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Wide flange I-beams with parallel flange contours, which are now predominantly used in production of monorail crane girders, are characterized by a relatively large radial transition between flange contour and rib contour. Therefore, the influence of the radius on the stress state, due to the local bending caused by the action of crane trolley wheels, is more pronounced in wide-flange I-beams (IPB) than in conventional (I) and mid-wide (IPE) I-beams. This paper presents the results of numerical-analytical and experimental research of local stresses in the lower flange-rib transition zone at wide flange I-beams. It was found that the highest values of the considered stresses occur at the start of the transition contour, and not in the fictive point of intersection of the rib contour and the upper contour of the lower flange, as stated in relevant literature and current technical regulations (standard SRPS EN 15011: 2014). In addition, research results show that the absolute values of local stresses on the lower and upper contours of the lower flange are not equal.

Bariatric surgery is the most efficient treatment for obesity and comorbidities. This treatment modality is the most potent for weight reduction with long-term weight maintenance and positive metabolic effects. The effect on weight loss and possible side effect depends of type of surgery. Micro and macronutrient deficiencies can occur after malapsorptive procedures. Iron deficiency occurs in almost half of patients following RYGB (Roux-en-Y gastric bypass). The main causes of iron deficiency are insufficient meat ingestion and lack of hydrochloric acid after removal of pylorus. B12 deficiency occured 6 months after RYGB in patients with oral supplementation of B12. Bone turnover increased three months after RYGB, and the levels of bone turnover markers increased 200% in next 12-18 months. Impaired vitamin D absorption leads to decreased calcium absorption and secondary hyperparathyroidism with lower bone mineral density. After the bariatric surgery, testosterone level becomes higher and all sexual quality indicators improving. Malapsorptive procedures with nutritive deficiency can cause oligo-astenozooteratospermia and male infertility. Due to the same reason pregnancy is not recommended in the first year bariatric surgery. Possible side effect of pregnancy within 12 months after surgery is fetal growth retardation. There is twice higher incidence for developing alcohol or other addition after bariatric surgery then in non-operated obese patients. The frequency of depressive episodes and suicide attempt is higher after bariatric surgery.

The results of numerical and experimental researches of local bending problems, carried on classic and medium-wide I profiles, were a basis for the adoption of the current standards (EN 15011: 2014) which regulates the action of the local stress caused by the effect of cart wheels. Regarding the fact that IPB (HE-B) wide flange profiles are largely used for production of the main carriers of monorail transport systems, this paper presents the results of the action of the local stress caused by the effect of cart wheels on the HE-A flange profile, using the methods and procedures of relevant researchers, the procedures prescribed by the standard EN 15011 as well as the results of calculations using finite element method. It has been revealed, based on comparative analysis of the results, that in the transition zone low flange / rib longitudinal local stress on the lower contour flange, determined using the above mentioned standards have tightening characteristic, while all other methods, including finite element method, give the pressing nature of the considered voltage. In addition, all of these procedures, except for the finite element method, adopt the assumption that absolute value of voltage, caused by local bending on upper and lower contour of the loaded flange, are the same, and there is no physical justification. Bearing in mind the fact that stress identification, caused by the flange local bending, is an extremely important phase proving the strength of monorail beams, we may conclude that the application of standard EN 15011 does not provide reliable results when it comes to wide flange profiles.

Introduction: pseudohypoparathyroidism (PHP) is hormone resistance syndrome described for the first time in 1942 by Albright et al. All this patients had high levels of the PTH and specific skeletal deformities which were later termed as Albright hereditary osteodystrophy (AHO). The PTH requires the alpha subunit of G protein for its action. GNAS1 gene encodes the alpha subunit of the G protein and molecular defects in this gene lead to the occurrence of at least four different forms of this syndrome. Pseudopseudohypoparathyroidism (PPHP) is a form of PHP which is characterized by physical features of AHO without any evidence of PTH resistance. Albright hereditary osteodystrophy like syndrome (AHO like syndrome) has some common characteristics with AHO but is not connected with the molecular defect in the GNAS 1 gene. Case outline: we reported the case of the female patient with the phenotypic characteristics of AHO (brachydactyly, short stature, mild degree of intelectual deficit and genu varum) but without any evidence of PTH resistance. PPHP occurs mainly in families with PHP 1a and it is inherited from the father which is not the case with our patient. There is a theoretical possibility that the mutation of the GNAS 1 gene occurred de novo but without genetic testing the 2q37 deletion and AHO like syndrome can not be excluded. Conclusion: in same cases of PPHP the diagnosis of AHO like syndrome should be considered but the only way to make the precise diagnosis is the genetic testing as it was in our case.

