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Background Return to work (RTW) might be delayed in patients with complicated mild traumatic brain injury (MTBI), i.e., MTBI patients with associated traumatic intracranial lesions. However, the effect of different types of lesions on RTW has not studied before. We investigated whether traumatic intracranial lesions detected by CT and MRI are associated with return to work and post-concussion symptoms in patients with MTBI. Methods We prospectively followed up 113 adult patients with MTBI that underwent a brain MRI within 3–17 days after injury. Return to work was assessed with one-day accuracy up to one year after injury. Rivermead Post-Concussion Symptoms Questionnaire (RPQ) and Glasgow Outcome Scale Extended (GOS-E) were conducted one month after injury. A Kaplan–Meier log-rank analysis was performed to analyze the differences in RTW. Results Full RTW-% one year after injury was 98%. There were 38 patients with complicated MTBI, who had delayed median RTW compared to uncomplicated MTBI group (17 vs. 6 days), and more post-concussion symptoms (median RPQ 12.0 vs. 6.5). Further, RTW was more delayed in patients with multiple types of traumatic intracranial lesions visible in MRI (31 days, n = 19) and when lesions were detected in the primary CT (31 days, n = 24). There were no significant differences in GOS-E. Conclusions The imaging results that were most clearly associated with delayed RTW were positive primary CT and multiple types of lesions in MRI. RTW-% of patients with MTBI was excellent and a single intracranial lesion does not seem to be a predictive factor of disability to work.

OBJECTIVE To examine perceived injustice and its associations with self-reported symptoms and return to work at 3 months after injury in a prospectively recruited sample of patients with mild traumatic brain injury (mTBI). DESIGN Observational study. SETTING TBI outpatient unit. PARTICIPANTS Adult patients aged 18 to 68 years with mTBI (n = 100) or orthopedic injury ([OI]; n = 34). MAIN MEASURES The Injustice Experience Questionnaire (IEQ) and its associations with the Rivermead Post Concussion Questionnaire (RPQ), Beck Depression Inventory-Second Edition (BDI-II), PTSD Checklist-Civilian Version (PCL-C), and Pain Visual Analog Scale (PVAS). Information on injury-related characteristics, compensation seeking and litigation, and return-to-work status was also collected. RESULTS Median IEQ total score was 3 (range, 0-23) in the mTBI group and 2.5 (range, 0-25) in the OI group. In the mTBI group, IEQ was significantly correlated with RPQ (rs = 0.638, P < .01), BDI-II (rs = 0.612, P < .01), PCL-C (rs = 0.679, P < .01), and PVAS (rs = 0.232, P < .05). The association between IEQ and PCL-C (rs =0.797, P < .01) and BDI-II (rs = 0.395, P < .05) was also found in the OI group. In both groups, patients who were still on sick leave at 3 months after injury tended to report higher perceived injustice (IEQ total score) than patients who had returned to work or studies. However, this difference did not reach statistical significance. CONCLUSIONS Perceived injustice is associated with self-reported symptoms in patients with mTBI. Our results suggest that perceived injustice could be a relevant construct to consider in clinical management of patients with mTBI. Also, perceived injustice could be a potential target for psychological interventions promoting recovery after mTBI.

The 2020 pandemic came at a huge demographic cost, particularly regarding the increase in mortality. In this paper we examine excess deaths in Serbia and 34 other European countries in 2020. Methodological inconsistencies and big differences in how COVID-19 deaths were recorded across different countries make it difficult to make any cross-country comparisons, even with the scope limited only to Europe. Since the number of total deaths is a methodologically solid indicator, we looked at the differences between the total number of deaths in 2020 and compared that to deaths in 2019. The lowest increase in mortality - below 5% - occurred in countries in the north of Europe (Norway, Denmark, Finland, Latvia), while the highest increase - over 18% - was recorded in the southern and central parts of the continent (Albania, Northern Macedonia, Spain, Belgium, Poland, Slovenia, Russia). There is no clear geographical regularity. In 2020, Serbia had 12.6% more deaths compared to 2019, which was close to the European average. Within Serbia, statistical differences between regions were not large. Measuring the contribution of COVID-19 deaths to excess mortality is much more problematic. The excess death ratio is more helpful for understanding methodological and data-gathering issues than finding evidence about composition and divergence in mortality. According to this indicator (based on preliminary data), only 25% of excess deaths in Serbia in 2020 were caused by COVID-19, while the European average was 54%. However, in many (primarily Eastern European) countries in 2020, the indirect consequences of COVID-19 on the health of the population were more significant than the direct ones. It is precisely the ratio of COVID-19 diagnoses that led to death in total mortality that shows this. The final results may confirm this statement or indicate potential data manipulation. While this paper focuses only on the year 2020, as of Q1 of 2021, the pandemic is not nearing its end. Based on preliminary data published daily, Serbia had more COVID-19 deaths in the first four months of 2021 than for the whole of 2020. This indicates that the consequences of the pandemic for Serbia will be dire in 2021, regardless of the course the pandemic takes.

