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BACKGROUND/AIMS The most effective and safe treatment protocol for Graves' orbitopathy (GO) needs to be further assessed. The aim of the present study was to evaluate the efficacy, safety and outcome of parenteral versus parenteral and oral glucocorticoid (GC) protocols in euthyroid patients with untreated and active moderate to severe GO. METHODS This was a retrospective observational study in 140 patients comparing intravenous GC pulses only (IVGC group, 74 patients, 51 ± 11 years) with historical controls of combined oral and intravenous GC therapy (CombGC group, 66 patients, 49 ± 10 years, P = ns). IVGC therapy included infusions of 500 mg of methylprednisolone weekly for the first six weeks, followed by infusions of 250 mg weekly for the remaining six weeks (cumulative dose 4.5 g). CombGC therapy included 500 mg of methylprednisolone in 500 mL of saline solution for two alternative days, followed by oral prednisone tapering dose repeated each month for the next 5 months (cumulative dose 10.2 g). RESULTS The overall success of the treatment was 43/66 (65%) in the CombGC group and 37/73 (51%, P = .071) in the IVGC group. Deterioration of GO developed in four (6%) patients during CombGC therapy and in nine (12%, P = .214) patients during IVGC therapy. After 6 months, relapse of GO was observed in 10/37 (26%) in the IVGC group, whereas none of the patients in CombGC had a relapse (P < .001). There were significantly more side effects in the CombGC versus IVGC group (49/66, 74% vs 28/74, 38%, P < .001). CONCLUSIONS Our data suggest that CombGC therapy was more efficient with significantly less relapse rate, but with more side effects in comparison to IVGC therapy.

To test the hypothesis that the use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% solution (COSOPTIn this prospective comparative study, 30 primary open-angle patients and 30 healthy subjects filled in the questionnaire on symptoms (Ocular Surface Disease Index) and subjective stinging feeling scale (1-10), at the start of study and 30 days after continuous use of refrigerated fixed combination or placebo eye drops. Results were processed by applying the methods of descriptive (arithmetical mean, standard deviation) and analytical statistics for evaluation of significance of the difference (Student's t-test).Ocular discomfort parameters were significantly lower after the use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% solution (t-test, P 0.0001). Breakup time, Schirmer 1 test, and intraocular pressure values did not differ.The use of refrigerated fixed combination of dorzolamide 2% plus timolol 0.5% (COSOPT) solution is associated with less ocular discomfort than the use of the same fixed combination at room temperature.

Customer satisfaction with service quality is one of the fundamental goals of hotel enterprises. Numerous specifics of hotel services (intangibility, inability to storage, etc.) make this goal hard to reach, and thus hotels invest enormous efforts in identification of guests' needs, in order to adjust their supply. The aim of this paper is to identify weaknesses and advantages of the selected hotel attributes by analysis of guests' importance and performance evaluation. The respondents were accommodated in four and five-star hotels in Serbia. In order to identify the weak points that could enable managers to raise the quality of services, the IPA method (Importance-Performance Analysis) was used. The results obtained reveal that guests are generally satisfied with the hotel attributes they consider highly important, while it is not the case with those less important. Furthermore, certain differences could be observed between the guests who stayed in city hotels and those in mountain and spa hotels.

Car-to-car and car-to-infrastructure messages exchanged in intelligent transportation systems can reach reception rates over 1000 messages per second. As these messages contain elliptic curve digital signature algorithm (ECDSA) signatures, this puts a very heavy load onto the verification hardware. In fact, the load is so high that, currently, it can only be achieved by implementations running on high-end CPUs and field-programmable gate arrays. These implementations are far from cost-effective or energy efficient. In this paper, we present an application-specified integrated circuit implementation of a dedicated ECDSA verification engine that can reach verification rates of up to 27 000 verifications per second, which is by far the fastest implementation on a single core reported in the literature.

