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Background/Aim. In implant prosthetics, there is an increasing use of materials that, with their mechanical characteristics, can alleviate the negative consequences of implant stress. The aim of this study was to conduct a comparative analysis of stress distribution and deformation of implant-supported telescopic systems and surrounding structures made of different materials using the finite element method. Methods. The 3D finite element models were prepared using the SolidWorks program (SolidWorks 2018, Concord, MA, USA). Two models of telescopic crowns with the characteristics of polyetherether-ketone (PEEK) polymer and cobalt-chromium (Co-Cr) alloy faceted with feldspar ceramics were used. The models were loaded with an axial force of 150 N in the region of the central fossa. The analysis of stress and strain distribution was per-formed by the finite element method in the Ansys software (ANSYS Workbench 16; Ansys Inc., Pittsburg, PA, USA). Results. Implant-supported telescopic crowns made of PEEK polymer significantly reduced stress in the implant and abutment neck area compared to the conventional Co-Cr crown veneered ceramic. At the level of bone structure, both models showed a concentration of stress at the level of the cortical bone, while the trabecular bone was significantly less exposed to stress. Under the same conditions, the degree of deformation of the secondary telescopic crown was more pronounced in models with PEEK polymer characteristics. Conclusion. Owing to their mechanical characteristics, PEEK polymers can be the materials of choice in the fabrication of superstructures on implants. Given that this in vitro study was accompanied by limitations, further research is needed to confirm the superior role of PEEK material in implant prosthetics.

Background/Aim. Anterior cruciate ligament reconstruction is one of the most commonly performed knee surgeries in young adults. The success of this procedure largely depends on the proper formation of the tunnel, which is obtained by drilling the tibia and which serves to position and fix the graft. The aim of the study was to present a method for determining the spatial position of the graft based on only two standard X-rays. Methods. The study was performed on a group of 15 patients in whom the developed software applied the measurement of the angle of the tunnel in the tibia based on the selection of characteristic points on two standard X-rays of the knee (anterior-posterior and lateral projection). The obtained results were compared with the results of measuring the angle of the tunnel in the tibia on knee images by computed tomography (CT) in all patients. Results. The drilling angle measured in CT scans was, on average, some-what greater (59.07? ? 5.61?) than the angle measured by applying a developed application (58.65? ? 5.89?). The obtained results indicated minimal differences without statistical significance in the measurements of the angle of the tunnel in the tibia using the developed software and on CT images (Wilcoxon test: Z = -1.363; p = 0.173). Conclusion. The presented method and developed software are suitable for everyday clinical applications in terms of precision and usability and can be used to assess the position of tunnels in the tibia in the process of determining the success of surgery or in preparing patients for revision surgery.

Background/Aim. Since glaucoma has a very high prevalence worldwide, it is important to examine additional treatment modalities, especially the prevention of its progression. The aim of the study was to determine the importance of laser peripheral iridotomy (LPI) in patients with acute primary angle closure (APAC) in preventing primary angle closure glaucoma progression and APAC in the fellow eye. Methods. The research included 40 patients and 80 eyes treated between 2017 and 2021, which was also the follow-up period in the study. In all patients, LPI was performed bilaterally on both the APAC-affected eye and the healthy fellow eye. The patients with an age range from 40 to 79 years who had the pupillary block in one eye were monitored. All patients underwent bilateral LPI, and the changes in angle width were monitored using gonioscopy. Intraocular pressure (IOP) measurements were made with an applanation tonometer and Vertical Cup/Disc ratio (Ver C/D rat) performing biomicroscopic examination with indirect ophthalmoscopy and +90 D lens. Results. All 40 patients underwent bilateral LPI. The angle width of the APAC-affected eye before treatment was 0.15 ? 0.36, and 1.20 ? 0.41 of the fellow eye. After 12 months, the measurements taken were 0.85 ? 0.36 for the affected eye and 1.90 ? 0.36 for the fellow eye (Wilcoxon rank test, p < 0.01 statistically significant difference). The mean value of IOP in the eye without progression of the disease before therapy was 53.6 ? 3.73 mmHg, while in the eye with progression, it was 60.10 ? 4.37 mmHg. After 12 months, it was 14.92 ? 1.22 mmHg in the eye without progression, while in the eye with disease progression, it was 23.40 ? 2.53 mmHg (independent samples t-test, p < 0.01). The change in the Ver C/D rat in the eye without progression was 0.40 ? 0.10, while in the eye with progression, it was 0.45 ? 0.05. After 12 months, it remained unchanged in the eye without progression, while in the eye with progression, it was 0.65 ? 0.06 (independent samples t-test, p < 0.01). Conclusion. Simultaneous LPI has been proven efficient in patients with APAC in both affected and fellow eyes.

Introduction. An arteriovenous fistula is one of the complications that can occur during percutaneous liver biopsy (PLB). Hepatic arteriovenous fistula with chronic bleeding from the puncture site on the skin is an extremely rare complication following PLB. Case report. We present a 35-year-old woman with secondary anemia caused by chronic bleeding at the site of a granuloma caused by a previous liver biopsy performed 7 years ago. The patient was examined and treated for several years due to anemic syndrome. The pathological communication between the right hepatic vein, the anterior sectional branch of the portal vein, and the posterior arterial sectional branch were detected on a computed tomography scan and proven by fistulography. Due to the failed embolization, a laparotomy was performed, where a tumor mass was found in the VI and VII segment of the liver, which communicates with the skin. The tumor mass was removed by atypical resection of the VI and VII liver segments. Due to hemorrhage, reexploration was performed, where the bleeding was found from the surface of the resected liver parenchyma. The patient was released for home treatment two weeks after the last operation. Conclusion. Although PLB is a safe procedure, a complication in the form of bleeding sometimes occurs but with spontaneous cessation. In the presented patient, there was a complicated intra-hepatic arteriovenous-portal fistula with the formation of communication with the puncture site on the skin. That is the first published case of complications of this type after PLB.

Background/Aim. The Structured Inventory of Malingered Symptomatology (SIMS) is a self-report measure to be used with adults, which may be utilized to assess the potential malingering of psychosis, neurologic impairment, amnesia, low intelligence, or affective disorder. The aim of the study was to examine the discriminant validity of SIMS under conditions of simulating symptoms of neurological and memory disorders, in response to a hypothetical situation, after watching a recording of an actual car accident in which a motorcycle rider sustained head injuries. Methods. The study involved 94 students (35 men and 59 women) from the University of Criminal Investigation and Police Studies in Belgrade and the Faculty of Medicine – Special Education and Rehabilitation in Novi Sad, aged 20–26 [arithmetic mean = 20.69; standard deviation (SD) = 0.80], divided into two groups (n = 47), malingerer and control. The malingerer group was instructed to identify with the motorcycle rider hit by the car and malinger symptoms related to neurological difficulties and amnesia in order to obtain greater reimbursement from the insurance company. The control group had instructions to honestly assess the probability of occurrence of the symptoms. Results. The results of the multivariate one-way analysis of variance suggested that the effect of experimental manipulation was statistically significant [F (88, 5) = 91.21, p < 0.001; η2p = 0.838]. Univariate effects were also statistically significant for all five scales. Participants in the malingerer group scored higher on all five scales than participants in the control group. The magnitudes of the effects support the largest differences between the malingerer and control groups on the scales of Memory Disorders and Neurological Disorders, which was also the basic instruction for simulating symptoms given to the participants in the malingerer group. Conclusion. The obtained results support the discriminant validity of the SIMS questionnaire in the situation of simulating symptoms of neurological disorders and memory disorders. Uvod/Cilj. Strukturisani inventar simuliranih simptoma – Structured Inventory of Malingered Symptomatology (SIMS) je mera samoprocene koja se koristi kod odraslih osoba, a može biti korišćena za procenu potencijalnog razvoja psihoze, neurološkog oštećenja, amnezije, niske inteligencije ili afektivnog poremećaja. Cilj rada bio je da se ispita diskriminativna validnost SIMS-a u uslovima simuliranja simptoma neuroloških oštećenja i poremećaja pamćenja u odgovoru na hipotetičku situaciju, nakon gledanja snimka realne saobraćajne nezgode u kojoj je vozač motocikla zadobio povrede glave. Metode. U istraživanju su učestvovala 94 studenta (35 muškaraca i 59 žena) Kriminalističkopolicijskog univerziteta u Beogradu i Medicinskog fakulteta – smer Specijalna edukacija i rehabilitacija u Novom Sadu, starosti od 20–26 godina [aritmetička sredina = 20.69; standardna devijacija (SD) = 0.80)], koji su bili podeljeni u dve grupe (n = 47), kontrolnu grupu i grupu ispitanika koji su simulirali simptome. Grupa ispitanika koji su simulirali simptome imala je zadatak da se poistoveti sa motociklistom kojeg je udario automobil i da simulira neurološke simptome i amneziju, sa ciljem da dobiju više novca od osiguravajuće kompanije. Kontrolna grupa imala je zadatak da iskreno proceni koji simptomi bi mogli nastati nakon saobraćajne nesreće. Rezultati. Rezultati multivarijatne jednosmerne analize varijanse su pokazali da je efekat eksperimentalne manipulacije bio statistički značajan [F(88, 5) = 91.21, p < 0.001; η2p = 0.838]. Univarijatni efekti su takođe bili statistički značajni za svih pet skala. Ispitanici iz kontrolne grupe postizali su niže skorove na svih pet skala u odnosu na ispitanike iz grupe koja je simulirala simptome. Veličine efekata govore u prilog najvećih razlika između grupe koja je simulirala simptome i kontrolne grupe na skalama Poremećaji pamćenja i Neurološka oštećenja, što je ujedno i bila osnovna instrukcija za simuliranje simptoma kod te grupe ispitanika. Zaključak. Dobijeni rezultati idu u prilog diskriminativne validnosti upitnika SIMS u situaciji simuliranja simptoma neuroloških oštećenja i poremećaja pamćenja.