Purpose Severity of white matter lesion (WML) is typically evaluated on magnetic resonance images (MRI), yet the more accessible, faster, and less expensive method is computed tomography (CT). Our objective was to study whether WML can be automatically segmented from CT images using a convolutional neural network (CNN). The second aim was to compare CT segmentation with MRI segmentation. Methods The brain images from the Helsinki University Hospital clinical image archive were systematically screened to make CT-MRI image pairs. Selection criteria for the study were that both CT and MRI images were acquired within 6 weeks. In total, 147 image pairs were included. We used CNN to segment WML from CT images. Training and testing of CNN for CT was performed using 10-fold cross-validation, and the segmentation results were compared with the corresponding segmentations from MRI. Results A Pearson correlation of 0.94 was obtained between the automatic WML volumes of MRI and CT segmentations. The average Dice similarity index validating the overlap between CT and FLAIR segmentations was 0.68 for the Fazekas 3 group. Conclusion CNN-based segmentation of CT images may provide a means to evaluate the severity of WML and establish a link between CT WML patterns and the current standard MRI-based visual rating scale.

The impact of alcohol on mortality is not negligible, not globally and especially not in Europe. Alcohol as a mortality factor in Serbia has not yet been specifically analysed, chiefly due to a lack of data. The cultural pattern and results from surrounding countries - as well as research on the extent of alcohol consumption in Serbia - all suggest that alcohol-related mortality represents a significant share of total mortality, especially when it comes to men. The results of the study on alcohol abuse or excessive consumption in this paper do not confirm that this mortality factor places a significant burden on the population. This paper provides estimates of alcohol-related mortality using guidelines from the World Health Organization. Analysis of the direct impact and estimates of the indirect impact of alcohol on mortality in Serbia (2016-2018) show that the average number of deaths is about 2,500 annually. The number of alcohol-related deaths is highest in the later years of life, while the proportion of alcohol-related deaths is highest in early adulthood. Men are more likely to consume alcohol, so their mortality is higher as a consequence. Men die from alcohol-related causes at a rate almost four times higher than that of women, and they have more deaths caused by alcohol than women across all age groups. The overall alcohol-related mortality rate for men is 56.6 per 100,000, while for women it is significantly lower at 14.2 per 100,000. The most common cause of alcohol-related mortality is in the form of digestive system diseases (about 26% of all alcohol-related deaths in Serbia), followed by tumours and violence (24% and 23% respectively). From region to region (NUTS 2), significant differences in alcohol-related mortality can be noted. Every third death due to alcohol occurs in Vojvodina, which leads the way for both sexes. There, values for men are as much as 60% higher than those in the Sumadija and Western Serbia regions, while those values are about 30% higher for women. Standardised alcohol-related death rates are highest in the north of Vojvodina, in the districts of North Backa and North Banat (NUTS 3). Moravicki, Sumadija, and Pirot districts have values that are about 30% lower than average for Serbia. Excessive alcohol consumption is one of the preventable mortality factors that can be addressed with appropriate prevention measures. Some good reasons to avoid alcohol abuse include longer lifespan, lower likelihood of depression, significantly lower likelihood of committing suicide, and lower likelihood of dying from liver disease. Those who drink less are also less likely to be involved in a car accident or have to deal with the police. When consumed in excess, alcohol disrupts family relationships, leads to obesity, damages the brain, and causes sexual dysfunction.

Objective Data on post-stroke use of antidepressants in young individuals are scarce. We examined pattern and factors associated with initiating post-stroke antidepressants (PSAD) after ischemic stroke (IS) in young adults. Methods Helsinki Young Stroke Registry includes patients aged 15–49 years with first-ever IS, 1994–2007. Data on prescriptions, hospitalizations and death came from nationwide registers. We defined time of initiating PSAD as time of the first filled prescription for antidepressants within 1 year from IS. We assessed factors associated with initiating PSAD with multivariable Cox regression models, allowing for time-varying effects when appropriate. Results We followed 888 patients, of which 206 (23.2%) initiated PSAD. Higher hazard of starting PSAD within the first 100 days appeared among patients with mild versus no limb paresis 2.53 (95% confidence interval 1.48–4.31) and during later follow-up among those with silent infarcts (2.04; 1.27–3.28), prior use of antidepressants (2.09; 1.26–3.46) and moderate versus mild stroke (2.06; 1.18–3.58). The relative difference in the hazard rate for moderate–severe limb paresis persisted both within the first 100 days (3.84, 2.12–6.97) and during later follow-up (4.54; 2.51–8.23). The hazard rate was higher throughout the follow-up among smokers (1.48; 1.11–1.97) as well as lower (1.78; 1.25–2.54) and upper white-collar workers (2.00; 1.24–3.23) compared to blue-collar workers. Conclusion One-fourth of young adults started PSADs within 1 year from IS. We identified several specific clinical characteristics associated with PSAD initiation, highlighting their utility in assessing the risk of post-stroke depression during follow-up.

