Search

Introduction Sarcoidosis involving the thyroid gland is an exceedingly rare condition characterized by non-necrotizing and non-caseating granuloma. This study represents a case of thyroid sarcoidosis in an elderly female.Case report A 62-year-old female presented with anterior neck swelling associated with difficulties in breathing and swallowing for six months. Physical examination revealed an enlarged, firm, and non-tender thyroid gland. Thyroid function tests were normal, with a high level of angiotensin-converting enzyme. A neck ultrasound revealed nodules in both thyroid lobes and bilateral cervical lymphadenopathies. The patient underwent a total thyroidectomy and lymph node excision. Histopathological examination of the specimen showed features suggestive of thyroid sarcoidosis.Conclusion Sarcoidosis involving the thyroid gland is a rare finding, and its diagnosis necessitates the exclusion of other potential explanations for similar symptoms. Surgery becomes necessary when there are compression symptoms or a risk of malignancy.

Follicular thyroid carcinoma (FTC) is a well-differentiated malignancy, while insular thyroid carcinoma (ITC) is a very rare and poorly differentiated tumor. The present study reports a case of ITC arising within the background of FTC. A 52-year-old housewife presented with an anterior neck swelling for a duration of 6 months. An ultrasound examination revealed a well-defined solid nodule measuring ~58x37x28 mm in the mid-lower third of the right thyroid lobe, and two small nodules of <3 mm in size in the left lobe. Fine needle aspiration cytology of the lesion led to the suspicion of follicular neoplasm. A right thyroid lobectomy was performed, and the histopathological examination revealed poorly differentiated insular carcinoma arising in the background of FTC. As a result of this diagnosis, a completion thyroidectomy was performed. ITC is a rare and highly aggressive thyroid malignancy that is morphologically and biologically regarded as an intermediate between fully differentiated and undifferentiated/anaplastic thyroid carcinomas. In comparison to patients solely with follicular carcinoma, patients with insular carcinoma are older, more often male, have larger tumor sizes, are at greater risk of metastasis, and have a lower survival rate. Poorly differentiated ITC with follicular carcinoma is a very rare and aggressive condition that could be managed by thyroidectomy followed by radioiodine therapy. [ABSTRACT FROM AUTHOR]

The main component of error minimization in operating rooms (ORs) is to maintain high reliability of surgical teams. The analysis of adverse events in the OR reveals deficiencies in cognitive and interpersonal skills as the main factors influencing surgeons’ errors. Therefore, research of these additional factors is necessary, besides factors related to surgeons’ clinical knowledge and technical skills. In this paper, the key factors for evaluating activities in surgical operating rooms are identified. Fuzzy analytic hierarchy process is used for identification of key factors. Fifteen key factors are identified for evaluating activities in surgical operating rooms to improve the efficiency of surgical operations. For each group of activities (surgical “capabilities,” operating room characteristics, and non-technical skills), five factors are identified. As the most important, the following factors are obtained: communication, indoor environment standardization, and tool handle design. The aim of the analysis of these key factors is surgeons’ work capability enhancement, rational design of operating rooms, and advancement of operators’ cognitive and interpersonal skills.

The definition of new molecular biomarkers could provide a more reliable approach in predicting the prognosis of invasive breast cancers (IBC). The aim of this study is to analyze the expression of p16 protein in IBC, as well as its participation in malignant transformation. The study included 147 patients diagnosed with IBC. The presence of non-invasive lesions (NIL) was noted in each IBC and surrounding tissue. p16 expression was determined by reading the percentage of nuclear and/or cytoplasmic expression in epithelial cells of IBC and NIL, but also in stromal fibroblasts. Results showed that expression of p16 increases with the progression of cytological changes in the epithelium; it is significantly higher in IBC compared to NIL (p < 0.0005). Cytoplasmic p16 expression is more prevalent in IBC (76.6%), as opposed to nuclear staining, which is characteristic of most NIL (21.1%). There is a difference in p16 expression between different molecular subtypes of IBC (p = 0.025). In the group of p16 positive tumors, pronounced mononuclear infiltrates (p = 0.047) and increased expression of p16 in stromal fibroblasts (p = 0.044) were noted. In conclusion, p16 protein plays an important role in proliferation, malignant transformation, as well as in progression from NIL to IBC.

