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Headspace sampling is a fast, simple and economical way to prepare plant samples for analysis by gas chromatography. For the first time, the composition of the head space volatiles (HSV) of six Salvia species (S. verticillata, S. glutinosa, S. nemorosa, S. aethiopis, S. amplexicaulis and S. officinalis) in the flowering stage and two (S. glutinosa and S. sclarea) in the fruiting stage from Southeastern Serbia was analysed using the GC-FID-MS technique after headspace sampling. The chemical composition of the highly volatile compounds of the analysed species varies considerably. Monoterpene hydrocarbons represented the dominant class of volatile compounds in all the Salvia species, except for S. sclarea and S. aethiopis. The content of sesquiterpenes was the highest in S. aethiopis (96.9%) and S. glutinosa in the flowering phase (29.5%), while in all the other samples that percentage was below 10%. Oxygenated monoterpenes were the most abundant in S. sclarea, where the main component was oxygenated monoterpene linalyl acetate (97.7%). The main component of S. verticillata was ?-phellandrene, and its content varied depending on the plant location and sampling time. The main component of S. glutinosa in the flowering phase was limonene (16.6%), and in the fruiting phase sabinene (87.1%). Headspace analysis of the volatile components of S. aethiopis was carried out for the first time and the most abundant detected components were sesquiterpenes: (E)- caryophyllene (36.8%), ?-copaene (33.4%) and ?-elemene (7.3%). The analysis of the principal components was performed to interpret the grouping patterns, as well as to analyse the similarities and differences between the samples in terms of the composition of the volatile components. The samples were grouped into three clusters. The first cluster consisted of samples of S. verticillata (S1, S4 and S5) from different locations, the second comprised samples of S. glutinosa (S3), S. aethiopis (S8), S. amplexicaulis (S9) and S. officinalis (S10), while samples of S. nemorosa (S7) made up the third cluster. The HS-GC-FID-MS technique can be successfully used for the qualitative and quantitative analysis of volatile compounds of different Salvia species. The obtained results are important for evaluating the possibility of using different types of sage.

Background/Aim. Aging entails a wide range of cognitive processes that are not independent of one another. It leads to changes in physical-motor characteristics and sometimes to disability. The aim of this study was to examine the asso- ciation between multiple cognitive performances in elderly subjects and their physical-motor abilities. Method. The study included 98 elderly participants (60+) (16 males and 82 females). Cognitive abilities were assessed by the Mon- treal Cognitive Assessment (MoCA)/Serbian version, and physical measures were assessed by the Senior Fitness Test with its five subtests, supplemented by the Walking Speed Test. Results. Several MoCA items demonstrated relatively low variability, i.e., they proved to be too easy for most of the participants. The participants exhibited the lowest per- formance on the memory relating to other domains, fol- lowed by executive functions, visuospatial skills, attention, concentration, and working memory domains, with the highest performance on temporal and spatial orientation re- lating to other domains. Executive functions and language correlated most significantly with physical strength. Agility and dynamic balance, lower- and upper-body strength, and aerobic endurance correlated moderately and positively. Conclusion. This study underlines the positive correlation between physical fitness and cognitive level in the elderly and emphasizes the importance of physical fitness for cog- nitive functions, especially those of executive type in elderly subjects. Clinicians should consider the association between cognitive function and physical-motor performances when dealing with functioning improvement in the elderly. The importance of designing the most efficient exercise pro- grams to achieve maximal somatic and cognitive effects is emphasized. Uvod/Cilj. Proces starenja podrazumeva promene na širo- kom spektru kognitivnih procesa koji nisu nezavisni jedni od drugih. On, takođe, dovodi do promena u fizičko-motoričkim karakteristikama, a ponekad i do invaliditeta. Cilj istraživanja bio je da se ispita povezanost između više kognitivnih per- formansi kod starijih ispitanika i njihovih fizičko-motoričkih sposobnosti. Metode. U istraživanju je učestvovalo ukupno 98 starijih ispitanika (60+) (16 muškog i 82 ženskog pola). Kognitivne sposobnosti procenjene su Montrealskom skalom kognicije (Montreal Cognitive Assessment – MoCA)/srpska verzi- ja, a mere fizičkih sposobnosti su procenjene Senior Fitness tes- tom koji se sastoji od pet subtestova, dopunjenih testom brzine hoda. Rezultati. Na nekoliko subtestova MoCA re- zultati su ukazali na relativno malu varijabilnost, tj. pokazalo se da su previše jednostavni za većinu ispitanika. Ispitanici su pokazali najslabije rezultate u funkcionisanju memorije u od- nosu na druge domene, a zatim slede izvršne funkcije, vizue- lno prostorne veštine, pažnja, koncentracija i radna memorija, sa najvišim performansama na vremenskoj i prostornoj ori- jentaciji u odnosu na druge domene. Izvršne funkcije i jezik su najznačajnije korelirali sa fizičkom snagom. Spretnost i dinamična ravnoteža, snaga donjih i gornjih ekstremiteta i aerobna izdržljivost su korelirali umereno i pozitivno. Zaključak. Studija ukazuje na pozitivne korelacije između fizičko-motoričkih sposobnosti i kognitivnog nivoa kod stari- jih osoba i naglašava značaj fizičke spremnosti za kognitivno funkcionisanje, a naročito u domenu izvršnih funkcija kod njih. Kliničari bi trebalo da imaju u vidu povezanost između kognitivnih funkcija i fizičko-motoričkih performansi, kada se bave poboljšanjem funkcionisanja starijih osoba. Ukazuje se na važnost dizajniranja najefikasnijih programa vežbanja za postizanje maksimalnih somatskih i kognitivnih efekata.