Background Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

The main objective of this prospective cohort study was to evaluate whether traumatic microbleeds (TMBs) are a significant prognostic factor of return to work (RTW), post-traumatic symptoms, and overall recovery in patients with mild traumatic brain injury (mTBI). One hundred and thirteen patients with mTBI were recruited from the Helsinki University Hospital emergency units. All patients underwent multi-contrast 3T magnetic resonance imaging (MRI) 3-17 days after mTBI. Patients were evaluated in the Traumatic Brain Injury Outpatient Clinic of Helsinki University Hospital 1 month after injury. Post-concussion symptoms were assessed with the Post-Concussion Symptom Questionnaire (RPQ) and overall recovery was assessed with the Glasgow Outcome Scale Extended (GOS-E). Their time to RTW was continuously measured up to 1 year after TBI. Median RTW was 9 days (interquartile range [IQR] 4-30) after mTBI and full RTW rate after 1 year was 98%. Patients with TMBs (n = 22) did not have more post-concussion symptoms (median RPQ 10.0 vs. 7.0, p = 0.217) or worse overall recovery (58% vs. 56% with GOS-E = 8, p = 0.853) than patients without TMBs (n = 91). There was no significant difference in time to RTW (13.5 vs. 7.0 days, p = 0.063). In this study, patients with TMBs did not have delayed RTW or more post-concussion symptoms than other patients with mTBI. TMBs in mTBI do not seem to be a significant prognostic factor of RTW.

Spondylocostal dysostosis is a very rare combination of complex vertebra and rib malformations, accompanied occasionally by other disorders. A 3-year-old girl presented kyphoscoliosis, foot deformities, gate disturbance, and urinary incontinence. The CT and MRI examination revealed kyphosis and scoliosis with a double curve, some absent, broadened, bifurcating and fused ribs, hemivertebrae, butterfly and cleft vertebrae in thoracic and lumbar region, sporadic cleft or absent vertebral arches or pedicles, and hypoplastic sacrum with a cleft of the S2 vertebra. Spina bifida occulta extended from T10 to T11, and from L3 to the end of the sacrum. Two hemicords, separated by a bony septum and surrounded by their own dural tubes (type I), were present from the level of T9 to the conus medullaris. Filum terminale was thick and duplicated. Syringomyelia was present in the thoracic cord from T5 to T8. Finally, a small meningocele was seen at the T10–T11 level, and a subcutaneous lipoma in the thoracolumbar region. To our knowledge, such a combination of vertebra, rib, and cord malformations, including the mentioned additional disorders, has never been reported.

BackgroundPsychiatric sequelae after traumatic brain injury (TBI) are common and may impede recovery. We aimed to assess the occurrence and risk factors of post-injury psychotropic medication use in intensive care unit (ICU)-treated patients with TBI and its association with late mortality.MethodsWe conducted a retrospective multi-centre observational study using the Finnish Intensive Care Consortium database. We included adult TBI patients admitted in four university hospital ICUs during 2003–2013 that were alive at 1 year after injury. Patients were followed-up until end of 2016. We obtained data regarding psychotropic medication use through the national drug reimbursement database. We used multivariable logistic regression models to assess the association between TBI severity, treatment-related variables and the odds of psychotropic medication use and its association with late all-cause mortality (more than 1 year after TBI).ResultsOf 3061 patients, 2305 (75%) were alive at 1 year. Of these, 400 (17%) became new psychotropic medication users. The most common medication types were antidepressants (61%), antipsychotics (35%) and anxiolytics (26%). A higher Glasgow Coma Scale (GCS) score was associated with lower odds (OR 0.93, 95% CI 0.90–0.96) and a diffuse injury with midline shift was associated with higher odds (OR 3.4, 95% CI 1.3–9.0) of new psychotropic medication use. After adjusting for injury severity, new psychotropic medication use was associated with increased odds of late mortality (OR 1.19, 95% CI 1.19–2.17, median follow-up time 6.4 years).ConclusionsPsychotropic medication use is common in TBI survivors. Higher TBI severity is associated with increased odds of psychotropic medication use. New use of psychotropic medications after TBI was associated with increased odds of late mortality. Our results highlight the need for early identification of potential psychiatric sequelae and psychiatric evaluation in TBI survivors.

Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan–Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5–19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3–14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0–8.0) compared to 8.0 (IQR 7.0–8.0, p = 0.003). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient’s return to work.

