of a specialist in the field of legal medicine or pathology is to clarify the cause of death and give a professional opinion on the degree and duration of violent starvation. For the evaluation of protein-energy malnutrition, several classification systems have been developed, which are also described in the article. There are many age-related factors that can lead to loss of appetite and weight loss, and they are being considered in this review article. Suddenly, specially interesting cases of starvation affect children, as a result of abuse and neglect. It is precisely these examples from the literature and we are cited in this paper, concerning older people. These people, due to the unbalanced relationship of strength, are particularly vulnerable to the group, which is also the most common type of malnutrition protein-energy malnutrition.

Cilj: cilj ove studije je ukazati na ulogu patohistološke analize (PHA) preparata tkiva bojenih hemalaun-eozin (HE) bojom u sudskomedicinskoj praksi. Metode: Radi se o retrospektivnoj studiji obdukcija izvršenih na Zavodu za sudsku medicinu i kriminalistiku Medicinskog fakulteta u Rijeci u periodu od 2000.-2014. Istražena je zastupljenost prirodnih prema nasilnim smrtima, te vrsta prirodnih smrti koje su kod sudskomedicinskih obdukcija najzastupljenije. Također ćemo prikazati koji udio u srčanim smrtima čine smrti uslijed ishemijske bolesti srca (IBS) te koliki je udio preminulih od infarkta miokarda (IM). Rezultati: temeljem analiziranih podataka proizlazi da se u istraživanom petnaestogodišnjem periodu odnos između nasilnih i prirodnih smrti nije značajnije mijenjao (p=0,052) te je tijekom tog razdoblja broj obdukcija relativno konstantan. Uočen je trend porasta prirodnih u odnosu na nasilne smrti od 2010. godine. Kod prirodnih, srčane smrti su vodeći uzrok, a udio smrti uslijed ishemijske bolesti srca (IBS) u tim srčanim smrtima iznosi 87%. Od ukupnih smrti uslijed IBS-a, u provedenom istraživanju IM je zastupljen 21%. Zaključak: PHA je neizostavna kod naglih srčanih smrti (NSS) u koje, kao smrt uslijed IBS spada i IM. To je pretraga koja pomaže kada pri na obdukciji nije moguće utvrditi stvaran uzrok smrti; pretraga koja omogućava vizualizaciju infarktom zahvaćenog srčanog mišića i unutar 24 sata od nastanka lezije (što se ne može uočiti makroskopski), te pretraga koja u sudskom postupku može otkloniti dvojbe. Osim što može potvrditi makroskopski nalaz s obdukcije, može katkad biti pretraga koja utvrđuje stvarni uzrok smrti, a kod naglih srčanih smrti ta pretraga je neizostavna. Predstavlja materijal koji se može koristiti za pregled duže vrijeme nakon smrti, za znanstvena istraživanja i edukaciju., Aim: We aimed this study to highlight the role of histopathological analysis (HPA) using Hemalaun-eosin (H&E) staining technique in forensic medical practice. Methods: This is a retrospective study of autopsies performed at the Department of Forensic Medicine and Criminology, School of Medicine in Rijeka in the period from year 2000 to 2014. We reviewed our data for the natural or a violent death, and whether natural death was of cardiac origin, we reviewed the number of deaths due to ischemic heart disease (IHD) and myocardial infarction (MI). Results: during the fifteen years, the relationship between violent and natural death did not changed significantly (p=0.052) and during this period the number of autopsies remained relatively constant. There has been an increase of natural in relation to the violent deaths since 2010. In natural deaths, cardiac death is the leading cause of death, and the proportion of deaths due to IBS in total cardiac deaths was 87%. Of the total deaths caused by IBS, in the conducted research IM is represented by 21%. Conclusion: HPA is indispensable to sudden cardiac death (SCD). This is a test that helps whenever the autopsy alone cannot bring out the real cause of death; this assessment allows visualization of the infarction-affected cardiac muscle within 24 hours (what cannot be observed macroscopically), and the results could help eliminate doubt in legal proceedings. It represents a material that can be used to check for a long time after the death, for scientific research and education.

