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Purpose Endophthalmitis following intravitreal anti-VEGF injections is frequently caused by Streptococcus viridans organisms and tends to be aggressive. Herein we present a case of post-injection Streptococcus viridans endophthalmitis presenting in an atypically delayed fashion with good visual outcome. Methods Single clinical case report. Patients A 91-year-old female treated with Aflibercept for exudative age-related macular degeneration of the left eye presented to the emergency department with mild pain and visual acuity decline to counting fingers, pigmented anterior chamber cells and vitreous haze 7 weeks after her most recent intravitreal injection. She had no symptoms of systemic infection. The presumptive diagnosis initially was vitreous haemorrhage. Results Over 10 days of observation, she developed worsening pain and vitritis suggestive of endophthalmitis, leading us to perform vitrectomy with intravitreal Vancomycin and Ceftazidime. Vitreous biopsy was culture positive for Streptococcus intermedius, a type of viridans streptococcus typically associated with head and neck abscesses. The infection resolved and the patient's visual acuity returned to her baseline of 20/100, with no recurrence of infection after four months of follow-up DISCUSSION:: The virulence of viridans streptococci capable of producing post-injection endophthalmitis may vary widely. Infection ought to be suspected even in cases of delayed onset intraocular inflammation.

Aim The aim of this observational split-mouth study was to compare the retention and caries protective effect of four different sealing materials in children aged 6-13 years during 2- year follow-up period. Design This was a observational split-mouth prospective 2-year study. Materials and methods There were 80 children included in this study which was conducted in Blato (Korčula island) Croatia. Each participant received at least two different sealing materials on caries-free permanent molars in two different quadrants. Sealing materials (M1 – glass ionomer cement ; M2, M4 – resin-based filled sealants ; M3 – resin-based unfilled sealant) were delivered in a random order. Results The results of this study showed that M2 (30 teeth, 46.2%) and M4 (27 teeth, 46.6%) showed statistically significantly higher number of teeth with total retention after 2-year follow-up period, in comparison to M1 (10 teeth, 19.2%) or M3 (12 teeth, 20.7%) (P

A program for Artificial Intelligence (AI) is knowledge as intelligent agent, which typically interacts with the ecosystem. This agent is capable of identifying the status of the ecosystem using the sensors before affecting the state via the actuators. We call the smart systems "agents” whenever they are able to make some decisions on their own with respect on particular goals. On the other hand, Machine Learning (ML) signifies a specific strategy meant to design smart systems whereby these systems can adapt to specific behaviors with respect to data. In the modern age, humans are rapidly collaborating with ML and AI systems. The AI that is human-based is a perspective of ML and AI, which algorithms have to be established with the awareness that they are a major segment of the massive system incorporating human. In this paper, we have presented a research that means that AI systems understand humans with respect to their socio-cultural aspects and that AI system assist humans comprehend them. We also present an argument of the challenges of social responsibility e.g. transparency, interpretability, accountability and fairness.

Background Fremanezumab, a fully humanized monoclonal antibody (IgG2Δa) selectively targets the calcitonin gene-related peptide and has proven efficacy for the preventive treatment of migraine. In this study, we evaluated the long-term efficacy, safety, and tolerability of monthly and quarterly fremanezumab. Methods Episodic migraine and chronic migraine patients completing the 12-week double-blind period of the FOCUS trial entered the 12-week open-label extension and received 3 monthly doses of fremanezumab (225 mg). Changes from baseline in monthly migraine days, monthly headache days of at least moderate severity, days of acute headache medication use, days with photophobia/phonophobia, days with nausea or vomiting, disability scores, and proportion of patients achieving a ≥50% or ≥75% reduction in monthly migraine days were evaluated. Results Of the 807 patients who completed the 12-week double-blind treatment period and entered the open-label extension, 772 patients completed the study. In the placebo, quarterly fremanezumab, and monthly fremanezumab dosing regimens, respectively, patients had fewer average monthly migraine days (mean [standard deviation] change from baseline: − 4.7 [5.4]; − 5.1 [4.7]; − 5.5 [5.0]), monthly headache days of at least moderate severity (− 4.5 [5.0]; − 4.8 [4.5]; − 5.2 [4.9]), days per month of acute headache medication use (− 4.3 [5.2]; − 4.9 [4.6]; − 4.8 [4.9]), days with photophobia/phonophobia (− 3.1 [5.3]; − 3.4 [5.3]; − 4.0 [5.2]), and days with nausea or vomiting (− 2.3 [4.6]; − 3.1 [4.5]; − 3.0 [4.4]). During the 12-week open-label extension, 38%, 45%, and 46% of patients, respectively, achieved a ≥50% reduction and 16%, 15%, and 20%, respectively, achieved a ≥75% reduction in monthly migraine days. Disability scores were substantially improved in all 3 treatment groups. There were low rates of adverse events leading to discontinuation ( Conclusion Fremanezumab demonstrated sustained efficacy up to 6 months and was well tolerated in patients with episodic migraine or chronic migraine and documented inadequate response to multiple migraine preventive medication classes. Trial registration ClinicalTrials.gov NCT03308968 (FOCUS).

Objective To evaluate the efficacy of fremanezumab in patients with chronic migraine (CM) and moderate to severe depression. Background Fremanezumab, a fully humanized monoclonal antibody that selectively targets calcitonin gene–related peptide, has been approved for the preventive treatment of migraine in adults. CM and depression are highly comorbid. Methods The 12‐week, Phase 3 HALO trial randomized patients with CM to fremanezumab quarterly (675 mg/placebo/placebo), fremanezumab monthly (675/225/225 mg), or placebo. Post hoc analyses evaluated the effects of fremanezumab in patients with moderate to severe depression (baseline 9‐item Patient Health Questionnaire sum score ≥10) on monthly number of headache days of at least moderate severity; monthly migraine days; Patient Global Impression of Change (PGIC); 6‐item Headache Impact Test (HIT‐6) scores; and depression. Results For the 219/1121 (19.5%) patients with moderate to severe depression at baseline, fremanezumab was associated with a significant reduction in monthly number of headache days of at least moderate severity for active treatment versus placebo (least‐squares mean change ± standard error for quarterly dosing: −5.3 ± 0.77; for monthly dosing: −5.5 ± 0.72; and for placebo: −2.2 ± 0.81; both p

IntroductionMetabolic syndrome arises from abnormal adipose function accompanied by insulin resistance. As early factors reflecting/impacting lipid storage dysfunction of adipose tissues, we sought to determine adipokine levels in subcutaneous and visceral adipose tissues (SAT and VAT).Material and methodsGene and protein expression of leptin, adiponectin, and resistin were analyzed in SAT and VAT of normal-weight and overweight/obese women, subclassified according to insulin resistance index, triglyceride, total-, LDL- and HDL-cholesterol levels into metabolically healthy and “at risk” groups.ResultsCompared with normal-weight women, obese women had higher serum leptin levels (PConclusionsLow adiponectin in both examined adipose tissues and inappropriate leptin expression levels in SAT appear to be important characteristics of obesity-related metabolic syndrome. Intriguingly, this adipokine dysregulation is primary seen in SAT, suggesting that endocrine dysfunction in this abdominal depot may be an early risk sign of metabolic syndrome.

Objective To study the racial and socioeconomic characteristics of women seeking fertility care in a state with mandated insurance coverage for fertility testing and treatment. Design Cross-sectional, self-administered survey. Setting Academic fertility center in Illinois. Patient(s) Of 5,000 consecutive fertility care patients, 1,460 completed the survey and were included in the study sample. Intervention(s) None. Main Outcome Measure(s) Details about demographic characteristics and health care access on the basis of patient race/ethnicity and socioeconomic status. Result(s) The mean age of participants was 36.1 years; 75.5% were White, 10.2% Asian, 7.3% Black, 5.7% Latinx, and 1.3% Other. Most women had a bachelor’s (35.5%) or master’s degree (40.5%) and an annual household income of >$100,000 (81.5%). Black and Hispanic women traveled twice as far (median 10 miles) as White and Asian women (median 5 miles for both) for treatment. Black women (14.7%) were more likely to report that their race was a barrier to getting fertility treatment compared with White (0.0%), Hispanic (5.1%), and Asian (5.4%) women. Black and Hispanic women were approximately twice as likely to report income level (26.5% and 20.3%, respectively) and weight (7.8% and 8.9%, respectively) as barriers compared with White and Asian respondents. Conclusion(s) Significant racial and socioeconomic disparities exist among fertility patients accessing care. Beyond providing all Americans with health insurance that covers fertility treatment, further research in the general population is needed to understand the complex social, cultural, racial, and economic factors that prohibit many individuals from accessing needed fertility care.