BackgroundCombination antiplatelet therapy with clopidogrel and aspirin may reduce the rate of recurrent stroke during the first 3 months after a minor ischemic stroke or transient ischemic attack (TIA). A trial of combination antiplatelet therapy in a Chinese population has shown a reduction in the risk of recurrent stroke. We tested this combination in an international population.MethodsIn a randomized trial, we assigned patients with minor ischemic stroke or high-risk TIA to receive either clopidogrel at a loading dose of 600 mg on day 1, followed by 75 mg per day, plus aspirin (at a dose of 50 to 325 mg per day) or the same range of doses of aspirin alone. The dose of aspirin in each group was selected by the site investigator. The primary efficacy outcome in a time-to-event analysis was the risk of a composite of major ischemic events, which was defined as ischemic stroke, myocardial infarction, or death from an ischemic vascular event, at 90 days.ResultsA total of 4881 patients were enrolled at 269 international sites. The trial was halted after 84% of the anticipated number of patients had been enrolled because the data and safety monitoring board had determined that the combination of clopidogrel and aspirin was associated with both a lower risk of major ischemic events and a higher risk of major hemorrhage than aspirin alone at 90 days. Major ischemic events occurred in 121 of 2432 patients (5.0%) receiving clopidogrel plus aspirin and in 160 of 2449 patients (6.5%) receiving aspirin plus placebo (hazard ratio, 0.75; 95% confidence interval [CI], 0.59 to 0.95; P=0.02), with most events occurring during the first week after the initial event. Major hemorrhage occurred in 23 patients (0.9%) receiving clopidogrel plus aspirin and in 10 patients (0.4%) receiving aspirin plus placebo (hazard ratio, 2.32; 95% CI, 1.10 to 4.87; P=0.02).ConclusionsIn patients with minor ischemic stroke or high-risk TIA, those who received a combination of clopidogrel and aspirin had a lower risk of major ischemic events but a higher risk of major hemorrhage at 90 days than those who received aspirin alone. (Funded by the National Institute of Neurological Disorders and Stroke; POINT ClinicalTrials.gov number, NCT00991029 .).

Serbia in the second decade of the 21st century is one of the demographically oldest countries of the world with marked depopulation. The prolongation of life expectancy and the long-term fertility below the level needed for population replacement, as well as the emigration of predominantly young people, are the main factors for demographic aging in Serbia and the current decrease in population size. As a result of decades-long adverse demographic trends, the age structure is increasingly becoming a limiting factor in defining population policy measures. In the period between years 1991 and 2011, the cohort of women aged between 15-49 years decreased by 250 thousand, and at the same time the population of women in the so-called optimal reproductive age (20-34 years) decreased by almost 90 thousand. Mathematical simulations, in which the current distribution of the population of Serbia by age and sex is projected in the coming decades, will show what the result can be expected with the growth of fertility, the prolongation of life expectancy and influx of young immigrants. In particular, the focus will be on the constraints imposed by the inherited age structure on the population dynamics. The notion of demographic inertia will be considered and whether the depopulation effect is unstoppable in the next few decades. We discuss possibilities and constraints in establishing population policy measures.

Mortality among married is lower than in those out of wedlock. Studies in European countries show that the difference in mortality between those who are married and those unmarried is increased regardless of sex. The main objective of the analysis in this paper is to show the impact of marriage on the mortality of the population, as well as the difference in the life expectancy of men and women in Serbia, by marriage status. Is there a protective effect of marriage? That is, can we confirm the hypothesis of higher importance of marriage status, when it comes to mortality of the men, and can we determine whether there are strong links between mortality and various modalities of marriage in the female population? Mortality trends for married and unmarried individuals were analyzed between the years 1981 and 2011, for both male and female population by five-year age groups. The scope of the analysis is the territory of Central Serbia and Vojvodina. This aspect of mortality is not sufficiently addressed in national research, which is why it is expected that the results of the conducted research can contribute to a deeper understanding of the factors affecting the mortality of the population in Serbia.