Prikazom smrti do koje se dolazi utapanjem, čestom nesrećom u čijoj je podlozi asfiksija, pružamo jedinstven pogled na noviju literaturu, te se nadamo kako ćemo čitateljima približiti područje čije je proučavanje na hrvatskom jeziku gotovo nemoguće. Interes za ovu temu možemo objasniti s jedne strane epidemiološkim kretanjima; naime, utapanjem godišnje u svijetu strada velik broj ljudi, naročito djece; a, s druge strane, umiranje utapanjem često obuhvaća spektar najrazličitijih tema iz sudske medicine. Pri pisanju članka trudili smo se raditi jasnu razliku između utopljenika i tijela preminulih koji su izvađeni iz vode, razjasniti slijed patofizioloških zbivanja kod smrti utapanjem, te predstaviti tipične sudskomedicinske nalaze. Uz pregled područja „klasičnog utapanja“ prikazujemo i neke rjeđe a jednako interesantne smrti do kojih dolazi utapanjem. Uz činjenice navedene u međunarodnoj literaturi donosimo i podatke do kojih smo došli analizom dokumentacije prikupljene na Zavodu za sudsku medicinu i kriminalistiku u Rijeci., With an overview of deaths by drowning - a common accident based on asphyxia, we bring a unique perspective at the newer literature, bearing in mind our students, who we hope to bring closer to this obscure and hardly accessible topic. An interest in this topic can be explained, on the one hand, by epidemiology; namely, each year a large number of people, especially children dies in water; and, on the other hand, deaths by drowning often involve a spectrum of various topics from forensic medicine. While writing this article, we tried to make a clear distinction between drowned and bodies retrieved from water, to clarify the pathophysiological sequence of events of death by drowning, and present typical pathoanatomical findings. In addition to the "classic drowning", we also show some lesser and equally interesting deaths involving submersion in water. Along with the facts listed in the international literature, we also bring the data that we have collected through the thirty-year documentation, which will make our work more interesting and valuable.

Although drowning in rainwater tanks is a generally rare phenomenon, this method for suicide has been observed in parts of Croatia. Review of autopsy records at the University of Rijeka, Croatia, was undertaken from 1987 to 2016 to examine this phenomenon. Of 469 drowning deaths, there were 35 suicides in rainwater tanks (7.5%). Overall drowning deaths showed no temporal trends. In contrast, suicidal drownings in rain water tanks showed a marked decline over the years, with 15 cases in 1987-1991, seven in 1992-1996, six in 1997-2001, six in 2002-2006, one in 2007-2011, and none in 2012-2016. Thus, suicidal drowning cases as a percentage of overall drownings dropped from 18% to zero (p

When abuse, maltreatment and neglect are suspected, a proper physical examination is essential. This is even more important at autopsy, when there is no possibility to gain information from the alleged victim and where the forensic pathologist has to link the evidenced signs or sequalae of abuse with the possible manner and cause of death. This case report presents the results and conclusions of the medico-legal autopsy of a 30-year-old woman found dead in her fiancé's home. The conditions and material evidence found on scene aroused doubts on the cause and manner of death. Dermatological signs found on the corpse (abrasions, contusions and decubitus ulcers) suggested a history of domestic abuse and neglect that was further confirmed by a detailed macroscopic and microscopic examination of the body. An insight into the woman's medical history further implied the possibility of long-term domestic violence. The forensic pathologist reported bronchopneumonia as the main cause of death, provoked by the combined effect of malnourishment, deliberated immobilization and neglected decubitus ulcers. This case is uncommon as it presents the homicide of a young woman caused by a prolonged abusive behaviour associated with complete neglect of her aggravating health conditions and provoked injuries.