The purpose of this work was to evaluate computed tomography simulators used in radiotherapy treatment planning in Serbia, Croatia, and Bosnia and Herzegovina. A survey of quality assurance programmes of 24 computed tomography simulators in 16 facilities was conducted. A dedicated CT-to-ED phantoms was scanned at 120 kV and 140 kV, to obtain CT-to-ED con version curves as well as CTDI vol. Thoracal phantoms were scanned in the standard and extended field of view to evaluate the dosimetric effect on treatment planning and delivery. The mean age of the measured scanners was 5.5 years. The mean water HU value was –6.5 (all scanners, all voltages) and air HU value was –997. Extended field of view computed tomography data differ from the standard field of view and differences between conversion curves have significant dosimetric impact. The CTDI data showed a large range of values between centers. Better quality assurance of computed tomography simulators in all countries is recommended. The CT-to-ED curve could be used as default at one voltage and per manufacturer. Extended field of view imaging can be used, but treatment planning should be avoided in the regions out of the standard field of view.

Introduction. Ticagrelor is an oral, reversible, direct-acting inhibitor of adenosine diphosphate receptor P2Y12, which has a faster onset of action and stronger inhibition of platelet aggregation than clopidogrel. Case Report. This case report describes a 54-year-old male patient with repeated, transient ischemic attacks due to ipsilateral, significant carotid stenosis registered by carotid duplex ultrasound. In addition to aspirin, clopidogrel and rosuvastatin were added to the therapy. Despite optimal treatment, the patient was continuously unstable with frequent but transient neurological symptoms. A magnetic resonance imaging of the brain showed acute, cortical-subcortical ischemic lesions in the left frontal and parietal lobes, while the computed tomography angiography of the endocranium showed progression of findings and occlusion of the left common carotid artery. Subsequently, laboratory platelet aggregation analysis confirmed aspirin resistance and poor response to clopidogrel. Episodes of transient ischemic attacks were stabilized after the exclusion of dual antiplatelet therapy and introduction of ticagrelor. After that, the patient?s symptoms did not recur and he remained stable. Conclusion. The incidence of resistance to antiplatelet therapy in patients with stroke or transient ischemic attack varies greatly and ranges from 3% to 85% for aspirin, and 28% to 44% for clopidogrel. Our case showed that platelet aggregation analysis is reasonable if patients with transient ischemic attack or minor acute ischemic stroke are neurologically unstable, despite optimal medical treatment and when other therapeutic options, such as carotid revascularization, are not indicated. In such situations, ticagrelor may be a suitable alternative to dual antiplatelet therapy.

Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54 ± 11y, body mass index (BMI) 32.7 ± 6.6 kg/m2 and apnea-hypopnea index (AHI) 40.3 ± 24.4 n/h) undergoing PAP therapy for at least three months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from nine centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, weight changes, lipid lowering medication, PAP compliance, and treatment duration) were used to compare changes in TC concentration. Incident risk for a coronary heart disease event (CHD) was used to compute a Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p = 0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in men and from 11.2% to 10.1% in women, p < 0.001 respectively). Conclusion: This observational study demonstrates a reduction of TC after long-term PAP treatment. The close association between TC concentration and cardiovascular (CV) mortality suggests that identification and treatment of OSA may have a beneficial effect on overall CV risk due to this mechanism. This possibility needs to be evaluated in prospective randomized studies. © 2020 Elsevier B.V., ResMed Foundation European Respiratory Society, ERS European Respiratory Society, ERS European Respiratory Society, ERS, The ESADA network has received support from the European Union COST action B26 and the European Respiratory Society (ERS) funded Clinical Research Collaboration (CRC). Unrestricted seeding grants from the ResMed Foundation and the Philips Respironics Foundation for establishment of the database in 2007 and 2011 are gratefully acknowledged. The ESADA network has a scientific collaboration with Bayer AG., Nonfinancial support was provided by the European Sleep Research Society (ESRS) and the European Respiratory Society (ERS) in terms of logistics for communication, meetings and data presentations for the ESADA collaborators., Dr. Verbraecken reports grants and personal fees from ResMed, Bioprojet, Jazz Pharmaceutics; personal fees from Philips, Sanofi, Agfa-Gevaert, grants from AirLiquide; personal fees from Springer, Westfalen Medical, SomnoMed, Vivisol, Total Care, Medidis, Fisher & Paykel, Wave Medical, OSG, Mediq Tefa, NightBalance, Heinen & Löwenstein, AstraZen, Accuramed, Bekaert Deslee Academy and UCB Pharma, outside the submitted work. Dr. Hedner reports grants from ResMed, Philips Respironics, and the European Respiratory Society all related to maintenance of database on behalf of the ESADA group during the conduct of the study. Dr. Grote reports grants from Bayer, Resmed, Respironics/Philips, and from the European Respiratory Society during the conduct of the study; non-financial support and other from Itamar Medical, Resmed, Philips, and Astra Zeneca, outside the submitted work. In addition, Dr. Grote has a patent on sleep apnea therapy licensed. The remaining co-authors have no conflict of interest to declare.

BACKGROUND Migraine preventive medications are used to reduce headache frequency, severity, and duration. In patients with chronic migraine (CM), reversion to episodic migraine (EM) is an important treatment goal. OBJECTIVE To evaluate the effect of fremanezumab on the rate of reversion from CM to EM. METHODS This phase 3, randomized, double-blind, placebo-controlled, parallel-group trial included a 28-day pretreatment period and a 3-month treatment period. Patients with CM received subcutaneous fremanezumab quarterly (675 mg at baseline) or monthly (675 mg at baseline; 225 mg at Weeks 4 and 8), or placebo. Post hoc analyses evaluated the proportion of patients who reverted from CM to EM, defined as either a reduction to an average of

The comprehensive aquatic systems model (CASM), an aquatic food web-ecosystem model, was developed originally to explore relationships between food web structure and ecosystem function, and was then subsequently adapted to assess potential ecological risks posed by chemical contaminants. The present short communication presents the history of the CASM, describes the model structure, lists the outputs of the model, and introduces user-friendly versions of CASM applications that are being made publicly available. Environ Toxicol Chem 2020;39:2298-2303. © 2020 SETAC.

In pesticide risk assessments, semifield studies, such as large‐scale colony feeding studies (LSCFSs), are conducted to assess potential risks at the honey bee colony level. However, such studies are very cost and time intensive, and high overwintering losses of untreated control hives have been observed in some studies. Honey bee colony models such as BEEHAVE may provide tools to systematically assess multiple factors influencing colony outcomes, to inform study design, and to estimate pesticide impacts under varying environmental conditions. Before they can be used reliably, models should be validated to demonstrate they can appropriately reproduce patterns observed in the field. Despite the recognized need for validation, methodologies to be used in the context of applied ecological models are not agreed on. For the parameterization, calibration, and validation of BEEHAVE, we used control data from multiple LSCFSs. We conducted detailed visual and quantitative performance analyses as a demonstration of validation methodologies. The BEEHAVE outputs showed good agreement with apiary‐specific validation data sets representing the first year of the studies. However, the simulations of colony dynamics in the spring periods following overwintering were identified as less reliable. The comprehensive validation effort applied provides important insights that can inform the usability of BEEHAVE in applications related to higher tier risk assessments. In addition, the validation methodology applied could be used in a wider context of ecological models. Environ Toxicol Chem 2020;39:2269–2285. © 2020 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC., Left: Comparison plot of adult bee numbers and honey stores between data from an example large‐scale colony feeding study (LSCFS, dots) and model outputs (shaded areas). Right: Quantitative performance indicators for BEEHAVE across several LSCFSs used for validation. The combination of visual and quantitative validation methods provides comprehensive insight into model performance across studies, endpoints and time periods simulated.