Background/Aim. Determining the value of Gissane?s angle (GA) plays a role in the diagnosis and prognosis of heel fractures, determining treatment methods, and assessing the outcome of surgical treatment. Normal values of the GA vary in relation to ethnicity, age, and gender of the examined group, which indicates its anthropometric significance. The aim of this study was to determine the range of normal GA values in the population of Central Serbia. Methods. GA was determined on lateral radiography of the foot of 145 subjects of both sexes (67 women and 78 men), with subjects divided into 6 age groups. The patients included in the study did not have a calcaneus fracture. The obtained results were processed in the Graph Pad program. Results. The average value of GA in Central Serbia was 110.8? ? 8.1?, ranging from 93? to 132.9?. The mean value of GA decreased with age, and no difference was observed between women and men, except in the youngest age group, where women had higher GA values than men. Conclusion. The results of the study showed a wide range of normal GA values, as well as the existence of a difference in subjects of different ages and sex.

Background/Aim. Cephalomedullary and extramedullary methods are used for the internal fixation of trochanteric fractures. The usage of the third generation Gamma Nail (GN) is a gold standard in this kind of treatments. Self-dynamisable Internal Fixator (SIF) is an extramedullary implant for trochanteric fractures? treatment. The aim of this study was to compare these two methods regarding operation time and intraoperative fluoroscopy time. Methods. A total of 89 patients with a surgical treatment of a trochanteric fracture were included in this study. There were two groups of patients ? GN group (43 patients) and SIF group (46 patients). Results. Average operation times were 67.5 min (GN group) and 56.0 min (SIF group). Average intraoperative fluoroscopy times were 84.8 s (GN group) and 36.7 s (SIF group). The difference between the groups was statistically significant for both of the given parameters (p < 0.05). The correlation between operation time and intraoperative fluoroscopy time was confirmed in the SIF group (p < 0.05; r = 0.405), while it was not confirmed in the GN group (p > 0.05). There was a higher variability in the GN method than in the SIF method regarding the duration and type of repeated surgical maneuvers followed by X-ray checks. Conclusion. The number of planned surgical interventions per day could depend on the type of trochanteric fracture internal fixation (intramedullary or extramedullary). Certain additional analyses including radiation dose assessment are desirable to clarify if shorter intraoperative fluoroscopy time in the SIF method can have the influence regarding intraoperative X-ray protection clothing. If there is the need to activate dynamization in long femoral axis after initial static fixation in that axis, the SIF method provides its spontaneous activation several weeks after the surgery without the need neither for additional surgery nor for additional intraoperative fluoroscopy

Background/Aim. Chronic pancreatitis (CP) causes inflammatory changes in the tissue of the pancreas, resulting in irreversible tissue damage. Pain, endocrine, and exocrine pancreatic insufficiency develop, thereby reducing the quality of life (QoL) of patients. The aim of the study was to determine the significance of surgical treatment in improving the QoL of patients with CP. Methods. QoL assessment of 50 patients diagnosed with CP was per-formed using a certified Euro Quality of Life-5 Dimension-5 Level (EuroQol-5D-5L) Questionnaire translated into Serbian. According to the method of treatment, patients completed the questionnaire. Patients were divided into two groups (conservatively treated ? CT and surgically treated ? ST), and all comparisons were made between groups. Results. Patients in stage B of CP were divided into two groups of 25 patients. The mean age in the ST group was 48.56 ? 11.91, and in the CT group was 51.08 ? 11.61 (p = 0.452). The male/female ratio in the ST group was 18/7, and in the CT group was 22/3 (p = 0.289). Pain in the ST group was present in 23 patients, and in the CT group was present in 18 patients (p = 0.141). Loss of appetite in the ST group was present in 7 patients and in the CT group in 10 patients (p = 0.256). Weight loss in both groups was equal (p = 1.000). Based on the EuroQol-5D-5L Questionnaire, significant differences were found (p < 0.001) between groups in Mobility and Pain/Discomfort, in Anxiety/Depression (p = 0.003), in Self-care (p = 0.004), and in Usual activities (p = 0.008). Conclusion. CP significantly reduces the QoL of patients treated either conservatively or by surgical approach. This study showed that surgical treatment is more beneficial for the QoL of patients with CP than the conservative approach.

Background/Aim. Four-dimensional (4D) computed tomography (CT) simulation is a useful tool for motion assessment in lung cancer radiotherapy. Conventional three-dimensional (3D) free-breathing (FB) simulation is static, with limited motion information on respiratory movements that can produce inaccuracies in the delineation process and radiotherapy planning. The aim of this study was to compare clinically significant differences between the target volumes defined on 3D CT vs. 4D CT simulation and the potential impact on the planning target volume (PTV), bearing in mind that a reduced PTV with precise coverage of the primary tumor is extremely important. In addition, quantification of movements of the primary tumor (gross tumor volume ? GTV) was performed during 4D CT simulation on three axes: Z-superoinferior (SI), X-mediolateral (ML), and Y-anteroposterior (AP). Methods. This retrospective study evaluated 20 lung cancer patients who underwent CT simulation for radical radiotherapy treatment. FB 3D CT and 4D CT simulations were acquired for each patient in accordance with our institutional protocol. A volumetric comparison of radiation volumes defined on 3D CT vs. 4D CT simulation was done on the following: GTV 3D vs. internal GTV (IGTV) 4D and PTV 3D vs. internal PTV (IPTV) 4D. The comparison of GTV movement in the FB phase GTV (GTV FB), phase 0 (GTV 0), phase 50 (GTV 50), and phase maximum intensity projection (GTV MIP) was made with GTV FB as the basic value. The evaluation was made on all three axes. Results. The comparison of volumetric values between GTV 3D vs. IGTV 4D was 63.15 cm3 vs. 85.51 cm3 (p < 0.001), respectively. IGTV 4D was significantly larger than GTV 3D (p < 0.001). The mean value of equivalent spherical diameter (ESD) for PTV 3D vs. IPTV 4D was 8.44 cm vs. 7.82 cm (p < 0.001), respectively, and the mean value volume PTV 3D vs. IPTV 4D was 352.70 cm3 vs. 272.78 cm3 (p < 0.001), respectively. PTV 3D was significantly larger than IPTV 4D (p < 0.001). A statistically significant difference (p < 0.05) was identified in the deviation related to the Z-axis between the upper and lower lobe. Conclusion. 4D CT simulation-based delineation can reduce PTV compared to 3D simulation-based radiation therapy; therefore, it is a prerequisite for high-quality and precise radiation therapy treatment.

Background/Aim. Immune checkpoint therapy is a well-established therapeutic approach in the treatment of malignant diseases and is thought to be mostly based on facilitating the adaptive immune response. However, the cells of the innate immune response, such as natural killer T (NKT) cells, might also be important for a successful anti-programmed cell death protein-1 (anti-PD-1) therapy, as they initiate the antitumor immune response. The aim of this study was to investigate the influence of anti-PD-1 therapy on the immune response against tumors. Methods. For tumor induction, 4T1 cells synergic to BALB/c back-ground were used, after which mice underwent anti-PD-1 treatment. After the mice were sacrificed, NKT cells, dendritic cells (DCs), and macrophages derived from spleen and primary tumor tissue were analyzed using flow cytometry. Results. Anti-PD-1 therapy enhanced the expression of activating molecules CD69, NKp46, and NKG2D in NKT cells of the tumor and spleen. This therapy activated NKT cells directly and indirectly via DCs. Activated NKT cells acquired tumoricidic properties directly, by secreting perforin, and indirectly by stimulating M1 macrophages polarization. Conclusion. Anti-PD-1 therapy activates changes in DCs and macrophages of primary tumor tissue towards protumoricidic activity. Since anti-PD-1 therapy induces significant changes in NKT cells, DCs, and macrophages, the efficacy of the overall antitumor response is increased and has significantly decelerated tumor growth.

Background/Aim. Nowadays, low birth weight is considered to be one of the main causes of cardiovascular diseases or metabolic syndrome occurring later in life. Many studies have shown a strong impact of abnormal birth weight onto the future development, however, due to its stronger influence onto the development, a special emphasis is placed on low birth weight as compared to higher one. There is still no high-percentage accuracy test that will clearly classify expectant women under the risk of giving birth to a child too low or too big for gestational age. The aim of this paper was to set up a model that may indicate future low or high birth weight. Methods. This study included 191 expectant women who were divided into three groups, based on the birth weight (group 1: ? 3,000 g; group 2: 3,000?4,000 g; group 3: ? 4,000 g). The values of biochemical (pregnancy associated plasma protein A ? PAPP-A, free ? human chorionic gonadotropin) and ultra-sonographic markers (nuchal translucency) as well as their multiple of the median (MoM) were determined and com-pared among groups. Results. It was shown that the values of PAPP-A MoM were considerably lower in groups of expectant women that had a fetus with low body weight (p = 0.003, p = 0.001). Statistically significant correlation between PAPP-A MoM and the newborn?s weight (rs = 0.221, p = 0.001) was proven among the groups examined within this study. Conclusion. The usage of a combination of biochemical parameters, sonographic and demographic data in screening program increases the chances for early identification of fetuses that are under higher risk for growth restriction or increased growth. Al-so, the increase in the value of PAPP- A MoM causes the increase of fetus? body weight.