Pojam „iznenadna smrt u epilepsiji“ (engl. Sudden Unexpected Death in Epilepsy – SUDEP) označava iznenadnu, neočekivanu (bez obzira na postojanje evidentiranog napadaja), neposvjedočenu ili posvjedočenu smrt u bolesnika s epilepsijom, koja nije nastupila kao izravna posljedica neke traume. Budući da je iz definicije jasno da uzrok smrti nije očit, ne čudi što ovaj entitet u modernoj forenzici dobiva sve veću važnost. Naime, stručnjak sudske medicine u stvaranju svojih zaključaka rukovodi se uglavnom heteroanamnestičkim podacima, nekim tipičnim ozljedama i toksikološkom analizom. U sudskomedicinskoj praksi smrt pacijenta koji boluje od epilepsije može nastupiti tijekom izvođenja neke od svakodnevnih aktivnosti (poput vožnje ili ronjenja), što naglašava ulogu stručnjaka sudske medicine u utvrđivanju prirode smrti. Stoga smo pregledali literaturu o iznenadnoj i neočekivanoj smrti u epilepsiji, definirali termine, prikazali dosadašnje hipoteze o mehanizmu nastupanja smrti te ulogu suvremenih terapijskih pristupa. Epilepsija može biti povezana s mnogim patološkim stanjima, što na obdukciji treba prepoznati. S obzirom na to da se dijagnoza smrti zbog epilepsije temelji na metodi isključivanja, postoji mogućnost zanemarivanja prave incidencije takvih uzroka smrti., The term sudden unexpected death in epilepsy, regardless of the existing recorded attacks, represents a sudden, unexpected, witnessed or unwitnessed death in patients with epilepsy, which did not occur as a direct result of some trauma or drowning. As it is clear by definition that the cause of death is not obvious, it is not surprising that this entity is becoming increasingly important in modern forensics. In the creation of this conclusions a forensic expert mainly uses heteroanamnestic data, some typical injuries and toxicological examination. In forensic practice, the death of a patient suffering from epilepsy can occur during daily activities (such as driving or diving), which emphasizes the role of forensic medicine ­experts in such cases. Therefore, we conducted a literature review on the topic of sudden and unexpected death in epilepsy, defined terms, and showed the current hypotheses about the mechanism of death, and the role of modern therapeutic ­approaches. In particular, we review the possible forensic implications and the importance of conducting autopsies.

High pressure injection injuries (HPII) of the foot are not common in every-day practice. We present a 50-year-old patient with a HPII of the left foot caused by water-gun in a self- inflicted accident working as a technical diver four meters under the sea surface. Surgical treatment included extensive debridement of necrotic tissue and fibrin deposits and removal of foreign material. A negative pressure wound therapy (NPWT) device was applied resulting in a good wound base for subsequent skin grafting leading to a good functional and cosmetic outcome.

The authors present a unique case of decollement injury found on an 85-year-old victim that was run-over by a tank truck. While external examination evidenced multiple severe injuries, autopsy confirmed the preliminary findings and revealed also the presence of an extensive decollement that spread from the left hemithorax to a wound on the left ankle, through which parts of the small intestines and pertaining mesentery protruded. The article offers an interpretation of the injuries sustained by the victim, focusing on the most probable decollement mechanism. The forensic pathologist in this case could rely also on the valuable help of surveillance cameras of a nearby bank office that helped to better understand the events that brought to the fatal injuries. The authors concluded that the expulsion of the jejunum was produced by a combination of two movements: a forward passage that created the decollement and detachment of the jejunum and a backward movement that completed the expulsion of the jejunum through the open fracture of the ankle. This case report evidences the importance of the forensic pathologist and a correct and detailed investigation of injuries in reconstructing an accident, as well that of surveillance cameras as investigation tool in forensic cases.

Background The aim of the study was to retrospectively analyze diving fatalities occurring in Primorje-Gorski Kotar County (northern Croatian littoral), Croatia between 1980 and 2010 in order to identify differences between fatally injured tourist and resident divers, as well as temporal changes in the frequency of diver deaths. Methods Medico-legal and police reports of 47 consecutive fatal diving cases were reviewed to determine the frequency of death among divers in relation to year and month of death, age, sex, nationality, organization of diving, diving type, and health condition. Results The majority of victims were foreign citizens (59.6%) most of whom fell victim to scuba diving (70.4%). It was found that 79% of resident divers succumbed during free-diving. The number of diving fatalities increased significantly in the last three decades, especially among free-divers. Of the victims, 93% were males, usually belonging to younger age groups with tourist divers being significantly older than local divers. And 31.9% of divers, mostly tourists, showed signs of acute, chronic, or congenital pathological conditions. Conclusion Fatally injured foreign divers differ from resident diver fatalities in diving method and age. Tourists are the group most at risk while scuba diving according to the Croatian sample. Occupational scuba divers and free-divers are the group most at risk among resident divers. This study is an important tool in uncovering the most common victims of diving and the related risk factors. It also highlights the problems present in the legal and medical monitoring of recreational divers and discusses possible pre-event, event, and post-event preventive actions that could lead to reduced mortality rates in divers.