Background/Aim. Diabetes mellitus (DM) is considered to be an epidemic, chronic and progressive disease. The treatment of DM reqiures substantial effort from both the diabetes treatment team and a patient. Patient education is one of the treatment elements. The most efficacious form and content of education has not yet been established. However, every DM education must include introduction to a substantial number of facts about diabetes. The aim of our study was to estimate the levels of DM knowledge and glycemic control in Serbian patients with DM type 2 as well as to estimate the effects of education using printed material on the levels of glycemic control and knowledge about DM. Also, the effects of education on glycemic control and the level of knowledge in differently treated patients were estimated. Methods. The patients with DM type 2 (n = 364), aged 40 to 65 years, from three regional health centers, were randomized for the study. After informed consent, patients filled out the questionnaire, and were checked for HbA1c and fasting blood glucose. Finally, booklet „Healthy lifestyle with diabetes mellitus type 2“ was given to them. The same procedure was repeated after 3, 6 and 18 months. Results. There was a significant improvement in HbA1c levels after 3 months (8.00 ± 1.66% vs 9.06 ± 2.23%, p < 0.01) and after 6 months (7.67 ± 1.75% vs 9.06 ± 2.23%, p < 0.01). There was no further improvement in HbA1c levels after 18 months (7.88 ± 1.46% vs 7.67 ± 1.75%, p > 0.05). There was a significant improvement in the average test score (percent of correct answers per test sheet) after three monts (64.6% vs 55.6%, p < 0.01). There were no further statistically significant changes in the general level of DM knowledge after 6 months (65.0 ± 32.5% vs 64.5 ± 33.7%, p > 0.05 ) and after 18 months ( 64.8 ± 32.7 vs 64.5 ± 33.7%, p > 0.05). There was a significant difference in educational intervention response in DM type 2 patients on different therapeutic regimens. Conclusion. Education with printed material led to improvement in glycemic control and level of DM knowledge in our patients. Education with printed material may be a useful adjunct to DM treatment and should be structured according to the treatment modality.

Background/aim: Diabetes mellitus is associated with an increased risk for neonatal morbidity and mortality. One of the most important goals in treating pregnancies complicated with diabetes is keeping glucose level within the normal range, especially in the first trimester. A portable insulin pump for continuous subcutaneous insulin infusion (CSII) represents the best form of therapy for patients with type 1 diabetes mellitus during pregnancy. The aim of our study was to evaluate the effects of therapy with a portable insulin pump for continuous subcutaneous insulin infusion during the first trimester of pregnancy on the quality of glycoregulation and pregnancy outcome in women with type 1 diabetes mellitus. Methods. A total of 17 newly diagnosed pregnant women with type 1 diabetes mellitus were treated with CSII therapy for three months. The parameters of glycoregulation (hemoglobin A, glycosylated - HbA1c, mean blood glucose value in daily profiles - MBG, daily requirement for insulin - IJ/kg BM), lipid levels, blood pressure and renal function were estimated before and after the therapy. These parameters were correlated with parameters of pregnancy outcome: fetal weight, APGAR score, duration of pregnancy. Results. There was a significant improvement in HbA1c (8.94±1.62 vs. 6.90±1.22 %, p < 0.05), MBG (9.23±2.22 vs. 6.41±1.72 mmol/l, p < 0.01), and daily requirement for insulin (0.66±0.22 vs. 0.55±0.13 IJ/kg BM, p < 0.05) during the CSII therapy. There were significant correlations between fetal weight and HbA1c (r = -0.60, p < 0.05), triglyceride levels (r = −0.63, p < 0.01), and the number of pregnancies (r = −0.62, p < 0.01), as well as between APGAR score and MBG (r = −0.52, p < 0.05) and cholesterol levels (r = −0.65, p < 0,01) before a portable insulin pump was applicated. Conclusions. There was a significant improvement in the quality of glycoregulation during CSII therapy in the pregnant women with type 1 diabetes mellitus. The quality of glycoregulation in the moment of conception was the important factor for pregnancy outcome.

Polycystic ovary syndrome (PCOS) is considered a metabolic disorder closely related to obesity, insulin resistance (IR), hyperinsulinemia and unfavorable lipid profile, all increasing the risk for the occurrence of cardiovascular diseases. The aim of this study was to assess age and body mass index (BMI) related changes of cardiovascular risk factors in 90 women with PCOS. The cut-off age point was 30 years and for BMI 27.8 kg/m2. In all patients systolic and diastolic blood pressure (BP), metabolic parameters comprising values of glucose and insulin during oral glucose tolerance test (OGTT), and basal lipid values were determined. Significant increase in blood pressure (BP) indices, basal insulin values and insulin resistance (IR) assessed by HOMA model were observed with aging and the increase of BMI, while the parameters of glucose metabolism, total cholesterol and triglycerides were significantly elevated only with aging. However, the correlation between the indices of arterial blood pressure, and lipid and glucose metabolism parameters occurred only in patients over 30 years of age, pointing to the causative relation and the consequent deterioration of IR and lipid profile with aging, influencing cardiovascular function in women with PCOS.

