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The term “aristolochic acid nephropathy” (AAN) is used to include any form of toxic interstitial nephropathy that is caused either by ingestion of plants containing aristolochic acids (AA) or by the environmental contaminants in food such as in Balkan endemic nephropathy (BEN). Aristolochic acid (AA) intoxication is strongly associated with the development of upper tract urothelial carcinoma (UTUC); however, the underlying molecular mechanism remains to be defined. MicroRNAs (miRNA) regulate several biological processes, including cell proliferation, differentiation, and metabolism, acting as oncogenes or tumor suppressors. A unique miRNA expression profile suggested that miRNAs could function as regulators in UTUC developmental processes.

Introduction/Objective. Active treatment options for localized prostate cancer (LPCa) include surgery and radiotherapy with androgen deprivation therapy (ADT) in selected cases, but all options have side effects, mainly addressed to urinary, sexual, and bowel function. Our study aimed to assess and compare patient-reported outcome measures (PROMs) after open retropubic radical prostatectomy (ORRP) or external beam radiotherapy (EBRT). Methods. Between June 2019 and May 2021, a total of 120 patients, with LPCa had undergone active treatment, as follow: ORRP – 60 patients and EBRT – 60 patients. A validated questionnaire, the Expanded Prostate Cancer Index Composite Short Form (EPIC-26) instrument was used to assess PROM, through the following domains: urinary, sexual and bowel. Patients completed a questionnaire at baseline and six, 12, and 24 months after primary treatment. Results. All urinary scores had statistically significant interaction between time and group. After six, 12, and 24 months, all urinary scores were statistically significantly lower in the ORRP group. After 12 and 24 months, bowel score values were statistically significantly lower in patients in the ERBT group. Sexual scores change statistically significant during the follow-up period, without difference between the groups (p < 0.05). Conclusion. Both ORRP and EBRT are associated with decline of sexual scores. ORRP showed significant variations in all urinary scores, with more pronounced negative impact on urinary symptoms compared to EBRT during the entire follow-up period. Bowel scores are lower in EBRT.

The mining industry has faced intense challenges and disruptions from global trends. The mining industry needs to perform a transformation to survive. The important thing for mining companies in technological adoption is digital transformation. XYZ is a holding company with many subsidiaries with primary businesses in the coal mining sector spread throughout Indonesia. As part of digital transformation, one of the company's initiatives is to centralize IT resources into one organization, with the objective can share its utilization with all subsidiaries. IT's centralization and shared services caused problems, such as human resources in different company ownership, budget allocation among companies, and the structure of financing and utilization of IT resources for use. The problem was solved by mapping all the components' IT roles at the company based on the framework created by Applegate, Austin, and Soule. Mapping the role of IT in this company can be used as a guideline to make organizational change. Organizational changes that need to be done base on analysis is to change the structure of the organization of IT into a bimodal model, its combination between the Functional-Lean model and Matrix-Agile model. The Functional-Lean model provides organizations as a function to keep lean but can deliver high standard services and keep it stable. The Matrix-Agile model can provide agility for the organization to develop new and run projects. IT Governance at XYZ will use the Federal model.

The Great Financial Crisis of 2008 exposed certain weaknesses in the field of investment banking and the necessity to adapt certain innovative solutions to the newly created economic and financial environment. The process of securitization is a financial innovation, which some financial analysts consider one of the causes of the Great Financial Crisis. Although it is often linked to the emergence of the Great Financial Crisis, the advantages of the securitization model, together with a level of adaptability and enhanced process control throughout all procedural levels, significantly outweigh its perceived shortcomings.

