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This case report presents a patient diagnosed with Tolosa-Hunt syndrome (THS) after an extensive neuro-diagnostic and neuroimaging evaluation. Diagnostic work-up included thorough physical and neurological examination, complete laboratory serum assessments, neuroendocrine and immunohistochemistry analysis, cerebrospinal fluid analysis, neurophysiology assessment, ophthalmologist examination and neuroimaging. Th e most important diagnostic tool in deriving the diagnosis of THS was neuroimaging evaluation that included baseline and follow-up cranial contrast enhanced magnetic resonance imaging (MRI). Baseline cranial contrast enhanced MRI detected a nonspecific inflammatory granulomatous lesion in the right cavernous sinus extending basally towards the right trigeminal cave (Meckel‘s cave) and anteriorly towards the apex of the right orbit. Systemic intravenous high-dose corticosteroid therapy was administered for 3 consecutive days and then tapered down to lower oral steroid doses. Following therapy, the patient experienced complete regression of symptoms. Follow-up cranial contrast enhanced MRI showed significant regression of inflammatory lesion in the area of right cavernous sinus, thus verifying the efficacy of the treatment applied. This paper shows that an extensive diagnostic schedule for THS must be conducted prior to therapeutic treatment, for the possibility of alternative diagnosis. Patients suspected of having THS require careful evaluation, appropriate treatment, and follow-up.

Th e fi rst hospital-based registry of patients with multiple sclerosis (MS) was established at the University Department of Neurology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia, in 2014. Th e aim of the registry was to continuously provide data on the number of hospital-managed MS patients, patterns of disease progression, predictors of disability progression, changes in lifespan and long-term outcomes. Relevant medical data included age and gender of MS patients, family history of MS, data on previous immunization, disease course, Expanded Disability Status Scale (EDSS) score, cerebral magnetic resonance imaging (MRI) lesion load quantification, and cerebrospinal fl uid analysis. Lifestyle habits in MS patients including smoking and alcohol consumption were also analyzed. All data were obtained from primary medical records between January 1, 2014 and January 1, 2015, and entered into the database. Data were evaluated retrospectively according to age and gender diff erences. Results showed that the majority of patients enrolled in the registry had the remitting relapsing course of disease, with low EDSS score indicating no disability or minimal disability. Cerebrospinal fl uid analysis showed that oligoclonal bands were present in the majority of MS patients, with aff ected blood-brain-barrier permeability. According to the remitting relapsing course of the disease, cerebral MRI quantitative analysis demonstrated a signifi cant lesion load in the majority of patients. When stratifi ed by lifestyle habits, smokers and alcohol consumers were more prevalent among male patients. Our hospital-based registry might be considered as a prototype for the national MS registry and should be improved for reliable statistical analysis.

In a certain percentage of patients with craniocervical artery dissection, dissections affect multiple arteries. Some investigators consider that the dissections diagnosed as multiple might have occurred sequentially within a short time frame. We describe an oligosymptomatic patient with bilateral progressive vertebral artery dissection. Careful history taking added new data on transient left arm weakens two months earlier, as a possibility of the earlier disease onset.

The standard costing provides a number of information useful in the management process. In particular, these are data on the level of deviations of manufacturing costs. Effective control requires determining the reasons for the deviations. Factor analysis is the basic tool for calculating the impact of changes in the level of observed factors affecting costs. The impact of these factors can be calculated using the standard cost deviation analysis model. The model determines the stages of the procedure, the components on which the total deviation is divided and how the individual elements are calculated. In this approach, the method of subsequent substitutions is dominated. In connection with the subjectivism of this method, the algorithm has been proposed in the article. In order to improve the objectivity of division of partial deviations, the article presents an approach using the logarithmic method.(original abstract)