The amount of nineteen elements in eleven different lichen species, six fruticose (Bryoria capillaris, Bryoria fuscescens, Cladonia rangiformis, Ramalina capitata, Usnea chaetophora and Evernia prunastri) and five foliose (Hypogymnia tubulosa, Lobaria pulmonaria, Peltigera horizontalis, Umbilicaria cylindrica and Umbilicaria crustulosa) from five natural areas of the Balkan Peninsula (Serbia and Bulgaria) were determined by using inductively coupled plasma optical emission spectrometry (ICP-OES). Among macronutrients, the highest content was observed for Ca and K, while Mg and Na were represented in the smallest amount. Fe, Mn, Zn and Ba were the most abundant trace elements in contrast to Cd and Co, whose concentration? w?re the lowest.

Background: Anemia is a presentation of an underlying disease or deficiency. As stated by the WHO, anemia is defined as hemoglobin (Hb) levels Summary: Nutritional deficiencies, medications, chronic inflammatory conditions, malignancy, renal dysfunction, and bone marrow and inherent disorders contribute to anemia development. Anemia is classified and diagnosed by the values of hematological parameters, underlying pathological mechanism, and patient history. The diagnostic approach of anemia in primary care settings is focused on history, physical examination, laboratory findings including complete blood cell count, reticulocyte count, and peripheral smear examination, fecal occult blood test, and ultrasound findings. Key Messages: Anemia is the most common hematological disorder that represents a major health burden worldwide. Hb levels alter with gender, ethnicity, and physiological status. Anemia is often multifactorial. The evaluation of a patient with anemia in primary care includes clinical history, physical examination, and laboratory findings with fecal occult blood test and abdominal ultrasound. The wide variations in general practice in European countries are based on different health care systems but also knowledge of GPs that reflect educational and research policy.

Background: Jaundice is a common clinical finding in clinical practice of hepatologists and general practitioners. It occurs when serum bilirubin levels exceed 3 mg/dL. Summary: In this review, we summarize the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and laboratory and imaging techniques. Clinical presentation of jaundice manifests through yellow skin and sclera coloration. Evaluation of every patient includes detailed medical history and examination. In the laboratory, evaluation of enzymes of hepatic inflammation as well as cholestatic enzymes with serum bilirubin must be included. Additional laboratory analysis and imaging modalities are needed in order to differentiate jaundice etiology. Moreover, imaging is available and needed in further evaluation, and treatment is dependent on the underlying cause. Key Messages: In this review, we will outline the pathophysiological mechanism of jaundice, clinical approach to the patient with jaundice, and diagnostic and treatment approach to these patients.

This study aimed at analyzing and comparing the elemental composition of different parts of cultivated Physalis alkekengi (ljoskavac): rhizome with roots, stem with leaves, fruit, and inflated calyx. The contents of twenty- -one macro- and micro-elements were determined by inductively coupled plasma optical emission spectrometry (ICP-OES). In addition, the patterns of the distributions of both macro- and micro-elements were subjected to AHC analysis which gave different grouping of samples in sub-clusters. Generally, potassium, calcium, iron, and aluminum were the most abundant elements, but with different distribution in examined parts. High contents of iron and aluminum were detected in a stem with leaves, followed with samples of rhizome with roots and calyx, while potassium dominates in samples of calyx and stem with leaves. Edible fruits did not contain potentially toxic metals in concentration higher than permissible limits, wherein the lowest contents of lead and aluminum were detected; cadmium was under limit of quantification. Arsenic, mercury, and thallium were below the method detection limit.

Background and Aim. Differentiating iron deficiency anemia (IDA) from anemia of chronic disease (ACD) in patients with inflammatory bowel disease (IBD) represents a clinical challenge. Hepcidin is a polypeptide synthetized in the liver, and iron levels or inflammation mostly regulate hepcidin production. Our aim was to determine serum hepcidin levels in patients with inflammatory bowel disease (IBD) as well to investigate whether hepcidin levels correlate with disease activity. Material and Methods. A case-control study was preformed among newly diagnosed IBD patients and same number age- and sex-matched healthy controls. All patients underwent a total ileocolonoscopy. Complete blood count was obtained in addition to inflammatory markers (CRP, erythrocyte sedimentation rate-ESR). Serum levels of hepcidin were determined with commercially available enzyme-linked immunosorbent assay (DRG Instruments Marburg, Germany). Serum iron, TIBC, and UIBC were assessed with an electrochemiluminesence immunoassay, and soluble transferrin receptor (sTfR) was assessed using an immunoturbidimetric method. Mayo score and CDAI, respectively, were calculated for each patient. Statistical analyses were performed using the SPSS software version 20.0 for Windows. Results. There was a high statistically significant difference between IBD patients and controls in levels of hepcidin ( P < 0.01 ). Namely, serum hepcidin levels were significantly higher in the control group. There was no statistically significant correlation of serum hepcidin with CRP, Mayo score, or CDAI, respectively ( P > 0.05 ). However, we have found a statistically significant negative correlation of sTfR and TIBC with hepcidin ( P < 0.01 ). Conclusion. Results of our study suggest that hepcidin is a reliable marker of IDA in patients with IBD, and it could be used in routine clinical practice when determining adequate therapy in these patients.