Free-fall fractures represent a specific form of blunt force trauma that can be hard to interpret because of the numerous factors that affect it. The aim of this study is to focus on skeletal injury patterns resulting from free-falls and to analyse the relationship between specific skeletal fractures, and the height and cause (accidental vs. suicidal) of the fall. A total of 179 autopsy reports of fatal free-falls from known heights were analysed at the Department of Forensic Medicine and Criminalistics, in Rijeka, Croatia. The location, type and frequency of fractures, as well as the number and distribution of fractured regions were analysed with regard to height and cause of fall. Height was found to be the major factor influencing fracture patterns in free-falls. In our sample, the frequencies of thoracic fractures, fractures to the extremities and those to the pelvis increased with height. Head fractures show no such relationship. However, types of fractures recorded in different anatomical regions, including the cranium, differ between height groups suggesting different injury mechanisms in each. Victims of falls generally sustained fractures in more than one body region, and the number of injured regions correlates significantly with height. Although no statistical difference was found in the number of fractured regions or frequency of fractures between accidental fallers and suicidal jumpers, jumpers showed a significantly higher number of bilateral extremity fractures when compared to victims of accidental falls. Logistic regression analyses also demonstrate a significant relationship between lower extremity fractures, and the cause of the fall. Our results highlight the need for further investigations of the influence that behaviour and height have in free-fall fractures.

It was confirmed that bone morphogenetic protein-9 (BMP-9), like insulin, improves glycemia in diabetic mice and regulates glucose metabolism in hepatocytes, which is why it is proposed as a candidate for the hepatic insulin-sensitizing substance (HISS). Regarding the fact that BMP-9 has a signaling pathway similar to other BMPs as well as insulin, it is expected that BMP-9 would also have certain effects on the liver. In our 2011 hypothesis, we aimed towards BMP-9 as a possible “hepatic insulin-sensitizing substance” (HISS) and in this article, we provide further evidence, derived from existing studies, suggesting that this putative hormone might in fact be none other than BMP-9.

Sudden cardiac death is natural, unexpected death, related to cardiovascular disease. Its postmortem elucidation is significant, as the family of the deceased aspires to prevent other sudden deaths. Irrespective of the proper etiological entity, the myocardial collagen matrix remodels, associated with the progression of cardiovascular diseases. It has become evident that many mediators such as humoral factors, transforming growth factor (TGF)-β1 among them, are involved in the remodeling process. Cardiac remodeling is the balance of regenerative and eliminatory processes that include enzymes involved in the degradation of extracellular matrix (ECM) components. Enzymes capable of degrading native fibrillar collagen are interstitial collagenases, specifically matrix metalloproteinases (MMP)-1 and MMP-8. Here, we suggest a technique of visualizing turnover of collagen in cardiac tissue.