Background: In HIV negative population metabolic syndrome and steatosis are related to poorer neurocognitive (NC) performance. We investigated if similar relation exists in people living with HIV (PLWH). Methods:: We included male PLWH aged 20-65, with undetectable viral load for at least 6 months. Data on levels of education, anthropometric measurements, CD4 levels, ART, markers of metabolic syndrome, smoking and concurrent treatment were collected from database. Concentrations of TNF-α and IL-6 were measured. An ultrasound was used to establish the presence of steatosis, visceral fat thickness and carotid intima media thickness. An extensive NC assessment was done by an experienced neuropsychologist. Cognitive domains were defined as executive functions, divergent reasoning, visuo-constructional abilities, delayed recall and working memory and learning and were measured using a battery of 12 tests. Results: 88 PLWH were included (mean age 39,9 years), 51% on PIs, 46% on NNRTI; 20,4% had metabolic syndrome, 42% patients had steatosis. Weak but statistically significant negative correlations were found between the presence of metabolic syndrome, steatosis and VFT and cognitive domains (divergent reasoning, delayed recall and working memory). Poorer perfomrance in the domains of divergent reasoning and in the working memory were found in participants with steatosis (p=0,048 and 0,033 respectively). Conclusion: Although the sample size was relatively small, our results show consistent correlations between the observed neurocognitive variables and metabolic parameters. As central obesity is one of the contributors to NCI, it would be one of the modifiable factors to prevent further neurocognitive decline.

Aim: To evaluate the health-related life quality of patients after surgically treated midface fractures. ----- Patients and methods: This retrospective cohort study compared the 36-Item Short Form Health Survey (SF-36) scores of 42 male patients following surgically treated maxillary or zygomatic fractures with the reported normative data of the SF-36 for the Croatian population. ----- Results: The current study showed that the health-related life quality of surgically treated patients was comparable to similar age, gender, and regional demographics in the Croatian population norm. However, we revealed a significant deterioration of the "Emotional wellbeing" domain in younger patients (P = 0.03) and a severely affected domain of "Physical functioning" in older patients (P = 0.049). ----- Conclusion: There was a significant negative psychological impact from facial trauma on younger patients. In contrast, older patients were more prone to physical impairment. Therefore, follow-up visits are an opportunity to screen and refer younger patients to mental health services in a timely manner to prevent severe psychological difficulties and an opportunity to identify older patients who require physical therapy.

SUMMARY: Inconsistent data are available on the relation between breast cancer, adiposity, body size and somatotype. The aim of our study was to compare anthropometric characteristics, body composition and somatotype between breast cancer patients and healthy controls. Study group consisted of 106 breast cancer patients while control group consisted of 100 healthy women who underwent 29 anthropometric measurements. Women with breast cancer expressed more male anthropometric features like higher stature (160.75±6.91 vs. 158.17±4.89 cm, p=0.020), shorter trunk (sitting height in premenopausal: 84.94±5.07 vs. 88.50±3.84 cm, p=0.001 and postmenopausal women: 81.96±6.08 vs. 85.19±3.36 cm, p=0.001), narrower hips (29.20±3.78 vs. 32.24±1.78 cm, p=0.000), higher biepicondylar diameter of humerus (premenopausal: 6.64±0.71 vs. 6.31±0.42 cm, p=0.012; postmenopausal: 6.95±0.63 vs. 6.54±0.49 cm, p=0.000), larger upper- and forearm as well as upper thigh circumferences followed by lower biceps and higher thigh skinfold thicknesses. They also had significantly lower endomorphy (premenopausal: 5.84±1.78 vs. 6.55±0.96, p=0.027; postmenopausal: 6.89±1.52 vs. 7.37±0.86, p=0.035) and significantly higher ectomorphy (premenopausal: 2.05±1.30 vs. 1.41±0.99, p=0.018; postmenopausal: 1.06±0.90 vs. 0.68±0.56, p=0.007), as well as higher mesomorphy only in postmenopausal women (6.10±2.04 vs. 5.37±1.34, p=0.022). Most represented somatotype among breast cancer patients was endomorph-mesomorph while the most healthy controls were mesomorphic endomorph. Android body type increases the risk of development of breast cancer. Indicators of skeletal dimensions, muscle volume and peripheral adiposity had better predictive value over markers of central and overall adiposity.

Red blood cell autoantibodies (RBC autoAbs) of IgG class are found in the majority of patients with warm autoimmune hemolytic anemia (wAIHA) but sometimes also during the pretransfusion testing of patients with different diagnoses but without hemolysis. The aim of the study was to identify the main differences between these two groups of patients according to age, gender, subclass and titer of IgG RBC autoAbs and diagnosis.In the 9-year retrospective study, data were collected from records of 291 patients with IgG RBC autoAbs detected by gel technique, from which 111 with wAIHA.More than 85% of patients in both groups were over 40 years old, with male to female ratio 1:1.9 in wAIHA vs 1:1.3 in patients without hemolysis (P=0.0916). The main characteristics of patients with wAIHA vs patients without hemolysis were: IgG only 38% vs 70%, IgG+Complement 62% vs 30%, total IgG1 79% vs 55%, IgG1+IgG3 35% vs 11%, titer of 100 for IgG1+IgG3 17% vs 3% (P0.0001), respectively, while titer of 100 for IgG1 18% vs 9% (P=0.0241). The underlying diagnosis in wAIHA vs patients without hemolysis: hematologic disorders 41% vs 22% (P=0.0006), autoimmune disorders 12% vs 13% (P=0.8033), solid tumors 5% vs 14% (P=0.0154) and surgery procedures 6% vs 26% (P0.0001).We observed more wAIHA patients with high titer of IgG1 and high prevalence of IgG1+IgG3 and consider that patients without hemolysis having identical results might be interesting to find out how they are protected from damage by RBC autoAbs.

An ecosystem services (ES) approach to chemical risk assessment has many potential advantages, but there are also substantial challenges regarding its implementation. We report the findings of a multi-stakeholder workshop that evaluated the feasibility of adopting an ES approach to chemical risk assessment using currently available tools and data. Also evaluated is the added value such an approach would bring to environmental decision making. The aim was to build consensus across disparate stakeholders and to co-produce a common understanding of the regulatory benefits and feasibility of implementing an ES approach in European chemicals regulation. Workshop discussions were informed by proof of concept studies and resulted in the development of a novel tiered framework for assessing chemical risk to ES delivery. There was consensus on the substantial added value of adopting an ES-based approach for regulatory decision making. Ecosystem services provide a common currency and a ‘unifying approach’ across environmental compartments, stressors and regulatory frameworks. The ES approach informs prioritisation of risk and remedial action and aids risk communication and risk management. It facilitates a more holistic assessment, enables ES trade-offs to be compared across alternative interventions, and supports comparative risk assessments and a socio-economic analysis of management options and decisions. Key to realising this added value is a shift away from using a single threshold value to categorise risk, towards a consideration of the exposure-effect distribution for individual ES of interest. Also required is the development of an integrated systems-level approach across regulatory frameworks and agreement on specific protection goals and scenarios for framing environmental risk assessments. The need to further develop tools for extrapolating toxicity data to service providers and ES delivery, including logic chains and ecological production functions, was highlighted. Also agreed was the need for methods and metrics for ES valuation to be used in assessing trade-offs.

Gunduz C, Basoglu OK, Hedner J, et al; onbehalf of the European Sleep Apnoea Databasecollaborators (Biruni University; Ege University;Gothenburg University; Sahlgrenska UniversityHospital; University of Palermo; CNR Institute ofBiomedicine and Molecular Immunology; St. AdolfStift; Hospital de Santa Maria; University of Crete;Antoine-Beclere Hospital; G. PapanikolaouHospital; Institute of Tuberculosis and LungDiseases; University Hospital Brno; St. Ann’sUniversity Hospital; Universite ́ Grenoble Alpes)Hyperlipidaemia prevalence and cholesterolcontrol in obstructive sleep apnoea: Data from theEuropean sleep apnea database (ESADA).J InternMed2019;286: 676–688.Background and objective.Obstructive sleep apnoea(OSA) and hyperlipidaemia are independent riskfactors for cardiovascular disease. This studyinvestigates the association between OSA andprevalence of hyperlipidaemia in patients of theEuropean Sleep Apnea Database (ESADA) cohort.Methods.The cross-sectional analysis included11 892 patients (age 51.9 12.5 years, 70% male,body mass index (BMI) 31.3 6.6 kg/m2, meanoxygen desaturation index (ODI) 23.7 25.5events/h) investigated for OSA. The independentodds ratio (OR) for hyperlipidaemia in relation tomeasures of OSA (ODI, apnoea-hypopnoea index,mean and lowest oxygen saturation) was deter-mined by means of general linear model analysiswith adjustment for important confounders suchas age, BMI, comorbidities and study site.Results.Hyperlipidaemia prevalence increased from15.1% in subjects without OSA to 26.1% in thosewith severe OSA,P

