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The excavation of Crno Vrilo site (Zadar, Dalmatia, Croatia), carried out by B. Marijanović, has unearthed the vestiges of an Early Neolithic village dating back to ca. 5800–5600 cal BC. The lithic assemblage, with more than 4000 pieces, represents the biggest Impressed Ware assemblage of littoral Croatia. Lithic production at Crno Vrilo is characterised by the pressure Blade flaking on high-quality exogenous cherts (Gargano, southern Italy) reflecting important socio-economic and technical aspects that are specific to the Neolithic. The presence of some débitage elements such as flakes, debris, cortical and technological pieces indicates that standard pressure flaking occured at the site, while the presence of large Blades (with widths exceeding 20 mm) suggests production by lever pressure, a technique that required specialized knowledge and equipment. This article questions whether the lever pressure technique was used in the production of large Blades and examines the status of these Blades in the Crno Vrilo lithic assemblage by examining their technological and functional aspects.

The beginning of the Neolithic in the Adriatic region dates back to approximately 6000 cal BC, and the appearance of Impressed Ware pottery marks its generic development. By combining lithic, economic, and paleoenvironmental data, we propose a new arrhythmic model for the chronology of Neolithisation in the Adriatic. On the one hand, the available data suggest that in the south-central part of the basin (Dalmatia and Apulia) the transition to farming was relatively quick, resulting from the colonisation of an open landscape (seemingly linked to the “8.2 ka event” and the onset of a drier climate). These newcomers mostly settled in the fertile plains of the Dalmatian and Apulian hinterlands, basing their subsistence almost exclusively on agriculture and livestock, while lithic blade production in cherts from Gargano (southern Italy) indicates important social aspects and complex management strategies (mining activities, more complex modes of pressure flaking, and specialised distribution networks). However, on the other hand, in the northern Adriatic (Istria, Karst, eastern Po Plain, and Marches), the Neolithic emerged somewhat later, possibly as a result of some form of acculturation. Although available data are still scarce, some evidence suggests that the last Mesolithic groups played an active role in the process of Neolithisation in these areas, where certain Castelnovian traditions have been identified in the lithic production accompanying Impressed Ware (the use of local cherts, lamellar production by indirect percussion, and “simpler” forms of pressure flaking) and in the economy, e.g. importance of fishing.

Ovarian Sertoli-Leydig cell tumors (SLCTs) are extremely rare ovarian sex-cord stromal tumors. Alpha-fetoprotein (AFP) production by SLCTs is a rare event generally linked to the presence of hepatocytes or intestinal mucinous epithelium as heterologous elements. We report here a case of a 15-year-old female complaining about abdominal pain, constipation, and spaniomenorrhea with high level of serum AFP leading to a clinical suspicion of malignant germ cell tumor. Final histopathological diagnosis was a moderately differentiated Sertoli-Leydig cell tumor of the ovary with alpha-fetoprotein-producing cells without hepatocytic or intestinal epithelium differentiation. NGS analysis showed mutation in DICER1 gene. SLCTs occur in patients at any age with a mean age of 25 years. The presence of alpha-fetoprotein-producing cells is an important tool in the differential diagnosis of germ cell tumors and challenging in this case of SLCT because of its rarity in this context. An adequate sampling and exhaustive immunohistochemical analyses are mandatory to make the correct differential diagnosis and confirm the presence of alpha-fetoprotein-producing cells and also define the differentiation because of therapeutic strategies between conservative surgery and/or chemotherapy.

Modelling and control applications of dynamical systems in chaos theory arising in several areas are investigated and new control techniques are designed in the chaos literature. We propose a new complex finance chaotic model with states as the interest rate, investment demand, and price index. In this work, after studying the dynamical properties of the new finance model, an electronic chaotic circuit of the model is realized in Multisim. Based on passive control theory, we derive a new controller for globally synchronizing state trajectories of the new finance models. Using the new finance chaotic model developed in this work, a new voice encryption algorithm design is presented. With the proposed algorithm, voice encryption application is performed, and results are described.