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Introduction. A transorbital intracranial injury with a foreign body can be a very complex and controversial therapeutic problem. The orbit's content is susceptible to penetrating trauma, and neurovascular skull base structures are at high risk from injury. There are some traditional cranial surgical approaches, and more recently reported different endoscopic approaches for treating this kind of injury. Case report. We present a case of a 30-year-old male who had an accident at work when a piece of wood hit him in his head and entered through the medial aspect of his left orbit with skull base and cavernous sinus injury. Rapid and complete radiological and clinical assessments were performed, and the patient was treated in a minimally invasive manner. The foreign body was manually extracted with an endoscopic and endovascular team ready to treat adverse events. No postoperative complications were reported, and visual acuity increased at one month follow up. Conclusion. Penetrating wounds of the orbit represent a challenge that requires a multidisciplinary assessment and well-organized management. Combined endoscopic minimally invasive approaches should be considered during the treatment of this kind of injury.

Background/Aim. Rheumatoid arthritis (RA) is accompanied by numerous comorbidities, among which depression and anxiety (D/A) occupy a significant place. The aim of the study was to determine the prevalence of D/A in RA patients and the relationship with their quality of life (QoL). Methods. The study included RA patients treated at the Rheumatology Clinic of the Military Medical Academy in Belgrade, Serbia in the period from May to November 2016. Disease activity was assessed by the Disease Activity Score 28-SE (DAS28-SE). D/A was determined using the Hospital Anxiety and Depression Scale (HADS) questionnaire and European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L) questionnaire Question 5. Three questionnaires were used to assess QoL: the general RAND 36-item Health Survey 1.0 (RAND36), the specific Rheumatoid Arthritis Quality of Life Questionnaire (RAQoL) and EQ-5D-3L. Results. Based on the HADS questionnaire, the prevalence of depression was 52% with the average HADS score value of 7.6 ? 3.2, while the prevalence of anxiety was 32% with the mean HADS score value of 5.8 ? 3.8. Question 5 of the EQ-5D questionnaire showed that the prevalence of D/A was 77.4%, of which 71.7% of patients had moderate D/A, while 5.7% of patients had severe D/A. Impairment in all the domains of QoL was found in tested patients, as assessed by all three questionnaires. The RAQoL questionnaire showed moderate QoL impairment, with a score value of 15.5 ? 7.9. The EQ-VAS score value was 58.6 ? 16.0, while the EQ-5D index was 0.6 ? 0.3. Univariate linear regression produced a statistically significant negative predictive value of QoL for the presence of D/A. Multivariate linear regression showed a statistically significant independent negative predictive value of QoL, as assessed by the RAQoL questionnaire (p = 0.010) and the mental QoL component of the RAND 36 questionnaire (p = 0.030) for the degree of depression. Conclusion. In RA patients, there is a significant prevalence of D/A as well as impairment of QoL in all domains. The tests performed have shown that QoL has a statistically significant negative predictive value for the presence of D/A.

Introduction. Chronic total occlusion (CTO) of the coronary artery still represents one of the most challenging lesion subsets in the field of interventional cardiology. Considering the complexity and increased risk posed by the retrograde approach, it is most often performed after a failed antegrade approach. Case report. We present a series of cases describing the retrograde approach as a special technique for treating CTO of the coronary artery. All cases had some special characteristics that are part of a dedicated portfolio in every catheterization lab today. In our series of cases, all three percutaneous coronary interventions (PCI) with a different strategies of the retrograde approach and supported with rotational atherectomy or intravascular ultrasound finished with successful recanalization of CTO. Conclusion. In cases where there is the presence of ?interventional? collaterals, as well as when the antegrade approach is very difficult, the retrograde approach can increase the success rate of procedures. The retrograde approach requires a long learning curve as well as very skilled and experienced operators who are able to per-form the procedure independently.

Background/Aim. Total hip arthroplasty is the replacement of the hip joint with an artificial one. Standard surgical procedures involve a long skin incision and extensive dissection of healthy tissue. Mini-incision surgery is a modification of standard operative approaches. In addition to a significantly smaller skin incision, the main difference is based on much less damage to soft tissues, especially the muscles that move the hip. The aim of this study was to compare the early results of the mini-incision and a standard approach in total hip arthroplasty and to determine the advantages and disadvantages of the mini-incision surgical technique. Methods. A retrospective study analyzed data based on 63 patients who underwent total hip arthroplasty with a mini-incision and standard approach at the Institute of Orthopaedic Surgery ?Banjica?, Belgrade from 2004 to 2010. All the patients suffered from primary coxarthrosis. All operations were carried out by the same surgical team. All patients were clinically evaluated before and after the surgery using the Harris Hip Score (HHS). Results. The group of patients operated on with the mini-incision approach included 32 patients, while 31 patients made up the group of patients operated on with the standard approach. Comparing these groups did not reveal a statistically significant difference in age, body mass index, surgery duration, and HHS before the surgery. A statistically significant difference was determined by comparing intraoperative blood loss, the amount of drainage fluid after the surgery, and the HHS after the surgery. Conclusion. The mini-incision posterolateral approach, compared to the standard approach, apart from an esthetically more acceptable scar, achieves significantly less intraoperative blood loss and better hip function with almost the same risk of complications.

Background/Aim. Risk factors concerning computer use-related migraine onsets are still unknown. The aim of this study was to determine the prevalence of headaches in computer users as well as the effects of computer use and behavior on the prediction of migraine presence. Methods. A cross-sectional study included 1,500 subjects from the general population who were given a questionnaire to assess the presence and type of headache and questions regarding computer-assisted behavior. All examinees were divided into two groups: the first group consisted of respondents who had a headache, and the second group consisted of subjects without a headache. Results. A total of 67.9% of the subjects had a headache, of which 23.9% had a migraine. Results of multinomial regression analysis showed that significant predictors of the migraine group, compared to the group without headache, were gender (female) and family anamnesis positive for migraine, as well as spending more time on the computer, making shorter and infrequent breaks in which physical activities were less included. Furthermore, members of the migraine group, compared with the group with other types of headaches, were younger and had family anamnesis, rarely made pauses during computer use, and their pauses were shorter. Conclusion. Improper and excessive computer use could be considered a risk factor for migraine occurrence, particularly in young people who have positive family anamnesis for migraine.

Introduction. SARS-CoV2 2019 infection represent global problem. At this moment there is no vaccine or efficient treatment of infected patients. Treatment with blood plasma rich with anti SARS-CoV2 specific antibodies represents rare safe and effective treatment of Covid19 patients. Patients and Material. A total number of 950 patients were analyzed in this study, whose samples were collected in time interval from 01.05. till 15.08.2020. Patients were enrolled in study from Covid-19 hospitals, out-clinics and as family members of SARS-CoV2 infected patients. Original ELISA tests were developed to measure the concentration of anti-S1S2 Spike and anti-Nucleoprotein (IgG, IgA, IgM) SARS-CoV2 antibodies. Blood convalescent plasma was selectively collected from recovered patients according to specific antibodies concentration. Results. The highest concentrations of anti-S1S2 Spike or anti-Nucleoprotein specific IgG antibodies were detected in patients with the moderate/heavy clinical form of infection as well as in group of family members of SARS-CoV2 infected patients. Extremely high concentration of anti S1S2 Spike IgG and anti-Nucleoprotein IgG was demonstrated in 3% and 6% (respectively) of patients recovered from severe Covid19. From our hospitalized patients 63% and 51% had modest antibody levels (anti S1S2 Spike and anti-Nucleoprotein, respectively). After 60 days, in our selected donors’ concentration of anti S1S2 Spike IgG antibodies increased in 67%, paralleled with increase of anti-Nucleoprotein IgG antibodies in 58% of donors. Conclusion. Originally developed ELISA tests enable novel protocol for selection of convalescent blood plasma donor.

Introduction. Ring chromosome 20 [r(20)] syndrome is a rare genetic abnormality where two arms of the 20th chromosome fuse forming a ring chromosome, resulting in intractable epilepsy and wide range of behavioral problems and cognitive deficits. Case report. We presented four patients with r (20) syndrome diagnosed between the years 2000?2018. In all patients we analyzed clinical epilepsy features (seizure semiology, seizure frequency/drug response, the presence of nonconvulsive status epilepticus), cognitive status and the phenotype characteristics. The average age of epilepsy onset was 6 years. All four patients had nocturnal epileptic events and normal brain magnetic resonance (MR) imaging. Dysmorphism was present in two children, behavioral problems also in two children and intellectual disabilities were observed in three children. R(20) syndrome mosaicism ranged between 17% and 83% of blood lymphocytes. Conclusion. Despite the small size of our group, we think that our findings have clinical relevance. Refractory child-hood onset epilepsy and especially the occurrence of nocturnal epileptic events should help physicians to recognize this chromosomopathy. Routine karyotyping can be employed to identify the patients easily.