Prvog veljače 2016. godine Zavod za sudsku medicinu i kriminalistiku Medicinskog fakulteta Sveučilišta u Rijeci proslavio je svoj 50. rođendan. U pedeset godina aktivnosti Zavod za sudsku medicinu i kriminalistiku razvijao se i napredovao u stručnom i znanstvenom smislu, suočavajući se s brojnim profesionalnim izazovima. Djelatnosti Zavoda obuhvaćaju nastavne, stručne i znanstvene aktivnosti. Nastavnici Zavoda uključeni su u programe obavezne i izborne izobrazbe studenata Medicine, Dentalne medicine i Fakulteta zdravstvenih studija. Stručne aktivnosti Zavoda su provođenje sudsko-medicinskih obdukcija, mrtvozornička služba, sudska vještačenja, procjene težine tjelesnih ozljeda, toksikološke i molekularne analize DNK-a. Stručna djelatnost provodi se u suradnji sa sudovima, državnim odvjetništvom, policijom i Uredom za javno zdravstvo Primorsko-goranske županije. Znanstvenom aktivnošću i razvojem novih metodoloških pristupa Zavod nastoji pridonijeti unapređenju sudskomedicinske prakse u Hrvatskoj., On the first day of February 2016, the Department of Forensic Medicine and Criminalistics, School of Medicine, University of Rijeka celebrated its 50th birthday. At fifty years of activity, the Department evolved and progressed in both professional and scientific senses, confronting the many professional challenges. Activities of the Institute include teaching as well as many professional and scientific obligations. Department’s teachers are included in mandatory and elective programs of training medical and dental medicine students and they cover the classes in Faculty of Health Studies. Professional activities comprise of the performing forensic autopsies, conducting a medical examiner’s office, expert witnessing, assessing the severity of injuries, performing toxicological and molecular DNA analyses. In performing professional projects, collaboration with the State’s judiciary (i.e. courts, state’s attorney, and the police) or the County’s Office of Public Health is the most crucial. With its scientific activities and the development of new methodological approaches, the Institute seeks to contribute to the advancement of forensic practice in Croatia.

Concussion is the most common type of traumatic brain injury, with headache being the most frequent symptom of mild traumatic brain injury (MTBI) (including dizziness, vomiting, nausea, lack of motor coordination or difficulty balancing). Concussion may be caused by a blow to the head, or by acceleration forces without a direct impact. Often, MTBI occurs as the result of a sports injury. Loss of consciousness is always present, unlike vomiting. Therefore, we hypothesize vomiting to be considered as a cardinal sign of concussion. Stimulation of vomiting centres finally triggers vomiting. Professional boxers and mixed martial arts competitions reluctantly agree with stringent rules and protective clothing. We discuss the issue of further protection for those engaged in these and other sports.

Recent understandings of the vascular contribution of pathophysiology of osteoarthritis (OA) mount new evidence of cross-talking between subchondral bone tissue and articular cartilage that might have a decisive role in a pathophysiology of Osteoarthritis (OA). These understandings include blood flow (or interstitial fluid) impairment in subchondral bone. With regard to the mentioned role of the vasculature, the absence of custom nourishing to articular cartilage, and established, vasoconstrictive role of endothelin-1 (ET-1) it was reasonable to assume that ET-1 has an inconvertible role in pathophysiology of OA. Another moment in pathophysiology of OA is apoptosis of subchondral osteocytes, what induces osteoclastic resorption and at least temporarily reduces the bony support for the overlying cartilage. Since regional dependence of this protein's expression was presumed, we suggest a regional division of subchondral bone by histomorphometrical analysis and quantification of identified protein by Real Time Polymerase Chain Reaction Analysis (RT-PCR). Obtained results should be compared to serum levels of soluble ET-1, what would enforce this methods validity. Herewith, a new screening marker of patients with osteoarthritis would be established. This would enable detection and follow-up of groups threatened by this, growing, cause of disability and decreased quality of life.

Bone morphogenetic protein-9 (BMP-9) is a member of the transforming growth factor beta (TGF-β) super-family of cytokines, which regulate cell growth and differentiation during embryogenesis. Apart of that, the hypoglycemic potential of BMP-9 is of great interest. It has been confirmed that BMP-9, like insulin, improves glycemia in diabetic mice and regulates directional glucose metabolism in hepatocytes ; therefore it is proposed to be a candidate hepatic insulin-sensitizing substance (HISS). In liver fibrosis, due to the portocaval shunt, insulin bypasses the organ and the liver undergoes atrophy. Parenteral administration of insulin reverses atrophy by stimulating mitogenic activity of the hepatocytes. Because BMP-9 has a signaling pathway similar to other BMPs and insulin, it is to be expected that BMP-9 has a certain regenerative role in the liver. Also supporting the above-mentioned is evidence of BMP- 9 expression in Dissè's spaces and BMP-7’s mitogenic activity in mucosal cells. However, further studies are needed to confirm the possible regenerative role of BMP-9.