Seasonal variations on phospholipid (PL) and triacylglycerol (TG) fatty acid (FA) compositions in muscles of Salmo trutta macrostigma were investigated by gas chromatography (GC) using the method described by Folch. The total lipid of the muscle was extracted using chloroform/methanol (2:1, v/v) and was separated into TG and PL using thin layer chromatography (TLC). A total of nineteen and sixteen different fatty acids were determined in TG and PL, respectively. The distributions of ΣSFAs (saturated fatty acids), ΣMUFAs (monounsaturated fatty acids) and ΣPUFAs (polyunsaturated fatty acids) proportions were found to be different among PL and TG fractions in all seasons. TG contained a lower proportion of ΣPUFA, but a higher proportion of ΣMUFA and ΣSFA than PL. The major components were palmitic acid (16:0), oleic acid (18:1 n-9), eicosapentaenoic acid (EPA, 20:5 n-3) and docosahexaenoic acid (DHA, 22:6 n-3) in PL, 16:0, palmitoleic acid (16:1 n-7), 18:1 n-9, linoleic acid (LA, 18:2 n-6), linolenic acid (ALA, 18:3 n-3), 20:5 n-3 and 22:6 n-3 in TG extracted from muscle of S. trutta macrostigma in all seasons. The total lipid content varied seasonally from 1.44% to 1.90% in female muscle of wet weight for S. trutta macrostigma. N-3/n-6 ratios of PL and TG were found to be 5.19-12.0 and 1.09-2.62, respectively. Practical applications: The information in this study will be of practical value from a health perspective for populations who consume S. trutta macrostigma and for food producers. Effect of seasonal variations on the fatty acid compositions of phospholipid and triacylglycerol fractions of Salmo trutta macrostigma were investigated in view of saturated fatty acids, monounsaturated fatty acids and polyunsaturated fatty acids by using GC. [ABSTRACT FROM AUTHOR]

Introduction: Acute mesenteric ischemia (AMI) in cardiac surgery is a rare condition, associated with low incidence (0.2-0.4%) and very high mortality (up to 95%). Advanced age and coexisting morbidity, such as acute myocardial infarction or atrial fibrillation are the known risk factors. Case report: We are presenting 76 years old patient with aortic valve replacement and double coronary artery bypass grafting followed by hemodynamic instability and lactic acidosis on the first postoperative day. Diagnosis of AMI was made by exclusion. We discuss diagnostic and therapeutic approach applied regarding existing data from the literature. Conclusion: Diagnosis of AMI after cardiac surgery demands high level of suspicion. Early diagnosis is of vital importance. Systematical approach and early surgical exploration affects the overall outcome.

Specific left ventricular assist device infections are the leading cause of morbidity and second most common cause of death in patients who survive the first six months after implanting device, and also they are the most common cause of readmissions to hospital. The patient is a 63-year-old who received LVAD HeartMate II. The patient was readmitted to the hospital due to a driveline exit site infection and a developed abscess formation at 4 cm from the DL exit site. After reducing infection with antibiotics therapy, he was successfully operated by creating new exit site while removing the driveline from the infected region of the subcutaneous tissue. Repositioning of the driveline to a new exit site with mandatory removal of part of the driveline from the subcutaneous tissue in the region of infection, with extensive debridement of the wound is appropriate therapeutic option for patients with driveline infection.

Chylopericardium refers to existing communication between the pericardial sac and the thoracic duct carrying the chyle. The objective of our report was to highlight the specificity of diagnosis and treatment of this rare but tedious condition through the analysis of two case reports. Male patient, aged 63 years, with chylopericardium was diagnosed perioperatively (implantation of artificial aortic - St. Jude No 21 and mitral valve - St. Jude No 29). Etiology of pericardial effusion was established by Sudan III staining of punctate specimen obtained by subxiphoid pericardial puncture. Probable cause of chylopericardium was the lesion of ductus thoracicus during cross-clamping of the superior caval vein with a Cooley clamp. Initial treatment included diet rich in medium-chain triglycerides which resulted in resolution of the effusion. During five-year follow-up, there were no recurrences of pericardial effusion. The second patient was female, 21 years old, with chylopericardium after partial pericardiectomy performed because of the chronic severely symptomatic pericardial effusion, resistant to other forms of treatment. Pericardiocentesis provided 650 ml of yellowish fluid with a high concentration of cholesterol (3.2 mmol/l), triglycerides (16.6 mmol/l), and proteins (64.7 g/l), which verified chylopericardium, most probably as a consequence of the lesion of ductus thoracicus during partial pericardiectomy. Diet rich in medium-chain triglycerides failed to decrease the effusion, after two weeks of treatment (daily secretion 250-350 ml). Lymphography revealed lesion of ductus thoracicus, most probably at Th9/Th10 level, with no direct visualization of extravasal accumulation of contrast media. Surgical ligation of ductus thoracicus was performed through the right thoracotomy. However, postoperative secretion increased to 1000 ml/day. Patient underwent redo surgery comprising the ligation of lymphatic vessels, guided by extravasation of intraoperatively iwected methylene-blue indicator. During one-year follow-up, there were no recurrences of pericardial effusion. In conclusion, intraoperative lymphography significantly contributed to successful surgical treatment of patients with chylopericardium.