Background/Aim. A substantial line of evidence indicates that Kv4.2 and Kv4.3 channels are the major components of rapid transient-outward potassium currents (A-type cur-rents). It is speculated that those currents may be involved in the maintenance of the membrane potential, as well as in the regulation of propagation and frequency of action potentials. However, very little is known about the presence and function of A-type currents in human vascular smooth muscles such as the human umbilical vein (HUV). Bearing in mind its crucial role in the proper fetal oxygenation, the aim of the study was to determine whether Kv4.2 and Kv4.3 potassium channels are present in HUV smooth muscle and to investigate potential alterations of their expression during maternal pathological conditions such as gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH). Methods. Healthy, diabetic, and hypertensive pregnancies were subjects of this investigation. Each group consisted of 6 HUV samples obtained from 6 normal pregnancies, 6 pregnancies with GDM, and 6 with PIH. After pharmacology analysis, immunohistochemistry (IH) and Western blot were performed. Results. IH revealed similar expression patterns of both, Kv4.2 and Kv4.3 subunits in HUV smooth muscle in all groups of patients. Results obtained by Western blot were in agreement with IH staining. The expression of Kv4.2 and Kv4.3 subunits were not significantly different between the groups. Conclusion. Collective-ly, this is the first study that demonstrated the presence of Kv4.2 and Kv4.3 potassium channels in the HUV smooth muscle and their preservation during GDM and PIH pregnancies. These channels are most likely major components of rapid A-type currents that may be relevant for maternal-fetus blood flow and hence fetal development. In addition, they may represent sensors for detecting hemodynamic and/or metabolic changes in the local environment. Uvod/Cilj. Značajan niz dokaza ukazuje na to da su kanali Kv4.2 i Kv4.3 glavne komponente brzih prolazno- ispravljačkih struja kalijuma (struje tipa A). Pretpostavlja se da bi te struje mogle da budu uključene u održavanje membranskog potencijala ćelije, kao i u regulaciju propagacije i učestalosti akcionih potencijala. Međutim, vrlo malo se zna o prisustvu i funkciji struje tipa A u glatkim mišićima krvnih sudova čoveka, kao što je humana umbilikalna vena (HUV). S obzirom na njenu ključnu ulogu u adekvatnoj oksigenaciji fetusa, cilj rada bio je da se utvrdi da li su podtipovi kalijumovih kanala Kv4.2 i Kv4.3 prisutni u glatkim mišićima HUV-a i da se istraže potencijalne promene njihove ekspresije tokom patoloških stanja majke – gestacijskog dijabetesa melitusa (GDM) i arterijske hipertenzije (AH) izazvane trudnoćom (AHT). Metode. U istraživanje su uključene HUV sakupljene posle trudnoće zdravih porodilja, onih čije trudnoće su bile komplikovane GDM i AH. Svaka grupa sastojala se od 6 uzoraka HUV-a dobijenih iz 6 zdravih trudnoća, 6 trudnoća komplikovanih GDM i 6 trudnoća komplikovanih AH. Nakon farmakoloških analiza, urađene su imunohistohemijska (IH) analiza i Western blot. Rezultati. Primenom IH analize pokazan je sličan obrazac ekspresije obe podjedinice Kv4.2 i Kv4.3 kanala u glatkim mišićima HUV-a u svim grupama trudnica. Rezultati dobijeni Western blot-om bili su u skladu sa IH bojenjem. Ekspresija podjedinica Kv4.2 i Kv4.3 nije se značajno razlikovala između grupa trudnica. Zaključak. Ovo je prema našim saznanjima prva studija kojom je pokazano prisustvo Kv4.2 i Kv4.3 kalijumovih kanala u glatkim mišićima HUV-a zdravih porodilja, kao i onih porodilja čija je trudnoća bila praćena prisustvom GDM ili AHT. Ti kanali su najverovatnije glavne komponente brzih struja A-tipa, koji mogu biti relevantni za protok krvi majke i ploda i na taj način delovati protektivno za razvoj fetusa. Takođe, oni mogu predstavljati senzitivne pokazatelje hemodinamskih i/ili metaboličkih promena u lokalnoj fetomaternalnoj sredini.

Background/Aim. Hydroxyapatite (HAp) is one of the most commonly used calcium phosphate bioceramics with osteoconductive properties. Growth factors are capable of directly inducing morphological and functional differentiation of neodontoblasts. The aim of this study was to investigate the effectiveness of HAp-based biomaterial in combination with transforming growth factor-?1 (TGF-?1) in the creation of new dentine and obturation of the root canal apex in the teeth of an experimental animal model. Methods. Rodent (rabbit) teeth were used as the experimental animal model. After pulp removal with a pulp extirpator in vital pulpectomy, the biomaterial was applied using a Lentulo spiral in the apex portion at the level of the physiological foramen apicale. The experiment was performed in general anesthesia. Animals were kept alive for 3, 6, and 12 months after the treatment. The extracted teeth were analyzed by scanning electron microscopy (SEM). Results. Using SEM, it was found that the number of teeth with newly created dentine and apex canal obturation was greater 12 months after the treatment. Conclusion. Apex obturation of the dental root canal with newly created dentine took place in our experimental groups treated by biomaterial with or without TGF-?1.

Background/Aim. The studies of hydroxyapatite (HAp) and growth factors as the materials used for direct pulp capping have produced conflicting results for both the issue of the inflammatory response and the issue of calcified bridge formation. Hap/poly (lactide-co-glycolide) (HAp/PLGA) is a bioresorbable polymer with demonstrated good characteristics as the carrier for the bone morphogenetic protein necessary in bone tissue regeneration. The role of growth factors in dental tissue reparation (in both reactionary and reparative dentinogenesis) represents the new foundation and provides a different approach to dental pulp treatment. Growth factors ? transforming growth factor beta-1 (TGF-?-1) ? directly induce morphological and functional differentiation of neo-odontoblasts. The aim of this study was to investigate the effect of calcium HAp/PLGA and growth factors (TGF ?-1) in the formation of a calcified tissue ? dentine bridge ? on the teeth of our experimental model. Methods. In this experimental study, rodent (rabbit) teeth were used as the animal model. After the trepanation of pulp space with sterile steel drills, the pulp was capped with calcium HAp/PLGA (experimental group I; n = 60); calcium HAp/PLGA combined with TGF ?-1 growth factor (experimental group II; n = 60), and there was a control group of intact teeth (n = 20). The experiment was performed in general anesthesia. The animals were kept alive for 1, 3, and 6 months. The extracted teeth were adequately prepared for scanning electron microscopy. Results. Scanning electron microscopy demonstrated that the number of teeth with calcified tissue in the form of dental bridges in the HAp/PLGA+TGF ?-1 group, 6 months after the treatment, was statistically significantly greater (66.67%) than after 3 months (26.67%), at the statistical significance level of p < 0.05. Conclusion. Direct pulp capping covers the artificially exposed dental pulp and makes possible the formation of a dentine bridge (a tubular structure composed of reparative dentine) in the period of 3 months.

Background/Aim. Although apicoectomy is performed routinely and yields excellent results, a close patient observation during the postoperative course is desirable in order to avoid possible complications. The aim of this study was to investigate the adequacy of postoperative control visits a day after surgery using the store-and-forward telemedicine method compared to the clinical in-person controls. Methods. A total of 122 apicoectomies were performed during 115 dental surgery interventions. The follow-up dental ex-amination a day after apicoectomy consisted of reviewing extraoral and intraoral photographs on the internet and re-viewing responses to the questionnaire. After that, patients were examined in-person. Cohen?s kappa (?store-and-forward? method) coefficient, diagnostic sensitivity (SE), sensitivity (SP), and efficiency (EFF) were determined. Statistical comparisons were performed using the Z-test, and nonparametric characteristics were tested using McNemar?s ?2-test at the statistical significance cut-off value of p = 0.05. Results. There were 106 (92%) patients seen at the control dental examination. The agreement between in-person and store-and-forward telemedicine method was found in 104 (98%) cases. The obtained agreement values (K = 0.85, S = 0.99, SP = 0.86, EFF = 0.98) indicated an almost complete diagnostic agreement. Conclusion. Based on the internet transmission of patients? digital photographs and ac-companying patient medical history records, the study showed that the in-person control dental examinations a day after surgery can be successfully replaced with the remote store-and-forward method of telemedicine.

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Introduction. Infantile hemangiomas (IHs) occur 3 to 4 times more frequently in preterm infants than in those born at term. Yet, data about efficacy and safety of topical therapy for IHs in preterm infants, especially in those born with very low gestational age (less than 33 gestational weeks) is very scarce. Case report. We reported five very preterm girls treated with topical timolol maleate 0.5% gel for superficial cutaneous IHs. In four infants topical timolol was applied on a single IH each, and in one infant two IHs were treated. Out of six treated IHs, one was located on the face, four on the trunk and one on the leg. They were regularly monitored for IH involution and potential adverse effects of timolol for 6?13 months of local treatment. Good therapeutic effect was achieved in all the presented infants, with no adverse effects related to topical administration of timolol-maleate. Conclusion. Topical timolol is an effective and safe therapy for superficial cutaneous infantile hemangiomas in very preterm infants. The treatment should be discussed in detail with parents and individualized management plan should be tailored for each infant in order to maximize the chances of a successful outcome, while avoiding adverse effects.