BACKGROUND Rectal cancer (RC) is one of the most common diagnosed cancers, and one of the major causes of cancer-related death nowadays. Majority of the current guidelines rely on TNM classification regarding therapy regiments, however recent studies suggest that additional histopathological findings could affect the disease course. AIM To determine whether perineural invasion alone or in combination with lymphovascular invasion have an effect on 5-years overall survival (OS) of RC patients. METHODS A prospective study included newly diagnosed stage I-III RC patients treated and followed at the Digestive Surgery Clinic, Clinical Center of Serbia, between the years of 2014–2016. All patients had their diagnosis histologically confirmed in accordance with both TMN and Dukes classification. In addition, the patient’s demographics, surgical details, postoperative pathological details, differentiation degree and their correlation with OS was investigated. RESULTS Of 245 included patients with stage I-III RC, lymphovascular invasion (LVI) was identified in 92 patients (38%), whereas perineural invasion (PNI) was present in 46 patients (19%). Using Kaplan-Meier analysis for overall survival rate, we have found that both LVI and PNI were associated with lower survival rates (P < 0.01). Moreover when Cox multiple regression model was used, LVI, PNI, older age, male gender were predictors of poor prognosis (HR = 5.49; 95%CI: 2.889-10.429; P < 0.05). CONCLUSION LVI and PNI were significant factors predicting worse prognosis in early and intermediate RC patients, hence more aggressive therapy should be reserved for these patients after curative resection.

The blood-brain barrier (BBB) is formed by continuous, closely connected endothelial cells, enveloped in the basal lamina, pericytes, and foot extensions of astrocytes. BBB has a vital role in brain metabolism and protects the brain parenchyma from harmful agents present in the systemic circulation. Damage to the BBB and an increase in its permeability have an important role in many neurodegenerative diseases. This paper aims to review the literature on the impact of the BBB damage on psychiatric illness, a largely neglected and under researched area. Links between BBB impairment and specific neuropsychiatric disorders are described including schizophrenia, affective disorders, dementias with behavioral disorders, and alcohol use disorder, with comparison to typical hereditary small vessel diseases affecting the BBB such as cerebral autosomal dominant arteriopathy with subcortical infarction and leukoencephalopathy (CADASIL) and mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS). The authors critically summarize possible pathogenic mechanisms linking BBB damage and these common disorders. Крвно-мождана баријера (КМБ) се састоји од континураних, тесно спојених ендотелних ћелија омотаних базалном ламином, перицитима и сто-паластим продужецима астроцита. КМБ има виталну функцију и можданом метаболизму и штити мождани паренхим од штетних фактора присутних у системској циркулацији. Показано је да оштећење КМБ и повећање њене пропустљи-вости има значајну улогу у многим неуродегене-ративним обољењима. Циљ овога рада је преглед литературе о значају оштећења КМБ код психијатријских обољења, до сада занемареној и недовољно истраженој облас-ти. Повезаност измедју поремећаја КМБ и неуро-психијатријских поремећаја је посебно анализи-рана за схизофренију, афективне поремећаје, де-менције са бихевиоралним изменама, поремећај употребе алкохола, са посебним освртом на на-следне болести малих крвних судова мозга са оштећењем КМБ као што су церебрална аутозо-мално доминантна артериопатија са супкортика-ним инфарктима и леукоенцефалопатијом (CADASIL) и митохондријска енцефаломиопатија са лактатном ацидозом и епизодама налик можда-ном удару (MELAS). Аутори критички сумирају могуће патогенетске механизме који повезују оштећења КМБ са овим честим обољењима.