We had hoped that the publication of our comments on the possible detrimental effect on rehabilitation of overlooking ap-parently insignificant, mild traumatic brain injuries (mTBI) (1, 2) last year, would dispel the recycling of advice regarding the need for follow-up visits. We advised that patients with crani-ofacial fractures should be examined by a clinician specialized in a field related to neuroscience. In another publication (3), we proposed detailed neurological check-ups for patients at risk, especially those who participate in certain sports. Meticulous assessment is imperative, especially in conditions such as those described by Carlsson & Af Geijerstam (4), where specimen (Swedish model) in-hospital stay is maximally reduced. One intriguing idea is to promote international and multidis-ciplinary collaboration in traumatic brain injury (TBI) research (5). Traditional lack of collaboration disallows the promotion of international and multidisciplinary collaboration. However, collaboration depends on agreement about an unambiguous, single definition of mTBI, which, at times, is regarded as “con-cussion.” Thus, it is perhaps rather academic at this stage to advocate careful follow-up over time and possibly to distress patients and professionals with the entire spectrum of long-term sequelae of unnoticed mTBI. In addition, there is no current research into determining a multidisciplinary view. However, is this not merely an example of reinventing the wheel?Calls to abandon the path of reductionism, to take a broader view, and to update the classification and characterization of multidimensionality could all be silenced by the argument that these ideas have already all been put forward. After all, such thinking was the incentive for the development of the Inter -national Classification of Functioning, Disability and Health. Have we heard enough of these arguments? Articles repeating the same conclusions are just a subtle way of announcing that need to the wider masses. Or, are they highlighting the need for a Core Set? REFERENCES

As cardiovascular pathology grows in numbers, research into the discovery of new chemokine biomarkers should not be neglected, as they seem to be paramount in atherosclerosis prevention and its early detection. Chemokines attract and activate leukocytes and are well recognized in the environment of inflammatory response. MCP-1 is a valuable chemokine whose potential to become a new crucial atherosclerosis marker is surely worth investigating. Since quantities of MCP-1 found in lesions are as low as immeasurable, we propose the use of an immunohistochemical method for the quantification of MCP-1 levels in atherosclerotic lesions. Additionally, serum levels of MCP-1 can be measured by commercially available immunoassays. Proposed MCP-1 concentration increase may explain the acceleration in lesion’s atherosclerosis progression as chemokine activation occurs once they bind to specific ligands. If proven, this hypothesis would indicate the need for further studies in order to objectively link the increased MCP-1 expression with carotid restenosis.

We report about a case series of kayaking fatalities occurred in Primorje-Gorski Kotar County from 2006-2013. Although kayaking fatalities are rather uncommon, in the three cases presented an interesting similarity emerged. All the kayakers suffered head injuries that probably led to unconsciousness and death by drowning although they were wearing they headgear. However, the headgear in question was a bicycle helmet in all three cases. The authors discuss the importance of wearing proper protective equipment and the difference between various types of sports helmets.

Articles in many journals are related to closed head injuries, and we feel that some details require update and clarification.

The aim of this study was to investigate the occurrence and characteristics of homicide-suicide events in Southwestern Croatia from 1986–2009 relying on autopsy reports of the Department of Forensic Medicine and Criminalistics, Rijeka and police records. A total of 17 cases involving 19 victims were identified. The perpetrators were most often men (82%), living in a spousal relationship with the victim. In 76.5% cases, suicide was committed immediately after homicide, and the same mean (most often an illegal firearm) was used for both. After examining the belongings of those involved in homicide-suicides, two factors differentiated our study from others, i.e. more victims and perpetrators were from the lower socioeconomic class and explosives were used in two homicide-suicide (12%) cases. The greater frequency of explosive used in homicide-suicide events may be a result of factors associated with the recent war fought in Croatia. These data prove the influence of sociological, historical and also political factors on the characteristics of a rare event such as homicide-suicide.