Sewing needle inside of the abdominal cavity after ingestion, is described in a minority of cases, according to reviewed literature. Swallowed foreign body is more common in children, persons deprived of their liberty and psychiatric patients. It frequently passes asymptomatic by elimination from the digestive tract. The patient J.P. 75 years old from Bar, hospitalized at the department because of metallic foreign bodie - sewing needle in the abdominal cavity. X-ray native abdominal, MDCT of the abdomen and EGDS in consultation with gastroenterologist from Clinical Center in Podgorica, is made outpatient. After treatment the patient was operated on 19th November, 2013 by the classic laparotomy and after the expected recovery, without complications discharged. Foreign body in the omentum can arrive from the digestive tube migration and penetration through the abdominal wall. In some organs of the abdominal cavity, such as the liver can come through bloodstream. Perforation of the GI tract occurs in less than 1% of cases, mainly through the digestive tube runs without problems in about a week. The migration of a sewing needle through the stomach can cause a state of emergency abdominal or can go through asymptomatic. Treatment is traditionally classical laparotomy, while today there are more works that favor the laparoscopic method. The rarity of surgical practice that has been treated laparotomy and removing foreign bodies. Today, more and more works where the extraction of foreign bodies from the abdominal cavity is made by the laparoscopic method.

Introduction. Eye injuries represent a significant problem in children. Objective. The aim of the study was to determine the incidence and causes of the eye injury and to propose measures of the eye injury prevention in children up to 15 years of age. Methods. This was a retrospective study of 552 children with the eye injuries treated at the Clinic of Eye Diseases in Belgrade during the period March 1999 to February 2010. Gender and age of the children, time of injury, the type and site of injuries, visual acuity upon admission and at discharge, as well as the time of surgery in relation to time of injury were analyzed. Results. The ratio between the injured boys and girls was 3.6:1. The highest percentage of injured children was in the group 6-10 years old (39.7%); the injuries were almost evenly distributed according to months during the year and days during the week. The percentages of severe closed and open injuries of the eyeball were almost equal. Visual acuity upon discharge and subsequent follow-up examinations were significantly improved after the applied treatment in comparison with the visual acuity upon admission. Conclusion. Eye injuries in children still represent a severe health problem. Regarding the youngest age group of children, adults are mainly responsible for these injuries due to their lack of attention, while in older children these injuries are the result of the production and distribution of inappropriate toys and a failure to implement the legal traffic regulations applicable to children. The prevention of eye injuries is essential.

Background/Aim. Eye enucleation is one of the oldest surgical procedures. The aim of the study was to determine the causes of enucleation as seen in a major reference eye center in Serbia. Methods. Retrospective case series involving a review of all enucleation procedures performed in the period between January 2000 and December 2008 at the Institute for Eye Diseases, Clinical Center of Serbia, Belgrade. The collected information included the basic demographic data and diagnosis of the affected eye. The diagnosis was made based on history, clinical and histological examinations. Clinical indications for enucleation were categorized as tumors, glaucoma, trauma, infections and other diseases. A statistical analysis was made using the Student's t-test. Results. There were 586 patients, 315 male and 271 female in our series. The mean age was 57.81, ranging from 3 months to 96 years. The most common cause of enucleations was tumor (76.11%), (p < 0.05). Choroid melanoma was the most common etiology leading to enucleation (81.18%), followed by retinoblastoma (12.34%). A total of 8.02% of enucleations were performed due to glaucoma that was primarily neovascular in 42.55% of cases or caused by trauma in 38.8% of cases. Trauma was the third common etiology of enucleation, and it was acute in 56.26% of cases or resulted in phthisis bulbi in 31.25% of cases. Enucleation caused by inflammation was performed in 2.90% of cases, out of which 52.94% of enucleations occurred after perforation of the cornea. In the group of other diseases the most common cause of enucleation was atrophy of the eye ball. Conclusion. Neoplasm, neovascular glaucoma, acute eye injury and atrophy of the eye ball are the most common causes of enucleation.