Ever more frequent natural disasters, such as snowfall, strong earthquakes, and severe flooding, require, in addition to the usual forces, the use of the Serbian Armed Forces’ units to provide assistance to civil authorities in the common struggle against their devastating consequences, which have lately been the most common causes of endangering general security of our society. An important place in the Serbian Armed Forces’ third mission, especially when it comes to assisting civil authorities in the events of severe flooding, has been assigned to the River Flotilla, with all its human, material, and organizational assets. This paper primarily aims to find a successful model of using the River Flotilla in an integrated protection and rescue system of the Republic of Serbia. The model suggested in this paper represents a universal and flexible approach to dealing with unpredictable, dynamic and complex challenges, risks and threats, based primarily on the implementation of relevant activities and actions before, during and after an emergency situation, and applying the existing doctrinal solutions and practical experiences gained during the use of the River Flotilla’ forces in providing assistance to civil authorities in the phases of prevention, response, and elimination of the consequences.

The possibility that orosomucoid was synthesized in endothelial cells was explored using primary cultures of human microvascular endothelial cells from dermal tissue. Human liver controls were used as positive controls and total RNA was prepared from both cell types. Findings indicate that endothelial cells normally produce orosomucoid, which is essential for capillary charge selectivity. It is possible that orosomucoid exerts its effect by interacting with other components of the endothelial glycocalyx.

Hepatocyte growth factor (HGF) expression of hypophysectonized rats is accelerated by treating with growth hormone before hepatectony, as observed in rat skeletal muscle, during the postnatal growth and the regeneration after ischemic injury. HGF mRNA is reexpressed in the regenerating muscle, giving rise to a distinct signal for the first few days following injury. A regenerating rat liver, subjected to partial hepatectony and carbon tetrachloride (CCl4), exhibits an increase in the expression of HGF, indicating the functional role of HGF in tissue reproduction.

IGF-I treatment attenuates renal abnormalities induced by neonatal ACE inhibition. Am J Physiol Regulatory Integrative Comp Physiol 279: R1050-R1060, 2000.--An intact renin-angiotensin system (RAS) during nephrogenesis is essential for normal renal development. We have shown previously that neonatal inhibition of the RAS, either with ANG II type 1-receptor blockade or angiotensin-converting enzyme (ACE) inhibition, induces irreversible renal abnormalities. The aim of the present study was to investigate whether an interrupted RAS can be compensated for by exogenous administration of another important renal growth-promoting factor, the insulin-like growth factor-I (IGF-I). Rats were treated daily with either the ACE inhibitor enalapril (10 mg/kg), recombinant human IGF-I (3 mg/ kg), or the combination enalapril + IGF-I from perinatal day 3 to 13. Urinary concentrating ability, renal function, and renal morphology were assessed at adult age. The gene expression and localization of IGF-I, its receptor, and the growth hormone receptor (GHR) were investigated during ongoing ACE inhibition. The present study demonstrates normalized renal function and histology in enalapril + IGF-I-treated animals. Ongoing ACE inhibition suppressed the medullary IGF-I mRNA expression and altered the local distribution of both IGF-I and GHR. Thus the present study provides evidence for an interaction between the RAS and GH/IGF-I axis in renal development. renin-angiotensin system; renal development; angiotens-inconverting enzyme; insulin-like growth factor

This paper presents the impact of text and background colour combinations on the legibility of characters and readability of text presented on video display units (VDUs). The stimulus features influencing the operator’s response latency and accuracy are analysed in two experiments, examining the effects of text–background colour combinations and stimulus exposition on the ability of character and word identification on VDUs. This is analysed for the purpose of improving the information presentation in control information systems in Serbian underground coal mines. The legibility of characters based on the main colour combinations was tested by focusing on 30 participants. The first experiment required the participants to identify the legibility of uppercase alphabetic characters and numbers randomly selected and presented on a VDU. The visual performance was expressed by the number of correctly identified characters. The second experiment required the participants to identify the readability of the presented characters, based on the colour combinations of the characters and the background, in order to identify the best possible combination of colours for fast identification of information, which is very important in the detection of fast-changing unwanted events. The results of the experiments suggested that the character recognition was strongly influenced by character/background colour combination and exposition. The adequate selection of these variables can significantly improve the legibility of characters, and improve the speed and the accuracy of the identification of potential problems in underground coal mines during emergency situations. [ABSTRACT FROM AUTHOR]