Background/Aims: Delayed graft function (DGF) is associated with adverse outcomes after renal transplantation. Bone morphogenetic protein-2 (BMP-2) is involved in both endothelial function and immunological events. We compared expression of BMP-2 in epigastric artery of renal transplant recipients with immediate graft function (IGF) and DGF. Methods: 79 patients were included in this prospective study. Patients were divided in IGF group (64 patients) and DGF group (15 patients). BMP-2 expression in intima media (BMP2m) and endothelium (BMP2e) of epigastric artery was assessed by immunohistochemistry. Results: Lower intensity of BMP2e staining was recorded in DGF compared to IGF. In DGF patients, 93% had no expression of BMP2e and 7% had 1st grade expression, compared to 45% and 41% in IGF group, respectively (P=0.001) (Pst grade expression). Patients who had BMP2e staining positive had lower odds for DGF (OR 0.059 [0.007, 0.477]) and this remained significant even after adjustment for donor and recipient variables, cold ischemia time, and immunological matching (OR 0.038 [0.003, 0.492]). Conclusions: Our results demonstrate that BMP-2 expression in endothelial cells of epigastric arteries may predict development of DGF.

Stroke is the second leading cause of death and the most important cause of adult disability worldwide and in Croatia. In the past, stroke was almost exclusively considered to be a disease of the elderly; however, today the age limit has considerably lowered towards younger age. The aim of this study was to determine age and gender impact on stroke patients in a Croatian urban area during one-year survey. The study included all acute stroke patients admitted to our Department in 2004. A compiled stroke questionnaire was fulfilled during hospitalization by medical personnel on the following items: stroke risk factors including lifestyle habits (smoking and alcohol), pre-stroke physical ability evaluation, stroke evolution data, laboratory and computed tomography findings, outcome data and post-stroke disability assessment. Appropriate statistical analysis of numerical and categorical data was performed at the level of p

Biofeedback is a training method, which connects physiological and psychological processes in a person for the purposes of improving his/her physical, emotional, mental and spiritual health. In biofeedback treatment, an active role of the patient is stressed for him/her to be able to actively control the physiological and emotional processes. The aim of biofeedback is to improve the conscious control of the individual’s involuntary physiological activity. Research has shown that biofeedback, either applied alone or in combination with other behavioral therapies (techniques), is an effective treatment for various medical and psychological disorders, from headache and hypertension to temporomandibular and attention deficit disorders. More than 90% of adults experience headache once a year, which makes headache one of the most common symptoms and diagnoses in medicine. Tension-type headaches occur in at least 40% of the population and their impact on the health insurance costs and diminished productivity is significant. Studies have shown that clinical biofeedback training is effective in treating headaches. Moreover, the authors stress the need for additional research and further development of methodology for this kind of research.

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system and usually occurs at the age when people would be expected to be in the prime of their sexual lives. In everyday practice, sexual dysfunction is underestimated because clinicians mostly concentrate on the classic neurologic deficits and often overlook symptoms that can seriously affect the quality of life. Our study included 98 patients (42 men and 56 women, mean age 35±12 years) with relapse from our MS register, with established diagnosis of relapsing remitting multiple sclerosis according to McDonald criteria. Patients completed the questionnaires (Sexual Satisfaction Scale, SSS and Beck Depression Scale BDS), and underwent neurological assessment (Expanded Disability Status Scale, EDSS). All patients were in the group with EDSS 2 to 4 points (mobile patients). There was no statistically significant difference in BDS and SSS values according to EDSS score. Correlation coefficients were calculated (BDS and SSS) for men (p=0.42) and women (p=0.44), yielding positive correlation. There was no statistically significant difference in BDS and SSS values according to gender, disease duration or immunomodulatory therapy. In our group of patients, despite low EDSS score (fully ambulatory without aid, self sufficient patients) we found positive correlation between sexual dysfunction and depression, showing that even in such patients the quality of life can be decreased. In conclusion, sexual dysfunction and depression are mostly under-recognized by neurologists because they are not part of routine testing; therefore, some additional questionnaires should be used in the evaluation in MS patients, even those with low EDSS score, in order to improve their quality of life.

Each sleep phase is characterized by specific chemical, cellular and anatomic events of vital importance for normal neural functioning. Different forms of sleep deprivation may lead to a decline of cognitive functions in individuals. Studies in this field make a distinction between total sleep deprivation, chronic sleep restriction, and the situation of sleep disruption. Investigations covering the acute effects of sleep deprivation on the brain show that the discovered behavioral deficits in most cases regenerate after two nights of complete sleep. However, some studies done on mice emphasize the possible chronic effects of long-term sleep deprivation or chronic restriction on the occurrence of neurodegenerative diseases such as Alzheimer’s disease and dementia. In order to better understand the acute and chronic effects of sleep loss, the mechanisms of neural adaptation in the situations of insufficient sleep need to be further investigated. Future integrative research on the impact of sleep deprivation on neural functioning measured through the macro level of cognitive functions and the micro molecular and cell level could contribute to more accurate conclusions about the basic cellular mechanisms responsible for the detected behavioral deficits occurring due to sleep deprivation.