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Epidemy of obesity is associated with increased incidence of type 2 diabetes mellitus (T2DM). Patients with T2DM has two fold increased risk for developing fractures inspit normal or even increased bone mineral density (BMD). That is consequence of poor bone quality due to accumulation of AGEs in collagen fi bres as well decreased effects of insulin and adiponectin on osteoblasts and cytokine stimulation of osteoclast activity. Another signifi cant factor is increased frequency of falls due to polyneuropathy, retinopathy and hypoglycemia. Obesity without T2DM was considered as protective factor for fractures although there is insulin resistance and chronic infl ammation, probably due to increased production of estrogen and leptin. Recent studies demonstrated that obese patients has increased risk for fractures of humerus, femur and foot, while the risk for hip fracture is decreased. Meta analysis shown that abdominal obesity is associated with risk for hip fracture. Evaluation of BMD and radiographic parameters of bone strength should be done using this indices per body weight instead of absolute values. [ABSTRACT FROM AUTHOR]

Primarni hiperparatireoidizam (PHPT) je sistemsko oboljenje koje utiče na metabolizam kostiju i glikoze. Kod pacijenata sa PHPT je venfikovana insulinska rezistencija i aterogeni profil lipida. Osteokalcin (OC) je koštani biomarker udnižen sa pojačanom insulinskom sekrecijom insulinskom senzativnosti i smanjenom visceralnom masti. CILJ naše studije je da se evaluira telesni sastav i nivo koštaiuh biomarkera (OC i beta cross/laps), msulinske senzitivnosti i lipida kod pacijenata sa PHPT MATERIJAL I METODE: Kod 25 pacijenata sa PHPT (Grupa 1 - starosti 55.08±11.62 godina. ITM 26.75±4.44 kg/m². PTH 144.27±138.17 ng/l, Kaldjum 2.94±0.26 mmol/l) i 8 zdravih kontrola (Grupa 2 - starosti: 55.00±6.90 godina, ITM 224.70±3.94 kg/m², PTH 35.46±10.82 ng/l, Kalcijum 2.52±0.15 mmol/l) određivan je nivo OC (ng/ml), betaCL (ng/ml), glikemija (mmol/l), insulina (IU/ml), fosfata (mmol/l), ukupnog holesterola (TC, mmol/l), HDL-C, LDL-C. triglicerida (TG, mmol/l), ApoAl, ApoA2, ApoB, ApoE. Lp(a) i nivo vitamina D. HOMAIR je izračunavana kao mdeks msulinske rezistencije, telesni sastav je evaluiran putem DEXA. REZULTATI: Dobijena je statistički značajna razlika između Grupe 1 i Grupe 2 u ukupnom (35.00±4.84 vs. 29.90±4.77%,p<0.05) I abdonnnalnom procentu masti (33.59±6.72 vs. 24.60±6.38%,p<0.05), TC (6.47±1.34 vs. 5.32±0.88,p<0.05), LDL (4.27±1.14 vs. 3.26±0.93,p<0.05), TG (1.83±0.82 vs. 1.14±0.61,p<0.05) i Apo B (1.20±0.0.29 vs. 0.85±0.23,p<0.05). U Grupi 1 OC (67.93±14.39 vs. 30.08±15.54,p=0.05), betaCL (1.11±1.00 vs. 0.61±0.39,p=0.05)iApoE(50.17±14.62 vs. 40.37²10.79,p=0.05) verifikovane su veće ali statistički neznačajne razlike u odnosu na Grupu 2. Nije bilo razlike u HOMAIR indeksu između grupa (3.29±1.24 vs. 3.12±1.38,p>0.05). Dobijena je značajna korelacija između nivoa betaCL i procenta abdonunalne masti (R=-0.44, p<0.05), insulina (r=-0.42,p<0.05), OC (r=0.95,p<0.01) i PTH (r=0.62,p<0.01), kao i između OC i fosfata (r=-0.42,p<0.05) i PTH (r=0.68,p<0.01). U zaključku pacijenti sa PHPT imaju aterogeni profil lipida, veći nivo koštanih biomarkera i više visceralne masti u poređenju sa zdravim kontrolama. U našoj gupi pacijenata sa PHPT nivo betaCL (ali ne i OC) ukazuje na moguću interrelaciju između koštanog. glikoznog i lipidnog metabolizma. [ABSTRACT FROM AUTHOR]

Copyright of Medical Gazette / Medicinski Glasnik is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction. Juxtaglomerular cell tumor (JGCT) or reninoma is a very rare cause of curable hypertension among young people. The early diagnosis is the most important based on the clinical presentation, hormonal and radiological findings observed on computed tomography (CT) and/or magnetic resonance imaging (MRI). The final confirmation of the JGCT is the lateralization of the plasma renin activity (PRA) during the selective renal venous sampling. Case report. This report presents a typical case of young women with JGCT which was manifested for the first time with severe hypertension during the pregnancy and was the reason of fetal death. After the miscarriage, the diagnosis of JGCT was made by the CT scanning and confirmed by the selective renal venous sampling. After the partial nephrectomy, the blood pressure and serum potassium normalized without the medications. Conclusion. Reninoma should be considered in the differential diagnosis as a cause of severe hypertension in pregnancy and also should be suspected in young hipertensives (especially females) with hypokalemia and secondary hyperaldosteronism after the exclusion of other causes particularly renal artery stenosis. A dynamic contrast-enhanced CT, MRI and selective renal venous sampling are the most important tools in the diagnosis of JGCT. [ABSTRACT FROM AUTHOR]