Sensor node localization with an acceptable accuracy is one of the most important challenges for location-aware applications of Wireless Sensor Networks (WSNs). The Received Signal Strength (RSS)-based localization techniques are very attractive because of their simplicity and low cost. However, those methods suffer from evident estimation errors. In our previous work, we developed fuzzy set-based localization method, called Fuzzy Ring Overlapping Range Free (FRORF) localization. In this paper we further extend the concept and propose an improved FRORF localization method, IFRORF for short, which uses two-layer fuzzy processing. IFRORF is an area-based localization approach that partitions the localization space into overlapping rings modeled as fuzzy sets with ambiguous boundaries, and then generates fuzzy set of regions by intersecting rings from different fuzzy ring sets. IFRORF estimates the location based on degrees of sensor node membership in regions in the fuzzy set of regions that are additionally tuned using the second layer of fuzzy processing. Simulations demonstrate that IFRORF method outperforms localization accuracy of FRORF. [ABSTRACT FROM AUTHOR]

SUMMARY Time-division multiple-access (TDMA) is a common medium access control paradigm in wireless sensor networks. However, in its traditional form, the TDMA-based protocols suffer from low channel utilization and high message delay because of a long frame length needed to provide collision-free transmissions, which is particularly damaging in dense wireless sensor networks. In this paper, we investigate the performance and the energy efficiency of a class of TDMA-based protocols, called reduced-frame TDMA, where every TDMA slot is augmented with a short time period dedicated for carrier sense multiple access-based contention resolution mechanism. Because of their ability to dynamically resolve collisions caused by conflicting slot assignments, the reduced-frame TDMA protocols can be configured with any frame length, independently of node density. In addition, we present a distributed heuristic slot assignment algorithm that minimizes interslot interference in the presence of limited number of slots per frame. The simulation results indicate that the reduced-frame TDMA protocols significantly reduce the message delay and increase the maximum throughput without incurring significant penalty in energy efficiency compared with the traditional TDMA scheme. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper analyzes the potential problems in the exploitation of the older generation of spark-ignition engines with higher octane number of petrol (unleaded petrol BMB 95) than required (leaded petrol MB 86). Within the experimental tests on two different engines (STEYR-PUCH model 712 and GAZ 41) by applying piezoelectric pressure sensors integrated with the engine spark plugs, acceleration sensors and special electronic block connected with distributor, show that the cumulative first and second theoretical phase of combustion when petrol of higher octane number (BMB 95) is used lasts slightly longer than when the low-octane petrol MB 86 is used. For new petrol (BMB 95) higher optimal angles of pre-ignition have been determined by which better performances of the engine are achieved without a danger of the combustion with detonation (also called knocking). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate toxicological risks for workers who are exposed to lead in their work environment. Methods: Since it is an important indicator of toxicological risk, a statistical analysis of lead concentration and biological lead toxicity markers in blood and urine were performed for both exposed and control groups. Both experimental groups consisted of employees from "NISSAL" JSC factory. Analytical epidemiological method in the form of a retrospective cohort study was applied, and covered the period from 2001 to 2010. The concentration of lead, δ-aminolevulinic acid, and coproporphyrin in biological samples were determined by spectrophotometric methods. Results: The results showed a high positive correlation between lead concentrations in blood and urine and the length of exposure of the participants (p < 0.01). Also, increase of lead concentration in the biological material significantly increased δ-aminolevulinic acid (p < 0.01) and slightly increased the concentration of coproporphyrin, both of which are important indicators of toxicological risk. Conclusion: The control group of employees belonged to the normal risk category, while the exposed group belonged to a moderate risk category. Correlation between the monitored parameters is statistically significant at p < 0.01 and p < 0.05. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of NASH needs a liver biopsy, an invasive procedure that is not frequently accepted by patients. The aim of our study was to evaluate the efficacy of the 13 C-Octanoate breath test (OBT) as a non-invasive surrogate marker to differentiate patients with NASH from patients with simple steatosis (NAFL)., Methods: We performed a prospective study on patients with histologically established non-alcoholic steatohepatitis and no other hepatic disease. Each patient underwent a testing protocol, which included a clinical exam, laboratory blood tests, standard abdominal ultrasound, and a 13 C-Octanoate breath test., Results: The study group included: 82 patients with steatohepatitis, 64 patients with simple steatosis, and 21 healthy volunteers. The univariate and bivariate analysis identified that significant values were the percent dose recovery (PDR) at 15 min-r = 0.65 (AUROC = 0.902) and cumulative percent dose recovery (cPDR) at 120 min-r = 0.69 (AUROC = 0.899)., Discussion: Our study showed that 13 C-OBT had good efficacy for identifying patients with NASH from those with NAFL (steatosis alone) but not those with NAFL from healthy subjects. Considering all these pathogenic steps in NASH we considered that OBT could have the clinical utility to identify patients at risk for NASH, especially "fast progressors".