INTRODUCTION: The study describes ocular injuries caused by airsoft guns pellets, type of these injuries and their incidence in different age groups. METHODS: This is a retrospective review of medical charts of patients who were hospitalized due to airsoft guns ocular injuries in ten-year period (from 2000 to 2009). Patient’s age, gender, duration of hospitalization, type of treatment and initial and final visual acuity were analyzed. RESULTS: Overall 92 patients with ocular injuries caused by airsoft gun pellets were hospitalized in tenyear period. In all patients only one eye was injured and there were 72 (78.3%) male patients. Injuries involved ocular adnexa, anterior and posterior segment of the eye. On initial examination 41 (44.6%) patients were presented with subconjunctival hemorrhages, 42 (45.6%) with corneal abrasion, 42 (45.6%) patients had corneal edema, 6 (6.5%) had traumatic mydriasis, 90 (97.8%) patients exhibited hyphema, 10 (10.9%) iridodialysis, in 27 (29.3%) patients high intraocular pressure (IOP) was measured, one patient had subluxation of intraocular lens (IOL) and one patient had traumatic cataract. Posterior segment findings included vitreous hemorrhage in 3 (3.3%) patients, retinal hemorrhage in 15 (16.3%) patients, retinal edema in 35 (38.0%) patients and one patient had globe rupture. Average duration of hospitalization was 5.7 days (range from 1 to 18 days). Three patients (3.3%) required eye surgery, eight patients (8.7%) had anterior chamber washout while rest of the patients were conservatively managed. Visual acuity at hospital release was significantly improved comparing to initial visual acuity, ranging from counting fingers at 1 meter to 20/60 in 7 (8.6%) patients, from 20/50 to 20/30 in 13 (16.0%) patients and from 20/25 to 20/20 in 61 (75.3%) patients. In 11 patients testing the visual acuity was not possible because of their young age. CONCLUSION: Injuries attributed to airsoft guns were confined mostly to anterior segment. There was also high percentage of severe posterior segment trauma requiring hospital admission. The most important factors in preventing such injuries are restricting access to airsoft guns, especially to minors, as well as mandatory use of protective equipment such as protective eyeglasses.

Introduction. An altered perfusion of the optic nerve head has been proposed as a pathogenic factor in glaucoma. Objective. To evaluate changes of haemodynamic parameters in the retrobulbar arterial circulation after a decrease of elevated intraocular pressure (IOP) in patients with primary open angle glaucoma (POAG). Methods. Twenty-six patients were examined, 14 men and 12 women, 21 up to 50 years old and 5 below, all with previously diagnosed and treated POAG, and all examined at the Eye Clinic, Clinical Centre of Serbia. IOP was measured both with a Goldmann aplanation tonometer and dynamic contour tonometer. Central corneal thickness was measured with ultrasound pachymeter. Imaging of the retrobulbar arterial circulation by colour Doppler was performed at the Neurology Clinic, Clinical Centre of Serbia. It involved measuring of haemodynamic parameters of the ophthalmic artery, central retinal artery, and posterior ciliary arteries. Peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured, and resistive index (RI) and pulsatility index (PI) were calculated. Results. Haemodynamic arterial parameters PSV and EDV in the ophthalmic and central retinal artery after decrease of IOP were lower, while RI and PI were higher. In the posterior ciliary arteries PSV, EDV and PI were lower, and RI was higher. Conclusion. Changes of the retrobulbar arterial circulation after elevated IOP in POAG patients are important for approach and treatment, while the role of vascular factors in the supplement of the optic disc neuroretinal rim could be a key for progression backlash of glaucoma and the radix of neuroprotection.