The use of tobacco in Serbia has for many years been one of the most frequent risk factors affecting disease development. Although its impact is often neglected and the effects on health minimised, reviewing the existing literature and calculating the tobacco consumption impact on the mortality of the population in Serbia (using the Peto-Lopez method) show a clear link between smoking and health of the population. Serbian population is heavily burdened with the negative effects of tobacco on health, especially men. At the beginning of the second decade of the 21st century, mortality from the illness or cause of death associated with smoking was at about 17% of the total mortality. In men, it is estimated that even a quarter of the total mortality is associated with smoking. In the female population, the share of smokers is considerably lower, and consequently the mortality from this factor is lower, about 9% of the total mortality. Of all major disease groups, tumours are most affected by smoking. The share of tobaccorelated mortality in neoplasms is high and accounts for 30% (43% in men and 14% in women). In cardiovascular diseases, the impact of smoking is much smaller and about 6,000 deaths per year are associated with the use of tobacco. Since the early 1990s, the number of smoking-attributable death has been growing. Relatively, the share of men has not changed, but for 20 years of analysis the share of women has significantly increased from 5% to 9%. In all age groups, the share of smoking-related mortality has increased in the female population, especially in the 45-69 age range where mortality has been doubled. Surveys on the health of the Serbian population also confirm the trend of increasing the share of women smokers in the population, especially in the categories of young people. Men in Serbia (35-69 years of age) have the highest smoking-attributable death rate in Europe. As much as 44% of total deaths in that age are directly related to smoking. Besides Hungary, where mortality in men is also relatively high (42%), other countries have significantly lower shares. Observed at the level of the entire continent, countries of the Balkan Peninsula (and their neighbours) have the highest shares of smoking-attributable death. Women in Serbia have a moderately high share of 9% and are among the ten most vulnerable countries in Europe. The biggest difference in smoking-related mortality by gender is observed in the Pyrenees Peninsula and in the eastern and south-eastern parts of Europe. These are also the countries with the largest absolute difference in the mortality rate of men and women, thus confirming the hypothesis that tobacco smoke, as a single mortality factor, plays the most important role in establishing a different gender mortality pattern. A high percentage of smokers in the total population limits the growth of life expectancy and affects the difference in gender mortality rate. If a certain mortality factor potentially affects the life expectancy of up to three years for men in Serbia, as shown in the paper, then it is especially important to pay attention to measures of prevention and awareness of the population regarding this issue. Moreover, it is particularly important to recognise the consequences of passive smoking the youth and children are exposed to, since in Serbia there is a great deal of tolerance for smoking indoors. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III47006]

Background: Identification and anatomic features of the feeding arteries of the arteriovenous malformations (AVMs) is very important due to neurologic, radiologic, and surgical reasons. Materials and methods: Seventy-seven patients with AVMs were examined by using a digital subtraction angiographic (DSA) and computerised tomographic (CT) examination, including three-dimensional reconstruction of the brain vessels. In addition, the arteries of 4 human brain stems and 8 cerebral hemispheres were microdissected. Results: The anatomic examination showed a sporadic hypoplasia, hyperplasia, early bifurcation and duplication of certain cerebral arteries. The perforating arteries varied from 1 to 8 in number. The features of the leptomeningeal and choroidal vessels were presented. The radiologic examination revealed singular (22.08%), double (32.48%) or multiple primary feeding arteries (45.45%), which were dilated and elongated in 58.44% of the patients. The feeders most often originated from the middle cerebral artery (MCA; (23.38%), less frequently from the anterior cerebral artery (ACA; 12.99%), and the posterior cerebral artery (PCA; 10.39%). Multiple feeders commonly originated from the ACA and MCA (11.69%), the MCA and PCA (10.39%), the ACA and PCA (7.79%), and the ACA, MCA and PCA (5.19%). The infratentorial feeders were found in 9.1% of the AVMs. Contribution from the middle meningeal and occipital arteries was seen in 3.9% angiograms. Two cerebral arteries had a saccular aneurysm. The AVM haemorrhage appeared in 63.6% of patients. Conclusions: The knowledge of the origin and anatomic features of the AVMs feeders is important in the explanation of neurologic signs, and in a decision regarding the endovascular embolisation, neurosurgical and radiosurgical treatments.

Intracerebral hemorrhage (ICH) is the least treatable form of stroke and is associated with the worst prognosis. In up to 40% of cases, ICH is further complicated by intraventricular hemorrhage (IVH), which predisposes to hydrocephalus, and increases case-mortality to 80%. However, IVH is not present in widely used preclinical models of ICH. Here, we characterize a novel rat model of combined ICH and IVH. Rats were injected with different volumes of autologous whole blood into the right deep basal ganglia region (100μL, 150μL, 200μL, and 250μL, n=10 per group). MRI was performed immediately, and at 24, 48, 72h, and 1week after blood injection, along with neurological evaluations. Injected blood volume reliably correlated with blood volumes measured from MRI obtained after blood injection. Brain edema was most prominent in the ⩾200μL groups, peaking at 48h in all groups, being statistically different between the ⩾200μL and

This paper analyses the differential mortality in Vojvodina according to the economic activity and occupations of the population. The analysis covers the period from 1971 to 2011. The aim of the research is to determine the influence of socio-economic factors on differences in the level of mortality among different population groups. In particular, the aim is to detect the impact of working conditions and manner of performing the job to the differences in the mortality of the population with different occupations. Also, the goal is to detect changes in differential mortality according to economic activity and occupations of the population during the analysed period.

Ethnic homogeneity of settlements, or in other words, formation of ethnically homogeneous settlements in ethnically heterogeneous environment, such as Vojvodina, as well as the regions of Raska and Pcinja, is the issue which will be discussed in this paper. The analysis involves total population according to their ethnic affiliation (the 2011 Census), at the level of settlements. The estimates on the number of Albanian population at the level of settlements were made for the needs of this paper considering the fact that the census was not successful on the entire territory of the Republic because the ethnic Albanian boycotted it. Spatial distribution analysis and the determination of majority of population at the level of settlements represent the research focus of the paper. Furthermore, the aim of this paper was to point out certain ethnic characteristics of Serbian population (excluding Kosovo and Metohija), with the emphasis on the continuous trend of increasing number of people who do not want to declare their ethnic affiliation.