Cilj: Cilj nam je istaknuti superiornost Wolfove endokamere nad ostalim uređajima za izravnu laringoskopiju visoke rezolucije. Kamera koju koristimo, High-Speed Endocam 5562®, izgrađena je posebno za laringoskopiju, te je opremljena automatskim fokusom, a proizvodi je Richard Wolf GmbH (Knittlingen, Njemačka). Prikaz slučaja: Prikazujemo 58-godišnju bolesnicu koja se žali na teškoće s grlom i hrapav glas kroz gotovo mjesec dana. Povijest bolesti ne pokazuje osobitosti, osim palpatorne bolne osjetljivosti vratne kralježnice. Pregledom kamerom High-Speed Endocam 5562 jasno smo uočili vokalni hematom. Rasprava: Tijekom svakodnevnih pregleda nalazimo razne anatomske varijacije, neke uz oštećenje, a neke bez oštećenja epitela. Laringoskopija visoke rezolucije omogućuje bolji pregled defekata vokalnih nabora, ne ostavljajući prostor za spekulacije i subjektivnost. Korištenjem Wolfove endokamere određuje se i precizna pozicija lezije, te je lakše odrediti adekvatnu terapiju. Kod indiciranog kirurškog zahvata ovakva vizualizacija poboljšava predoperativno razumijevanje problema, a time i izglede za uspjeh. Zaključak: Ako je kamera u rukama iskusnih liječnika, moguće je obraditi do 20 bolesnika dnevno. Pregled se obavlja brzo i bez potrebe za lokalnom anestezijom. Endokamera nudi pouzdanost i objektivnost, a rezultati se mogu snimiti i pregledati kada je to potrebno. To omogućuje adekvatno liječenje bolesnika i stvaranje potpuno informirane odluke zasnovane na vrhunskoj vizualnoj dokumentaciji lokalnog stanja., Aim: Our aim is to underline the superiority of Wolf endocam among other high resolution close-up laryngoscopy devices. We use a camera made by Richard Wolf GmbH (Knittlingen, Germany). High-Speed Endocam 5562 was constructed specifically for laryngoscopy, so it is equipped with an automatic focus. Case report: Patient whom we present is a 58-years old female who displayed throat discomfort and harsh voice for nearly a month. Her medical history was unremarkable except for the cervical spine tenderness. When examined with High-Speed Endocam 5562, vocal fold hematoma became visible. Discussion: So far, we have found various anatomical variations with or without epithelial damage. High resolution laryngoscopy shows a better and more objective view of vocal fold defects with no room for speculation based on subjective observation of obvious defects. With the use of Wolf endocamera precise positions are determined and accurate treatment can be achieved, also choosing a suitable approach. When surgical treatment is indicated, this imagining improves preoperative understanding of the problem, subsequently increasing the odds of success. Conclusion: Once handled by an experienced physician, up to 20 patients can be examined each day. Examination is performed quickly and without the need for local anesthesia. Endocamera offers reliability and objectivity as findings may be recorded and reviewed when necessary. This enables treating the patients adequately as making a fully informed decision is significantly upgraded by superior visual documentation of local condition.

Recreantly published paper of M. Hoffman we found to be alike to our work by focusing on the connection of elevated plasma homocysteine levels and the risk of developing diabetes or its complications.

Physicians occasionally encounter the punch-drunk syndrome among boxers after longlasting careers characterized by blows to the head. The list of sports leading to punch-drunk syndrome is rapidly increasing, making it a notable public health problem. A lack of specific findings leads to defects in reporting the condition, and consequently to delay in treatment. Although the rigorous enforcement of sport rules and constant improvements of sporting equipment have decreased the occurrence of the syndrome, early detection of punch-drunk syndrome is crucial and would have comprehensive benefits. Two groups of signs and symptoms can be identified: dementia and Parkinsonism. A prompt diagnosis with a correct classification of the suspected cases is crucial. Therefore, we offer an overview of the symptomatology as well as proposing the introduction of a screening method among risk groups based on generic and minute neurological examination and dementia testing.