Background/Aim. Osteoporosis is the most common metabolic bone disorder worldwide characterized by decreased bone strength that predisposes to an increased fracture risk, especially in postmenopausal women. Today, over 25 million people, mainly women, suffer from this metabolic disorder. In addition to genetic predispositions, hormonal disorders, lifestyle, and insufficient vitamin D levels in the blood are significant risk factors for the occurrence of osteoporosis and low-energy fractures. The aim of our study was to analyze the incidence of osteoporosis and the correlation between vitamin D deficiency and secondary hyperparathyroidism in women of different ages with low-energy fractures. Methods. This cross-sectional study included 559 women who were not previously treated for osteoporosis. All women were clinically examined and their anamnesis of chronic illnesses, fractures, and therapies was taken. Height and weight were measured, and body mass index (BMI) was calculated. Risk factors for osteoporosis, including the concentration of 25-hydroxyvitamin D [25(OH)D] and parathyroid hormone (PTH), were measured. Vitamin D deficiency was defined as serum level of 25(OH)D less than 30 ng/mL (75 nmol/L). Results. The study included a total of 559 women, of which low-energy fractures were identified in 102 women. Women with fractures were older (63.69 ? 13.88 years) compared to women without fractures (54.39 ? 14.10 years) (p < 0.0005). Furthermore, BMI was also higher (27.75 kg/m2) in women with fractures compared to the other group (26.49 kg/m2) (p < 0.025). Out of 102 women with fractures, 88 were postmenopausal. The most frequent fractures were the humerus and radius fractures, 11.62% (65/559), followed by femoral neck fractures, 7.15% (40/559), and body vertebrae fractures, 3.04% (17/559). A significant decrease of the bone mineral density (BMD) in the spinal and the femoral neck sites was observed in women with femoral neck and body vertebrae fractures, but not in women with humerus and radius fractures. Vitamin D deficiency did not have a significant impact on fracture incidence. The increased concentration of PTH was statistically significant in women with femoral neck and body vertebrae fractures. Conclusion. In women with all three types of low-energy fractures, compared to women without fractures, significant risk factors for osteoporosis were age, BMD, and the strength of mechanical force during fall (estimated through BMI).

Background/Aim. Pectus excavatum (PE) is the most common deformity of the frontal aspect of the chest wall in children. A particular dilemma arises about the degree of deformity that should be subjected to surgical treatment. The aim of this study was to compare several morphological methods of evaluating the degree of deformity and determine the matching among them, a s w ell a s t o determine the connection between the functional and morphological abnormalities of echocardiography. Methods. The study included 35 patients with PE, aged between 7 and 15 years. A noninvasive evaluation of chest deformity was carried out in all patients by photographic method (surrogate of clinical examination), native X-ray imaging, and computed tomography (CT), as well as by echocardiographic examination. Results. In our group of patients, males were more common (67.5%), as well as children with the Haller index (HI) > 3.5 [represented in most children (86.7%)]. A significant correlation of the index of the affected sternum segment (ASt) and the total length of the sternum (ASt/LSt) determined by the photographic method with that determined by the CT scan of the chest was established (p = 0.001). In addition, the correlation between HI, determined by the X-ray method and CT images was presented (p = 0.012). In contrast, despite the high frequency of echocardiographic abnormalities (69%), those were not mutually correlated with the degree of pronounced morphological deformities of the chest wall. Conclusion. A detailed clinical examination and photographic evaluation method, combined with the X-ray method, can determine the severity of deformity with a high degree of agreement with the CT chest findings. In this way, it is possible for children with PE, who are not candidates for surgical treatment, to be s pared f rom r epeated C T scans t hat a re c arried o ut i n order to monitor the development of chest deformities with growth. Echocardiographic evaluation remains an integral part of the assessment of children with PE.

Background/Aim. Often asymptomatic, enthesitis can be an integral feature of the wide clinical spectrum in psoriasis as well as an early sign of development of psoriatic arthritis (PsA). It may be difficult to clinically recognize enthesitis in patients with psoriasis or distinguish it from other causes of extraarticular pain. Ultrasound (US) expanding use with the development of accurate assessments through standardized US algorithms as the Glasgow Ultrasound Enthesis Scoring System (GUESS) and the Madrid Sonographic Enthesitis Index Scoring System (MASEI) scores made the US the dominant imaging technique in diagnosing enthesitis. The aims of this study were to establish the prevalence of US signs of en-thesitis, compare it with screening questionnaires results, and estimate possible connections of US verified enthesitis with quality of life (QOL) of patients with psoriasis without PsA diagnosis. Methods. A cross-sectional study was performed on 67 patients with psoriasis who were without systemic therapy. The clinical presence of enthesitis was examined by an experienced rheumatologist, and systemic inflammation was estimated through serum level of C-reactive protein (CRP). The Psoriasis Area Severity Index (PASI) and Body Surface Area- Psoriasis (BSA-PsO) were calculated by a dermatologist. Visual analogue scale (VAS) for pain, screening questionnaires ? the Toronto Psoriatic Arthritis Screening (ToPAS), Psoriasis Ep-idemiology Screening Tool (PEST), Psoriatic Arthritis Screening and Evaluation (PASE), Early Psoriatic Arthritis Screening Questionnaire (EARP), and Psoriasis and Arthrosis Screening Questionnaire (PASQ) ? were filled by patients. GUESS and MASEI scores were determined by US. The QOL was estimated by the Dermatology Life Quality Index (DLQI). Results. The presence of clinical enthesitis was recorded in 8.7% of patients. According to US signs of enthesitis using GUESS and MASEI scores, only 7% and 2% of patients, respectively, had no sign of enthesitis. Duration of psoriasis and age of subjects were in a significant correlation with GUESS and MASEI scores, while systemic inflammation, V AS v alue, PASI, and BSA-PsO scores were not. GUESS and MASEI scores significantly correlated with scores of all screening questionnaires as well as with DLQI. Conclusion. US can detect subclinical enthesitis better than clinical examination and widely used screening questionnaires, even though the correlations between MASEI and/or GUESS scores and results of screening questionnaires were positive. US examination is important in the multidisciplinary approach in diagnosing and managing psoriasis.

Introduction. Retained intracranial missiles migration is rarely reported. Most of the time, the missile will migrate and remain intracranially, but in extremely rare cases, it may reach the spinal canal. The aim of the study was to present a patient with this rare clinical entity. Case report. The 29-years-old male suffered from the gunshot wound to the head through the left external auditory meatus. The bullet was located in the posterior fossa. Initial debridement without bullet removal was performed. Four months after the injury, the patient came back complaining of neck stiffness and progressive weakness of all extremities. Plain radiography revealed the bullet in the spinal canal at the level of C2 vertebra and computed tomography confirmed localization in the posterior aspect. An emergency procedure was performed for bullet removal and spinal cord decompression. Conclusion. The bullets tend to migrate. Migration to the spinal canal is rare, but takes a significant risk, due to the potential secondary injury. The removal of a bullet at-all-costs may not be justified. However, the prediction of migration based on the predisposing factors would be of great value to treating these patients adequately.

Background/Aim. Reactive thrombocytosis, as a paraneoplastic syndrome, is often observed in cancer patients. A variety of tumor-related humoral factors and cytokines con-tribute to tumor-stimulated thrombopoiesis. However, the exact role of these cytokines in the pathogenesis of thrombocytosis remains unclear. The aim of this study was to analyze systemic values of cytokines and clinical-pathological characteristics in colorectal carcinoma (CRC) patients with and without thrombocytosis. Methods. Fifty nine CRC patients were involved in this study and divided into two groups according to the number of platelets. We recorded and analyzed the data about: age, gender, size of the cancer, localization, metastasis, vascular or lymph vessel invasion, nuclear grade, histological differentiation rate, tumor, nodus, metastasis (TNM) stage and concentration of cytokines [interleukin (IL)-1, IL-33, IL-12, IL-17 and interferon (IFN)-?] in both groups. Results. CRC patients with thrombocytosis had significantly higher nuclear grade of the cancer (p = 0.002); higher percentage of detectable metastatic lesions in the liver (p = 0.002), lung (p = 0.001), peritoneal carcinomatosis (p = 0.001), detectable invasion of blood (p = 0.012) and lymph vessels (p = 0.010). Concentrations of tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA19-9)] and se-rum values of IL-1 a nd I L-33 were significantly higher in CRC patients with thrombocytosis. IL-1/IL-12 (p = 0.016), IL-1/IFN-? (p = 0.007), IL-1/IL-17 (p = 0.006), IL-33/IL- 12 (p = 0.001), IL-33/IFN-? (p = 0.001), IL-33/IL-17 (p = 0.002), and IL-33/IL-1 (p = 0.006) ratios were significantly higher in CRC patients with thrombocytosis in comparison to CRC patients without thrombocytosis. Analysis of Receiver Operating Characteristic (ROC) curves showed that values of IL-1 [area under curve (AUC) = 0.718; 95% confidence interval (CI): 0.567?0.868; sensitivity 69.2%, specificity 62.9%] and IL-33 (AUC = 0.763; 95% CI: 0.614? 0.911; sensitivity 84.6%, specificity 65.7%)], could be serve as possible markers for paraneoplastic thrombocytosis in CRC patients. Conclusion. IL-1 a nd I L-33 significantly correlated to high thrombocyte number in patients with more aggressive CRC.

