Patients are admitted to the surgical intensive care (SICU) unit after emergency and elective surgery. After elective surgery, for further support, or to manage coexisting comorbidities. The implementation of the ERAS (Enhanced recovery after surgery) protocols in surgery should decrease the need for ICU beds, but there will always be unpredicted complications after surgery. These will require individual management. What we can do for our surgical patients in ICU to further enhance their recovery? To promote early enhanced recovery in surgical intensive care—SICU, three areas need to be addressed, sedation, analgesia, and delirium. Tools for measurement and protocols for management in these three areas should be developed to ensure best practice in each SICU. The fourth important area is Nutrition. Preoperative screening and post-operative measurement of the state of nutrition also need to be developed in the SICU. The fifth important area is early mobilization. ERAS protocols encourage early mobilization of the critically ill patients, even if on mechanical ventilation. Early mobilization is possible and should be implemented by special multidisciplinary ICU team. All team members must be familiar with protocols to be able to implement them in their field of expertise. Personal and professional attitudes are critical for implementation. In the core of all our efforts should be the patient and his well-being.

Background and Objectives: Total knee arthroplasty (TKA) is sometimes associated with significant perioperative bleeding. The aim of this study was to determine the efficacy of tranexamic acid (TXA) in reducing perioperative blood loss in patients undergoing primary TKA. The secondary objectives were to assess the efficacy of TXA in reducing the need for blood transfusion in these patients and to determine its effect on verticalization and ambulation after TKA. Materials and Methods: This study included 96 patients who were randomly assigned to two groups, each containing 48 patients. The study group received intravenous TXA at two time points: immediately after the induction with doses of 15 mg/kg and 10 mg/kg 15 min before the release of the pneumatic tourniquet. The control group received an equivalent volume of 0.9% saline solution via the same route. Results: TXA markedly reduced (Z = −6.512, p < 0.001) the total perioperative blood loss from 892.56 ± 324.46 mL, median 800 mL, interquartile range (IQR) 530 mL in the control group, to 411.96 ± 172.74 mL, median 375 mL, IQR 200 mL, in the TXA group. In the TXA group, only 5 (10.4%) patients received a transfusion, while in the control group, 22 (45.83%) received it (χ2 = 15.536, p = 0.001). Patients in the study group stood (χ2 = 21.162, p < 0.001) and ambulated earlier postoperatively, compared to the control group (χ2 = 26.274, p < 0.001). Patients who received TXA had a better overall postoperative functional recovery. There was a statistically significant difference in all the above results. Conclusions: TXA is an effective drug for reducing the incidence of perioperative bleeding, decreasing transfusion rates, and indirectly improving postoperative functional recovery in patients undergoing primary TKA.

Introduction: Maximal effort physiological tests provide information about the current functional capacity of athletes. Objective: The aim of this study was to evaluate anaerobic performance parameters in elite athletes and to compare them in terms of the specific demands of each sport. We also created and applied the new software which enables us to quantify a new parameter -explosive muscle power (EP), a major component in sports requiring explosive bursts of movement lasting from a few seconds to 1 or 2 minutes. This new parameter reflects the velocity of energy transformation from intramuscular ATP and high-energy phosphates into mechanical power. Methods: All Wingate test parameters (standard parameters) - anaerobic power (AP), anaerobic capacity (AC), and explosive power (EP) as the new parameter were recorded in 104 subjects: 30 non-athletes and 74 athletes divided into different groups depending on their sport specialty (20 rowers, 28 wrestlers and 26 soccer players). Results: Anaerobic power (AP), anaerobic capacity (AC) and explosive power (EP) were significantly higher in the group of athletes compared to non-athletes. Among athletes, significant differences were observed in some parameters according to the type of activities they are involved in. The highest values were recorded in the group of wrestlers (AP=836W; AC=16.6kJ; EP=139W/s). The values of AP (absolute values) and EP (absolute and relative values) were significantly higher in wrestlers than in soccer players and rowers, but there was no significant difference in AC among these groups. The EP variable had a distribution similar to AP. Conclusions: Alongside anaerobic power and anaerobic capacity, the assessment of explosive power may complement the anaerobic profile of athletes. Experts in the field of sports medicine and exercise physiology could find these results useful in improving test variables, which are more important for specific sports, and for evaluating and monitoring training progress. Level of Evidence I; Diagnostic studies - Investigating a diagnostic test.

Background/Aim. Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. Methods. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people’s (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. Results. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p ≤ 0.01). The patients whose blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p < 0.01). Conclusion. Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

The Fortress consists of several spatial entities, among which the Upper Town is the most attractive and the most developed one. Cultural and tourist-catering contents should have a primary function of the space, which would enable the Fortress to become the gathering place and the centre of cultural tourism in a wider area. One of the most important questions refers to the way of management of this cultural value while one of the most appropriate solutions is establishment of a special public enterprise. Intensive development of tourism implies special conditions for the protection and preservation of the Fortress. The topic of this work is Petrovaradin Fortress, i.e. the Upper Town and its tourist organization in the function of cultural tourism. This work is aimed at presenting the possibilities that this area has for the development of tourism with a special accent placed upon cultural tourism. The tasks of this work are to present suggestions for tourist organization of this area with necessary urban equipment and for enrichment of museum and gallery objects with additional contents as well as the establishment of completely new exhibitions.