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Background/Aim. Quality of life (QoL) is one of the out-come measures for patients with chronic diseases. Mental health issues often impact the QoL of cancer patients. Cancer patients with a good QoL have a longer life expectancy and are able to lead a more productive and social life. The aim of the study was to determine the association of mental health with the QoL, as well as to determine significant predictors of QoL in patients with breast cancer (BC). Methods. The study included 118 patients treated at the Specialized Breast Cancer Department of the Oncology Clinic of the University Clinical Center Niš, Serbia. The study’s inclusion criteria were the presence of early-stage nonmetastatic BC and completed surgical treatment. The following questionnaires were used: the general sociodemographic questionnaire, Hospital Anxiety and Depression Scale (HADS), Buss-Perry Aggression Questionnaire, Early Maladaptive Schema questionnaire - short form (SQ-SF), Flanagan’s Quality of Life Scale (QoLS), Holmes and Rahe Stress Scale, Berlin Social Support Scales (BSSS), Health Locus of Control. Results. A statistically significant negative correlation was found with emotional state, i.e., anxiety score, depressiveness score, total stress score, and physical aggression score, while QoL correlated positively with all subscales of the perceived social support (PSS) questionnaire. QoL was significantly different for patients with the following early maladaptive schemas: emotional deprivation, emotional inhibition, and a sense of entitlement/narcissism. Moreover, QoL differed significantly depending on partnership status, the presence of clinically significant anxiety, the presence of hormone-sensitive cancer, the presence of human epidermal growth factor receptor 2 (HER2)-positive cancer, and time since diagnosis. Multiple linear regression was per-formed, and depression and PSS had the highest share. Conclusion. In our study, the presence of depressiveness and PSS were the best predictors of QoL of BC survivors.

Background/Aim. A type of personality and negative emotional reactions could be important for clustering biological risk factors for a cardiovascular disease in patients with arterial hypertension (AH). This study investigated if the patients with AH and psychological characteristics of the Distressed Type of personality with elevated anxiety/depression/aggression, have a higher risk of metabolic syndrome (MS) and explored value of the assessed parameters for MS occurrence. Methods. A total of 85 patients with AH were included in the cross-sectional observational study. Type D Scale-14 (DS-14) was used to detect Type D (Distressed) personality. The Hospital Anxiety and Depression Scale (HADS) assessed the levels of anxiety and depression and the Buss Perry Aggression Questionnaire (BPAQ) was used for the assessment of aggression. The explored biological parameters included: blood pressure, lipid status, body mass index (BMI), the occurrence of diabetes mellitus (DM) and MS. Results. Type D patients were frequently more anxious, aggressive and had more frequent MS compared to non-type D. Type D females were younger, more anxious and had a greater prevalence of DM than those with non-type D personality. A multivariate analysis revealed that in type D personality patients with AH, depression had predictive value for MS. Conclusion. The occurrence of both MS and AH was in correlation with the type D personality, anxiety and depression. Early detection/treatment of depression in patients with AH and Type D personality could decrease a risk of metabolic syndrome.

Background/Aim. Functional mitral regurgitation (FMR) is a common entity in patients with aortic stenosis (AS) undergoing aortic valve replacement (AVR). The aim of this study was to examine evolution of moderate and moderate to severe FMR after an isolated AVR, to identify prognostic indicators for persistent MR postoperatively, and to offer the recommendation regarding surgical intervention for moderate and moderate to severe FMR at the time of AVR for AS. Methods. We retrospectively reviewed 39 consecutive patients with moderate and moderate to severe FMR at the time of isolated AVR from January 2007 to December 2013. We collected preoperative and postoperative echocardiographic data to determine the evolution of FMR after AVR. Patients were divided into the persistent (n = 14) and improved FMR group (n = 25). Secondary division was into the prosthesis-patient mismatch (PPM, n = 7) and non prosthesis-patient mismatch group (non PPM, n = 32 patients). Late follow-up echocardiography was completed in 100% (39/39) of patients. Results. FMR improved postoperatively (MR ˂ 2+) in 64% (25/39) of patients, while 36% (14/39) of patients had persistent MR ≥ 2). In comparison to the persistent group, the patient with improved FMR had significant decrease in the left ventricular enddiastolic diameter, left ventricular end-systolic diameter, posterior wall and septum thickness postoperatively. The same indicators of reverse remodeling were found in the non PPM group in comparison to the PPM group. The incidence of postoperative FMR improvement was higher in the non PPM group (65.6%, p = 0.001) in comparison to the PPM group (42.9%, p = 0.125). The mean follow-up duration was 39.5 ± 23.5 months. Conclusion. In accordance with previous studies, this study also showed improvement in FMR following AVR surgery. Improvement in MR degree was associated with echocardiographic parameters of reverse left ventricular remodeling. Conservative approach is advisable in patients with moderate and moderate to severe FMR, believing that repair or replacement is unnecessary at the time of AVR for severe AS. PPM could prevent downgrading of FMR, stressing out the importance of choosing the prosthesis of adequate size.