Assessing and managing risks of anthropogenic activities to ecological systems is necessary to ensure sustained delivery of ecosystem services for future generations. Ecological models provide a means of quantitatively linking measured risk assessment endpoints with protection goals, by integrating potential chemical effects with species life history, ecological interactions, environmental drivers and other potential stressors. Here we demonstrate how an ecosystem modeling approach can be used to quantify insecticide-induced impacts on ecosystem services provided by a lake from toxicity data for organism-level endpoints. We used a publicly available aquatic ecosystem model AQUATOX that integrates environmental fate of chemicals and their impacts on food webs in aquatic environments. By simulating a range of exposure patterns, we illustrated how exposure to a hypothetical insecticide could affect aquatic species populations (e.g., recreational fish abundance) and environmental properties (e.g., water clarity) that would in turn affect delivery of ecosystem services. Different results were observed for different species of fish, thus the decision to manage the use of the insecticide for ecosystem services derived by anglers depends upon the favored species of fish. In our hypothetical shallow reservoir, water clarity was mostly driven by changes in food web dynamics, specifically the presence of zooplankton. In contrast to the complex response by fishing value, water clarity increased with reduced insecticide use, which produced a monotonic increase in value by waders and swimmers. Our study clearly showed the importance of considering nonlinear ecosystem feedbacks where the presence of insecticide changed the modeled food-web dynamics in unexpected ways. Our study highlights one of the main advantages of using ecological models for risk assessment, namely the ability to generalize to meaningful levels of organization and to facilitate quantitative comparisons among alternative scenarios and associated trade-offs among them while explicitly accounting for different groups of beneficiaries.

Antibodies targeting calcitonin gene-related peptide (CGRP) or its receptor have shown efficacy in the prevention of migraine attacks. We investigated the efficacy and tolerability of fremanezumab, a fully humanised CGRP antibody, in patients with migraine who had previously not responded to two to four classes of migraine preventive medications.The randomised, double-blind, placebo-controlled, parallel-group, phase 3b FOCUS trial was done at 104 sites (including hospitals, medical centres, research institutes, and group practice clinics) across Belgium, the Czech Republic, Denmark, Finland, France, Germany, Italy, the Netherlands, Poland, Spain, Sweden, Switzerland, the UK, and the USA. We enrolled participants aged 18-70 years with episodic or chronic migraine who had documented failure to two to four classes of migraine preventive medications in the past 10 years. Failure was defined as no clinically meaningful improvement after at least 3 months of therapy at a stable dose, as per the treating physician's judgment; discontinuation because of adverse events that made treatment intolerable; or treatment contraindicated or unsuitable for the preventive treatment of migraine for the patient. Participants were randomly assigned (1:1:1) by electronic interactive response technology to subcutaneously administered quarterly fremanezumab (month 1, 675 mg; months 2 and 3: placebo), monthly fremanezumab (month 1: 225 mg in episodic migraine and 675 mg in chronic migraine; months 2 and 3: 225 mg in both migraine subgroups), or matched monthly placebo for 12 weeks. The primary outcome was mean change from baseline in the monthly average number of migraine days during the 12-week treatment period. This trial is registered with ClinicalTrials.gov, number NCT03308968, and is now completed.Between Nov 10, 2017, and July 6, 2018, 838 participants with episodic (329 [39%]) or chronic (509 [61%]) migraine were randomly assigned to placebo (n=279), quarterly fremanezumab (n=276), or monthly fremanezumab (n=283). Reductions from baseline in monthly average migraine days over 12 weeks were greater versus placebo (least-squares mean [LSM] change -0·6 [SE 0·3]) with quarterly fremanezumab (LSM change -3·7 [0·3]; LSM difference vs placebo -3·1 [95% CI -3·8 to -2·4]; p0·0001) and with monthly fremanezumab (LSM change -4·1 [0·34]; LSM difference vs placebo -3·5 [-4·2 to -2·8]; p0·0001). Adverse events were similar for placebo and fremanezumab. Serious adverse events were reported in four (1%) of 277 participants with placebo, two (1%) of 276 with quarterly fremanezumab, and four (1%) of 285 with monthly fremanezumab.Fremanezumab was effective and well tolerated in patients with difficult-to-treat migraine who had previously not responded to up to four classes of migraine preventive medications.Teva Pharmaceuticals.

Purpose To examine vision-related quality of life in patients with diabetic macular edema (DME) treated with intravitreal aflibercept (EYLEA, Regeneron Pharmaceuticals, Inc, Tarrytown, NY). Design AQUA was a multicenter, open-label, single-arm, phase 4 study. Participants Adults 18 years of age or older with type 1 or 2 diabetes mellitus and DME. Methods Patients received intravitreal aflibercept 2 mg every 8 weeks for 52 weeks, after 5 initial doses every 4 weeks. Main Outcome Measures The primary outcome was the change in 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) total score from baseline to week 52. Secondary outcomes included the change in NEI VFQ-25 near and distant activities subscale scores, best-corrected visual acuity (BCVA; Early Treatment Diabetic Retinopathy Study [ETDRS] letters), and central retinal thickness (CRT) from baseline to week 52. Change in NEI VFQ-25 score at week 52 for better-seeing eyes (BSEs) and worse-seeing eyes (WSEs) also was evaluated. Results A total of 553 patients comprised the full analysis set, and 560 patients comprised the safety analysis set. At baseline, the mean NEI VFQ-25 total score was 70.12, mean BCVA was 61.5 ETDRS letters, and mean CRT was 464.81 μm. A mean of 8.8 injections were administered over 52 weeks. At week 52, the mean improvement from baseline in the NEI VFQ-25 total score was +6.11 (standard deviation [SD], 11.46); the corresponding improvements in near and distant activities were +11.37 (SD, 18.01) and +7.33 (SD, 17.32), respectively. Similarly, improvements in patients whose BSE and WSE were treated were 7.74 (SD, 13.59) and 5.48 (SD, 9.70), respectively. At week 52, mean change in BCVA was +10.0 ETDRS letters (SD, 8.0 ETDRS letters), and mean change in CRT was –175.38 μm (SD, 132.62 μm). Overall, 53.6% of patients reported treatment-emergent adverse events (TEAEs), of whom 26.8% experienced an ocular TEAE in the study eye. The most common serious ocular TEAE was endophthalmitis (0.5% [n = 3]). Five deaths (0.9%) were reported, but were not considered treatment related. Conclusions Intravitreal aflibercept was associated with clinically meaningful improvements in NEI VFQ-25 total score over 52 weeks in patients with DME; these were even more pronounced for near than for distant activities. Adverse events were consistent with the known safety profile of intravitreal aflibercept.

Purpose To compare the efficacy of ranibizumab using a treat-and-extend (TE monthly, n = 258). At baseline, mean age was 78.8 years (standard deviation [SD], 7.8 years), 60.3% were women, and 94.3% were white. No significant between-group baseline differences were observed. The primary outcome of noninferiority regarding visual acuity was met with mean BCVA improvement of 8.4 letters (SD, 11.9 letters) and 6.0 letters (SD, 11.9 letters; P = 0.017) in the T&E and monthly regimens, respectively, with a between-group mean difference of 2.38 letters (95% confidence interval, 0.32–4.45 letters). Per protocol, a secondary analysis was performed to test for superiority of number of injections received up to month 12. This analysis demonstrated significantly fewer injections with T&E versus monthly dosing (9.4 and 11.8 injections, respectively), with a mean difference of –2.46 injections (95% confidence interval, –2.68 to –2.23 injections). Conclusions The 12-month results of this 2-year study demonstrated that regarding visual outcomes, the T&E regimen was noninferior to a monthly dosing regimen. Similar visual outcomes in the T&E group as in the monthly dosing group were achieved with significantly fewer injections.