Epilepsy is the most common neurological complication in pregnancy. Women with epilepsy have a higher risk of complications in pregnancy. In Croatia, women with epilepsy are treated by neurologists at tertiary centers according to the place of residence. We prospectively followed-up pregnancies in women with epilepsy and healthy controls, and analyzed the factors responsible for their delivery outcomes and development of their babies. Healthy pregnant women had a higher level of education and economic status, but pregnant women with epilepsy took folic acid in a higher proportion than controls, possibly due to timely preconception counseling. Complications during pregnancy depended on the number of antiepileptic drugs and epilepsy control. We noticed some behavioral and cognitive aspects in children exposed in utero to valproic acid, which required follow up. The rate of congenital malformations was not increased. In conclusion, women with epilepsy should receive preconception counseling about the risk for pregnancy, but also about the possibilities to minimize that risk. We have introduced a model of integrative management of pregnancy and epilepsy based on close collaboration among different clinical experts in Croatia, in order to provide prompt counseling and timely intervention.

Summary:. Hyaluronic acid dermal fillers are becoming popular all over the world, but due to the presence of many blood vessels in the face, there is always a small possibility of vascular complications. We present a case with the ischemic involvement of chin and neck skin after accidental submental artery involvement after hyaluronic acid filler injection for chin region. Impending skin necrosis on the chin and upper neck on the right side was diagnosed quickly by observing the skin changes in the immediate postfiller phase. Pain in the mandible and in the muscles during swallowing due to possible ischemia of muscles supplied by submental artery was another crucial diagnostic feature. All parts of the affected zone were treated with high-dose pulsed hyaluronidase protocol using 4 pulses of hyaluronidase injection in first 24 hours after filler injection. Complete resolution of cutaneous ischemic changes and painful swallowing was achieved within days after treatment. Knowledge of presenting features of postfiller vascular complications and the extent of vascular territory of the involved artery is quite helpful in quickly instituting treatment leading to the near-complete recovery with minimal sequelae.

Background/Aims: Residual renal function (RRF) has been shown to influence survival of peritoneal dialysis (PD) patients. This study examined the relations between RRF and left ventricular hypertrophy (LVH) before switching on dialysis treatment and observed during 18 months on PD treatment. Methods: A prospective longitudinal study was performed in 50 non-anuric (defined as >200 mL urine output in a 24-hour period) PD patients. Echocardiography, RRF and other known risk factors for the increase of LV mass index (LVMi) were determined at study baseline and the end of follow-up. Results: There was 78% patients with LVH in end-stage renal disease (ESRD) baseline and 60% at the end of follow-up. RRF at the start of the study showed no significant difference between patients with normal and increased LVMi, as well as in daily collection of urine. After 18 months, patients with decreased LVMi had better RRF, lower CRP and better Kt/V compared to patients with increased LVMi (p Conclusions: PD in non-anuric ESRD patients the first 18 months has a positive effect on the preservation of RRF and partial regression of left ventricular remodeling.

Recently migraine has been associated with increased arterial stiffness, procoagulant state, increased incidence of cerebral white matter lesions (WML) and stroke. Our aim was to compare the characteristics of migraineurs to headache free controls regarding their functional carotid ultrasound parameters. Sixty patients (45 women) with migraine (mean age 40.42±10.61 years) were compared with 45 controls (30 women) with no prior history of repeating headache (men age 38.94±5.46 years) using E-tracking software on Alpha 10 ultrasound platform. Student’s t-test was used on statistical analysis with alpha