Sudden memory loss, with prolonged cognitive deterioration, clinically initially resembling a transitory global amnesia (TGA)-like episode, might be caused by ischemic stroke in the hippocampal regions. We report a patient with TGA-type sudden anterograde amnesia and normal head CT. Examinations revealed that the patient had several vascular risk factors and 3 tesla (T) head MRI showed ischemic lesions in diffusion-weighted images (DWI) in both hippocampi. Neuropsychological assessment revealed sustained moderate verbal memory deterioration and abnormal executive functions. We suggest that small ischemic strokes in hippocampal regions might remain unrecognized and underdiagnosed if follow-up of TGA-type episodes is not adequate and if head CT remains the only method of brain imaging.

International audience; This chapter focuses on four stakes: (i) the huge demographic changes of the Western Balkans, and the mobility issue namely due to a re-bordering process since the end of the Yugoslavian wars ; (ii) the undeniable income rise but also rising social disparities; (iii) an economy which is just recovering with strong geographical fragmentation; (iv) in the field of environment, an early stage regulation and the necessity for a rising international cooperation with the European union. We highlight a still low international openness, an obvious core-periphery pattern in economic flows with the EU, and the various shortcomings of territorial cooperation with the EU. The strategic recommendations insist on the internal fragmentation, which hinders connection to the EU and any perspective of the Western Balkans to become one day “South-East Europe”.

Geographica Pannonica; Vol 20, No 4, 2016. ISSN 1820-7138, The research presented in this paper is dealing with mortality and its impact on the natural increase, i.e. population dynamics in Serbia at the beginning of the 21st century. The aim is to draw attention to the potential of mortality as a natural component of changes in population when it comes to the possibility of mitigating the negative population trends. This paper will analyse changes in the age patterns of mortality of Serbian population from the mid 20th century, in order to point to the lack of progress in reducing age-specific mortality. The comparison with countries with low mortality rates (Slovenia and Sweden) will highlight the potential space for further mortality reduction in Serbia. The effect of a hypothetical fall of mortality by age on the level of natural increase will be measured on the basis of population projections for the period of half a century.

Diffusion tensor (DT) imaging measures the random molecular diffusion of water in vivo and provides information on the microstructure of tissue. Ischemic brain damage leads to tissue disorganization and structural lost. We aimed to evaluate these changes in a rat model of focal stroke from the hyperacute to chronic phase by utilizing several DT indices. Adult male Wistar rats, subjected to temporary focal cerebral ischemia by suture occlusion of the middle cerebral artery for 90 min, and sham controls were serially imaged at 4.7 Tesla. DT scans were collected repeatedly during the hyperacute (2 and 3.5 h), acute (1, 2, and 3 days), subacute (4, 7, and 14 days), and chronic (4, 6, and 8 weeks) phases. We measured the evolution of DT indices (mean diffusivity (MD), axial diffusivity (λ ║ ), radial diffusivity (λ ┴ ), and fractional anisotropy (FA)) in the cortex, subcortex, and corpus callosum of the ischemic hemisphere. In the hyperacute phase, MD, λ ║ , and λ ┴ reduced with no change in FA. From the acute to subacute phase, MD, λ ║ , and λ ┴ normalized and thereafter increased, whereas FA decreased in all the tissues. In the chronic phase, MD, λ ║ , and λ ┴ continued to rise, whereas FA normalized in the corpus callosum and subcortex, but remained low in the cortex. We described structural tissue changes in ischemic rat brain longitudinally utilizing DT analysis. DT indices reveal different individual patterns reflecting different facades and phases of tissue injury. The use of several DT indices may improve accuracy in estimating the age of the brain injury and in detecting ongoing pathological events.