Introduction/Objective. This 10-year prospective study’s primary objective was to evaluate the incidence of complications of radical retropubic prostatectomy (RRP). The secondary objective was to analyze how RRP affects lower urinary tract symptoms (LUTS) and quality of life (QoL) by using the International Prostate Symptom Score (IPSS). Methods. We analyzed 254 patients who underwent RRP in the period 2009–2018. All complications were graded according to the Clavien–Dindo classification. To assess urinary symptoms and the QoL, all the examinees filled out the IPSS and the International Prostate Symptom Score for QoL (IPSS QoL) questionnaires during preoperative preparation and three, six, and 12 months after surgery. Results. The incidence of complications Clavien–Dindo grade ≤ II and grade ≥ III were 26.4% and 16.5%, respectively. The mean overall IPSS for the entire group of patients after 12 months of follow-up was significantly different from the preoperative baseline value (p < 0.001). Patients with preoperative moderate (IPSS 8–19) and severe urinary symptoms (IPSS 20+) had a statistically significant reduction of urinary symptoms after RRP (p < 0.001). After 12 months, IPSS QoL was statistically significantly lower than the preoperative one (p < 0.05). Conclusion. For patients with clinically localized prostate cancer, RRP is a safe and effective treatment option. It is associated with a higher rate of complications from the Clavien–Dindo grade ≤ II group. RRP has clinically beneficial effects on LUTS in patients with moderate and severe urinary symptoms and the QoL related to LUTS.

Introduction. Simultaneous ipsilateral coexistence of renal cell carcinoma (RCC) and upper urinary tract urothelial carcinoma (UTUC) rarely occurs. Balkan endemic nephropathy (BEN) is a chronic degenerative tubulointerstitial renal disease, strongly associated with UTUC. Case outline. А 60-year-old man from the region of BEN was referred to our clinic due to right flank pain, fever, and purulent discharge from the cutaneous fistulous opening in the right lumbar area. Multislice computed tomography urography scan showed right-side pyonephrosis and nephrocutaneous fistulous tract between the kidney and the skin in the right lumbar region. Cystoscopy detected a papillary tumor protruding from the right ureteric orifice. Right-side nephroureterectomy with bladder cuff excision was performed. Histopathological examination revealed rhabdoid RCC of the kidney and multifocal urothelial carcinoma of the ureter. Conclusion. Our case report and literature review indicate that due to rising incidence of multiple primary malignant neoplasms (MPMNs), when treating patients with RCC or UTUC, and especially those from the region of BEN, one should keep in mind the likelihood of synchronous or metachronous occurrence of these tumors.

David Basic,1 Elizabeth Huynh,2 Rinaldo Gonzales,1 Chris Shanley3 1Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia; 2Department of Geriatric Medicine, Aged Care Research Unit, Liverpool Hospital, University of NSW, Liverpool BC, NSW 1871, Australia; 3Department of Geriatric Medicine, Centre for Applied Nursing Research, Western Sydney University and Ingham Institute of Applied Medical Research, Aged Care Research Unit, Liverpool Hospital, Liverpool BC, NSW 1871, Australia Purpose: Ineffective interdisciplinary communication is linked to many adverse consequences of hospitalization. This study evaluated the effect of SIBR, a model of care that encourages interdisciplinary communication and patient and family participations, on in-hospital deaths and new nursing home (NH) placements.Materials and methods: This before-after study included 3,673 consecutive inpatients of mean age 83.8 years, of whom 93.2% were admitted through the emergency department. After each twice-weekly SIBR session, an interdisciplinary care plan was implemented and recorded on a datasheet attached to the bedside record. Staff unable to participate in SIBR were asked to view the datasheet and to follow the care plan. Logistic regression models were computed for in-hospital deaths and new NH placements.Results: Although SIBR implementation had no effect on in-hospital deaths (OR, 1.00; 95% CI, 0.77–1.29), SIBR increased NH placements among those who survived the hospitalization (n=3,346) in both unadjusted (14.6% vs 9.1%; P