Background External dacryocystorhinostomy (DCR) is often performed under local anesthesia (LA) without adequate knowledge of the pain experienced by the patient. Material/methods We subdivided our surgical technique into stages easily understood by the patients (introducing cotton tipped applicators, performing parabulbar injection, creating the incision, bone cracking (opening the ostium), manipulating the nose, intubating, closing the wound, and packing with gauze). A total of 50 patients ranging in age from 31 to 83 years of age (63.64±9.64) underwent external DCR. Each patient was asked 30 minutes after surgery to indicate the intensity of pain experienced at each stage of the surgery and during intramuscular (i.m.) injection of an antibiotic using a visual analog scale (VAS). Results Analysis of the VAS-based pain scores indicated 3 statistically equal occurrences of pain coinciding with the opening of the ostium, and receiving both parabulbar anesthetic and i.m. antibiotic injections. Conclusions The level of pain experienced during the most unpleasant stage of external DCR (ostium opening) was similar to the pain experienced from an i.m. injection. Patients can be informed that pain during external DCR with local anesthesia is comparable to receiving an i.m. gluteal injection.

Introduction: Spontaneous RSH is very rare and small series have been demonstrated in literature. Proper and timely diagnosis of a hematoma within straight abdominal muscle significantly influences the way of treatment and the application of appropriate protocol for specific stage of illness. Case report: A 62-year old patient presented himself at hospital because of pains under RRC, with unclear clinical features, and only after repeated radiological diagnostic procedures we began the treatment with the protocol for identified stage of illness which took us to complete recovery and the patient got back to his every day activities. Conclusion: Even though rare, RSH imitates acute abdomen therefore proper diagnosis contributes to proper treatment. Treatment can be conservative, invasive and surgical.

In traffic accidents, eye injuries occur as isolated or with polytrauma. They may involve just one eye, but simultaneous injuries to both eyes do happen occasionally. The aim of our paper was to reveal the risk factors, in an effort to reduce the number of such accidents and to prevent bilateral ocular damage.All patients hospitalized at the Clinic of Eye Diseases, Clinical Center of Serbia, Belgrade, due to traffic accidents with bilateral eye injuries in a period of 9 years from the beginning of 2000 to the end of 2008 were analyzed.In this 9-year period, a total of 36 patients were hospitalized and treated for bilateral ocular injury (72 eyes). There were 23 males among them, the male-female ratio being 1.8:1. Mean age was 33.9 years. The occupations of injured persons were the following: the most common were workers--15, followed by clerks--seven, while less common were pupils, students, pensioners and housewives-three of each of them, and farmers--two. Front-seat passengers were the most common among the injured--20 (55.6%), then drivers--15 (41.7%), with only one passenger from the back seat on the right side (2.7%). As many as 33 (91.7%) of them failed to fasten their seat belts, while 18 (50.0%) were drunk. Penetrating bulbar injuries or eyeball ruptures were predominant--66.7%, while blunt injuries were found in only two (2.8%) eyes in one single person; but in 22 cases (30.5%) there was adnexal damage, too. Visual acuity at discharge and subsequent controls was as follows: amaurosis in 21 (29.2%), less than 0.3 in nine (5.6%), 0.4 and better in 42 (58.1%), and normal visual acuity of 1.0 in 28 patients (38.3%).The major risk factors for getting bilateral eye injuries in traffic accidents proved to be: sitting in the front car seats, not fastening the seat belt and alcohol intoxication. Prevention of these risk factors would result in a decrease in such a large number of bilateral eye injuries.