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Background/Aim. The use of cisplatin as a chemotherapeutic opened the door to the new metal-based drug research. New complexes containing metals such as platinum, palladium, ruthenium and gold have recently been analyzed as potential antitumor agents. The aim of the study was to investigate the cytotoxicity of Au(III) complexes with pincer-type ligands against cervical carcinoma cells (HeLa), breast cancer cells (MDA-MB-231 and 4T1) and colon carcinoma cells (HCT116 and CT26), as well as to examine the type and mechanism of cell death that these complexes induced in cancer cells. Methods. The cytotoxicity of Au(III) complexes was investigated by MTT assay. The apoptosis of the treated cancer cells was measured by flow cytometry and applying Annexin V/7AAD staining. The expressions of active proapoptotic protein Bax, antiapoptotic protein Bcl-2 and the percentage of cells containing cleaved caspase-3 in the treated cancer cells were determined by flow cytometry. Results. Complex 1 showed the most potent antitumor effect on HeLa cells, both compared to other two examined gold complexes and compared to cisplatin. The IC50 values on HeLa cells after 72 hours were 1.3 ? 0.4 ?M, 3.4 ? 1.3 ?M, 5.7 ? 0.6 ?M, 26.7 ? 6.5 ?M for complexes 1, 2, 3 and cisplatin, respectively. Complex 1 also exhibited the highest cytotoxicity against MDA-MB-231 and HCT116 cells compared to other tested compounds. The results of Annexin V/7AAD staining showed that all three gold complexes induced apoptosis in the treated cells. Our Au(III) complexes induced apoptosis by caspase-dependent mechanism, but we did not observe that the activation of an internal pathway of apoptosis occurred in the treated cancer cells. Conclusion. According to the results of our in vitro study, all three gold compounds, and especially complex 1, are promising candidates for a new generation of anticancer drugs.

Background/Aim. Segmental fractures represent complex tibial injuries, featuring a unique fracture type that is most commonly caused by high-energy trauma. These fractures are considered to be a treatment challenge for orthopaedic surgeons due to their sporadic presentation, wide zone of soft tissue injury, and increased rate of complications. They are characterized by a highly unstable intermediary segment and a high rate of open fractures. The method of Ilizarov with its characteristics could offer many advantages over the existing operative techniques. This method, using a percutaneous approach, minimizes the intraoperative trauma and avoids the additional compromising of the biological environment at the fracture site. The aim of this study was to evaluate the results of the Ilizarov fixator in the treatment of segmental tibial fractures. Methods. We analyzed 30 patients treated with the Ilizarov fixator between 2012 and 2017. The average age of patients was 36 years (from 24 to 65). The most common mechanism of injury was a road traffic accident. Open fractures were noted in 22 cases. All fractures were reduced using indirect percutaneous techniques with a great focus on achieving the correct length, rotation, and axial alignment of fragments. All patients were advised to bear weight as tolerated from the second postoperative day. Bone healing and functional results were evaluated according to the criteria established by the Association for the Study and Application of the Method of Ilizarov. Results. Bone healing was achieved in all patients. The average time to union was 25 weeks (19 to 36 weeks). Bone results were excellent in 23 patients, good in five, and fair in two patients. Functional results were excellent in 22 cases, good in 5, and fair in three cases. Eight patients had minor pin-tract infections, successfully treated with oral antibiotics. Patients were without any major complications. Conclusion. The Ilizarov method is a safe and efficient treatment modality for segmental tibial fractures.

Introduction. Dermatofibrosarcoma protuberans (DFSP) is a very rare mesenchymal tumor that accounts for approximately 0.1% of all malignancies. It is a locally aggressive fibrous tumor, with a high recurrence rate, which sometimes gives rise to distant metastases, usually to the bones and lungs. DFSP usually occurs on the trunk and extremities with only a small number of cases in the breast, especially in men. Case report. This paper analyzes a rare case of DFSP in the male breast. A 66-year-old man presented with gynecomastia of the left breast. The diagnostic work-up comprised of clinical examination, ultrasonography, core biopsy, and mammography. Immunohistochemistry revealed diffuse and strong positivity for vimentin, CD99, and CD34, while the tumor cells were completely negative for keratin, S100 protein, STAT6, CD31, and factor VIII, highly suggestive for DFSP. Subsequently, a radical mastectomy was performed and preoperative diagnosis of dermatofibrosarcoma protuberans was confirmed by pathological examination and immunohistochemistry. The patient was still disease-free six months after the surgical treatment. Conclusion. DFSP is a soft tissue sarcoma that rarely occurs in the breast, especially in men. The most common clinical presentation in the breast is a mass, but it can also present as gynecomastia, as in our case. The diagnosis of DFPS is based on anatomopathology with immunohistochemistry analysis since there are no specific imaging features for this rare entity. Surgical excision with wide and negative margins is optimal for reducing the risk of recurrence.

Background/Aim. Identification of caries risk indicators involved in the disease development is of great importance. The aim of this study was to assess the association between distinctive risk indicators and different stages of caries disease process in children. Methods. The cross-sectional study was conducted on a sample (n = 327) of school children ages 7?11. A questionnaire submitted to parents was used to record the data regarding demographic characteristics, children's dietary habits, oral hygiene habits and oral health behaviors. Caries was assessed using the International Caries Detection and Assessment System (ICDAS) II and subjects were stratified according to the highest and most prevalent caries lesion stage. The data obtained were analyzed using the ?2 or Fisher`s exact test and multinomial logistic regression. Results. Caries lesions were detected in 56.6% of examinees observed in the study. Compared to caries-free subjects, appearance of initial caries lesions was statistically significantly influenced by maternal education level (p = 0.021), paternal occupational status (p = 0.023), toothbrushing frequency (p < 0.001), and caries status of deciduous teeth (p = 0.027). Maternal educational level (p = 0.026), paternal occupational status (p = 0.003), sweets and snacks taking frequency (p = 0.005), toothbrushing frequency (p < 0.001), and fluoridate dentifrice usage (p = 0.027) were associated with moderate caries lesions. Maternal educational level (p < 0.001), sweets and snacks taking frequency (p = 0.022) and toothbrushing frequen-cy (p < 0.001) were associated with extensive caries lesions. Maternal educational level (p = 0.02) and brushing frequency (p < 0.001) were statistically significantly associated with the highest prevalence of initial caries lesions. Maternal educational level (p = 0.025), toothbrushing frequency (p < 0.001) and frequency of dental check-ups (p = 0.016) were statistically significantly associated with the highest prevalence of moderate caries lesions. Conclusion. Parental socioeconomic indicators and children's behavior related to oral health were involved in the changes from caries-free status to different caries stages.

Background/Aim. Injury to the anterior cruciate ligament (ACL) of the knee is the most common ligament injury that requires operative treatment. So far, multiple ACL reconstruction (ACLR) techniques using a variety of graft types and implants that fixate the grafts have been described. The aim of the study was to compare two different ACLR techniques using two implant types for suspensory graft fixation in the femoral tunnel. Methods. This randomized-prospective study encompassed 60 patients/subjects who underwent ACLR in the period between January 2015 and December 2017 at the Department of Orthopaedics and Traumatology of Military Hospital ?Dr Vladan Djordjevic? Nis. The ACLR in all patients included in the study was per-formed using a quadruple semitendinosus-gracilis (STG) graft with two types of suspensory fixation on the lateral femoral cortex, whereas the graft fixation in the tibial tunnel was performed using an osteoconductive bioresorbable screw. The post-operative knee stability was assessed 24 months after surgery using the Lachman test and the lateral pivot shift test, as well as the KT-1000 arthrometer test. Results. In patients whose graft was fixated using a fixed-length loop implant, the mean post-surgery knee stability, measured with the KT-1000, was 1.167 ? 0.780; in patients whose graft was fixated using an adjustable-length loop implant, the mean value of the KT-1000 was 1.100 ? 0.894 (p = 0.605). The mean post-surgery International Knee Documentation Committee (IKDC) score for the fixed-length loop group was 84.887 ? 9.0207, while for the adjustable-length loop the score was 88.327 ? 7.302. The mean Lysholm score was 93.50 ? 6.872 for the fixed-length loop group of patients and 94.00 ? 5.527 for the adjustable-length loop group of patients. Conclusion. Both types of implants can be used with success during ACLR, because the functional results of operative treatment using both implants were identical after surgery.