Vitamin B1 (aneurin, thiamine) is a water-soluble vitamin necessary for the normal function of the nervous system, visual system and heart and is part of important enzymes in the body. Thiamine enables the normal use of glucose, other carbohydrates and proteins, and enables the supply of energy to the organism. The main sources of thiamine are exogenous and small amounts are synthesized by microorganisms of the human intestinal microbiome. Vitamin B1 cannot accumulate in the body, so signs of deficiency are quickly manifested. Hypovitaminosis B1 is seen in chronic ethyl abuse, persistent vomiting (as in some pregnant women) or after bariatric surgical procedures, but in a mild form it is present in the general population. Normal daily needs for vitamin B1 depend on calorie intake, and 0.4 mg should be ingested for every 1000 kcal. Vitamin B1 (aneurin, tiamin) rastvorljiv je u vodi, neopho- dan je za normalno funkcionisanje nervnog sistema, organa vida i srca i deo je važnih enzima u telu. Tiamin omogućava normalnu upotrebu glukoze, drugih ugljenih hidrata i pro- teina i snabdevanje organizma energijom. Glavni izvori tiamina su egzogeni i male količine sinte- tišu mikroorganizmi ljudskog crevnog mikrobioma. Vitamin B1 se ne može nakupljati u telu, pa se znakovi ne- dostatka brzo manifestuju. Hipovitaminoza B1 se opaža kod hronične zloupotrebe alkohola, upornog povraćanja (kao kod nekih trudnica) ili posle barijatrijskih hirur- ških procedura, ali u blagom obliku je prisutna i u opštoj populaciji. Normalne dnevne potrebe za vitaminom B1 zavise od unosa kalorija, pa na svakih 1000 kcal treba unetiti 0,4 mg ovog vitamina.

Introduction/Objective. Due to a very high mortality risk, acute-on-chronic liver failure (ACLF) patients require early identification and intensive treatment. Precise prediction is crucial for determining the urgency degree and therapy appropriateness, considering high mortality and multitude of clinical resources. The aim of our study was to determine the exact cut-off values of various prognostic scores in the prediction of morality of ACLF. Methods. This prospective study includes chronic liver disease (CLD) patients, admitted due to decompensation, that were subsequently diagnosed with ACLF at the Emergency unit. All patients were evaluated based on various prognostic scores, including Child?Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C, which were calculated on admission. Results. Alcoholic liver disease (ALD) was the most common underlying CLD cause (77.9%), followed by viral (8.6%), autoimmune (7.7%), and other causes (5.8%). A total of 37.5% of the patients died at the end of the first month of treatment. Average values of Child?Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C scores were significantly higher in patients who died compared to survivors (p < 0.05). CLIF C score showed the best performance with a cut-off value of 50.5, with a sensitivity of 94.9% and specificity of 40%. Conclusion. ACLF remains a condition with a high short-term mortality. Of all of the scores examined in our study, CLIF C proved to be the best scoring system for predicting short term and end of treatment mortality in patients with ACLF.

Summary: Background: Smartphone apps might enable interventions to increase physical activity, but few randomised trials testing this hypothesis have been done. The MyHeart Counts Cardiovascular Health Study is a longitudinal smartphone-based study with the aim of elucidating the determinants of cardiovascular health. We aimed to investigate the effect of four different physical activity coaching interventions on daily step count in a substudy of the MyHeart Counts Study. Methods: In this randomised, controlled crossover trial, we recruited adults (aged ≥18 years) in the USA with access to an iPhone smartphone (Apple, Cupertino, CA, USA; version 5S or newer) who had downloaded the MyHeart Counts app (version 2.0). After completion of a 1 week baseline period of interaction with the MyHeart Counts app, participants were randomly assigned to receive one of 24 permutations (four combinations of four 7 day interventions) in a crossover design using a random number generator built into the app. Interventions consisted of either daily prompts to complete 10 000 steps, hourly prompts to stand following 1 h of sitting, instructions to read the guidelines from the American Heart Association website, or e-coaching based upon the individual's personal activity patterns from the baseline week of data collection. Participants completed the trial in a free-living setting. Due to the nature of the interventions, participants could not be masked from the intervention. Investigators were not masked to intervention allocation. The primary outcome was change in mean daily step count from baseline for each of the four interventions, assessed in the modified intention-to-treat analysis set, which included all participants who had completed 7 days of baseline monitoring and at least 1 day of one of the four interventions. This trial is registered with ClinicalTrials.gov, NCT03090321. Findings: Between Dec 12, 2016, and June 6, 2018, 2783 participants consented to enrol in the coaching study, of whom 1075 completed 7 days of baseline monitoring and at least 1 day of one of the four interventions and thus were included in the modified intention-to-treat analysis set. 493 individuals completed the full set of assigned interventions. All four interventions significantly increased mean daily step count from baseline (mean daily step count 2914 [SE 74]): mean step count increased by 319 steps (75) for participants in the American Heart Association website prompt group (p

Background: According to recent epidemiological data, annual deaths due to liver disease have increased dramatically, while predictions show that trends will continue to rise in the upcoming years. Summary: Abnormal liver blood tests are one of the most common challenges encountered in the primary care setting. The prevalence of mildly elevated transaminase levels is around 10–20% in the general population. The most common causes for the rising burden of liver disease are nonalcoholic fatty liver disease (NAFLD), alcohol-related liver disease (ARLD), and viral hepatitis. With improvements in the management of viral hepatitis over the last decades, the causes for the rising burden of liver disease are shifting toward ARLD and NAFLD. It is well-known that liver disease usually progresses silently for years or decades until the complications of cirrhosis occur. The majority of patients will not require referral to a specialist but will need further assessment in primary care. They should be evaluated for the etiology of liver disease irrespective of the duration of abnormal liver blood tests or unmarked clinical presentation. The evaluation should include a history of alcohol use, a history of medicines or herbal supplements, testing for viral hepatitis, and assessment for NAFLD, especially in obese patients and patients with type 2 diabetes. Abdominal ultrasound should be performed. Key Messages: The general practitioner may contribute significantly by identifying and screening patients at risk for chronic liver disease, as well as prioritize individuals with symptoms or signs of advanced liver disease to the specialist clinic.