Introduction. Coronary artery anomalies are infrequent but anticipated findings during percutaneous coronary interventions (PCI). Compared to consistent reporting in angiographic series, they seem to be underreported in interventional studies, and particularly in the setting of primary PCI, where their prompt recognition is of the utmost importance. Case report. We present a 50 years old male with inferior ST-elevation of myocardial infarction (STEMI) and right ventricular involvement with solitary ostium for all three coronary arteries in the right aortic sinus of Valsalva. The patient had an extremely rare variant of coronary artery origination belonging to the type A4b2c2 of Angelini’s classification. Correspondingly, it belongs to the left Anomalous origination of a Coronary Artery from the Opposite Sinus of Valsalva (ACAOS) class with the intraseptal course of left anterior descending artery. We managed successfully to implant a drug eluting stent in the proximal right coronary artery in a lengthy and stormy procedure, with the need for guiding catheter exchange, temporary pacing and dealing with no-reflow phenomenon. Conclusion. We summarize diagnostic hints for angiographic recognition of dominant variants of the left ACAOS and practical aspects of performing PCI in such patients. Also, we debate on the functional significance of coronary anomalies and its further implications from the prognostic and therapeutic aspects. We propose adoption of the novel classification of coronary anomalies of Angelini’s group in the routine clinical practice. Finally, we call for the inclusion of specific training in coronary artery anomalies into the interventional cardiology fellowship curriculum.

Background/Aim. So far, no study has been focused exclusively on the tricuspid aortic valve stenosis (TAV) in the aorta without severe dilatation and none has aimed at correlating the high mycroscopy findings with the echocardiographic parameters. This research was conducted on the postulate that detecting the histopathological changes of different severity in the aortic wall could tailor decision about an aortic surgery. The aim of this study was to grade the histopathological changes in the wall of the nonseverely dilated ascending aorta in patients with the severe, calcific TAV stenosis and to correlate them with the echocardiographic parameters in order to analyze when the ascending aorta should be replaced simultaneously with the aortic valve replacement (AVR). Methods. The samples from 37 patients subjected to the AVR and the samples from the control group were analyzed morphologically. The echocardiographic parameters obtained in the TAV stenosis patients were preoperatively correlated with the morphological data, age and gender, diameters of the ventriculo-aortic junction (AA), the sinus Valsalvae (SV) and sinotubular junction (STJ), the largest diameter of the visualized ascending aorta (AscA), the sinus Valsalvae index (SVI) and AscA/AA index. Results. We confirmed morphometrically the exact region of the hemodynamic stress influence with the mathematical distinction in comparison to the controls. In this region, the gradual elastic lamellae disruption was proved by a statistically significant difference through the 3 grades. The elastic skeleton alterations were potentiated with aging and in females. The morphometric parameters of the ascending aorta wall statistically significantly correlated with the echocardiographic parameters: AA, SV, AscA and SVI. The echocardiographic parameters tended to be higher in the most severe grade 3, in the patients younger than 65 years of age. The AscAof more than 4.5 cm was associated with the irreversible morphological defects in these patients. Conclusion. The hemodynamic stress induced by the TAV stenosis leads to the ascending aorta elastic lamellae disruption that could be histopathologically graded and correlated with the echocardiographic parameters of the ascending aorta providing a potential tool for decision-making process in cases when the ascending aorta replacement is considered simultaneously with the AVR. [Projects of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175005, Grant no. 175061, Grant no. III45005, Grant no. III41002, Grant no. III41022]