Funding: This study was supported by the Ministry of Education, Science and Technological Development of the Republic of Serbia (Grant III41020). Background / Aim The sciatic nerve (SN) is a mixed nerve formed in pelvis by joining of L4 - S3 anterior spinal nerve roots. SN can be under the pressure in different regions throughout its course. However, the most frequent site of impingement is under the piriformis muscle which causes the occurrence of piriformis syndrome. High division of SN has its relevance considering the fact that it leads to the compression of nerve resulting in piriformis syndrome. The aim of this study was to determine the connection between anatomical parameters of pelvis and high division of SN, which is considered to be one of the most common causes of piriformis syndrome in both genders. Methods This study was conducted on 28 formalin fixed cadavers of both genders at the Institute of Anatomy, Faculty of Medicine, University of Belgrade (Belgrade, Serbia) and the Department of Anatomy, School of Medicine, University of St Andrews (St Andrews, United Kingdom). For the measuring of required dimensions, we used a ruler and a caliper. Results A statistically significant difference in the values of bispinal and bituberal lines was observed. A high division of SN was found on 58.33% of the male cadavers and 80% of the female cadavers. A statistically significant difference in the mean value of the bituberal line between the male and female sex was also recognised. Conclusion The connection between the anatomical parameters of the pelvis and the level of division of the SN is confirmed. Although on the basis of the results it could be assumed that people with smaller pelvic dimensions would have greater likelihood of developing a piriformis syndrome, the other factors, such as biomechanics related to a wider 'Q angle' in women that could result in a higher incidence of piriformis syndrome, should also be considered. Publisher PDF

Background/Aim. Development of allergic contact der-matitis as a complication of treatment of chronic venous insufficiency (CVI) is well known. The aim of this study was to determine the incidence and risk of eczematous contact sensitization in patients with CVI, as well as the correlation between disease duration and contact sensitization. Methods. The study involved 266 subjects examined during three-year-period who were divided into two groups: the study group included patients with CVI referred for allergy testing due to suspected contact dermatitis, and the control group included the ones without CVI patch tested for suspected contact dermatitis. The severity of CVI was assessed by Clinical Etiology-Anatomy-Pathophysiology (CEAP) classification. Thereafter, each patient underwent patch testing. Results. The incidence of contact sensitization among patients with CVI was 49.3%. In these patients, the incidence of contact sensitization to the European standard battery of allergens was 31.55%; to the battery specific for CVI it was 28.45%. Patients with CVI had a 2.45-fold higher risk for developing contact sensitization to two or more allergens, and a 3.69-fold higher risk for developing contact sensitization to five or more allergens compared to those without CVI. The prevalence of contact sensitization in patients with CVI was not significantly different from those without CVI. There was a positive correlation between the incidence of contact sensitization and the duration of the disease. Conclusion. Patients with CVI had no statistically significantly distinct contact sensitization prevalence and had 2.45 and 3.69 times higher risk to manifest contact sensitization to two and more allergens and five and more allergens, respectively, than patients with no CVI. The positive correlation between frequency of contact sensitization and disease duration was found.

Background/Aim. In-depth knowledge of the vascular net-work of the hand is of great importance in modern medicine. The main vessel of the hand is the superficial palmar arch (SPA). As typically described in anatomical textbooks, it arises as a terminal branch of the ulnar artery, which then anastomoses with the superficial palmar branch of the radial artery. However, the SPA is characterized by remarkable variability, which has been the area of interest of many researchers so far. The aim of this study was to exert a comprehensive examination of the anatomy of the SPA. Methods. The research was conducted at the Institute of Anatomy ?Niko Miljanic? on a total number of 14 cadavers. After careful dissection, variations of the modality of formation of the SPA and its distance of the SPA from Kaplan?s cardinal line were observed on the right hands. Collected data were then analyzed statistically in SPSS 11.0 using the Mann-Whitney U test, with the accepted level of statistical significance of p < 0.05. Results. According to Coleman and Anson?s classification, the higher incidence of the incomplete type (57.14%) of the SPA was observed compared to the complete type (42.86%). In addition to this, a statistically significant difference was discovered in the distance of the SPA from Kaplan?s cardinal line between two groups with complete and incomplete types, respectively. The parameter examined in the group with the complete type took the value of 2.13 ? 0.32 cm, while in the group with the incomplete type measured 3.33 ? 0.87 cm. Conclusion. The present study showed a very important complexity in the domain of anatomy of the SPA with numerous clinical implications. For that reason, a thorough evaluation of the hand circulatory system should be considered while planning surgical procedures in order to avoid operative and postoperative complications.

Background/Aim. Chronic total coronary artery occlusions (CTOs) are still one of the most complex procedures in the treatment of coronary arteries. If there is a bifurcation lesion within the CTO, it is certainly one of the biggest challenges for interventional cardiologists. Methods. We present a retrospective analysis of patients from our center who underwent percutaneous coronary intervention (PCI) with a bifurcation lesion within the CTO and a side branch with a diameter of 2 mm or more, in the period from January 2017 to December 2020. Results. Out of a total of 216 patients in the four-year period, 38 (18%) of them had a bifurcation lesion within the CTO. The most common bifurcation lesions were on the left anterior descending (LAD) artery (50%), and the least frequent on the circumflex coronary artery (21%). CTO recanalization was successful in 35 patients (92%). One stent technique was used in 27 patients (77%), while the two stent technique was used in 8 patients (23%). Conclusion. Bifurcation lesions in the context of PCI CTO are a relatively common finding on coronary angiography and represent a special challenge for CTO operators. Provisional technique (one stent technique) is the most common strategy for the treatment of bifurcation lesions in patients with CTO.

Background/Aim. The ability to effectively and consistently penetrate into dentinal tubules is considered as a favorable factor of root canal sealers RCS). The aim of the study was to assess the penetration depth into dentinal tubules of three RCS combined with four obturation techniques. Methods. Mesial canals of 66 extracted human mandibular molars were endodontically prepared and randomly allocated into 12 experimental groups depending on the sealer type used (AH Plus, EndoREZ, Sealapex) and the obturation technique applied (Cold Lateral compaction, Cone-Fit, Carrier-based, Warm Vertical compaction). Using scanning electron microscopy (SEM), transversal root cross-sections were analyzed and the maximum depth of sealer penetration was measured (396 sections in total corresponded to the apical, middle and coronary third). Results. Group AH Plus/Warm Vertical compaction yielded the highest penetration depth - 1,165 ?m, followed by EndoREZ/Cone-Fit - 1,154 ?m; the lowest depth was measured for EndoREZ/Warm Vertical compaction - 502 ?m. The maximum penetration depth of sealers in the coronary thirds (common mean value) yielded 1,204 ?m, in the middle thirds - 1,005 ?m and in the apical thirds - 770 ?m. AH plus penetrated deeper into dentinal tubules when the obturation techniques with heated gutta-percha were applied, while the opposite findings were obtained for EndoREZ. Conclusion. The sealer penetration depth appears to be influenced by the sealer type used, as well as the obturation technique applied.

Background/Aim. Apical periodontitis (AP) is an acute or chronic inflammation of the periradicular tissue, usually caused by the presence of microbial irritants in the root canal system. The aim of the present study was to radiographically investigate the AP prevalence in root-filled teeth in adults from an urban area of Vojvodina. Methods. Randomly selected digital ortopantomographs of 616 subjects attending the Clinic of Dentistry of Vojvodina, Serbia, were examined. Periapical status, root canal filling (RCF) quality, type of coronal restorations, and their relationships were evaluated. The chi-square test was used for statistical analysis. Results. The total number of endodontically treated teeth was 965, 44.2% of them received an adequate RCF score, and 34.9% had AP, which was diagnosed in 57.4% of inadequately scored root-filled teeth. Posterior teeth had significantly worse RCF quality than anterior teeth (p < 0.001). The direct logistic regression results indicate that a technically well-performed RCF reduced the risk of AP almost 21-fold. The prevalence of AP in our cohort was not influenced by the type of restoration (direct or indirect), but statistically significantly, the highest prevalence of AP was found in rootfilled teeth without any coronal restoration. Conclusion. The results of this study reaffirm that technically high-quality root canal treatment is crucial to ensure a more predictable root canal treatment outcome.

Background/Aim. Alveolar ridge dimensional alterations following tooth extraction in the anterior maxilla often result in an inadequate bone volume for a correct implant placement. In order to obtain optimal bone volume various bone graft substitutes have become commercially available and widely used for socket grafting. The aim of this study was to examine and compare long-term clinical outcomes of dental implant therapy in the maxillary esthetic zone, after socket grafting with beta-tricalcium phosphate (TCP) combined with collagen type I, either with or without barrier membrane and flap surgery, after a 12-month follow-up. Methods. Twenty healthy patients were allocated to either C group (beta-TCP and type I collagen without mucoperiosteal flap coverage) or C+M group (beta-TCP and type I collagen barrier membrane with mucoperiosteal flap coverage). Following clinical parameters were assessed: implant stability (evaluated by a resonance frequency analysis - RFA), periimplant soft tissue stability (sulcus bleeding index - SBI, Mombelli sulcus bleeding index - MBI, periimplant sulcus depth, keratinized gingiva width, gingival level) and marginal bone level at the retroalveolar radiograms. Results. Within C+M group, RFA values significantly increased 12 weeks after implant installation compared to primary RFA values. Comparison between investigated groups showed a significantly reduced keratinized gingiva width in the C+M group compared to the C group after 3, 6, 9 and 12 months. Comparison between groups revealed significantly lower gingival level values in the C+M group at 9th and 12th month when compared to the C group. Conclusion. Implant treatment in the anterior maxilla could be effective when using a 9 months alveolar ridge preservation healing with combined treatment with beta-tricalcium phosphate and type I collagen, with regard to the peri-implant soft and hard tissue stability., Uvod/Cilj. Posle ekstrakcije zuba, dimenzionalne promene alveolarnog grebena u estetskoj regiji gornje vilice za posledicu često imaju nedovoljnu količinu kosti za ugradnju zubnih implanata. U vezi sa tim, primenjuju se različiti koštani zamenici sa ciljem očuvanja dimenzija alveolarnog grebena posle ekstrakcije zuba. Cilj rada bio je da se, posle prezervacije alveolarnog grebena beta-trikalcijum fosfatom (TCP) sa kolagenom tip 1, sa barijernom membranom i mukoperiostalnim režnjem i bez nje, ispitaju i uporede klinički ishodi zarastanja posle ugradnje zubnih implanata u estetskoj regiji gornje vilice, tokom jednogodišnjeg perioda praćenja. Metode. Dvadeset zdravih bolesnika podeljeno je u dve grupe: C (beta TCP/kolagen tip 1 bez barijerne membrane i mukoperiostalnog režnja) i C+M (beta TCP/kolagen tip 1 sa barijernom membranom i mukoperiostalnim režnjem). Praćeni su uobičajeni klinički parametri ishoda terapije: implantna stabilnost (analiza rezonantne frekvence), stanje mekih tkiva (indeks krvarenja, plak indeks, širina pripojne mukoze, recesija gingive) i nivo periimplantnog koštanog tkiva na retroalveolarnom radiogramu. Rezultati. U C+M grupi, implantna stabilnost posle 12 nedelja bila je značajno veća u odnosu na primarnu stabilnost. U C+M grupi, širina keratinizovane gingive bila je značajno manja posle 3, 6, 9 i 12 meseci u odnosu na C grupu. Recesija gingive bila je značajno veća u C+M grupi u odnosu na C grupu posle 9 i 12 meseci. Zaključak. Razmatrajući stabilnost mekog i tvrdog periimplantnog tkiva, terapija zubnim implantima može biti uspešna prilikom ugradnje u estetskoj regiji gornje vilice.