David Basic,1 Tabitha J Hartwell2 1Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia; 2Department of Geriatric Medicine and Rehabilitation, Shoalhaven District Memorial Hospital, Nowra, NSW, Australia Purpose: To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness.Materials and methods: This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls. Demographic, medical, and frailty measures were considered in adjusted models.Results: The mean age of all patients was 82.8±7.6 years and 94% were admitted through the emergency department. During a median length of stay (LOS) of 11 days, 257 (8.7%) patients had a fall. Of these, 66 (25.7%) sustained an injury and 53 (20.6%) had two or more falls. Compared with nonfallers, fallers were more likely to be placed in a nursing home (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.37–3.00), after adjustment for age, sex, frailty, and selected medical variables (including dementia and delirium). Patients without injury (OR: 1.83, 95% CI: 1.17–2.85) and those with injury (OR: 2.35, 95% CI: 1.15–4.77) were also more likely to be placed. Patients who fell had a longer LOS (median 19 days vs 10 days; P

Background/Aim. Retroperitoneal fibrosis (RPF) represents a chronic pathological process characterized by fibrosis which entraps and compresses the ureters and the great blood vessels in the retroperitoneal space. A specific form of RPF is idiopathic RPF, an uncommon collagen vascular disease of unclear etiology. The series of 15 patients which underwent open surgical repair due to idiopathic RPF is presented herein. Methods. From 1989 to 2012, 11 male and 4 female patients underwent surgery due to primary RPF. The ureters were entrapped unilaterally (7 patients), or bilaterally (8 patients). Major symptoms included low back pain due to hydronephrosis (9 patients), uremia (4 patients), and urinary tract infection (2 patients). The diagnosis was based on intravenous urography (IVU), retrograde ureteropyelography and computed tomography (CT). Results. Surgical procedures included intraperitoneal ureteral displacement (8 patients) and ureteral wrapping with omental flap (6 patients). One patient underwent bilateral ureteral stenotic segments resection and oblique ureterography, followed by wrapping with omental flap. Pathological examination confirmed primary RPF in all patients. The mean operative time was 3.5 h (range 2.5-4.5 h). The average intrahospital stay was 21 days (range 16-26 days). The mean follow up was 32 months (6-46 months). During the follow up, 12 patients had improvement on IVU. Conclusion. Early recognition of signs and symptoms of RPF is of the utmost importance for the outcome. Surgical procedures, including ureteral wrapping with omental flap, or intraperitoneal ureteral displacement, usually represent definitive treatment.

Introduction. Iatrogenic ureteral injuries can occur during various abdominopelvic and retroperitoneal surgical procedures including gynecological, urological, colorectal and vascular. Objective. The aim of our study was to examine the incidence and types of iatrogenic ureteral injuries occurred over the period of 16 years, as well as to evaluate the values of applied diagnostic and therapeutic procedures. Methods. A retrospective analysis of clinical data (medical records and operative reports) of 55 patients (11 male and 44 female; mean age 54.5 years) with verified iatrogenic ureteral injury from 1998 to 2014, was performed. Results. Iatrogenic ureteral injuries occurred during gynecological procedures in 55%, urological in 25%, colorectal in 15% and vascular in 5% of cases. Mechanisms of injury were incomplete transection (n=23), complete transection (n=1), ligation (n=7), partial perforation (mucosal abrasion) (n=13) and total perforation (n=1). The most frequent diagnostic procedures for postoperative identification of ureteral injuries were abdominal ultrasonography, excretory urography, antegrade pyeloureterography and retrograde ureteropyelography. Early therapeutic procedures were applied in 35 (64%), while delayed in 20 cases (36%). Early (30 days) postoperative complications were verified in 14 cases (25%). Conclusion. Among different surgeries that may lead to the development of iatrogenic ureteral injury, gynecological procedures represent the most common cause. Rapid diagnosis enables immediate ureteral repair and is associated with low morbidity rates, representing a major factor contributing to the treatment success and ultimately preserving the renal function.