Background/Aim. The outcome of rectal cancer is dependant on the stage of the tumour. There are several classification systems used to describe the extent of the disease. The aim of this study was to compare the efficacy of transrectal ultrasonography (TRUS) in preoperative local staging of rectal cancer using endosonographic probes with different views (180? vs 360?), as well as an influence of experience of an endoscopist on the TRUS performance. Methods. TRUS was performed in 127 patients with rectal carcinoma by two endoscopists. Seventy-one patients were examined with a 180? endosonographic probe (group A) and 56 patients with a 360? rotating probe (group B). All findings were compared with a histopathology report. Results. TRUS had a diagnostic overall accuracy of 91.3% for the tumor (T) category (k = 0.866, SE (k) = 0.038, p < 0.0001) and 71.7% for the node (N) category (? = 0.374, SE (k) = 0.082, p < 0.0001). In the group A, TRUS had a diagnostic overall accuracy of 88.7% for the T category (? = 0.805, SE (k) = 0.063, p < 0.0001), and 70.4% for the N category (? = 0.376, SE (k) = 0.101, P < 0.0001). In the group B, TRUS had a diagnostic overall accuracy of 94.6% for the T category (? = 0.920, SE (k) = 0.044, p < 0.0001), and 73.2% for the N category (? = 0.379, SE (k) = 0.131, p = 0.004). Experience of the endoscopist had no significant influence on results of preoperative staging of rectal cancer by using TRUS. Conclusion. The accuracy rate of TRUS in the preoperative local staging of rectal cancer is high. Our results imply no significant difference in the overall accuracy rates when using endosonographic probes with different views (180? vs 360?). Also, there was no significant influence of endoscopist experience on results obtained.

Background: Cancer is the second leading cause of death worldwide next to cardiovascular diseases. Despite the advancement in screening, early diagnosis, and development in treatment technology in last several decades, cancer incidence overall, particularly that of gastrointestinal (GI) cancers, is far from being controlled, and is expected to increase worldwide. Summary: Although numerous preclinical and population-based clinical studies have already made important progress in restraining the overall cancer incidence and mortality, the full potential of preventive strategy is still far from being realized, and remains at an early stage. There are several major challenges regarding this issue, and one of the crucial challenges is to maintain the balance between risks and benefits. As a result of past investments, primary prevention nowadays include the integration of various activities such as lifestyle changes to reduce risk, screening to detect early lesions, vaccines and preventive therapies aimed to actively interrupt the carcinogenic pathway. Long-term aspirin use seems to have the largest potential effect on the general population on cancer incidence and mortality overall, especially GI cancers. Helicobacter pylori eradication reduces the risk for gastric cancer and is advocated regardless of the symptoms and stage of disease. Metformin and statins are promising in cancer prevention in patients with type 2 diabetes. Vitamin D supplementation is promising in the prevention of colorectal adenoma recurrence. Key Message: However, additional studies are warranted to establish the potential of various agents and to identify more specific and highly targeted new agents for chemoprevention in digestive oncology.

Background: The increasing incidence of duodenal neoplasm has underlined different methods of resection depending on the clinical presentation, endoscopic features and histopathology. In this comprehensive review, we systematically describe the current knowledge concerning the diagnosis and management of duodenal adenomas (DAs) and discuss data considering all possible therapeutic approaches. Summary: Among a variety of duodenal lesions, including neuroendocrine tumors and gastrointestinal stromal tumors, DAs present precancerous lesions of the duodenal papilla or non-ampullary region necessitating removal. DAs can occur sporadically (SDA) as rare lesions or relatively common in polyposis syndromes. The endoscopic resections of DA are associated with an increased degree of complexity due to distinctive anatomical properties of the duodenal wall, luminal diameter and the presence of ampulla with pancreatic and biliary drainage. The endoscopic techniques including cold snare polypectomy (CSP), endoscopic mucosal resection (EMR), and argon plasma coagulation ablation are suggested to be less invasive than surgical treatment, associated with shorter hospital stay and lower cost. According to the current clinical practice, surgery has been accepted as standard therapeutic approach in familial adenomatous polyposis patients with severe polyposis or DA not amenable to endoscopic resection. Key Messages: The strategy for endoscopic resection of DAs depends on the lesion size, morphology, location, and histopathology findings. Small adenomas are most frequently diagnosed and removed by standard CSP techniques, while large laterally spreading lesions and ampullary adenoma are referred for EMR or endoscopic papillectomy respectively. Screening colonoscopy is indicated in patients with SDA. Additional studies for new endoscopic strategies and techniques for curative therapy of DAs are needed to refine future management decisions. Complete resection of DA is considered curative, but nevertheless, long-term endoscopic follow-up is still required to detect and treat any recurrent arising lesions.