Background/Aim. Gastric cancer (GC) is fourth most frequent malignant tumor worldwide, frequently diagnosed at advanced stages with poor prognosis. The aim of study was to determine expression of interleukin (IL)-32, proinflammatory and angiogenic mediators in the tumor, peritumor and healthy tissue, in patients with intestinal gastric cancer and the relationship with the disease severity. Methods. The tissue samples of intestinal type of the tumor of 60 patients with GC were analyzed. Expression of IL-32, vascular endothelial growth factor (VEGF), IL-17 and CD31 were measured by immunohistochemistry. Results. IL-32, VEGF and IL-17 expression as well as microvascular density (MVD) were diminished in adjacent tumor tissues compared with the tumor ones. Further, more intense expression of IL-32 and VEGF and enhanced MVD were noticed in patients with severe (TNM stages III and IV) and more progressive GC (lymph vessel invasion). Conclusion. Higher expression of IL-32, VEGF and intense MVD in the tumor tissue of GC patients with detectable lymph vessel invasion may be considered as a sign of the tumor?s malignant progression. This indicates a protumorogenic and proangiogenic role of IL-32 in biology of intestinal type of gastric cancer.

Background/Aim. Atrioventricular nodal (AV) reentry tachycardia (AVNRT) is the most common form of supraventricular tachycardia. Treatment of choice is a catheter-ablation of the slow pathway of the AV node. The aim of the study was to present the outcomes of this procedure after ten years of follow-up. Methods. The catheter- ablation procedure was performed in 92 patients (30 men and 62 women, mean age 52.0 ? 13.3 years, range 19 to 76 years) with confirmed AVNRT during the electrophysiological examination, from 2007 to 2009. Out of these, 64 patients were followed-up for ten years by inviting them to clinical examinations regularly. The occurrence of AV block, arrhythmia and the use of antyarrhythmic drugs were the main outcomes of the ten-year follow-up. Multivariate logistic regression was applied to identify significant predictors of arrhythmia after a follow-up period. Results. The primary success of intervention was achieved in 91 (98.9%) patients. Third-degree AV block was registered in 1 (1.1%) patient after the intervention, which required the implantation of a pacemaker. After ten years of follow-up, AVNRT relapses were not registered. A total of 7 out of 64 (10.9%) patients died during the follow-up period, mostly due to non-cardiac causes. After ten years of follow-up, firstdegree AV block was registered in six (10.5%) patients, whereas other arrhythmias were observed in 17 (29.8%) patients such as atrial fibrillation or flutter, atrial premature beats and sinus tachycardia. The number of antiarrhythmic drugs were reduced from 2.1 ? 1.2 at baseline to 0.5 ? 0.6 during follow-up, mostly beta-blockers, propafenone and amiodarone, and 33 (57.9%) patients were no longer using anti-arrhythmic therapy. Logistic regression identified participant?s age above 55 years at baseline and re-intervention performed after the initial catheter-ablation as significant predictors of arrhythmia after a 10-year follow-up, independent from gender and arterial hypertension at baseline. Conclusion. The catheter-ablation of AVNRT represents a successful and safe procedure, from the perspective of tenyear follow-up.

Background/Aim. Interatrial conduction time is early marker of disturbed impulse propagation in adult with elevated blood pressure. The aim of our study was to evaluate significance of noninvasive echocardiographic marker of slow sinus impulse propagation (atrial conduction time) for the identification of persons with slightly elevated blood pressure and hypertension in adults. Methods. One hundred and forty nine adults with normal and elevated blood pressure were studied: 46 normotensive adults (group 1), 28 adults with elevated blood pressure and hypertension stage 1 (group 2) and 75 adults with hypertension stage 2 (group 3), based on the Joint National Committee 8 (JNC-8) hypertension guidelines. We studied P wave dispersion, reservoir function of the left atrium (LA), total emptying volume of the LA and total emptying fraction of the LA (LATEF). The atrial conduction time (ACT) was evaluated by the pulsed tissue Doppler, and expressed as interatrial and intraatrial conduction time. Results. The LATEF decreased progressively from the group 3 (64.8 ? 4.4%) to the group 2 (59.8 ? 5.2%) and the group 1 (55.6 ? 7.3%) (p < 0.001). The P wave dispersion (55.1 ? 9.8 ms vs. 46.8 ? 3.1 ms vs. 43.1 ? 2.6 ms; p < 0.01) and intra ACT were significantly prolonged only in the group 3 compared to the other groups (22.7 ? 11.0 ms vs. 8.4 ? 4.7ms vs. 5.6 ? 2.4 ms, respectively; p < 0.001). Inter ACT significantly increased from the group 1 to the group 2 and the group 3 (15.6 ? 3.9 ms vs. 24.6 ? 5.7 ms vs. 50.4 ? 20 ms, respectively; p < 0.05). Using a cut-off level of 19.5 ms, inter ACT could separate adults in the group 2 from the group 1 with a sensitivity of 85%, and specificity of 89% [area under receiver operating characteristic (ROC) curve 0.911]. Conclusion. Prolonged ACT estimated with the tissue Doppler may be useful for identification persons with slighty elevated blood pressure, and hypertension stage 1.

Background/Aim. Chronic lymhocytic leukemia (CLL) is considered more as a disease of cells accumulation due to the defect in apoptosis rather than deregulated cell?s proliferation. The activation of apoptosis is one of the main molecular mechanisms responsible for anti-cancer activities of most of the currently studied potential anti-cancer agents, including natural compounds. Teucrium polium (TP) extracts exhibited strong cytotoxic effects in murine leukemia cell line, RAW 264.7 and human melanoma cell line, C32, but their cytotoxic effects against human leukemia cells were unknown. Methods. The viability of human leukemia cell lines (MOLT 4 and JVM 13), lymphocytes isolated from 28 patients with CLL (CLL cells), and peripheral blood mononuclear cells (PBMCs) isolated from 16 healthy subjects treated with TP leaves methanolic extract, was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. Apoptosis of TP treated CLL cells was measured by flow cytometry applying Annexin V/7AAD staining. The expressions of active proapoptotic protein Bax, antiapoptotic protein Bcl-2, cytochrome c and the percentage of cells containing cleaved caspase-3 in treated CLL cells was determined by flow cytometry and immunocytochemistry. Results. The TP meth-anolic extract decreased the viability of all tested human leukemia cells but it had no effect on the viability of PBMCs isolated from healthy subjects. The cytotoxic effect of TP was caused by its induction of CLL cells? apoptosis. TP disarranged the ratio of the expressions of proapoptotic Bax and antiapoptotic Bcl-2 protein in favor of Bax, consequently inducing apoptosis by cytochrome c mitochondrial release and activation of caspase-3 in treated CLL cells. Conclusion. The TP leaves methanolic induced selective apoptosis in CLL cells and it affected the expressions of key proteins involved in the regulation of programmed cell death.

Background/Aim. Establishing a preoperative diagnosis of thyroid follicular tumors is difficult due to the fact that the cell morphology of adenomas and carcinomas are similar and that capsular and vascular invasion cannot be determined by cytology. We analyzed predictive factors of follicular carcinoma in order to enable a surgeon to indicate operative treatment and to perform an adequate operation for each patient with a follicular neoplasm. Methods. In this retrospective study, we analyzed medical records of all patients with follicular thyroid tumors operated at an endocrine surgery unit of a tertiary referral academic hospital, between 2008 and 2012. A total of 263 operated patients were included and divided into follicular adenomas (n = 97) and follicular carcinomas (n = 166) based on the histopathology results. The most important demographic and clinical characteristics were analyzed by univariate and multivariate logistic regression analysis. Results. In adenoma group (19 males, 78 females) age range was 19?79, mean age 50. In carcinoma group (35 males, 131 females) age range was 15? 78, mean age 48. Univariate analysis showed that thyroglobulin concentration ? 500 ng/mL, tumor diameter < 30 mm, presence of more than one thyroid nodule and an afunctional/hypofunctional nodule were significantly more frequent in follicular carcinoma than in follicular adenoma. Independent predictive factors of malignancy were: elevated preoperative thyroglobulin concentration (? 500 ng/mL) and presence of more than one nodule. Based on our results we formed a nomogram, a two-dimensional diagram designed to enable estimation of preoperative probability of malignancy. Conclusion. Elevated preoperative thyroglobulin concentration, ? 500 ng/mL, and the presence of more than one nodule are independent predictors of malignancy for follicular thyroid carcinomas.