Glucocorticoids (GC) are the treatment of choice for moderate-to-severe and active Graves’ orbitopathy (GO), but optimal treatment is still undefined. The aim of the present study was to analyze the efficacy and tolerability of combined parenteral GC pulse therapy followed by oral GC in the interpulse period. The study included 50 patients (48 ± 10 years; 37 female) with untreated, active and moderate-to-severe GO. Patients received 500mg of methylprednisolone in 500ml of physiologic saline. Infusion was repeated after 48h and then followed by tapering doses of oral prednisone and the cycle repeated each month for the next 5 months. The cumulative dose was 10.2g. Ophthalmic assessment was performed before and 6 months after start of treatment. Side effects of GC therapy were evaluated and recorded each month. GC showed the greatest effectiveness on soft tissue changes (incorporated in the CAS). Median CAS values decreased from 4.5 to 2 (p>0.001). Improvement was demonstrated in 37 patients (74%), there was no change in 13 patients (26%) and none of the patients presented with deterioration of inflammatory status. Diplopia improved in 21 patients (42%), was unchanged in 28 patients (56%) and deteriorated in 1 patient (2%). Improvement in visual acuity occurred in 36% of patients. At 6 months, 33/50 patients (66%) demonstrated overall treatment response. Response to GC therapy was influenced by CAS, TSHRAb and smoking behavior. The only independent parameter associated with positive treatment response was CAS ≥4 (p

The design of secure yet efficiently implementable cryptographic algorithms is a fundamental problem of cryptography. Lately, lightweight cryptography--optimizing the algorithms to fit the most constrained environments--has received a great deal of attention, the recent research being mainly focused on building block ciphers. As opposed to that, the design of lightweight hash functions is still far from being well investigated with only few proposals in the public domain. In this paper, we aim to address this gap by exploring the design space of lightweight hash functions based on the sponge construction instantiated with present-type permutations. The resulting family of hash functions is called spongent. We propose 13 spongent variants--or different levels of collision and (second) preimage resistance as well as for various implementation constraints. For each of them, we provide several ASIC hardware implementations--ranging from the lowest area to the highest throughput. We make efforts to address the fairness of comparison with other designs in the field by providing an exhaustive hardware evaluation on various technologies, including an open core library. We also prove essential differential properties of spongent permutations, give a security analysis in terms of collision and preimage resistance, as well as study in detail dedicated linear distinguishers.

Introduction. This paper was aimed at presenting our experience and results in the surgical management for proptosis in patients with Graves` orbitopathy. Material and Methods. This is a retrospective, interventional, non-comparative case series review. Seventeen eyes of ten patients underwent orbital decompression between 2008 and 2009. Depending on case, the surgery involved one to 3 orbital walls with or without fat removal, being approached through combined transcaruncular and lower fornix incision. Results. All the operated patients were females, their mean age being 48, with proptosis ranging from 21 to 28 mm, and 18 to 22 mm three months after surgery. A mean reduction in proptosis of 4.59 ? 1.58 mm was attained. Intra-operative course was uneventful and post-operatively transient infraorbital hypoesthesia was seen in twelve patients (70.57%). Conclusion. Orbital decompression proved to be a safe, reliable and effective way to reduce proptosis provided that the procedure is carefully planned and properly performed.

The first contribution of our paper is that we propose a platform, a design strategy, and evaluation criteria for a fair and consistent hardware evaluation of the second-round SHA-3 candidates. Using a SASEBO-GII field-programmable gate array (FPGA) board as a common platform, combined with well defined hardware and software interfaces, we compare all 256-bit version candidates with respect to area, throughput, latency, power, and energy consumption. Our approach defines a standard testing harness for SHA-3 candidates, including the interface specification for the SHA-3 module on our testing platform. The second contribution is that we provide both FPGA and 90-nm CMOS application-specific integrated circuit (ASIC) synthesis results and thereby are able to compare the results. Our third contribution is that we release the source code of all the candidates and by using a common, fixed, publicly available platform, our claimed results become reproducible and open for a public verification. © 1993-2012 IEEE. ispartof: IEEE Transactions on Very Large Scale Integration (VLSI) Systems vol:22 issue:5 pages:827-840 status: published