The relationship between aging and changes in heart rate variability (HRV) could depend on the metabolic profile of obese people, i.e. metabolically healthy obese (MHO) and metabolically unhealthy obese (MUO). We aimed to determine the age at which obesity related autonomic dysfunction becomes significant and whether it decreases differently according to metabolic profile. We analyzed HRV in 99 adults using Wildman’s criteria for metabolic profile and 5-minute HRV for autonomic nervous system. In MHO, high frequency (HF) decreased in the 4th decade of life. In MUO, standard deviation of R-R intervals (SDNN), root mean square of successive differences of all R-R intervals (RMSSD), number of adjacent intervals differing by more than 50 ms expressed as percentage of all intervals in the collecting period (pNN50), HF, low frequency (LF), LF/HF (LF divided by HF) and total power (TP) decreased in the 4th decade of life (partial shared variance 28%-36%). In conclusion, an age dependent decrease of HRV occurs in MUO between the third and fifth decade of life. In MHO, HF significantly decreases around the age of 40 years. Cardiometabolic profile influences metabolic aging, altering the autonomic nervous system., Dobne promjene u varijabilnosti srčane frekvencije (HRV) mogu zavisiti o metaboličkom profilu pretilih osoba, tj. metaboličkin zdrave (MHO) i metabolički rizične pretile osobe (MUO). Željeli smo utvrditi dob u kojoj nastupa autonomna disfunkcija povezana s pretilošću te opada li HRV različito kod osoba različitog metaboličkog profila. Analizirali smo HRV kod 99 odraslih osoba uz primjenu Wildmanovih kriterija metaboličkog profila i HRV kao aktivnosti autonomnog živčanog sustava. Kod MHO, visoka frekvencija (HF) opadala je u 4. desetljeću života. Kod MUO su standardna devijacija svih R-R intervala (SDNN), kvadratni korijen srednje razlike između sukcesivnih normalnih R-R intevala (RMSSD), postotak sukcesivnih R-R intervala vrijednost kojih prelazi 50 ms (pNN50), HF, niska frekvencija (LF), omjer LF i HF (LF/HF) i ukupna spektralna snaga (TP) opadali u 4. desetljeću života (parcijalna podijeljena varijanca 28%-36%). U zaključku, utvrđen je od dobi zavisan pad HRV kod MUO između trećeg i petog desetljeća života. Kod MHO osoba HF je značajno opala oko 40. godine života. Kardiometabolički profil utječe na starenje remeteći funkcije autonomnog živčanog sustava.

Introduction/Objective. Craniofacial dysmorphology has been shown as the most prominent among physical anomalies in schizophrenia patients. The aim of the present study was to investigate the frequency of craniofacial anomalies in Serbian schizophrenia patients. Methods. A list of 27 minor physical anomalies (modified Waldrop scale) and nine ratios of craniofacial measures was used to detect the presence of craniofacial dysmorphology in 126 schizophrenia patients and 124 healthy controls. Results. Compared to the healthy subjects, schizophrenia patients had significantly higher rates of the following minor physical anomalies: fine hair, two or more hair whorls, fused eyebrows, wide nose basis, low-seated ears, high steepled and high flat palate, and furrowed tongue (most prevalent were vertical fissures and diffusely distributed fissures) with significance of p ? 0.001. The best predicting parameters for distinguishing between schizophrenics and controls were the inner canthus distance, the outer canthus distance, hair whorls (all at level p = 0.000), and high steepled palate (p ? 0.001). Conclusion. The results of the present study confirm the neurodevelopmental concept of schizophrenia, being potentially useful for further psychiatric-anthropological research. Clinical significance is reflected in the possibility of monitoring the potential mental illness in childhood through potential ectodermal markers, as well as the possibility of their comparison with the psychological profile in early adolescence.

Purpose To assess the associations and predictive value of spectral-domain (SD) OCT inner and outer retinal structural parameters and visual acuity (VA) outcomes in macular edema (ME) secondary to central retinal vein occlusion (CRVO). Design Retrospective, longitudinal cohort study. Participants Eighty-four patients with ME secondary to CRVO receiving pro re nata anti–vascular endothelial growth factor (VEGF) therapy at 3 tertiary-level retina referral centers. Methods In all participants, VA, demographic and clinical parameters, and SD OCT images from baseline, 3 months, and 12 months were reviewed. Spectral-domain OCT–based morphologic features in the 1500-μm foveal zone were analyzed by masked graders for disorganization of the retinal inner layers (DRIL), ellipsoid zone (EZ) and external limiting membrane disruption, cone outer segment tip (COST) visibility, cysts, subretinal and intraretinal fluid, and epiretinal membranes. Main Outcome Measures Spectral-domain OCT–based retinal structural parameters and VA outcomes. Results In multivariate analyses adjusting for baseline VA, worsening VA over 1 year was associated with 1-year increases in DRIL (point estimate, 0.06 per 100 μm; P Conclusions Early recovery over 3 months in both DRIL and EZ parameters are key drivers of 1-year VA outcomes. Predictive models incorporating 3-month changes in DRIL and EZ disruption support their usefulness as potential robust determinants of future VA.

Waist-to-height ratio (WHtR) has been shown to be a valuable predictor of cardiometabolic risk. Most studies recommend value of 0.5 as the predictive value for both genders and for all age groups. Considering body height changes with aging and gender-dependent differences in patterns of fat distribution with aging, the main purpose of this study was to assess ageand gender-specific predictive values of WHtR for metabolic syndrome. A total of 1517 subjects (725 men and 792 women) aged 18 to 67y (BMI: 16.60-64.60 kg/m2) were included in the study. According to IDF criteria for metabolic syndrome predictive values of WHtR were calculated for each age-category and both genders. WHtR showed higher predictive values in men than in women. In men, predictive values increase with aging from 0.52 (

Background: Comorbidities are major predictors of in-hospital mortality in stroke patients. The Charlson comorbidity index (CCI) and the Elikhauser comorbidity index (ECI) are scoring systems for classifying comorbidities. We aimed to compare the performance of the CCI and ECI to predict in-hospital mortality in stroke patients. Methods: We included patients hospitalized for stroke in the Clinical Center of Kragujevac, Serbia for the last 7 years. Hospitalizations caused by stroke, were identified by the International Classification of Diseases-10 (ICD-10) codes I60.0 - I69.9. All patients were divided into two cohorts: Alive cohort (n=3297) and Mortality cohort (n=978). Results: There were significant associations between higher CCIS and increased risk of in-hospital mortality (HR = 1.07, 95% CI = 1.01–1.12) and between higher ECIS and increased risk of in-hospital mortality (HR = 1.04, 95% CI = 0.99–1.09). Almost 2/3 patients (66.9%) had comorbidities included in the CCI score and 1/3 patients (30.2%) had comorbidities included in the ECI score. The statistically significant higher CCI score (t = -3.88, df = 1017.96, P

BACKGROUND/AIM Dental trauma is one of the critical oral health problems in childhood and adolescence that can affect an individual's quality of life. Teachers may witness a dental injury on many occasions, and they are likely to be involved at the site of an accident. Hence, they should be capable of managing prompt and correct emergency treatment at the accident site. The aim of this cross-sectional study was to assess the level of knowledge and experience of Croatian elementary and high school teachers concerning dental trauma. MATERIALS AND METHODS A questionnaire-based cross-sectional online survey was conducted to determine knowledge and experience about traumatic dental injuries among 803 full-time working elementary and high school teachers. The inclusion criteria were full-time employment at the time of data collection with at least 1 year of teaching experience. Retirement (teachers aged ≥65 years) and unwillingness to participate in the survey were the exclusion criteria. The Student t test or one-way ANOVA, with Tukey's post hoc was used to evaluate the obtained data. The level of significance was set at p ≤ .05. RESULTS The overall mean level of teachers' knowledge regarding emergency management of dental trauma was 6.6 ± 2.5 points, out of a maximum possible score of 14. There were no significant differences in knowledge among teachers from lower elementary, upper elementary, and high school education (6.9 ± 2.5, 6.5 ± 2.4 vs 6.4 ± 2.6 points, respectively; p = .140). Teachers who had personally experienced dental trauma showed better knowledge (7.2 ± 2.6 vs 6.4 ± 2.5 points; p ≤ .001). CONCLUSION The knowledge of emergency management of dental trauma among elementary and high school teachers in Croatia is low. Since most of the participants expressed willingness for future education regarding this subject, educational programs are recommended.