The structure of the leading causes of death in Serbia has considerably changed in the last half century. Diseases which presented the main threat to the population a few decades ago are now at the level of a statistical error. On the one side are causes which drastically changed their share in total mortality in this time interval, while others have shown stability and persistence among the basic causes of death. Acute infectious diseases "have been replaced" with chronic noninfectious diseases, due to the improvement of general and health conditions. One of the consequences of such changes is increased life expectancy and a larger share of older population which resulted in cardiovascular diseases and tumors to dominate more and more in total mortality. Convergent trends in the structure of the leading causes of death in Serbia from the middle of the 20th century are the reasons why there are considerably fewer diseases and causes with a significant rate in total population mortality at the beginning of the 21st century. During the 1950s, there were five groups of diseases and causes which participated individually with more than 10% of population mortality (infectious diseases, heart and circulatory diseases, respiratory diseases, some perinatal conditions and undefined states) while at the beginning of the new century there were only two such groups (cardiovascular diseases and tumors). Identical trends exist in all European countries, as well as in the rest of the developed world. The leading causes of death in Serbia are cardiovascular diseases. An average of somewhat over 57.000 people died annually in the period from 2007 - 2009, which represents 55.5% of total population mortality. Women are more numerous among the deceased and this difference is increasing due to population feminization. The most frequent cause of death in Serbia, after heart and circulatory diseases, are tumors, which caused 21,415 deaths in 2009. Neoplasms are responsible for one fifth of all deaths. Their number has doubled in three decades, from 9,107 in 1975 to about 20,000 at the beginning of the 21st century, whereby tumors have become the fastest growing cause of death. Least changes in absolute number of deaths in the last half century were marked among violent deaths. Observed by gender, men are in average three times more numerous among violent deaths than women. In the middle of the 20th century in Serbia, one third of the deaths caused by violence were younger than 25 and as many as one half were younger than 35 years old. Only one tenth (11%) of total number of violent deaths were from the age group of 65 or older. At the end of the first decade of the 21st century (2009), the share of population younger than 25 in the total number of violent deaths was decreased four times (and amounted to 8%). At the same time, the rate of those older than 65 or more quadrupled (amounted to 39%).

Transient ischemic attacks (TIAs) are brief neurological deficits ofcerebrovascular origin that are followed by complete clinical recovery. Although a plethora of animal models exist for ischemic stroke, a verified TIA model is lacking. We aimed to optimize such a model in mice, investigating the impact of varying durations (from 2.5 to 20 minutes) of intraluminal middle cerebral artery occlusion (MCAo). Three conditions were required to mimic clinical TIA reliably: 1) an objective demonstration of occlusion and reperfusion (assessed by laser Doppler flowmetry); 2) no permanent neurological deficit (assessed by sensorimotor neurological evaluation); and 3) no lesion at 24 hours after reperfusion (assessed by magnetic resonance imaging [MRI]). We observed high incidences of MRI lesions with MCAo durations of 15 minutes or longer. In contrast, no permanent neurological deficits or MRI lesions were observed in animals with MCAo below or equal to 10 minutes. Middle cerebral artery occlusion of 12.5 minutes rarely induced MRI lesions, but histopathologic evaluation using routine and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end-labeling staining revealed minute ischemic changes even after 2.5-minute MCAo. Abundance of necrotic and apoptotic changes gradually increased with the duration of ischemia. These results indicate that 10 minutes or shorter focal cerebral ischemia proves a suitable mouse TIA model; in addition, they indicate that MRI-negative microscopic ischemic damage may occur with even a few minutes of arterial occlusion.

Cause mortality of a population is an important segment in the analysis of mortality, because it sums up all factors which influence death indicators on a certain territory in a direct way. At the beginning of the 21st century, the situation is not the same everywhere in the world and countries do not share a unique pattern of the causes of deaths. Infectious and parasitic diseases are still dominant in underdeveloped countries, while the leading causes of deaths in developed countries are circulatory disorders and neoplasm. Cardiovascular diseases are the cause of 29% of total mortality in the world, infectious cause 19%, tumors 13% and violent deaths about 9% (based on data from 2002). This paper gives an analysis of the spatial distribution of the leading causes of deaths using the geographic information system (Arc-View GIS), based on the ratio of total mortality and death rates of the population from a certain group of diseases. Based on data analysis, a hypothesis has been set on the significance of the regional factor in forming a picture of population mortality according to causes of death. A regional factor implies a set of physical geographical as well as general social specificities of a certain region which form a pattern of population behavior. Based on death rates, cardiovascular diseases are represented the most in the mortality rates of countries in Eastern and Southeastern Europe. Infectious diseases imperil the population in the Sub-Saharan region of Africa; tumors are most common in Europe, North America and Japan. The highest rates of violent deaths are in countries of the former Soviet Union and the Sub- Saharan zone. Classifying death rates according to leading causes of death represents a prerequisite for forming a final picture of mortality according to causes of death in the world at the beginning of the 'new century'. The method of gathering together the causes of death is possible by applying a statistical model of classifying data (cluster analysis). The countries of the world have been classified into eight clusters according to the leading causes of death for the year 2002. Developed countries have been classified into three clusters based on this analysis. The Arab world has been singled out in a separate cluster, and the specific traits of Middle Asian countries also deserved separate classification. Countries of the Indian subcontinent and South East Asia, as well as Sub-Saharan Africa and South America formed regions on the basis of a combination of the leading causes of death. As opposed to epidemic transition, which tried to determine a uniform trend of the causes of death for all countries of the world, the cluster data analysis shows the significance of the regional factor when forming the depiction on the leading causes of death. Modeling population mortality based on data on causes of deaths structure bears much information, primarily in which direction should the health policies of a country flow and what are the priorities for decreasing mortality and increasing life expectancy. .