In this letter, we share our concerns regarding fluctuations of homozygosity for ApoE/ɛ4 allele. It appeared that over time, expression of this gene raised the felled as reported by various researchers. Considering the diversity of phenotypic characteristics assigned to expression of ApoE/ɛ4, seems to be a potentially useful to direct practitioner on concrete figures related to the genetic propensity of many conditions, from circulatory to mental disorders.

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Encouraging progress in understanding the genetics of Alzheimer’s disease (AD) merely highlights the work that remains. AD and vascular dementia are two commonest dementias. Etiology of AD involves genetic factors in 25–40% [1]. Thus far, three fully penetrate genes’ mutations have been identified in patients younger than 60 years. First, this was assigned to the β amyloid precursor protein gene (APP) on chromosome 21and after that to the autosomal dominant gene defects of presenilin-1 (PS1) gene on chromosome 14. Presenilin-2 (PS2) gene on chromosome 1 was the last connected to earlyonset AD. Each of these mutations causes abnormal proteins to be formed. In 2012 for example, Kamboh identifies nine other genes/loci (CR1, BIN1, CLU, PICALM, MS4A4/MS4A6E, CD2AP, CD33, EPHA1 and ABCA7) for late-onset Alzheimer’s disease (LOAD) using genome-wide association studies (GWASs) [2]. With identification of more of the genes involved in development of the disorder, and a greater understanding of their action, AD research holds the hope of reducing or potentially eliminating the burden of this overwhelming disease [1]. The single-gene mutations directly responsible for early-onset Alzheimer’s disease do not seem to be involved in late-onset Alzheimer’s. A specific gene causing the late-onset form of the disease has not been identified yet. However, one genetic risk factor does appear to increase a person’s risk of developing the disease. This is related to the apolipoprotein E (APOE) gene found on chromosome 19. APOE encodes for a protein that helps carry cholesterol and other types of fat in the bloodstream. APOE comes in several different forms, or alleles. Three forms – APOE e2, APOE e3, and APOE e4 – occur most frequently. APOE e4 is present in about 25 to 30 % of the population and in about 40 % of all people with lateonset AD. People who develop AD are more likely to have an APOE e4 allele than people who do not develop the disease. Testing for the E-4 allele cannot predict who will get the disease. Two national panels have raised their voice against the use of apoE-4 as a predictive test for AD. This could be justified even more, if one bears in mind that a great majority of people who carry E4 will not develop AD, respecting many people who do not. Cent. Eur. J. Med. • 8(6) • 2013 • 730-731 DOI: 10.2478/s11536-013-0229-7

Suicide represents a serious public health problem throughout the world. Toxicology plays a crucial role in the investigation of suicide. Psychoactive substances are recognized in the literature as the main suicide-generating stimuli. Ethanol is known to produce disinhibition and increased self-confidence. Other psychoactive substances can predominantly be central nervous system (CNS) stimulants or depressors. In cases of overdose as a method of suicide, the link between toxicology and the method of suicide is a matter of common sense and requires no additional explanation. On the other hand, in cases of non-overdose suicides this link is much more complex, and has not yet been extensively elucidated. We hypothesize a close relationship between toxicology and the choice of the method of committing suicide other than overdose. Negative findings may reflect either poor prescribed drug compliance in psychiatric patients, or suggest the role of other (non-toxicological) suicide-generating stimuli. On the other hand, positive findings influence the choice of the suicide method in a way that it depends on the prevalence of either stimulation or depression of the CNS, and consequent degree of behavioral aggression. Simplified, if the prevailing effect is CNS stimulation (with an increase in aggression), the method would be more drastic and more immediately fatal one, while with the CNS depression the method would be less immediately fatal and less drastic. There are only a few studies on the prevalence of psychoactive substances amongst completed suicides and even fewer studies have attempted to examine the relationship between substances used and the circumstances surrounding suicide. In evaluation of our hypothesis, we suggest thorough studies of toxicology and the choice of methods of committing suicides other than overdose. The scientific knowledge gained this way will eventually make toxicology a useful target in suicide prevention, especially amongst younger population.

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