Despite prolonged survival and better quality of life as compared to dialysis, kidney transplantation frequently presents with a complex set of medical issues that require intensive management to protect graft function. Metabolic acidosis has an impact on several metabolic complications such as mineral and muscle metabolism, nutritional status and anemia. It may also have an effect on graft function, possibly through the stimulation of adaptive mechanisms aimed at maintaining acid-base homeostasis. We investigated current practice in the evaluation of metabolic acidosis at one of the largest transplant centers in the Eurotransplant region. Adult renal transplant recipients having received allograft from January 2011 to August 2012 were included in the investigation. We recorded the frequency of measuring the parameters of venous blood gas analysis, as well as creatinine and urea levels, creatinine clearance, proteinuria, calcium, phosphate and potassium blood levels, body mass index and the time spent on dialysis prior to kidney transplantation. Out of 203 patients who had received renal allograft at our institution during the observed period, 191 (124 males and 67 females, age range from 18 to 77 years) were enrolled in the study. Of these, only 92 (48.167%) patients had parameters of venous blood gas analysis measured at some time after kidney transplantation. Acid-base status was determined more often in males (77 males vs. 22 females, p=0.001). Patients with pH/blood gas analysis performed were found to have significantly higher creatinine and urea levels and significantly lower creatinine clearance (p

Diabetic nephropathy is a common complication in patients with diabetes mellitus and one of the major reasons for renal replacement therapy in Croatia, Europe and the United States. It is characterized by proteinuria, decline in glomerular filtration, hypertension, and high risk of cardiovascular morbidity and mortality. Deterioration of renal function in diabetic nephropathy develops through five clinical stages characterized by the respective histologic description. Genetic susceptibility, hyperglycemia, high blood pressure and duration of diabetes mellitus definitely play a role in the pathogenetic sequence. Early diagnosis, appropriate patient follow up and treatment are essential to improve the outcomes. Interdisciplinary approach and close collaboration of nephrologists and diabetologists are essential for timely detection of disease progression. Tight glycemic control under the supervision of diabetologists, screening of patients, and once a year report of albuminuria and glomerular filtration allow for detection of renal damage in the early stages and timely referral to a nephrologist. The points of interest given in this overview are description of clinical staging in relation to pathologic classification, repetition of basic causal features, and brief analysis of treatment.

The aim of the study was to determine the prevalence of pseudobulbar affect (PBA) in patients with multiple sclerosis (MS) and to analyze the link between PBA and patient age, sex, clinical course of MS, disease duration and degree of disability. The study was conducted on 79 MS patients that underwent inpatient rehabilitation at the Lipik Special Hospital for Medical Rehabilitation in the period from August 15, 2014 to February 15, 2015. PBA is a term used for an emotional disinhibition syndrome characterized by sudden and involuntary episodes of crying or laughing which are not in proportion to the stimulus applied or occur without stimulus. The condition can be present in patients with various neurological disorders, such as amyotrophic lateral sclerosis, Alzheimer’s disease, Parkinson’s disease, patients having recovered from stroke, or following traumatic brain injury. The estimated prevalence in patients with MS ranges from 10% to 46.2%. As a measuring instrument in the study, we used the Center for Neurologic Study-Lability Scale (CNS-LS), where a sum ≥17 denoted positive finding. The total number of respondents was 79, of which 33 (41.8%) met the CNS-LS criteria for the diagnosis of PBA. There was no statistically significant correlation between PBA, age and degree of disability, although PBA was more common in women and in patients with a secondary progressive form of the disease. We found that 42.4% of respondents with positive CNS-LS criteria for PBA did not inform their neurologist on the presence of sudden mood changes. The high frequency of PBA and the fact that a significant proportion of patients did not inform the neurologist on their affective disturbances call for an active approach to diagnosis and treatment.

Acute kidney injury is a clinical syndrome associated with increased patient morbidity and mortality, as well as serious short-term and long-term consequences, especially in the perioperative period. Yet, patients having suffering from temporary acute kidney injury and achieving full recovery of kidney function usually complain of poor quality of life associated with loss of energy and limited physical activity. Therefore, there is a necessity for a novel biomarker of acute kidney injury with better features than currently used serum creatinine and urine output. So far, several investigations have demonstrated that the fibroblast growth factor 23 could be that desperately searched novel biomarker of acute kidney injury. It cannot only detect kidney dysfunction at the time but also before the injury process begins. Moreover, serum levels of the fibroblast growth factor 23 can predict adverse progression of the kidney injury. However, the role of the fibroblast growth factor 23 in the acute but also in chronic kidney dysfunction is still a riddle that requires additional research to clarify it.