Abstract Background Ectopic opening of the common bile duct into the duodenal bulb (EO-CBD-DB) is a rare disease that may be complicated by duodenal ulcer, deformity, stenosis and biliary stones. The aim of this study is to report clinical presentations, endoscopic diagnosis and treatment of this entity as well as to investigate its association with duodenal stenosis. Methods Gastroduodenoscopic findings and radiological imaging were evaluated for ectopic papilla and duodenal stenosis. Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented. Results EO-CBD-DB was found in 74 (77.1%) of the 96 patients with duodenal deformity/stenosis (79 male, 17 female, mean age: 58.5, range: 30-87 years). The papilla with normal appearance was retracted to the bulb in 11 while it was at its usual location in the remaining 11. The history of biliodigestive surgery was more common in patients with EO-CBD-DB who were frequently presented with the common bile duct stone-related symptoms than the other patients. Thirteen (17.6%) of the patients with EO-CBD-DB were referred to surgery. Endoscopic treatment was completed in 60 (81.1%) patients after an average of 1.7 (range: 1-6) procedures. These patients were on follow-up for 24.8 (range: 2-46) months. Endoscopic intervention was required in 12 (20%) of them because of recurrent biliary problems. Treatment of the patient who had stricture due to biliary injury during laparoscopic cholecystectomy is still continued. Conclusions The presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.

Abstract Background Therapeutic biliary procedures disrupt the function of the sphincter of Oddi. Patients are potential "bile refluxers". The aim of this study was to assess how these procedures affect the histology-based bile reflux index (BRI), which can be used to reflect duodenogastric reflux (DGR). Methods Gastric antrum and corpus biopsies were collected from 131 subjects (56 men, 75 women; mean age, 55.9 ± 15.6 years). Group 1 (Biliary group-BG; n = 66) had undergone endoscopic sphincterotomy, endoscopic stenting, or choledochoduodenostomy for benign pathology; Group 2 (n = 20) had undergone cholecystectomy alone; and Group 3 (n = 6) Billroth II gastroenterostomy. Group 4 (no cholecystectomy; n = 39) had upper endoscopy with normal findings and served as controls. BRI > 14 indicated DGR (BRI [+]). To eliminate confounding effects of Helicobacter pylori (Hp) infection, comparisons were made according to Hp colonization. Results Fifty-nine subjects (45%) were Hp (+). The frequencies of BRI (+) status in antrum and corpus specimens from Hp (-) BG patients were 74.3% and 71.4%, respectively (85.7% for both antrum and corpus for choledochoduodenostomy). Corresponding results were 60% and 60% for Group 2, 100% (only corpus) for Group 3, and 57.1% and 38.1% for controls (BG, Group 2, and Group 3 vs controls – p > 0.05 antrum, p < 0.05 corpus). Fifty-four BG patients had previously undergone cholecystectomy. Excluding those, the rates of BRI (+) in Hp (-) BG patients were 75% antrum and 62.5% corpus (p > 0.05 for both vs. Group 2). Conclusion Patients who had undergone biliary procedures showed similar bile-related histological changes in both corpus and antrum biopsies, but the changes seen in controls were more prominent in the antrum than corpus. Therapeutic biliary procedures increase the rate of BRI (+) especially in the case of choledochoduodenostomy. Therapeutic biliary procedures without cholecystectomy also increase the rate of BRI (+) similar to that observed in patients with cholecystectomy.