Background/Aim. In recent years, many studies have demonstrated a proximal shift in the distribution of adenomas and colorectal cancers. The aim of this study was to investigate whether there are differences in the incidence and anatomical distribution of adenomas and colorectal cancers spanning a 20 year time gap. Methods. We performed a retrospective observational study of colorectal adenomas and cancers diagnosed during total colonoscopy in a high volume tertiary care facility in two 1-year periods of time ? 1990 and 2010. Results. During the analyzed period, 4,048 colonoscopies were performed, 1,148 were performed in 1990 and 2,900 were done in 2010. The study included 466 patients with adenomas and 121 patients with colorectal cancers. Frequency of proximal adenoma changed from 16.5% to 32.7% (p < 0.001). By analyzing colonoscopies in 2010, an increase in the incidence of adenomas compared to 1990 was noticed. The number of adenomas sized 0?5 mm rose from 32.8% to 56.9% (p < 0.001). Frequency of colon carcinoma changed from 5.3% to 2.0% (p < 0.001). Incidence of cancers in the proximal colon rose from 21.3% to 48.4% (p = 0.002). A higher incidence of cancers in the proximal colon and a lower incidence of distal cancers were observed, while no difference was observed in the incidence of rectal cancers. Conclusion. Presence of proximal colon adenoma and cancer is higher, while the overall incidence of colon cancer is lower. This finding should be taken into account when planning the screening for colorectal cancer.

Background and Objectives. Determination of inflammatory bowel disease activity determines further therapeutic approach and follow-up. The aim of our study was to investigate correlation between patients’ reported symptoms and endoscopic and histological disease activity. Methods. A cross-sectional study was conducted in consecutive newly diagnosed patients with inflammatory bowel disease in a tertiary care referral center. The initial evaluation included patient-reported outcome for stool frequency subscore and rectal bleeding. Endoscopic activity was determined using the Mayo scoring system for ulcerative colitis and the Simple Endoscopic Score for Crohn’s disease. Histopathological activity was assessed using a validated numeric scoring system. Results. We included 159 patients (63 Crohn’s disease with colonic involvement and 96 with ulcerative colitis). We found significant correlation between the Mayo endoscopic subscoring system and histology activity in ulcerative colitis, while no correlation was found in patients with Crohn’s disease. Patient-reported outcome showed inverse correlation with endoscopic and histological activity in Crohn’s disease (rs=−0.67; rs=−0.72), while positive correlation was found in ulcerative colitis (rs=0.84; rs=0.75). Interpretation and Conclusions. Patient-reported outcome is a practical and noninvasive tool for assessment of disease activity in ulcerative colitis patients but not in Crohn’s disease.

Heart failure is a leading cause of mortality, yet our understanding of the genetic interactions underlying this disease remains incomplete. Here, we harvest 1352 healthy and failing human hearts directly from transplant center operating rooms, and obtain genome-wide genotyping and gene expression measurements for a subset of 313. We build failing and non-failing cardiac regulatory gene networks, revealing important regulators and cardiac expression quantitative trait loci (eQTLs). PPP1R3A emerges as a regulator whose network connectivity changes significantly between health and disease. RNA sequencing after PPP1R3A knockdown validates network-based predictions, and highlights metabolic pathway regulation associated with increased cardiomyocyte size and perturbed respiratory metabolism. Mice lacking PPP1R3A are protected against pressure-overload heart failure. We present a global gene interaction map of the human heart failure transition, identify previously unreported cardiac eQTLs, and demonstrate the discovery potential of disease-specific networks through the description of PPP1R3A as a central regulator in heart failure., The genetic and pathogenetic basis of heart failure is incompletely understood. Here, the authors present a high-fidelity tissue collection from rapidly preserved failing and non-failing control hearts which are used for eQTL mapping and network analysis, resulting in the prioritization of PPP1R3A as a heart failure gene.

Studies have established the importance of physical activity and fitness for long-term cardiovascular health, yet limited data exist on the association between objective, real-world large-scale physical activity patterns, fitness, sleep, and cardiovascular health primarily due to difficulties in collecting such datasets. We present data from the MyHeart Counts Cardiovascular Health Study, wherein participants contributed data via an iPhone application built using Apple’s ResearchKit framework and consented to make this data available freely for further research applications. In this smartphone-based study of cardiovascular health, participants recorded daily physical activity, completed health questionnaires, and performed a 6-minute walk fitness test. Data from English-speaking participants aged 18 years or older with a US-registered iPhone who agreed to share their data broadly and who enrolled between the study’s launch and the time of the data freeze for this data release (March 10 2015–October 28 2015) are now available for further research. It is anticipated that releasing this large-scale collection of real-world physical activity, fitness, sleep, and cardiovascular health data will enable the research community to work collaboratively towards improving our understanding of the relationship between cardiovascular indicators, lifestyle, and overall health, as well as inform mobile health research best practices., Design Type(s)observation design · source-based data analysis objective · data collection and processing objectiveMeasurement Type(s)physical activity · sleepTechnology Type(s)crowd-sourced data generationFactor Type(s)sex · height · weight · age · smoking status measurement · employment statusSample Characteristic(s)Homo sapiens · United States of America Machine-accessible metadata file describing the reported data (ISA-Tab format)