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Paper entitled "Financing and importance of small business to encourage economic activity," deals with the problem which is an adequate model of financing activities of small businesses and what their importance in encouraging commercial activities. It is focused on models of financing small businesses in developed market economies. The main objective of this work is to define models, characteristics and trends in the financing of small business and defines an adequate selection of the structure of financing of small and medium-sized enterprises based on determinants such as economic policy, regulations, traditions, and the development of small business, subsidies and the level of motivation of small entrepreneurs. The study is based on proving the hypothesis that financing and encouraging the development of small business implies the development economic activity and increasing employment. It has made use of scientific research methods, such as analysis method and descriptive method to explain forms of small business financing in international practice and domestic environment, and inductive and deductive methods to make right conclusions from the research results. To extract trivial and highlight the important elements in the work used are methods of abstraction and concretization, and methods of specification and generalization.

Introduction. Uretero-intestinal anastomisis has a large influence on derivation quality. Objective. The aim of the study was to present the modified serous lined extramural Abol-Enein method of implantation of low quality ureter into the sigma-rectum pouch and comparison of the results with Le Duc implantation. Methods. From 1995 to 2009, 62 dilated ureter units were implanted in the detubularized rectosigmoid urinary reservoir. In 28 units Le Duc, and in 34 Abol-Enein method was done. Urinary fistula and ileus were considered as early complications, while late complications included stenosis and reflux pyelonephritis. Frequency of urination was considered as a parameter of functionality. Results. Transitory urine fistulae occurred only in the ureters implanted according to Le Duc technique in 4/28 (14.2%); the difference between the examined groups was close but still below the level of statistical significance (p=0.07). Ileus occurred with nearly equal frequency in both groups. Stenosis on the ureteral implantation place was significantly more frequent (p=0.04) in the Le Duc group 5/28 (21.7%) than in the Abol-Enein group 0/34 (0%). Refluxive pyelonephritis occurred in 3/34 (8.8%) of the Abol-Enein group, and in 5/28 (21.7%) of patients in the Le Duc group. Concerning the daily frequency, there was no difference between the examined groups. Conclusion. Uretero-intestinal anastomisis of dilated ureters through a serous-lined extramural tunnel decreases the risk of reflux in a considerable number of patients, with an acceptable level of complications. There are several advantages in comparison with Le Duc method.

Background/Aim. Nipple discharge syndrome is a clinical entity capable of presenting various disorders such is mammary infection (nonpuerperal and puerperal mastitis), intraductal papillomas, fibrodenoma, breast cancer and hyperprolactinemia syndrome. The aim of the study was to determine differencies in cytological features of mammary secretion in patients with hyperprolactinemia and those with normal serum prolactin levels and to define the role of growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone in creating cellular profile of breast secretion. Methods. The study included 50 patients with nipple discharge syndrome. The patients were devided into the clinical group (27 patients with hyperprolactinemia and nipple discharge) and the control group I (23 patients with normal serum prolactin and nipple discharge). The control group II included the patients of the clinical group achiving normalised serum prolactin levels after the treatment of hyperprolactinemia. Serum prolactin, follicle-stimulating hormone and luteinizing hormone levels were assessed by RIA using commercial kits IRMA hPRL, hLH and hFSH, (INEP, Zemun, Serbia) while serum growth hormone and thyroid-stimulating hormone levels were assessed by RIA using commercial kits LKB-wallac. Cytologic evaluation of samples, taken from all the patients with mammary secretion, was done using standard techniques of staining Haemathoxilin-eozine and May- Grünwald/Giemsa. Results. Our results showed a significantly higher presence of lipid and protein material in clinical group, in comparison with the control group I (p < 0.01). Also, our data demonstrated significantly higher number of ductal epithelial cells (p < 0.05) and ductal histiocities (p < 0.001) in the clinical group, compared with the control group I. Macrophagies frequency was proportionally higher in clinical group (44.44%) compared the control group I (17.39%). Erythrocites were significantly lower in the clinical group (p < 0.001) than in the control group I. Significantly decreased mammary secretion (p < 0.01), lower lipid (p < 0.01) and protein synthesis (p < 0.01), and less presence of all cellular categories (p < 0.01) were obtained after normalization of serum prolactin levels. Conclusion. Growth hormone, follicle-stimulating hormone, luteinizing hormone and thyroid-stimulating hormone did not show significant influence on creating cytological features of mammary secretion. The most expressive role, hyperprolactinemia demonstrated in the domain of mammary ductal secretory activity, making mammary secretion reach in lipid and protein material and simultaneously increasing number of ductal epithelial cells, ductal histiocytes and 'foam cells'- macrophages. These cytological findings indicate that hyperprolactinemia promote periductal and intraductal steril inflammation which withdraws after serum prolactin normalization.