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy characterized by excessive trabeculation and deep intertrabecular recesses most commonly affecting apical and mid- ventricular inferior and lateral segments. These patients are more prone to develop a typical triad of heart failure, thromboembolic events, and malignant arrhythmias. LVNC often coexists with other congenital or valvular heart diseases. Echocardiography is the standard imaging for the diagnosis of LVNC with several proposed criteria, mainly based on the ratio of non-compacted to compacted myocardial thickness

Aim: To study the impact of age and sex-related differences in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). Methods and Results: From March 2017 to November 2019, 9106 patients (6309 men and 2797 women) with ACS from 13 PCI centers were enrolled in this study (STENOS Registry). Among enrolled patients, men (69%) were younger than women (63y vs. 68y, P = 0.001), with a higher prevalence of previous myocardial infarction (15% vs 9.5% P < 0.001), previous PCI (15.9 vs. 9.7%, P = 0.003), and similar frequency of previous cerebrovascular insult and peripheral artery disease (PAD). The most affected coronary artery was proximal and mid left anterior descending (LAD) in both gender and all ages. PCI on coronary artery bypass (CABG) was performed in 0.3% (0.3% in men vs 0.18% in women). In patients under age 55, 25% of men vs 11% of women (p

Sleep disordered breathing (SDB) is highly prevalent with a male to female predominance of two to one, and is more common in middle-aged and elderly subjects [1]. Affected patients often present with comorbidities such as obesity, cardiovascular disease (systemic hypertension, heart failure, atrial fibrillation), and diabetes mellitus Type II [2]. The strong overlap between the profile for SDB patients and the identified risk factors for adverse outcomes of COVID-19 infection that include age, male gender, and cardio-metabolic comorbidity [3] suggest that SDB patients may benefit from effective therapy if confronted with COVID-19 infection [4].

Objective/Background: The Clinical Global Impression scale (CGI) reflects the clinician's assessment of the disease impact on patient's global functioning. We assessed predictors of CGI scale rating in patients with obstructive sleep apnea (OSA). Patients/Methods: Consecutive patients with suspected OSA (n = 7581) were identified in the European Sleep Apnea Database (ESADA). Anthropometrics, comorbidities, apnea severity obtained by polygraphy or polysomnography, and daytime sleepiness [Epworth Sleepiness Scale (ESS)] were assessed. The CGI 7-point scale was completed at the end of the diagnostic process (CGI-severity, ie, CGI-S) and, in a sub-population, at treatment follow-up (CGI-Improvement). Results: CGI-S was rated mild to moderate in 44% of patients. CGI rating at any given apnea intensity was worse in women than in men (p < 0.01). Patients undergoing polygraphy (n = 5075) were more frequently rated as severely ill compared to those studied with polysomnography (19.0% vs 13.0%, p < 0.001). In patients aged

Background Polycystic ovary syndrome (PCOS) is a complex and multi-faceted endocrine disorder that affects 5–20% of women. Literature is limited regarding potentially differing PCOS phenotypes among women around the world. Objective To use Flo app technology to understand the multifaceted characteristics of PCOS across several countries and identify contributing risk factors to the development of this condition. Study design Flo is a widely used female health and wellbeing app with period tracking functionality that provides a globally representative and medically unbiased perspective on PCOS symptomatology. A chatbot dialog on PCOS was subsequently administered on the Flo application (app) to users from 142 countries (with at least 100 respondents) who have the app running in English during September–October 2019. Results For analyses, we selected the five countries with the greatest number of respondents: US (n = 243,238), UK (n = 68,325), India (n = 40,092), Philippines (n = 35,131), and Australia (n = 29,926). Bloating was the most frequently reported symptom among PCOS-positive women and appeared to be the main predictor of PCOS in our model (odds ratio 3·76 [95% CI 3·60–3·94]; p Conclusion Our findings are based on the largest known PCOS dataset and indicate that symptoms are more complex than previously understood. The most frequently reported symptoms (bloating, facial hirsutism, irregular cycles, hyperpigmentation, and baldness) are broader than those included in the Rotterdam criteria. Future work should reevaluate and refine the criteria utilized in PCOS diagnosis.

Aim The evidence of the value of pharmaceutical care continues to grow, however, data on its effect in rural areas are still scarce. The aim of this article was to evaluate the economic impact of a clinical pharmacist's involvement in the hospital medicines policy design in a rural area, through the drug and therapeutics committee (DTC) and public procurement for medicines. Methods An economic evaluation was conducted in the General Hospital Bjelovar which covers the Bjelovarsko-Bilogorska County in Croatia. It included costs from denial and approval decisions of the drug and therapeutics committee, during a 1-year period between June 1, 2019 and June 1, 2020, and costs for medicines in 2018 and 2019 that were intended for public procurement. The cost-benefit analysis and cost-minimisation analyses for the DTC and public procurement data have been conducted for the evaluation of the economic impact of a clinical pharmacist. Results The involvement of a clinical pharmacist in the hospital medicines policy design through the DTC and public procurement for medicines provides an economic benefit. This resulted in a cost-benefit ratio of 14.18:1 and 18.31% and 17.58% savings through the DTC and public procurement process, respectively. To put in a different perspective, around 14 yearly gross salaries can be paid out from savings achieved by the clinical pharmacist through a 1-year period. Conclusion The involvement of a clinical pharmacist in the hospital medicines policy in a rural area hospital results with an optimisation of investment in medicines and leads to substantial cost savings for the healthcare system.

Background The experiences of Black children with food allergy (FA) are not well characterized, particularly with respect to bullying victimization and other psychosocial outcomes. Objective To evaluate bullying experiences of Black and White children with FA, including associations with peer relationships, anxiety, and school policies. Methods Surveys were administered to parents of 252 children with physician-diagnosed FA enrolled in the multisite FORWARD cohort. The surveys assessed demographics, atopic disease, bullying victimization, and school FA management practices and policies. Descriptive statistics of bullying by race were compared by χ2 tests. Multiple logistic regression analyses adjusting for race, age, parental education, household income, child sex, and multi-FA compared adjusted probabilities of bullying victimization by school policies. Results Nearly 20% of school-aged children were bullied for FA with no substantial racial differences overall, though for children ages 11 years and up, White children reported higher rates of bullying. However, Black children experienced non-FA–related bullying twice as frequently as White children (38.6% vs 17.7%; P = .002). Most of the caregivers (85.7%) who intervened in their child's bullying reported that it was helpful. Among parents, 17.3% reported that they were teased or bullied owing to their child's FA. More than half of the respondents (54.8%) reported that some allergens are banned from their child's school, most typically peanut. In schools banning peanuts, FA-related bullying was less frequently reported by all students who have food allergy. Conclusion Bullying owing to FA is common, and caregivers, medical professionals, and school administrators can help reduce bullying by screening for bullying and supporting and educating school policies.

This paper is focused on the assessment of human exposure to electromagnetic signals with continuous spectra. A convenient and simple approach is proposed, to compare the measured field levels with the maximum exposure levels and verify compliance with the relevant regulations. In the presence of signals with continuous spectra, the proposed method yields more accurate results than the procedure outlined by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). In particular, the proposed approach is based on the classical signal theory and requires the integration in the spectral domain of the electric field amplitude, or of the square of the electric field amplitude. Illustrative computational examples are presented, dealing with human exposure to Universal Mobile Telecommunications System (UMTS), Long-Term Evolution (LTE), experimental 5G, and Ground Penetrating Radar (GPR) signals. All of these examples are based on real measured data.

Background/aims: With the growing popularity of water polo across the world, there has been rising awareness of the risks for orofacial injures in water polo. The aim of this study was to evaluate knowledge and attitudes of water polo coaches regarding dental trauma, dental emergency procedures and awareness about prevention of such injuries. Materials and methods: A specific questionnaire comprising 25 questions regarding knowledge, experiences, and behaviors following dental trauma was distributed to 62 water polo coaches during the license renewal seminar held by the Croatian Water Polo Federation, in February 2018 in Split, Croatia. Chi-square with Yates correction when necessary, and Fisher's exact tests were used in statistical analysis, and the results were considered statistically significant when P < .05. Results: There were 51 water polo coaches who participated in this study. Their ages ranged from 19 to 60 years. Most of the coaches (90.2%) have seen a dental injury in their players during their coaching careers. Concerning the procedure with handling an avulsed tooth, there were 68.6% coaches who would maintain the avulsed tooth in a handkerchief or gauze along with four coaches (7.8%) who would rinse the avulsed tooth under water and wrap it in a handkerchief or gauze afterward. Only one participant (2%) would maintain the avulsed tooth in saline solution before its replantation. None of the coaches would use milk for maintaining the avulsed tooth. Only seven coaches (13.7%) have previously had education about sports-related dental injuries, dental emergency procedures, and prevention of such injuries. Conclusions: The results of this study demonstrated poor level of knowledge of water polo coaches about dental injuries and dental emergency procedures. Their knowledge and attitudes could be improved by educational programs on dental injuries and dental emergency procedures, as well as sports-related dental injuries management.