Introduction. Cerebral small vessel disease is a neurological con- dition characterized by motor, cognitive and affective disorders, often found on brain magnetic resonance imaging scans in patients with vascular risk factors. Affective disorders may have a major impact on patients’ quality of life, although they are often ignored as an entity in cerebrovascular pathology. Material and Methods. This prospective study included 80 patients with the diagnosis of cerebral small vessel disease admitted at the Clinic of Neurology, Clinical Center of Serbia in the period from January 1, 2017 to January 1, 2019. Baseline demographic data and brain magnetic resonance findings were obtained along with the results of cogni- tive function and affective status tests. Data were analyzed using standard statistical tests. Results. Standard screening tests revealed that 51.25% and 33.75% of our patients with cerebral small vessel disease suffer from apathy and depression, respectively. A sig- nificant correlation was found between the severity of white mat- ter changes on magnetic resonance scans and apathy (p = 0.0092). Additionally, white matter changes were also significantly associ- ated with depression (p = 0.021). Conclusion. Affective disorders are not uncommon in cerebral small vessel disease and apathy was the leading phenomenon among our patients. Since a strong cor- relation was detected between affective disorders and severity of vascular changes on magnetic resonance scans, we may conclude that both apathy and depression are key features of an underlying brain injury, rather than just comorbidity. Uvod. Bolest malih krvnih sudova mozga je neurološko stanje za koje su karakteristični motorni, kognitivni i afektivni poremećaji i koje se često dijagnostikuje na snimcima mozga magnetnom rezo- nancijom kod pacijenata sa vaskularnim faktorima rizika. Promene u afektivnom statusu imaju veliki uticaj na kvalitet života pacijena- ta iako su neretko bile zanemaren fenomen u cerebrovaskularnoj patologiji. Materijal i metode. U prospektivnoj studiji obuhvaćeno je 80 pacijenata sa dijagnozom bolest malih krvnih sudova mozga lečenih i ispitivanih na Klinici za neurologiju Kliničkog centra Sr- bije, u periodu od 1. januara 2017. godine do 1. januara 2019. godine. Analizirani su osnovni demografski podaci, nalaz na magnetnoj rezonanciji mozga i rezultati testova kognitivnih funkcija i afektiv- nog statusa, upotrebom standardnih statističkih metoda. Rezultati. Rezultati testova za apatiju i depresiju ukazali su da je 51,25% bo- lesnika sa ovom bolešću pokazivalo prisustvo apatije, a 33,75% prisustvo depresivnog poremećaja. Dokazana je statistički značajna povezanost između težine lezija bele mase mozga na magnetnore- zonantnim snimcima mozga i apatije (p = 0,0092), odnosno težine lezija bele mase i depresije (p = 0,021). Zaključak. Izmene afektiv- nog statusa nisu retka manifestacija cerebralne bolesti malih krvnih sudova mozga, a najčešći fenomen u našoj grupi bolesnika bila je apatija. Budući da je detektovana značajna povezanost između afek- tivnih poremaćaja i težine vaskularnih lezija na magnetno-rezonan- tnim snimcima mozga, smatramo da su apatija i depresivnost najpre deo kliničke slike ove bolesti a ne jedan od komorbiditeta.

Background. Systemic inflammation in colorectal cancer (CRC) may be reflected by neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV). This study was designed to investigate the efficiency of preoperative NLR, PLR, and MVP as a tool for the assessment of tumor characteristics in newly diagnosed patients with CRC. Patients and Methods. For 300 patients and 300 healthy volunteers, complete blood counts with automated differential counts were performed. The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count; PLR was calculated by dividing the absolute platelet count by the absolute lymphocyte count. The diagnostic performance of NLR, PLR, and MVP was estimated by ROC curve. Results. ROC curve analysis showed high diagnostic efficacy of NLR and PLR in CRC patients with cut-off values of 2.15 (AUC=0.790, 95% CI 0.736-0.884, Se=74.1%, and Sp=73%) and 123 (AUC=0.846, 95% CI 0.801-0.891, Se=73.5%, and Sp=80%) compared to healthy controls, respectively. The diagnostic efficacy of three combined markers was superior compared with individual markers (AUC=0.904, 95% CI 0.812-0.989, Se=96%, and Sp=70%). Conclusion. NRL, PLR, and MPV may be useful markers in diagnostic and early recognition of different stages of CRC; additionally combined all together have stronger diagnostic efficacy.