Background/Aim. According to currently available data, there is no research dealing with evaluating empathy in adolescents with conduct disorders in our region. The aim of the research was to examine the differences in the severity of cognitive and affective empathy in adolescents with and with no conduct disorder, as well as to examine the relationship between cognitive and affective empathy and the level of externalization in adolescents with conduct disorder. Methods. This research was conducted on 171 adolescents, aged 15 to 18, using the Interpersonal Reactivity Index, Youth Self- Report and a Questionnaire constructed for the purpose of this research. Results. The results showed that adolescents with conduct disorder had significantly lower scores for Perspective Taking (t = 3.255, p = 0.001), Fantasy (t = 2.133, p = 0.034) and Empathic Concern (t = 2.479, p = 0.014) compared to the adolescents in the control group, while the values for Personal Distress (t = 1.818, p = 0.071) were higher compared to the control group, but the difference was not statistically significant. The study showed a statistically significant negative correlation between Perspective Taking and aggression (r = - 0.318, p = 0.003) and a negative correlation between Perspective Taking and the overall level of externalizing problems (r = -0.310, p = 0.004) in the group of adolescents with conduct disorder. Conclusion. This research contributes to better understanding of behavioral disorders in terms of individual factors, especially empathic reactivity. Preventive work with young people who have behavioral problems associated with empathy deficit disorder proved to be an important tool in preventing the development, or at least relieving the symptoms, of this ever more common disorder.

[Projekat Ministarstva nauke Republike Srbije, br. 175005, 175061, III41002, III45005 i 41022]

Background/Aim. Intramyocardial bone marrow mononuclear cells (BMMNC) implantation concomitant to coronary artery bypass grafting (CABG) surgery as an option for regenerative therapy in chronic ischemic heart failure was tested in a very few number of studies, with not consistent conclusions regarding improvement in left ventricular function, and with a follow-up period between 6 months and 1 year. This study was focused on testing of the hypothesis that intramyocardial BMMNC implantation, concomitant to CABG surgery in ischemic cardiomyopathy patients, leads to better postoperative long-term results regarding the primary endpoint of conditional status-functional capacity and the secondary endpoint of mortality than CABG surgery alone in a median follow-up period of 5 years. Methods. A total of 30 patients with ischemic cardiomyopathy and the median left ventricular ejection fraction (LVEF) of 35.9 ± 4.7% were prospectively and randomly enrolled in a single center interventional, open labeled clinical trial as two groups: group I of 15 patients designated as the study group to receive CABG surgery and intramyocardial implantation of BMMNC and group II of 15 patients as the control group to receive only the CABG procedure. All the patients in both groups received the average of 3.4 ± 0.7 implanted coronary grafts, and all of them received the left internal mammary artery (LIMA) to the left anterior descending (LAD) and autovenous to other coronaries. Results. The group with BMMNC and CABG had the average of 17.5 ± 3.8 injections of BMMNC suspension with the average number of injected bone marrow mononuclear cells of 70.7 ± 32.4 × 106 in the total average volume of 5.7 ± 1.5 mL. In this volume the average count of CD34+ and CD133+ cells was 3.96 ± 2.77 × 106 and 2.65 ± 1.71 × 106, respectively. All the patients were followed up in 2.5 to 7.5 years (median, 5 years). At the end of the follow-up period, significantly more patients from the group that received BMMNC were in the functional class I compared to the CABG only group (14/15 vs 5/15; p = 0.002). After 6 months the results on 6-minute walk test (6-MWT) were significantly different between the groups (435 m in the BMMNC and CABG group and 315 m in the CABG only group; p = 0.001), and continued to be preserved and improved on the final follow-up (520 m in the BMMNC and CABG group vs 343 m in the CABG only group; p < 0.001). Cardiovascular mortality was also significantly reduced in the BMMNC and CABG group (p = 0.049). Conclusion. Implanatation of BMMNC concomitant to CABG is a safe and feasible procedure that demonstates not only the improved functional capacity but also a reduced cardiac mortality in a 5-year follow-up in patients with ischemic cardiomyopathy scheduled for CABG surgery.

[Projekat Ministarstva nauke Republike Srbije, br. 175005, 175061, III41002, III45005 i 41022]