Bone morphogenetic protein-7 (BMP-7) is expressed in all parts of the normal kidney parenchyma, being highest in the epithelium of proximal tubules. It protects kidney against acute and chronic injury, inflammation and fibrosis. Diabetic nephropathy is the leading cause of chronic kidney disease, and is characterized by decreased expression of BMP-7. The aim of our study was to analyze whether the expression of BMP-7 is significantly changed in advanced stages of human diabetic nephropathy. Immunohistochemical analysis of the expression of BMP-7 was per¬formed on archival material of 30 patients that underwent renal biopsy and had confirmed diagnosis of diabetic nephropathy. Results showed that BMP-7 was differently expressed in the cytoplasm of epithelial cells of proximal tubules and podocytes among all stages of diabetic nephropathy. At early stages of diabetic nephropathy, BMP-7 was strongly positive in proximal tubules and podocytes, while low expression was recorded in the majority of samples at advanced stages. In conclusion, increased expression of BMP-7 at initial stages of diabetic nephropathy with subsequent decrease at advanced stage highlights the role of BMP-7 in the protection of kidney structure and function. Further investigations should be focused on disturbances of BMP-7 receptors and signaling pathways in patients with diabetic nephropathy.

Background This is a study of the relationships between common reasons for encounter and common diagnoses (episode titles) within episodes of care in family practice populations in four countries.Method Participating family doctors recorded details of all their patient contacts in an EoC structure using the International Classification of Primary Care, including RfEs presented by the patient, and the FDs’ diagnostic labels. The relationships between RfEs and episode titles were studied using Bayesian methods.Results The RfE ‘cough’ is a strong, reliable predictor for the diagnoses ‘cough’, ‘acute bronchitis’, ‘URTI’ and ‘acute laryngitis/tracheitis’ and a less strong, but reliable predictor for ‘sinusitis’, ‘pneumonia’, ‘influenza’, ‘asthma’, ‘other viral diseases’, ‘whooping cough’, ‘chronic bronchitis’, ‘wheezing’ and ‘phlegm’. The absence of cough is a weak but reliable predictor to exclude a diagnosis of ‘cough’, ‘acute bronchitis’ and ‘tracheitis’. Its presence allows strong, reliable exclusion of the diagnoses ‘gastroenteritis’, ‘no disease’ and ‘health promotion/prevention’, and less strong exclusion of ‘adverse effects of medication’. The RfE ‘sadness’ is a strong, reliable predictor for the diagnoses ‘feeling sad/depressed’ and ‘depressive disorder’. It is a less strong, but reliable predictor of a diagnosis of ‘acute stress reaction’. The absence of sadness is a weak but reliable predictor to exclude the symptom diagnosis ‘feeling sad/depressed’. Its presence does not support the exclusion of any diagnosis.Conclusions We describe clinically and statistically significant diagnostic associations observed between the RfEs ‘cough’ and ‘sadness’, presenting as a new problem in family practice, and all the episode titles in ICPC.

Background This is a study of the epidemiology of acute and chronic episodes of care (EoCs) in the Transition Project in three countries. We studied the duration of EoCs for acute and chronic health problems and the relationship of incidence to prevalence rates for these EoCs.Method The Transition Project databases collect data on all elements of the doctor–patient encounter in family medicine. Family doctors code these elements using the International Classification of Primary Care.We used the data from three practice populations to study the duration of EoCs and the ratio of incidence to prevalence for common health problems.Results We found that chronic health problems tended to have proportionately longer duration EoCs, as expected, but also a lower incidence to prevalence rate ratio than acute health problems. Thus, the incidence to prevalence index could be used to define a chronic condition as one with a low ratio, below a defined threshold.Conclusions Chronic health problems tend to have longer duration EoCs, proportionately, across populations. This result is expected, but we found important similarities and differences which make defining a problem as chronic on the basis of time rather difficult. The ratio of incidence to prevalence rates has potential to categorise health problems into acute or chronic categories, at different ratio thresholds (such as 20, 30 or 50%). It seems to perform well in this study of three family practice populations, and is proposed to the scientific community for further evaluation.