This paper gives a critical analysis of the equation that predicts and estimates the progress of degradation for various building materials, recently proposed by Matsufuji et al.1 After the analysis, the paper suggests an improved mathematical model, particularly for the modeling of sulfate corrosion. Experiments were performed with two samples of Portland cement and two samples of Portland cement with 30 % coal ash. The samples were immersed into a 10 % (NH4)2SO4 solution and the concentration of SO 2-4 in the solution and the material was measured. As a parameter that quantifies cement degradation, the quantity of bonded SO 2-4 was suggested. According to the obtained data, mathematical models for the description of sulfate corrosion were defined for all the examined samples. The models were applied for the analysis of the behavior of ash and non-ash containing samples. They allowed a better explanation of degradation which occurred during the investigated time period and even further they showed that ash systems were significantly more resistant to sulfate corrosion.

Background: The study was conducted to determine whether prolactin (PRL) influences radiological features of benign breast lesions. Methods: During the 4-year period, we observed 50 patients with nipple discharge: 23 with normal serum prolactin levels (group 1) and 27 with hyperprolactinemia (group 2a before hyperprolactinemia treatment and group 2b after hyperprolactinemia treatment). Patients observed during this study underwent breast ultrasonography (US) and mammography. Radiological findings in group 1, group 2a and group 2b were compared. Results: The most frequent radiological findings in group 2a were dilated lactiferous ducts and cystic lesions with statistical significances p

INTRODUCTION Despite high graft and recipient survival figures worldwide today, a variety of technical complications can threaten the transplant in the postoperative period. Vascular complications are commonly related to technical problems in establishing vascular continuity or to damage that occurs during donor nephrectomy or preservation [13]. AIM The aim of the presenting study is to evaluate counts and rates of vascular complications after renal transplantation and to compare the outcome by donor type. MATERIAL AND METHODS A total of 463 kidneys (319 from living related donor LD and 144 from cadaveric donor - CD) were transplanted during the period between June 1975 and December 1998 at the Urology & Nephrology Institute of Clinical Centre of Serbia in Belgrade. Average recipients' age was 33.7 years (15-54) in LD group and 39.8 (19-62) in CD group. Retrospectively, we analyzed medical records of all recipients. Statistical analysis is estimated using Hi-squared test and Fischer's test of exact probability. RESULTS Major vascular complications including vascular anastomosis thrombosis, internal iliac artery stenosis, internal iliac artery rupture obliterant vasculitis and external iliac vein rupture were analyzed. In 25 recipients (5.4%) some of major vascular complications were detected. Among these cases, 22 of them were from CD group vs. three from LD group. Relative rate of these complications was higher in CD group vs. LD group (p

Introduction. Congenital renal arteriovenous fistulas (AVF) are rare, especially if they are associated with other developmental renal anomalies. Case Outline. A 34-year-old female was hospitalized due to total painless hematuria and bladder tamponade. Excretory urography revealed a horseshoe kidney with normal morphology of pyelocaliceal system and ureters. Aortography and selective renovasography detected a cluster-like vascular formation with multiple arteriovenous fistulas (AVF). Due to a large AVF gauge and poor flow of the efferent vein to the inferior vena cava, a surgical procedure of two renal artery segmentary branches ligation and division was performed. During the operative procedure, the presence of multiple superficial renal hemangiomas was detected. Conclusion. Although selective arterial embolization represents the preferable treatment option, conventional surgery remains favorable alternative in selected cases with large and complex AVF.