Background: Higher age is associated with less inflammatory disease activity in relapsing-remitting multiple sclerosis (RRMS). It is unknown whether age itself or disease duration underlies this association., Objectives: This study investigated the effects of age, disease duration, and inflammatory disease activity in people with RRMS., Methods: Individual patient-level data from five large phase III randomized controlled trials (RCTs) was utilized to investigate the association of both age and disease duration with annualized relapse rate (ARR), contrast-enhancing lesions (CELs), and new T2 lesions on magnetic resonance imaging (MRI) at baseline and follow-up., Results: The data set included 5626 participants. Higher age was associated with lower ARRs, lower CEL number on MRI at baseline and follow-up, and lower new T2 lesion numbers at follow-up. This effect was present in all disease duration groups. For example, we found a lower number of new T2 lesions on MRI during follow-up in higher age groups compared to lower age groups, independent of disease duration., Conclusion: Aging in RRMS is associated with a lower risk of inflammatory disease activity, across different disease durations. Age should be taken into account when designing clinical trials and future research should investigate how age should be integrated into personalized predictions of treatment response and risk profiling., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: E.M.E.C. reports no disclosures. S.K. reports no disclosures. O.C. is a member of independent DSMB for Novartis, gave a teaching talk on McDonald criteria in a Merck local symposium, and contributed to an Advisory Board for Biogen; she is Deputy Editor of Neurology, for which she receives an honorarium. M.P.S. received consulting fees from Biogen, Merck, Novartis, Roche, Sanofi, Immunic, Alexion. F.B. serves on the steering committee and is iDMC member for Biogen, Merck, Roche, and EISAI. He acts as a consultant for Roche, Biogen, Merck, IXICO, Jansen, and Combinostics. He has research agreements with Novartis, Merck, Biogen, GE, and Roche. He is co-founder and share holder of Queen Square Analytics Ltd. D.L.A. reports consulting fees from Biogen, Celgene, Frequency Therapeutics, Genentech, Merck, Novartis, Race to Erase MS, Roche, Sanofi-Aventis, Shionogi, and Xfacto Communications; grants from Immunotec and Novartis; and an equity interest in NeuroRx. M.M.S. serves on the editorial board of Neurology, Multiple Sclerosis Journal and Frontiers in Neurology; receives research support from the Dutch MS Research Foundation, Eurostars-EUREKA, ARSEP, Amsterdam Neuroscience, and ZonMW (Vidi grant, project no. 09150172010056); and has served as a consultant for or received research support from Atara Biotherapeutics, Biogen, Celgene/Bristol Meyers Squibb, EIP, Sanofi, MedDay, and Merck. Z.L.E.V.K. reports no disclosures. J.M. reports no disclosures. M.W.K. received consulting fees and travel support from Biogen Idec, Novartis, Roche, Sanofi Genzyme, and EMD Serono. B.M.J.U. has received research support and/or consultancy fees from Biogen Idec, Genzyme, Merck Serono, Novartis, Roche, TEVA, and Immunic Therapeutics. A.E. has received research grants from the Medical Research Council (MRC), National Institute for Health and Care Research (NIHR), Innovate UK, Biogen, Merck, and Roche. He serves as an advisory board member of Merck Serono and Bristol Myers Squib. He is the founder and equity stakeholder in Queen Square Analytics Ltd. He serves on the editorial board of Neurology (American Academy of Neurology). J.K. has accepted speaker and consulting fees from Merck, Biogen, TEVA, Sanofi, Genzyme, Roche, and Novartis. E.M.M.S. has accepted speaker fees from Merck and Novartis.

Background/aims:  Pancreatic steatosis (PS) is a pathology associated with metabolic syndrome (MS), endocrin and exocrine disfunctions of the pancreas, and fatty liver. The data on the frequency of PS are very limited. We aimed to evaluate the frequency of PS detected by transabdominal ultrasonography (TAU) in gastroenterology clinics located in different geographical regions of Turkey and the factors associated with it., Materials and Methods:  Volunteers were evaluated by TAU for PS and hepatosteatosis (HS), and its degree. Pancreatic stiffness was evaluated by ultrasonographic shear wave elastography (SWE). All demographic, physical, and biochemical parametres were measured., Results:  A total of 1700 volunteers from 14 centers throughout Turkey were included in the study. Mean age was 48.03 ± 20.86 years (56.9% female). Prevalance of PS was detected in 68.9%. In the PS group, age, body mass index (BMI), waist circumference, systolic blood pressure, fasting blood glucose (FBG), lipid levels, insulin resistance, diabetes mellitus, hypertension, MS frequency, and pancreatic SWE score were increasing, and fecal elastase level was decreasing in correlation with the degree of PS. The frequency of HS was 55.5%. Hepatosteatosis [odds ratio (OR): 9.472], increased age (OR: 1.02), and BMI (OR: 1.089) were independent risk factors for the occurrence of PS. Lean-PS rate was 11.8%. The lean-PS group was predominantly female and younger than non-lean PS. Also it has lower blood pressure, FBG, liver enzymes, lipid levels, and HS rates., Conclusion:  The frequency of PS was found 68.9% in Turkey. Its relationship was determined with age, BMI, HS, MS (and its components), pancreatic stiffness, and fecal elastase level.