Background: Smartphone applications may enable interventions to increase physical activity but this has limited evidence in randomized trials. Objectives: The MyHeart Counts Cardiovascular Health study (MHC) is a smartphone-based longitudinal research study aimed at elucidating the determinants of cardiovascular health. Among MHC participants, we performed a randomized controlled trial to investigate the response to four different physical activity coaching interventions on the primary outcome of change in daily step count. Secondary outcomes included life satisfaction, 6-minute walk distance, and sleep quality. Methods: The trial was completed entirely using personal smartphones: participants were digitally consented, the interventions were delivered via the device, and measurements of the primary and secondary outcomes were collected from smartphone sensors. Participants were enrolled from December 12, 2016 to June 6, 2018 and followed for up to 5 weeks. Participants completed the trial through the MyHeart Counts phone app in a free-living setting. All adults over 18 years of age with access to a smartphone (Apple iPhone, version 5S or later) were eligible to participate. After one week of baseline measurements, participants (n=2783) were randomized to a sequence of four, week-long interventions delivered in random order. Interventions consisted of either daily prompts to complete 10,000 steps (completed by n=853); hourly prompts to stand following a full hour of sitting (completed by n=879); instructions to read the guidelines from the American Heart Association website (completed by n=868); and e-coaching based upon the individual's personal activity patterns from the baseline week of data collection (completed by n=896). Results: 2783 participants consented to enroll in the coaching study, of whom 1075 completed the baseline week of data collection and at least one of the four interventions. 493 individuals completed the full set of assigned interventions. All four interventions were found effective at modestly increasing daily step count by a mean of 266 ±75 steps from a baseline mean of 2958±69 steps (p=0.003). Intervention-specific step increases were: 319±74 steps (p

Uvod: Bolest malih krvnih sudova (BMKS) mozga je čest nalaz kod pacijenata sa klasičnim vaskularnim faktorima rizika i povezana je sa motornim, kognitivnim i afektivnim poremećajima. Neuroradiološki, BMKS mozga se manifestuje lakunarnim infarktima i/ ili hiperintenzitetima bele mase (HBM), a moguća je i pojava mikrokrvarenja. Pored retkih naslednih oblika BMKS mozga, pacijenti sa glavoboljom, posebno migrenskog tipa, nalaze se u povećanom riziku za nastanak ovih lezija, mada je povezanost kompleksna i nedovoljno razjašnjena. Cilj: Cilj rada je identifikacija učestalosti i tipa glavobolja kod pacijenata sa sporadičnom BMKS mozga. Materijal i metode: Retrospektivnom studijom obuhvaćeno je 115 pacijenata sa dijagnozom BMKS mozga, lečenih i ispitivanih hospitalno na Odeljenju za cerebrovaskularne bolesti i rezistentne glavobolje Klinike za neurologiju Kliničkog centra Srbije, u periodu od 1. januara 2015. godine do 31. decembra 2017. godine. Analizirani su osnovni demografski podaci, tip glavobolje i nalaz na nuklearnoj magnetnoj rezonanci (NMR) mozga (prisustvo lakunarnih ishemija, HBM i ukupna težina lezija) standardnim statističkim testovima. Rezultati: Od ukupnog broja pacijenata uključenih u studiju, 44% je patilo od glavobolje. Lakunarni infarkti su uočeni kod 86,1% pacijenata, a HBM kod 46,1% pacijenta. Povezanost glavobolje i prisustva lakunarnih ishemija je bila na nivou statističkog trenda (p = 0,072), dok su pacijenti bez glavobolje imali tendenciju češće pojave HBM u odnosu na one sa glavoboljom (p = 0,065). Zaključak: Veliki broj pacijenata sa sporadičnom, arterioloskleroznom BMKS mozga se ujedno žali na glavobolju. Na NMR snimcima mozga prisustvo lakunarnih infarkta je vezano sa glavobolju kao simptom, a postojanje HBM je češće kod pacijenata bez glavobolje u anamnezi. Introduction: Cerebral small vessel disease (CSVD), a common finding in patients with vascular risk factors, is associated with motor, cognitive and affective disorders. Magnetic resonance imaging (MRI) brain scans of patients with CSVD include lacunar infarcts and/or white matter hyperintensities (WMH) and microhemorrhages. Aside from rare familiar forms of CSVD, patients with headaches, especially migraineurs, have an increased risk to develop these lesions, although this relationship is rather complex and yet to be fully elucidated. Aim: The aim of the study was to determine the frequency and type of headache in patients with CSVD. Material and methods: This retrospective study included 115 patients with CSVD diagnosis admitted at the Clinic of Neurology, Clinical Center of Serbia in the period January 1st, 2015 - December 31st, 2017. Baseline demographic data, headache type and MRI findings (ischemic lacunar infarctions, WMH, and overall lesion severity) were obtained. Data were compared between CSVD patients with headache and headache-free CSVD cases, with the use of standard statistical methods. Results: Among all patients included in this study, 44% had headaches. Lacunar infarcts were present in 86,1% and WMH in 46,1% cases. Correlation between headache symptoms and lacunar infarcts showed a trend towards statistical significance (p = 0.072) whereas headache-free patients more frequently had WMH, also approaching statistical significance (p = 0.065). Conclusion: A large number of arteriolosclerotic CSVD patients complain of different types of headaches. Based on MRI findings, lacunar infarcts are related to headache symptoms, and WMHs are more frequently present in patients with a negative history of headache.

There are a lot of different segmentation methods used to locate objects or particular scene parts. One of the most interesting scene parts can be horizon or skyline. The proper skyline image segmentation includes proper division into three clusters: sky, skyline region and the rest of the image. This paper analyzes the influence of color for the skyline-based segmentation.