For almost 60 years has been recorded a higher crude death rate in Vojvodina in relation to central Serbia. Sounds paradoxical that the mortality of infants and young children in Vojvodina is lower, the average age of the population is lower, and that the crude death rate is higher than in central Serbia. Life expectancy was lower during the entire period in Vojvodina, especially in men. This paper will analyze mortality by age and sex in the period 1950-2008. The main subject of this research is the difference in specific rates of mortality of these two areas. Also, we explore the difference in mortality rates and the major causes of death. International review, which will separately consider mortality pattern in both regions, will place them on the map of Europe and the world. The main objective of this paper is to point out that in addition to health infrastructure and economic development, diet and lifestyle of the individual have a significant influence on mortality pattern. .

OBJECTIVE: Intracerebral hemorrhage (ICH) has a high mortality rate and leaves most survivors disabled. The dismal outcome is mostly due to the mass effect of hematoma plus edema. Major clinical trials show no benefit from surgical or medical treatment. Decompressive craniectomy has, however, proven beneficial for large ischemic brain infarction with massive swelling. We hypothesized that craniectomy can improve ICH outcome as well. METHODS: We used the model of autologous blood injection into the basal ganglia in rats. After induction of ICH and then magnetic resonance imaging, animals were randomly allocated to groups representing no craniectomy (n = 10) or to craniectomy at 1, 6, or 24 hours. A fifth group without ICH underwent craniectomy only. Neurological and behavioral outcomes were assessed on days 1, 3, and 7 after ICH induction. Furthermore, terminal deoxynucleotidyl transferase dUTP nick-end labeling-positive cells were counted. RESULTS: After 7 days, compared with the ICH + no craniectomy group, all craniectomy groups had strikingly lower mortality (P < 0.01), much better neurological outcome (P < 0.001), and more favorable behavioral outcome. A trend occurred in the ICH + no craniectomy group toward more robust apoptosis. CONCLUSION: Decompressive craniectomy performed up to 24 hours improved outcome after experimental ICH, with earlier intervention of greater benefit.

The blood-brain barrier (BBB) is the principal regulator of blood-borne substance entry into the brain parenchyma. Therefore, BBB leakage, which leads to cerebral edema and influx of toxic substances, is common in pathological conditions such as cerebral ischemia, inflammation, trauma, and tumors. The leakage of BBB after ischemia-reperfusion injury has long been considered to be biphasic, although a considerable amount of discrepancies as for the timing of the second opening does exist among the studies. This led us to evaluate systematically and quantitatively the dynamics of BBB leakage in a rat model of 90-min ischemia-reperfusion, using gadolinium-enhanced (small molecule) magnetic resonance imaging and fluorescent dye Evans Blue (large molecule). BBB leakage was assessed at the following time points after reperfusion: 25 min, 2, 4, 6, 12, 18, 24, 36, 48, and 72 h, and 1, 2, 3, 4, and 5 weeks. We observed BBB leakage for both gadolinium and Evans Blue as early as 25 min after reperfusion. Thereafter, BBB remained open for up to 3 weeks for Evans Blue and up to 5 weeks for gadolinium. Our results show that BBB leakage after ischemia-reperfusion injury in the rat is continuous and long-lasting, without any closure up to several weeks. This is the first systematic and extensive study fully demonstrating BBB leakage dynamics following transient brain ischemia and the findings are of major clinical and experimental interest.

The results of the 2002 census pointed out to an enormous increase in the number of inhabitants who were nationally undeclared or undecided. In the inter-census period 1991-2002, this population group increased for more than ten times (from 5 054 to 55 016). According to the share in the total population of Vojvodina (2.71%), they are - along with the Croats (2.78%) and the Slovaks (2.79%) - located immediately after the most numerous nationalities, the Serbs and the Hungarians. The paper analyzes the basic demographic characteristics (gender and age structure) of the undeclared and undecided persons, as well as the differences and similarities with other nationalities. The paper also presents the unequal spatial distribution of that population (at the settlement and municipal level), pointing out the interdependence between a great number of Yugoslavs and the enormous increase in the persons who were nationally undeclared or undecided. Using the features mother tongue and religion, the author tried to establish the relative relation between the number of the nationally undeclared and the number of nationally undecided persons.

The Patlak plot analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows estimation of blood-brain barrier (BBB) leakage following temporary focal cerebral ischemia. Thus far, a systematic and quantitative in vivo evaluation of post-ischemic BBB leakage is lacking. Here, using DCE-MRI and the Patlak plot method, we quantitatively assessed BBB leakage in rats at the following time-points after reperfusion: 25 min, 2, 4, 6, 12, 18, 24, 36, 48, and 72 h, and 1, 2, 3, 4, and 5 weeks. Sham-operated animals served as controls. Data collected for each time-point were: the blood-to-brain transfer rate constant (K(i)) of the contrast agent gadolinium, distribution volume (V(p)), ischemic lesion volume, and apparent diffusion coefficient (ADC) values. Compared to controls, K(i), measured at all time-points, except for 5 weeks, appeared significantly different (p