Gas chromatography (GC) was used to determine the fatty acid (FA) compositions of total lipid, phospholipid (PL), phospholipid subclass (phosphatidylcholine (PC), phosphatidylinositol (PI), phosphatidylserine (PS), phosphatidylethanolamine (PE)), and TAG (triacylglycerol) fractions in male Chondrostoma regium. Percentages of myristic acid (14:0), palmitoleic acid (16:1n-7), oleic acid (18:1n-9), monounsaturated fatty acid (ΣMUFA), linoleic acid (18:2n-6) and linolenic acid (18:3n-3) were found to be higher in TAG than the values determined in PL classes. Palmitic acid (16:0), eicosapentaenoic acid (EPA, 20:5n-3), docosahexaenoic acid (DHA, 20:6n-3) in the PC fraction; 16:0, 20:5n-3, 22:6n-3 in PE; 16:0, stearic acid (18:0), arachidonic acid (AA, 20:4n-6), 20:5n-3, 22:6n-3 in PI; and 16:0, 18:0, oleic acid (18:1n- 9), 22:6n-3 in PS were found to be dominant. In total lipid, the PUFA/SFA ratio was 1.37-1.83; atherogenicity index (AI) was 0.34-0.47 and thrombogenicity index (TI) was found in the range of 0.18-0.22. The n-3/n-6 ratio, which is an important index for nutritional content, was found to be between 5.15 and 11.07. It was discovered that the FA compositions of male C. regium were affected by the reproductive period and season. These findings suggest that fish oil might be a beneficial dietary source for preserving human health.

Background: The glymphatic system removes neurodegenerative debris. The ocular glymphatic outflow is from the eye to the proximal optic nerve. In multiple sclerosis (MS), atrophy of the optic nerve increases the glymphatic outflow space. Here, we tested whether vitreous haze (VH) can provide novel insights into the relationship between neurodegeneration and the ocular glymphatic system in MS., Methods: This cross-sectional study comprised 315 persons with MS and 87 healthy controls (HCs). VH was quantified from optical coherence tomography (OCT) volume scans. Neurodegeneration was determined on three-dimensional T1 (3DT1) MRI, lesion detection on fluid-attenuated inversion (FLAIR), and layer thickness on OCT. Generalized estimating equations, corrected for age, were used to analyze associations between VH and metrics for neurodegeneration, demographics, and clinical scales. Group differences were determined between mild, moderate, and severe disability., Results: On the group level, VH scores were comparable between MS and control ( p = 0.629). In MS, VH scores declined with disease duration (β = -0.009, p = 0.004) and age (β = -0.007, p = 0.001). There was no relation between VH scores and higher age in HCs. In MS patients, VH was related to normalized gray (NGMV, β = 0.001, p = 0.011) and white matter volume (NWMV, β = 0.001, p = 0.003), macular ganglion cell-inner plexiform layer thickness (mGCIPL, β = 0.006, p < 0.001), and peripapillary retinal nerve fiber layer thickness (pRNFL, β = 0.004, p = 0.008). VH was significantly lower in severe compared to mild disability (mean difference -28.86%, p = 0.058)., Conclusions: There is a correlation between VH on OCT and disease duration, more severe disability and lower brain volumes in MS. Biologically, these relationships suggest accelerated glymphatic clearance with disease-related atrophy.

Objective: The association of treatment-related side effects and tumor characteristics with sexual function, depression, and anxiety were investigated in patients with locally advanced rectum cancer (LARC) receiving neoadjuvant chemoradiotherapy (CRT)., Material and Methods: Thirty-two patients who received neoadjuvant CRT with LARC were included. The Arizona Sexual Experiences (ASEX) Scale was used to determine the sexual function status whereas the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI) were used to evaluate the depression and anxiety status of the patient, respectively. The patients were asked to fill these scales before and at least 4 weeks after the neoadjuvant CRT. T-test and Mann-Whitney U test were used for the comparison of values., Results: Median age was 52.5 years (range: 33-76). Twenty-six patients were male, and 6 patients were female. At presentation, the tumor was located mostly in lower third rectum (72%), and 69% of the patients had T3 tumors. There was a statistically significant deterioration in the sexual functions of the patients (p < 0.001), a statistically significant decrease in their anxiety level after CRT (p: 0.037). Depression level was changed from mild to minimal during this process (p: 0.17). A significant deterioration in the ASEX scale was observed especially in patients with grade 2 and above gastrointestinal side effects (p: 0.01)., Conclusion: This prospective study showed that the patient's anxiety and depression levels had decreased during the treatment process probably due to the decrease in the patient's symptoms. However, deterioration of the sexual function status which might be correlated to increased gastrointestinal side effects during CRT has been observed. So, clinical and psychiatric support including therapies for sexual dysfunctions is needed for LARC patients during and after the neoadjuvant CRT., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)