This paper presents a block cipher that is optimized with respect to latency when implemented in hardware. Such ciphers are desirable for many future pervasive applications with real-time security needs. Our cipher, named PRINCE, allows encryption of data within one clock cycle with a very competitive chip area compared to known solutions. The fully unrolled fashion in which such algorithms need to be implemented calls for innovative design choices. The number of rounds must be moderate and rounds must have short delays in hardware. At the same time, the traditional need that a cipher has to be iterative with very similar round functions disappears, an observation that increases the design space for the algorithm. An important further requirement is that realizing decryption and encryption results in minimum additional costs. PRINCE is designed in such a way that the overhead for decryption on top of encryption is negligible. More precisely for our cipher it holds that decryption for one key corresponds to encryption with a related key. This property we refer to as α-reflection is of independent interest and we prove its soundness against generic attacks.

This paper presents a new modular multiplication algorithm that allows one to implement modular multiplications efficiently. It proposes a systematic approach for maximizing a level of parallelism when performing a modular multiplication. The proposed algorithm effectively integrates three different existing algorithms, a classical modular multiplication based on Barrett reduction, the modular multiplication with Montgomery reduction and the Karatsuba multiplication algorithms in order to reduce the computational complexity and increase the potential of parallel processing. The algorithm is suitable for both hardware implementations and software implementations in a multiprocessor environment. To show the effectiveness of the proposed algorithm, we implement several hardware modular multipliers and compare the area and performance results. We show that a modular multiplier using the proposed algorithm achieves a higher speed comparing to the modular multipliers based on the previously proposed algorithms. © 2011 Elsevier B.V. All rights reserved. ispartof: Integration, the VLSI Journal vol:44 issue:4 pages:259-269 status: published

The objective of the SHA-3 NIST competition is to select, from multiple competing candidates, a standard algorithm for cryptographic hashing. The selected winner must have adequate cryptographic properties and good implementation characteristics over a wide range of target platforms, including both software and hardware. Performance evaluation in hardware is particularly challenging because of the large design space, wide range of target technologies, and multitude of optimization criteria. We describe the efforts of three research groups to evaluate SHA-3 candidates using a common prototyping platform. Using a SASEBO-GII FPGA board as a starting point, we evaluate the performance of the 14 remaining SHA-3 candidates with respect to area, throughput, and power consumption. Our approach defines a standard testing harness for SHA-3 candidates, including the interface specifications for the SHA-3 module on the SASEBO testing board.

In this paper we show how modular reduction for integers with Barrett and Montgomery algorithms can be implemented efficiently without using a precomputational phase. We propose four distinct sets of moduli for which this method is applicable. The proposed modifications of existing algorithms are very suitable for fast software and hardware implementations of some public-key cryptosystems and in particular of Elliptic Curve Cryptography. Additionally, our results show substantial improvement when a small number of reductions with a single modulus is performed.

Purpose: We present the rare case of a young male patient with asymmetric ocular findings: pigmentary ocular hypertension associated with nonischemic central retinal vein occlusion (CRVO) in the right eye and pigmentary glaucoma (PG) with progressive glaucomatous optic damage in the left eye. Patients and Methods: A 31-year-old man showed nonischemic CRVO in the right eye and the clinical triad of pigment dispersion syndrome in both eyes, however more marked in the left eye. Best-corrected visual acuity was logMAR 0.3 in the right eye and 1.0 in the left eye at presentation. The single risk for developing PG and CRVO was hyperhomocysteinemia. The patient was a carrier of the methylenetetrahydrofolate reductase C677 homozygous mutation. Results: At 18 months of follow-up, visual acuity remained stable, intraocular pressure was in the normal range, but retinal tomography indicated an increase in glaucomatous optic damage to the nerve fiber layer in almost the complete temporal-inferior sector of the left eye, but without visual field defects in the left eye. Retinal tomography and automated perimetry were normal in the right eye. The patient received topical antiglaucomatous therapy. Conclusion: Higher levels of plasma homocysteine, even mildly elevated ones, could be associated with nonischemic CRVO and PG, especially when related to genetic risk factors or C677T mutation.