Introduction/Objective Irrigation has an important role in root canal cleaning and its efficiency depends on the type of irrigants, the amount, the technique and the irrigation protocol. The aim of this work was to estimate the efficiency of cleaning of the canal walls by using scanning electron microscope analysis after the instrumentation by rotary NiTi instruments with the use of three different irrigation solutions and two final irrigation protocols. Methods Sixty extracted human incisors were divided into two groups after the rotary instrumentation with the iRace instruments. In both groups, the same amount (1.5 ml) of three solutions (2% sodium hypochlorite solution, 2% chlorhexidine solution, and 10% citric acid solution) and total final irrigation time (90 seconds) was the same. The final irrigation in the first group was accomplished using the technique of continuous irrigation and in the second group it was done using the intermittent protocol. The roots were cut longitudinally and analyzed by thirds (coronal, middle, and apical) on a scanning electron microscope (JSM 6460LV, JEOL Ltd., Tokyo, Japan) with 1,000× magnification. Results the most efficient cleaning of the root canal walls in both groups was seen after the use of citric acid with the intermittent protocol of the final irrigation (90.7% clean walls), while the least efficient was the final irrigation by chlorhexidine with continuous irrigation (80.3%). The most efficient cleaning of the canal walls in both groups was observed in the coronal third and the largest amount of the smear layer in the apical third. Conclusion the most efficient cleaning of the canal was achieved by the use of citric acid and the intermittent protocol of the final irrigation. In all tested solutions, the intermittent protocol of irrigation was more efficient than continuous irrigation., Uvod/Cilj Irigacija ima važnu ulogu u čišćenju kanala korena, a njena efikasnost zavisi od vrste irigansa, količine, odnosno tehnike i protokola irigacije. Cilj ovog rada bio je da se analizom SEM proceni efikasnost čišćenja zidova kanala posle instrumentacije rotirajućim NiTi instrumentima uz primenu tri različita rastvora za irigaciju i dva protokola finalne irigacije. Metode Šezdeset ekstrahovanih humanih sekutića je posle mašinske instrumentacije iRaCe instrumentima podeljeno u dve grupe. U obe grupe su korišćena po tri rastvora - 2% rastvor natrijum-hipohlorita, 2% rastvor hlorheksidina i 10% rastvor limunske kiseline, u istoj količini (1,5 ml) i ukupnom vremenu finalne irigacije (90 sekundi). Finalna irigacija u prvoj grupi je realizovana tehnikom kontinuirane, a u drugoj tehnikom intermitentne irigacije. Korenovi su presečeni uzdužno i analizirani po trećinama (krunična, srednja i apikalna) na skenirajućem elektronskom mikroskopu (JSM 6460LV JEOL, Tokio, Japan) na uveličanju od 1000×. Rezultati Najefikasnije čišćenje zidova kanala korena u obe grupe uočeno je posle primene limunske kiseline uz intermitentni protokol finalne irigacije (90,7% čistih zidova), dok je najmanje efikasna bila finalna irigacija hlorheksidinom uz kontinuiranu irigaciju (80,3%). Najefikasnije čišćenje zidova kanala i u prvoj i u drugoj grupi uočeno je u kruničnoj trećini, a najviše razmaznog sloja u apikalnoj trećini. Zaključak Najefikasnije čišćenje kanala ostvareno je primenom limunske kiseline i intermitentnog protokola finalne irigacije. Kod svih testiranih rastvora intermitentni protokol irigacije je bio nešto efikasniji od protokola kontinuirane irigacije.

STUDY OBJECTIVES: The main objectives of the study were to determine plasma adropin, systemic inflammation biomarker levels, and glucose metabolism parameters in patients with moderate and severe obstructive sleep apnea (OSA) compared to healthy controls. METHODS: In this study, we included 50 male patients with OSA (25 moderate and 25 severe) and 25 age- and sex-matched control subjects. All subjects underwent fasting sampling of peripheral blood for laboratory analyses. RESULTS: Adropin plasma levels were significantly lower in the severe OSA group in comparison with the moderate and control groups (4.50 ± 1.45 versus 6.55 ± 1.68 versus 8.15 ± 1.79 ng/mL, P < .001). Plasma biomarkers of systemic inflammation were significantly increased in patients with moderate OSA (interleukin [IL]-6 and tumor necrosis factor alpha [TNF-α]) and severe OSA (IL-6, TNF-α, high-sensitivity C- reactive protein) when compared with controls (P < .001). Adropin levels showed a significant negative correlation with IL-6 (r = -.419, P < .001), TNF-α (r = -.540, P < .001), fasting glucose (r = -.331, P = .004), hemoglobin A1c (r = -.438, P < .001), homeostatic model assessment insulin resistance index (r = -.213, P = .046), and polysomnographic parameters including apnea-hypopnea index (r = -.615, P < .001) and oxygen desaturation index (r = -.573, P < .001). A multivariate regression analysis showed that plasma adropin remained as a significant negative predictor of severe OSA status, when adjusted for age and body mass index and computed along with other inflammatory biomarkers in the regression model (odds ratio 0.069, 95% confidence interval 0.009-0.517, P = .009). CONCLUSIONS: Plasma adropin concentrations significantly correlate with indices of disease severity in patients with OSA, suggesting that adropin potentially plays an important role in the complex pathophysiology of the disease.

Introduction Calcium hydroxide (CH) is a medicament widely used in endodontic treatment due to its antibacterial, regenerative and biocompatible properties. Studies have shown that remaining CH on root canal walls and dentinal tubules can compromise sealer penetration, leading to its weak adhesion, volume change and, consequently, apical leakage. The aim of this study was to compare the efficacy of four different techniques in removing calcium hydroxide from the root canal. Material and Methods 32 extracted single-rooted teeth with one canal were used in this study. The canals were prepared using BioRaCe system (FKG Dentaire, Swiss) BR5 40/.04 with sodium hypochlorite irrigation after each instrument. Longitudinal grooves were formed on the proximal root surfaces. All canals (except negative control) were filled with aqueous CH suspension. After seven days of incubation, the teeth were allocated into the four groups (n=7), plus positive and negative control. Four techniques (systems) for CH removal were tested: conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), XP-endo Finisher (FKG Dentaire, Swiss) and Canal Brush (Roeko, Coltene) with irrigation of 5 ml 2% NaOCl and 5 ml 10% citric acid. All the roots were then split into the two halves with chisel and observed under the stereomicroscope (Boeco, Germany) at magnification of 20x. The area with remaining CH on the root canal wall surface was then divided with the total root canal surface area (%). The obtained results were statistically processed using One-way ANOVA and Tukey post-hoc test (p lt 0.05). Results The most efficient system was XP-endo Finisher with 91.33% of clean surface, followed by PUI 88.36%, Canal Brush 87.83%, and CSI with 66.92%. Conclusion None of the systems completely removed the traces of the medicament from the root canal. For optimal clinical success, it is necessary to combine various systems with copious irrigation., Uvod Kalcijum-hidroksid (CH) predstavlja medikament koji se u velikoj meri koristi u endodontskoj terapiji zbog svojih antibakterijskih, regenerativnih i biokompatibilnih svojstava. Istraživanja pokazuju da ostaci CH na dentinskim zidovima i u tubulima mogu kompromitovati prodor silera, što doprinosi njegovoj lošijoj adheziji, promeni volumena, a samim tim i apeksnom curenju. Cilj rada je bio da se uporedi efikasnost četiri različite tehnike uklanjanja kalcijum-hidroksida iz kanala korena zuba. Materijal i metode Korišćena su 32 ekstrahovana jednokorena zuba sa jednim kanalom. Kanali su mašinski obrađeni BioRaCe sistemom (FKG Dentaire, Swiss) BR5 40/.04 uz irigaciju natrijum-hipohloritom posle svakog instrumenta. Na aproksimalnim površinama korenova napravljeni su uzdužni žlebovi. Svi kanali (osim negativne kontrole) napunjeni su vodenom suspenzijom CH. Posle sedam dana u inkubatoru, zubi su podeljeni u četiri grupe (n = 7), uz pozitivnu i negativnu kontrolu. Testirane su četiri tehnike (sistema) za ukljanjanje CH iz kanala korena: konvencionalna irigacija špricem (CSI), pasivna ultrazvučna irigacija (PUI), XP-endo Finisher (FKG Dentaire, Swiss) i Canal Brush (Roeko, Coltene), uz irigaciju 5 ml 2% NaOCl i 5 ml 10% limunskom kiselinom. Svi korenovi su dletom podeljeni na dve polovine i posmatrani pod stereomikroskopom (Boeco, Germany) na uveličanju od 20×. Od vrednosti ukupne površine kanala korena oduzimane su vrednosti neočišćene površine (%). Dobijene vrednosti su statistički obrađene oneway ANOVA i Tukey post hoc testom (p lt 0,05). Rezultati Najefikasniji sistem bio je XP-endo Finisher sa 91,33%, zatim PUI sa 88,36%, Canal Brush sa 87,83%, i konvencionalna irigacija špricem sa 66,92% očišćene površine kanala korena. Zaključak Nijedan sistem nije u potpunosti uklonio tragove medikamenta iz kanala korena. Za potpuni klinički uspeh neophodno je kombinovati više sistema uz obilnu irigaciju.