Prostate cancer (PC) is one of the most frequent malignancies. Better biomarkers are constantly wanted, such as those which can help with the prediction of cancer behavior. What is also needed is a marker which may serve as a possible therapeutic target. Oxidative stress (OS), which is a hallmark of cancer, is included in the pathogenesis and progression of PC. We have conducted the present study to determine whether xanthine oxidase/dehydrogenase activity is the source of OS in prostate tissue. We have also determined the concentration of TBA-reactive substances (TBARS) and advanced oxidation protein products (AOPP), as well as the activity of catalase. Xanthine oxidase (XO) activity is significantly higher ( p < 0.001) in tumor tissue when compared to the control healthy tissue. The concentration of TBARS ( p < 0.001) and AOPP ( p < 0.05) are also higher in tumor tissue. Catalase has raised its activity ( p < 0.05) versus the control. There is also a strong correlation between XO activity and prostate-specific antigen (PSA) levels in the serum. These results indicate a significant role of XO activity in OS in prostate carcinogenesis, and it could be a possible theranostic biomarker, which can be important for a better understanding of the disease, its evolution, and prognosis. A promising treatment may be using XO inhibitors such as allopurinol as adjuvant therapy.

Balkan endemic nephropathy (BEN) represents a chronic tubulointerstitial nephropathy which is followed by the progression of kidney fibrosis to end-stage kidney failure. The critical involvement of poisons in food (aristolochic acid (AA), ochratoxin, and heavy metals) and selenium deficiency are among nutritive factors which contribute to the pathogenesis of BEN, due to reactive oxygen species (ROS) liberation and/or decreased antioxidative defence system. The aim of the study is to distinguish a possible systemic and local origin of ROS through the measurement of xanthine oxidase (XO) activity in urine and plasma, along with the determination of the oxidative changes in lipids and proteins. The study included 50 patients with BEN and 38 control healthy subjects. We noted increased levels of both thiobarbituric acid-reactive substances (TBARS) and advanced oxidation protein products (AOPPs) in the plasma of patients with BEN, compared to the control group ( p < 0.001). The urinary levels of AOPPs were higher in patients with BEN in comparison to the control ( p < 0.001). The specific activity of XO was significantly lower in plasma and urine in BEN samples, compared to controls ( p < 0.005). Based on these results, we hypothesize that XO might not be considered a direct systemic or local contributor to ROS production in BEN, most probably because of the diminished kidney functional tissue mass and/or AA-induced changes in purine nucleotide conformation. The increased AOPP and TBARS level in both plasma and urine in BEN may predict ROS systemic liberation with toxic local effects., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Andrej Veljković et al.)

Introduction: Reconstruction of the long urethral strictures is a difficult task in urology. The most frequently usedmethod is augmentation with the free buccal mucosal graft., Material and Methods: Restrospective analysis of 57 patients with the long urethral stricture was performed. All patients were evaluated endosco- pically and radiologically before the surgery. Buccal mucosal graft harvested from the inner side of the cheek (unilateral or bilateral) was used for the urethral reconstruction in all patients. Follow-up was one year., Results: Complete follow up is achieved in 44/57 (77.2%) patients. The most important etiology of the strictures was previous iatrogenic trauma (instrumentation). The strictures were the most frequently located in the bulbar urethra. Preoperative exact evaluation of the stricture length was possible in only 35/57 patients (61.4%). Overall success rate of the surgery was 38/44 (86.3%). Complications occurred in 6/44 (13.7%) of patients--primary graft failure and urinary fistula. Mean preoperative IPSS was 19.2 ± 5.2, and postoperative 10.3 ± 3.2 (p < 0.0001). IPSSQOL was 4.9 ± 3.7 before the surgery, 2.9 ± 1.1 after the surgery (p < 0.001). Persistent urinary infection was present in 12/44 (27.2%) patients., Conclusion: Buccal mucosal free graft could be successfully used in the reconstruction of long urethral strictures. However, complications are not uncommon, and residual symptoms still exist after the surgery, and could not be neglected.