ÖZ: Bu makalede Ankara’daki sitelerde yaşayan bireylerin konut ve yer seçimi ile mekânsal tercihlerini belirleyen faktörler incelenmektedir. Bu bağlamda Ankara’da kent merkezindeki mahallelerden kentin yeni gelişme alanlarında bulunan site şeklindeki yeni yerleşimlere doğru yaşanan hareketliliğin bireylerin tercihleri ile olan ilişkisine odaklanılmaktadır. Söz konusu tercihlerin incelenmesinde Pierre Bourdieu’nün Sermaye Kuramı’nda tanımladığı kültürel sermaye kavramı kullanılmıştır. Araştırmanın verileri Ankara’nın önemli site projelerinden olan Or-An ve Koru Sitelerinde yapılan derinlemesine görüşmelerle toplanmıştır. Bu verilerin analizi bireylerin gerek konut seçimlerinde gerekse kentsel mekânla olan ilişkilerinde yaşam boyu edindikleri kültürel sermayenin önemli etkisi olduğunu göstermektedir. Ayrıca bu iki sitede yaşayan bireylerin tercihlerinde ve sosyo-mekânsal ilişkilerinde görülen farklılaşma, homojen bir olgu gibi görünen siteleşme sürecinin gerçekte kültürel sermaye bağlamındaki farklılaşmadan etkilenerek farklı algı ve pratiklere yol açabildiğini ortaya çıkartmıştır. Anahtar Kelimeler: Pierre Bourdieu, Sermaye Türleri, Kültürel Sermaye, Konut Tercihi, Ankara. ABSTRACT: In this article, the factors effecting the housing and spatial preferences of individuals living in the ‘site’ developments in Ankara are examined. In that context, it is focused on the mobility from the neighborhoods in central Ankara towards the new developments in the new growth areas, in terms of its relationship to the individual preferences. In the analysis of these preferences, Pierre Bourdieu’s concept of cultural capital as defined in his Theory of Capital was utilized. The data for this research was collected through in-dept interviews conducted in two main development projects in Ankara, namely Or-An Sitesi and Koru Sitesi. The analysis of data shows the significant effect of cultural capital accumulated throughout the individuals’ lives. On the other hand, the differentiation of preferences and socio-spatial relations between the residents of these two places reveals the fact that this process of mobility to live in ‘site’ developments is not a homogenous phenomenon as widely discussed. On the contrary, it is affected by the differentiation in cultural capital accumulations and lead to different perceptions and practices. Keywords: Pierre Bourdieu, Forms of Capital, Cultural Capital, Housing Preferences, Ankara.

Primary cardiac hemangioma is a very rare benign vascular tumor, with valvular hemangiomas being even less frequent as valves are generally avascular structures. We present the first case of mitral valve hemangioma in a renal transplant recipient. Patient presented with progressive dyspnea. Transesophageal echocardiogram (TEE) demonstrated a 0.8x0.9-cm pedunculated tumor mass on the posterior leaflet of the mitral valve. Coronary angiography identified a small artery which filled from the circumflex artery and fed the tumor. The tumor was surgically removed. Histopathological examination revealed a hemangioma. The postoperative course was uneventful with stable graft function.

Background and Objectives: The expression of soluble adhesion molecules inter-cellular adhesion molecule 1 (ICAM-1) and vascular cell adhesion molecule 1 (VCAM-1), besides activation of endothelial cells and transendothelial migration of leukocytes, play an important role in inflammation and progression of ischemic injury after acute stroke. The aim of this study was to determine serum levels of soluble ICAM-1 and VCAM-1 in patients with acute ischemic stroke and controls and correlate them according to etiological subtypes (thromboembolic or lacunar stroke), stroke severity and disability after acute stroke. Patients and Methods: Hospital-based prospective study of acute stroke patients hospitalized between December 2008 and September 2009 at the University Hospital Sestre Milosrdnice in Zagreb, Croatia. Methods: We enrolled 110 patients with acute ischemic stroke and 93 healthy individuals as controls. Serum concentrations of VCAM-1 and ICAM-1 were determined by means of quantitative sandwich enzyme immunoassay. Patients were classified according to etiological subtype, clinical severity of stroke and disability after stroke. Results: There was no significant difference between levels of soluble adhesion molecules VCAM-1 and ICAM-1 in patients and in controls. Levels of VCAM-1 were significantly higher in patients with thromboembolic stroke than in controls. There was no significant correlation between levels of soluble adhesion molecules VCAM-1 and ICAM-1 and stroke severity and disability. There was marked biological interindividual variability in all patient groups. Conclusion: This study confirms the role of adhesion molecule VCAM-1 in the pathogenesis of acute thromboembolic stroke.