Kresimir Gabric,1,2,* Andrija Matetic,1,* Marino Vilovic,1 Tina Ticinovic Kurir,1 Doris Rusic,3 Tea Galic,4 Ivana Jonjic,2 Josko Bozic1 1Department of Pathophysiology, University of Split School of Medicine, Split, Croatia; 2University Eye Hospital Svjetlost, Zagreb, Croatia; 3Department of Pharmacy, University of Split School of Medicine, Split, Croatia; 4Study of Dental Medicine, University of Split School of Medicine, Split, Croatia *These authorscontributed equally to the work Purpose: Our study primarily aimed to investigate health-related quality of life (HRQoL) in type 2 diabetes mellitus (T2DM) patients with different risk for obstructive sleep apnea (OSA).Patients and methods: This cross-sectional, questionnaire-based study included 466 adult patients with T2DM on regular visit to Center for Diabetes of University Hospital of Split from April to September 2017. All subjects underwent detailed anamnestical evaluation and physical examination with anthropometric measurements. Additionally, all subjects completed STOP (Snoring, Tiredness, Observed apnea, and high blood Pressure) questionnaire to assess risk for OSA, Epworth Sleepiness Scale to assess daytime sleepiness, and Medical Outcomes Study Short Form-36 (SF-36) instrument to evaluate HRQoL.Results: Most subjects (N=312, 67.0%) represented high-risk OSA group based on STOP questionnaire (STOP score ≥2). Statistically significantly lower HRQoL scores in all SF-36 dimensions were found in T2DM patients with high risk for OSA compared to low-risk group (P

Study objectives We prospectively investigated the effects of continuous positive airway pressure (CPAP) on long-term cognitive and psychomotor performances, and excessive daytime sleepiness in severe obstructive sleep apnea (OSA) patients. Methods A total of 40 patients were recruited and 23 patients with severe OSA fully completed the study protocol to investigate the effects of CPAP therapy on psychomotor performance at 1, 3, and 6 months and 1 year following initiation of the therapy. Psychomotor CRD-series tests measuring reaction times of light stimulus perception, solving simple arithmetic operations, and complex psychomotor limb coordination, were used in this study. The data collected following CPAP therapy were compared to baseline values prior to the CPAP treatment for each patient. Results All of the measured variables improved following CPAP treatment. However, the most pronounced effect was observed in improvement of reaction times to complex psychomotor limb coordination test (p < 0.05). Self-reported evaluation of excessive daytime sleepiness measured by Epworth Sleepiness Scale (ESS) showed significant decrease from 10.0 ± 1.1 before to 3.5 ± 0.5 (p < 0.001), after 1 year on CPAP therapy. Conclusions The CPAP therapy improved cognitive and psychomotor performance on CRD-series tests with the most significant improvement observed in complex psychomotor limb coordination of severe OSA patients.

This study examined to what extent managers in Slovenian public utility organizations implement intuition into their decision-making process. Study aimed to determine whether there is a statistically significant link between emotional intelligence and the implementation of intuition in the decision-making process of managers in public utility organizations and focused primarily on emotional competencies, or more precisely, on emotional intelligence and intuition and if any statistically significant differences will be determined of intuition among managers and level of education. Aims of the article: to determine whether there is a statistically significant link between emotional intelligence and the implementation of intuition in the decision-making process of managers in public utility organizations. The bases for the theoretical background were a systematic overview and a critical analysis of the literature from the study field. According to the findings from the literature study, links were developed between the study areas and a hypothesis of the relationship between competencies, emotional intelligence and intuitive decisionmaking of managers formed. The study used a questionnaire as a measuring instrument, divided into 6 sets: (1) demographic data, (2) emotional intelligence (ESCQ), (3) intuitive potential, (4) use of intuition in decision making, (5) intuitive synthesis, (6) environmental scale and they were distributed among (110) respondents. Unsolved issues: the research in public utility companies should be conducted on a larger sample of respondents. The respondents in the research often base important decisions on intuition (81.7%). The connection between emotional intelligence and implementation of intuition in the decision-making process was determined. A higher level of formal education is associated with rational decision making – that is, the higher the formal education is, the more rationally and nonintuitively decisions were made. The research was conducted in public utility organizations in Slovenia and it would be beneficial to conduct similar studies in other international public utility organizations, on the basis of which comparisons could be made. У статті автори досліджують частоту використання інтуїції менеджерами словенських комунальних організацій у процесі прийняття рішень. При цьому автори зосереджуються на емоційній компетенції, а саме на емоційному інтелекті та інтуїції. Метою статті є визначення статистичної значимості взаємозв'язку між емоційним інтелектом та використанням інтуїції у процесі прийняття рішень керівниками громадських комунальних організацій. Теоретичну основу дослідження склали результати критичного аналізу наукової літератури за даним напрямом. На основі результатів дослідження автори висунили гіпотези про існування взаємозв’язку між компетенціями, емоційним інтелектом та інтуїцією керівників у процесі прийняття рішень. У ході дослідження було використано метод анкетування та опитано 110 респондентів словенських комунальних організацій. Анкета була розділена на 6 блоків, а саме: (1) демографічні дані, (2) емоційний інтелект (ESCQ), (3) інтуїтивний потенціал, (4) використання інтуїції при прийнятті рішень, (5) інтуїтивний синтез, (6) оточення. При цьому автори наголошують, що аналіз комунальних підприємств повинен проводитися на більшій вибірці респондентів, що є перспективним напрямом для подальших досліджень. Результати опитування показали, що більшість респондентів приймають важливі рішення на основі інтуїції (81,7%). На основі результатів дослідження автори підтвердили гіпотезу про статистично значимий взаємозв’язок між емоційним інтелектом та використанням інтуїції керівниками у процесі прийняття рішень. При цьому, доведено, що рівень освіти впливає на процес прийняття раціональних рішень – тобто, чим вище рівень освіти, тим більше приймається раціональних рішень без використання інтуїції. Автори наголошують на тому, що так як дане дослідження проводилося на прикладі комунальних підприємств Словенії, то необхідним є розширення географії дослідження з метою порівняння та врахування культурних особливостей використання інтуїції при прийнятті рішень.

Background/Aim. Assessment of minor neurological dysfunction (MND) provides information about a child's neurological condition which helps to identify the vulnerability of the child to the development of motor impairment, difficulties in learning or behavioral disorders. The aim of this study was to determine differences in the prevalence of MND in children from the general population with respect to age (5 and 6 years old) and sex. Methods. The examination was carried out in a preschool institution in the city of Novi Sad, Serbia. The total sample included 120 children divided into two groups according to age: 60 children aged 5 (group A) and 60 children aged 6 years (group B). The children were recruited at three randomly selected kindergartens and approximately equal sex representation, randomly selected as well. The testing was done by the Touwen's test, modified by Hadders-Algra. The results were classified into three groups: the absence of MND, presence of simple MND (presence of one or two domains of dysfunction) and the presence of complex MND (presence of at least three domains of dysfunction). Results. Sixtyseven children out of 120 (55.8%) had a normal neurological condition, while 53 (44.2%) showed MND [49 (40.8%) simple, and 4 (3.4%) complex]. MND occurred more frequently in the youngest age group than in the older children (57% vs. 32%; p = 0.01). MND was also more frequent in boys than in girls, but this difference was not statistically significant. Conclusion. Our results show the importance of testing children at preschool age in order to detect potential neurological vulnerability and timely begin with the appropriate therapy.