Background/Aim. Conduct disorder is characterized by repetitive and persistent presence of dissocial, aggressive and defiant behavioral patterns, thus represents important public issue with comprehensive and far-reaching consequences both for the individual and society. The aim of this study was to investigate the differences in sociodemographic family characteristics and the prominence of parental acceptance/rejection dimensions in groups of adolescents with and without conduct disorder, as well as to examine the connection between parental acceptance/rejection dimensions and externalizing symptoms in the group of adolescents with conduct disorder. Methods. This research was conducted on 134 adolescents, aged 15 to 18, using the Parental Acceptance/Rejection Questionnaire (PARQ child), Youth Self-Report (YSR), and a questionnaire constructed for the purpose of this survey. Results. The results showed that the number of adolescents with conduct disorder coming from divorced families was significantly higher than from complete families (44.8% vs 13.4%, respectively; p < 0.001). Also, in this group of adolescents there was a statistically significantly higher number of parents suffering from psychiatric disorders compared to the controls (31.3% vs 8.9%; respectively; p = 0.001). The perceived rejection dimension and the total index of maternal acceptance/ rejection were significantly higher in adolescents with conduct disorder than in those with no such disorder (132.30 ± 38.05 vs 93.91 ± 26.29 respectively; p < 0.001). Similar results were found for paternal acceptance/rejection dimension (129.40 ± 39.58 vs 86.10 ± 15.95 respectively; p < 0.001). Adolescents with conduct disorder and severe perceived maternal and paternal rejection showed a significantly higher average score on the subscale of externalizing symptoms (14.55 ± 4.45 and 13,27 ± 5,05) compared to adolescents with conduct disorder and lower total index of parental acceptance/rejection (8.32 ± 5.05 and 8.28 ± 5.08). Conclusion. The results suggest that adolescents with conduct disorder perceive their parents as more rejecting and less warm and supportive compared to adolescents without conduct disorder. The perception of significant and severe parental rejection was associated with a significantly higher averaged score on the subscale of externalizing symptoms in the group of adolescents with conduct disorder compared to those with no such disorder. It was found that adolescents with conduct disorder most often come from large families, have divorced parents or parents with multiple psychiatric disorders.

Background/Aim. Traumatic stress refers to physical and emotional reactions caused by events which represent a life threat or a disturbance of physical and phychological integrity of a child, as well as their parents or gaerdians. Car accidents are the main cause of posttraumatic stress disorder (PTSD) in children. The aim of this study was to preview clinical efficiency of systemic family therapy (SFT) as therapy intervention in treatment of children with posttraumatic stress disorder (PTSD) traumatized in car accident under identical circumstances of exposure. We pointed out the importance of specific family factors (family cohesion and adaptability, emotional reaction of the parents) on PTSD clinical outcome. Methods. The sample of this clinical observational study included 7-sixth grade pupiles - 5 boys and 2 girls, aged 13. All of the pupils were involved in car accident with one death. Two groups were formed - one group included three children who were involved in 8 SFT sessions together with their families. The second group included 4 children who received an antidepressant sertraline in the period of three months. Results. Two months after the car accident, before the beginning of the therapy, all of the children were the members of rigidly enmeshed family systems, considering the high average cohesion scores and the low average adaptability scores on the FACES III. Three months after the received therapy, having evaluated the results of the therapeutic approaches, we established that the adaptability scores of the families included in the SFT were higher than the scores of the families of the children who received pharmacotherapy with one boy still meeting the criteria for PTSD. Conclusion. Systemic family therapy was efficient in the treatment of children with PTSD, traumatized in car accident. Therapy efficiency was higher when both parents and children were included in SFT than in the case when they were not included in the family therapy. The change in the functioning of the family systems was not accidental or simply time-dependant, but it depended on the therapy which was applied and the increased level of family adaptability as the main risk factor of retraumatization.

Background/Aim. Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) characterized by myelin destruction and axon loss. Among various clinical manifestations of MS cognitive disorders are frequent. Olfactory disorders are also noticed but they are rarely considered in clinical practice. The aim of the present study was to examine frequency of olfactory dysfunction in patients with MS and its relationship to clinical parameters. Methods. Our study comprised 61 consecutive patients with definite MS who were hospitalized at the Department for Multiple Sclerosis and Other Immune- Mediated Disorders of CNS, Institute of Neurology, Clinical Center of Serbia, Belgrade, and 45 gender-, age- and education-matched healthy voluntaries. The Pocket Smell Test (PST) was used for examination of olfactory function. Cognitive functions were analyzed using the tests from the Brief Battery of Neuropsychological Tests: Paced Auditory Serial Addition Test 3-minute Version (PASAT 3'), Word List Generation (WLG) and Symbol Digit Modalities Test (SDMT). Results. Olfactory dysfunction was found in 26 (43%) MS patients and 5 (11%) controls (p = 0.001). Statistically significant positive correlation was found only between PST score and WLG scores (r = 0.297, p = 0.030). In comparison with the previously published normative values, our subjects with MS had decrease in the mean indices of the PASAT 3' in 28%, SDMT in 51% and WLG in 90% of the subjects. Conclusion. Olfactory dysfunction is frequent in our population of patients with MS. This disturbance correlates with the impairment of cognitive functions in these patients.

Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV) is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA) was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab), according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.