Background: To date, no scale has been validated to assess bubbles associated with bowel preparation. This study aimed to develop and assess the reliability of a novel scale - the Colon Endoscopic Bubble Scale (CEBuS)., Methods: This was a multicenter, prospective, observational study with two online evaluation phases of 45 randomly distributed still colonoscopy images (15 per scale grade). Observers assessed images twice, 2 weeks apart, using CEBuS (CEBuS-0 - no or minimal bubbles, covering < 5 % of the surface; CEBuS-1 - bubbles covering 5 %-50 %; CEBuS-2 - bubbles covering > 50 %) and reporting the clinical action (do nothing; wash with water; wash with simethicone)., Results: CEBuS provided high levels of agreement both in evaluation Phase 1 (4 experts) and Phase 2 (6 experts and 13 non-experts), with almost perfect intraobserver reliability: kappa 0.82 (95 % confidence interval 0.75-0.88) and 0.86 (0.85-0.88); interobserver agreement - intraclass correlation coefficient (ICC) 0.83 (0.73-0.89) and 0.90 (0.86-0.94). Previous endoscopic experience had no influence on agreement among experts vs. non-experts: kappa 0.86 (0.80-0.91) vs. 0.87 (0.84-0.89) and ICC 0.91 (0.87-0.94) vs. 0.90 (0.86-0.94), respectively. Interobserver agreement on clinical action was ICC 0.63 (0.43-0.78) in Phase 1 and 0.77 (0.68-0.84) in Phase 2. Absolute agreement on clinical action per scale grade was 85 % (82-88) for CEBuS-0, 21 % (16-26) for CEBuS-1, and 74 % (70-78) for CEBuS-2., Conclusion: CEBuS proved to be a reliable instrument to standardize the evaluation of colonic bubbles during colonoscopy. Assessment in daily practice is warranted., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

The main component of error minimization in operating rooms (ORs) is to maintain high reliability of surgical teams. The analysis of adverse events in the OR reveals deficiencies in cognitive and interpersonal skills as the main factors influencing surgeons' errors. Therefore, research of these additional factors is necessary, besides factors related to surgeons' clinical knowledge and technical skills. In this paper, the key factors for evaluating activities in surgical operating rooms are identified. Fuzzy analytic hierarchy process is used for identification of key factors. Fifteen key factors are identified for evaluating activities in surgical operating rooms to improve the efficiency of surgical operations. For each group of activities (surgical "capabilities," operating room characteristics, and non-technical skills), five factors are identified. As the most important, the following factors are obtained: communication, indoor environment standardization, and tool handle design. The aim of the analysis of these key factors is surgeons' work capability enhancement, rational design of operating rooms, and advancement of operators' cognitive and interpersonal skills.

.

Capsule endoscopy (CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients. It has the advantage of excellent visualization of digestive tract mucosa, a good tolerability and safety in well-selected patients. The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule. The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis, thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings. When symptoms and biomarkers point to a change in the disease's activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards. The appearance of the new capsule from Medtronic-the Pillcam Crohn's might be an important step forward in diagnosis, evaluating disease extent, the severity of the disease, prognosis, management in a treat to target approach, with treatment modifications according to the data from CE examination. Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed. We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach., Competing Interests: Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Background and Aim: Malnutrition is a common feature of inflammatory bowel disease (IBD). There are numerous methods for the assessment of nutritional status, but the gold standard has not yet been established. The aims of the study were to estimate the prevalence of undernutrition and to evaluate methods for routine nutritional assessment of active IBD patients., Material and Methods: Twenty-three patients with active Crohn disease, 53 patients with active ulcerative colitis and 30 controls were included in the study. The nutritional status was assessed by extensive anthropometric measurements, percentage of weight loss in the past 1-6 months and biochemical markers of nutrition., Results: All investigated nutritional parameters were significantly different in IBD patients compared to control subjects, except MCV, tryglicerides and serum total protein level. Serum albumin level and body mass index (BMI) were the most predictive parameters of malnutrition. According to different assessment methods the prevalence of undernutrition and severe undernutrition in patients with active IBD were 25.0%-69.7% and 1.3%-31.6%, respectively, while in the control subjects no abnormalities have been detected. There was no statistically significant difference of nutritional parameters between UC and CD patients except lower mid-arm muscle circumference in UC group., Conclusions: Malnutrition is common in IBD patients. BMI and serum albumin are simple and convenient methods for the assessment of the nutritional status in IBD patients. Further studies with larger group of patients are necessary to elucidate the prevalence of malnutrition and the most accurate assessment methods in IBD patients.