Background: Previous studies suggest that infarct expansion may be responsible for increased mortality after stroke onset in patients with prolonged stress hyperglycemia. Therefore, we evaluated the influence of prolonged stress hyperglycemia on stroke mortality in patients with and without diabetes. Patients and Methods: For 630 stroke patients admitted to the neurological intensive care department within 24 hours of stroke onset, we correlated mean blood glucose levels (MBGL) at admission and 72 hours after admission in diabetic and non-diabetic patients with final outcome. Blood glucose levels higher then 6.1 mmol/L (121 mg/dL) were treated as hyperglycemia. Results: Of 630 patients (mean age 71 ± 6), 410 were non-diabetic (mortality, 25%) and 220 patients were dia-- betic (mortality, 20%). All patients who died within 28 days of hospitalization had prolonged hyperglycemia (at admission and after 72 hours, despite insulin therapy). The unadjusted relative risk of in-hospital mortality within 28 days for all stroke patients was 0.68 (95% CI, 0.14-1.9) for non-diabetic patients and 0.39 (95% CI, 0.27-1.56) for diabetic patients. The unadjusted relative risk of in-hospital mortality within 28 days in ischemic stroke in patients with MBGL > 6.1-8.0 mmol/L (121-144 mg/dL) at admission and after 72 hours was 1.83 (95% CI, 0.41-5.5) for non-diabetic patients and 1.13 (95% CI, 0.78-4.5) for diabetic patients. Non-diabetic patients with hyperglycemia had a 1.7 times higher relative risk of in-hospital 28-day mortality than patients with diabetes. Conclusion: Prolonged stress hyperglycemia in ischemic stroke patients increases the risk of in-hospital 28-day mortality, especially in non-diabetic patients.

• During >2.5 years of treatment, >70% of pwPPMS did not experience confirmed disability worsening. • The effectiveness was unrelated to age, disease activity, disease duration, or level of neurological disability. • Except for one case of febrile neutropenia, no new safety signals were observed. Ocrelizumab is the only disease-modifying therapy (DMT) approved for the treatment of people with primary progressive multiple sclerosis (pwPPMS). To provide real-world evidence of ocrelizumab effectiveness and safety in pwPPMS in Croatian MS centers. A retrospective observational multi-center study of pwPPMS who were started on ocrelizumab in 7 MS centers in Croatia. We identified 230 pwPPMS of whom 176 fulfilled the inclusion criteria. The median follow-up of the cohort was 2.73 (0.51–5.77) years. During the follow-up, 50 (28.4%) pwPPMS experienced confirmed disability worsening (CDW) and 19 (10.8%) stopped treatment with ocrelizumab. Baseline EDSS >5 was a statistically significant positive predictor for the development of CDW and/or stop of the treatment due to any cause (OR 2.482, 95% C.I. 1.192–5.166, p = 0.015). However, there was no significant difference in the development of CDW and/or stop of the treatment due to any cause if stratifying the patients based on active PPMS, age at treatment start (≤55 years vs >55 years), disease duration at treatment start (≤10 years vs >10 years), or EDSS at treatment start (≤5.0 vs >5.0). During the follow-up, 26 (14.8%) pwPPMS experienced infusion reactions, 64 (36.4%) had an infection and 4 (2.3%) developed a tumor. The percentage of pwPPMS with low levels of IgG was persistently above 10% and with low levels of IgM was persistently above 20% after cycle 4. Our real-world data support the use of ocrelizumab in a much broader pwPPMS population than in the original randomized controlled trial. [ABSTRACT FROM AUTHOR]

In order to reproduce previous results in Bi-2212 single crystals, the effects associated with the addition of Ti to the precursors of Laser Floating Zone textured Bi-2212 thin rods have been analyzed. It has been found that Ti induces a great number of nucleation centers in the molten zone and, in consequence, it reduces the grain size one order of magnitude. In addition, using the same growth conditions, the texture of the sample is strongly degraded. These microstructural changes strongly affect the superconducting properties showing that Ti addition destroys the network of low angle grain boundaries that are responsible for the high critical currents in these materials.Se ha analizado el efecto de la introducción de Ti en precursores de Bi-2212 para ser texturados mediante láser a través del método de zona flotante, todo ello debido a los resultados esperanzadores obtenidos en monocristales. Se ha encontrado que el Ti introduce un gran número de centros de nucleación en la zona fundida, por lo que se reducen las dimensiones de los granos en un orden de magnitud aproximadamente. Por otra parte, y utilizando las mismas condiciones de crecimiento, se observa que la textura de la muestra se degrada severamente, Estos cambios microestructurales afectan en gran medida a las propiedades superconductoras, demostrándose que la introducción de Ti destruye la red de fronteras de grano de bajo ángulo, que son las responsables en estos materiales de las altas corrientes criticas.

Background: Red seaweed extract of kappa and iota carrageenan is commonly used as a gel base. Kappa carrageenan is stiffed or breakable that may experience syneresis. Iota carrageenan has a softer gel texture, elastic, and has less possibility of syneresis, but not as strong as kappa carrageenan gel. Therefore, kappa and iota carrageenan can be mixed to obtain better gel properties and water-soluble. It will be proposed as a carrageenan-based ultrasound gel as acoustics connector, certainly in renal ultrasonography (USG) examination. Objectives: To demonstrate the ability of gel made from red seaweed extract as an intermediary for ultrasonic waves in ultrasound examination. Material and methods: A quasi-experimental study with post-test only control group design to reveal the potency of red seaweed (carrageenan) extract as an alternative gel in renal USG examination. A total of 22 voluntary respondents were included in this present study. Results: Red seaweed extract based gel can be used as an intermediary for ultrasonic waves in ultrasound examination. Quality of renal ultrasound image by a well-known manufactured carbomer-based ultrasound gel product (Gel A) compared to alternative carrageenan-based ultrasound gel (Gel B) was not different. Conclusion: The finding is carrying an expectation to lift the potency of red seaweed extract as carrageenan-based ultrasound gel in renal ultrasonography (USG) examination. Considering its environmental friendly and inexpensive nature, carrageenan-based gel extracted from red seaweed can be proposed as an alternative ultrasound gel in renal ultrasonography (USG) examination. Journal of Associated Medical Sciences 2017; 50(2): 307-313. Doi: 10.14456/jams.2017.31

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A natural consequence of the budgeting process is budget control, the effectiveness of which depends largely on the quality of the deviation analysis. As part of this analysis, the expected quantities are most often compared with the observed/actual ones, and the reasons for the deviations are investigated. In budget control, it is important to deconstruct deviations into components and to determine the impact of factors affecting these deviations. Therefore, budgetary control should be extended to the analysis of budget deviations in terms of its subject and temporal nature. This generally applies to every planning and control process, while the authors in their research concentrate on budgeting revenues and operating costs in enterprises. In this study, three measures used in economics – the GINI, Hirschman-Herfindahl, and Theil coefficients – were evaluated as potential metrics for budget deviation differentiation. Simulated computer data was used for this study. The GINI coefficient was the most statistically significant metric tested, making it the selected measure for budget deviation differentiation. The GINI coefficient is a normalized variable (ratio) with a range between 0 to 1, making it a convenient metric to evaluate differences in deviations between individual budget items, between years, and between budgeted units. [ABSTRACT FROM AUTHOR]

The problem of student structure prediction is very important from the viewpoint of the fundamental planning and control functions associated with this specific form of management. The purpose of this study is to present the results of an experiment involving the prediction of student structure based on the use of a machine learning solution (GANs) and compare them against real data obtained from a registry system of a European public institution of higher education in economic sciences. The research attempt provided a wealth of knowledge and insight into practical skills related to the potential application of such solutions and revealed a number of problems associated with student structure prediction tasks. The experiments revealed that – for 11 out of the 48 examined datasets – the PSI index was in excess of 75% but was decidedly lower for the remaining sets (with 18 sets assessed below the margin of 50%). [ABSTRACT FROM AUTHOR]