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Antimicrobial resistance (AMR) is an increasing global concern in small animal veterinary practices. The overuse and misuse of antimicrobials in companion animals can contribute to the spread of AMR between animals and humans. This study aimed to assess small animal veterinarians’ knowledge, attitudes, and behaviors towards antimicrobial use (AMU) and AMR in North Macedonia. A web-based questionnaire was developed, including questions addressing demographics, owner influence on antibiotic prescription and prescribing practices. The response rate of the small animal veterinarians was 47.50% (57/120), with most of them (84.20%) having 1-15 years of work experience. Pearson’s chi-square test of independence was used for contingency tables that met the chi-square assumption, and Fisher’s exact test was conducted for contingency tables that did not. Most veterinarians responded that they had perceived pressure and direct demands from pet owners to prescribe antimicrobials (35.09% frequently, 45.61% occasionally). In the survey, 50.77% of the veterinarians reported frequently administering antibiotics without conducting bacteriological or antimicrobial susceptibility testing. They typically resorted to these tests in cases with recurrent infections, such as skin infections (19.63%), or when empirical therapy is ineffective (14.72%). Based on the findings, it can be concluded that veterinarians play a crucial role in tackling the AMR in North Macedonia. The lack of stewardship programs or guidelines for responsible antimicrobial use in companion animals is a critical issue that requires urgent attention, emphasizing the vital role of veterinarians in combating AMR.

Stress is defined as a reaction of the body to any given stressor, external or internal. These stressors are common among participants in sports. Therefore, this study aimed to determine the dynamics of two stress biomarkers during an official cliff diving competition. The sample of participants included six professional cliff divers (three females and three males). Their salivary cortisol (C) and alpha-amylase (AA) samples were collected during a 3-day competition (four samples on day 1 and six samples on days 2 and 3). The analysis of the results showed a non-significant increase in AA from day one to day three. On the other hand, C has an increase in the first two days (0.58 ± 0.16 µg/mL–0.61 ± 0.23 µg/mL) and then a decrease in the last competition day (0.53 ± 0.23 µg/mL). Analysis of samples collected during each day demonstrates a fluctuation of the biomarkers. For AA, the sample after the training dive on the 2nd day has the highest value (326.34 ± 280.73 U/mL), whereas on day 3, the samples after training and before the competition dive are the highest (364.50 ± 287.13 U/mL; 466.49 ± 218.39 U/mL). Regarding C levels, the sample after the competition dive tends to show the highest values (0.66 ± 0.17 µg/mL; 0.89 ± 0.29 µg/mL; 0.76 ± 0.32 µg/mL, respectively). Furthermore, the correlation between the results of competition and biomarkers is not significant. These results demonstrate how cliff diving competition tends to have a high impact on the sympathetic nervous system, as observed mainly in AA dynamics. One might contend that even though there is no significant physical strain, cliff divers demonstrate heightened stress biomarker levels that could affect their performance and focus while diving.

This study explores teacher perceptions of newcomer parents and investigates how a small sample of teachers are making the shift from deficit to asset-based approaches to working with newcomer parents. This research uses one-on-one semi-structured interviews with three Toronto District School Board high school teachers to examine their perceptions of newcomer families living in Toronto, Ontario. Critical race theory is used as the theoretical framework for this study to critically analyze teachers' conceptualization of asset-based approaches. Research findings reveal specific strategies used by the participants in incorporating asset-based approaches to working with newcomer parents and their children. This study also provides critical reflection opportunities for teachers who wish to engage in asset-based work in and beyond their multicultural classroom.

Aim To investigate an association between eye injury and later academic and social performance.Methods A retrospective longitudinal study of taking measurements multiple times was conducted including all severe eye injuries admitted during 2011-2017 at the main regional clinic to investigate changes in academic success and social inclusion before and after an injury. Parents/caregivers were surveyed asking questions on academic performance, and community/social involvement. In 2023 data on employment status were obtained. Kappa (ĸ) and non-parametric Wilcox-on signed-rank test for multiple comparisons were used. For association of employment status and post-injury visual acuity Fisher score was tested.Results The total sample for assessing social inclusion and academic success was 36 and 25 children, respectively. In the following academic year ĸ agreements decreased from 0.88 (p

Introduction Patient-reported outcome measures (PROMs) are validated and standardised questionnaires that capture patients’ own reports of their symptoms, functioning and well-being. PROMs can facilitate communication between patients and clinicians, reduce symptom burden, enhance quality of life and inform health service re-design. We aim to determine the acceptability of PROMs and the preferred timing of PROM completion in New South Wales (NSW) at the point of care, facilitated by the Health Outcomes and Patient Experiences (HOPE) platform.Methods and analysis Semi-structured interviews with patients (~50-75, sampling across seven language groups and seven clinical cohorts), carers (~10–20) and clinicians (~18) enrolled in HOPE will be conducted via videoconference, telephone or in person. Participants will be asked questions about (1) what makes PROMs acceptable for use in chronic disease management (2) when patients would prefer to complete PROMs and when clinicians would like to use PROMs for clinical decision-making and (3) factors that impede the acceptability of PROMs for culturally and linguistically diverse patients. Interviews will be analysed using a reflexive thematic approach, guided by Normalisation Process Theory.Ethics and dissemination Ethics approval has been obtained from the Sydney Local Health District Human Research Ethics Committee (SLHD HREC, Study Protocol #X24-0138). Results will be published in appropriate peer-reviewed journals, presented at conferences, disseminated to participants in the form of a plain language summary, and widely disseminated to consumer groups and professional stakeholders.

Infectious hematopoietic necrosis (IHN) is a common disease in the intensive production of salmonids. The IHN virus (IHNV) was isolated for the first time in North Macedonia in 2018. This study aimed to investigate the distribution and genotype of IHN in farmed rainbow trout and autochthonous salmonid fish in North Macedonia following the first detection. The samples were collected from 47 trout farms. Trout fry with or without clinical signs of IHN were selected as individual samples. Kidney, spleen, and heart were taken from each fish during the dissection. Three pooled samples were collected from each farm. A total of 141 pooled samples were collected: Rainbow trout (Oncorhynchus mykiss) n=127, Macedonian trout (Salmo macedonicus) n=11, and Ohrid trout (Salmo letnica) n=3. The virus was detected in 43 samples (30.50%): rainbow trout (n=40), Macedonian trout (n=2), and Ohrid trout (n=1). There were 18 (38.30%) positive fish farms. The MAKIHNV1 isolate from 2018 (MN641902) and the newly isolated virus shared a similarity of >99 and were placed in clade E-1 of European genogroup E. The IHN has spread throughout the country and is also present in the autochthonous salmonids.

The present study aimed to determinate the effect of external progesterone (P4) supplementation on luteolysis in cows under heat stress. Forty-eight (n=48) dairy cows in the period from July September 2018 were part of and at day 35±3 postpartum scored for BSC, synchronized using PG-3-G + Ovsynch protocol and randomly allocated into two treatments: PRID group (n=27) treated with external P4 device between G1 and PGF2α and CON group (n=21) left without treatment. Collection of blood samples to assess P4 concentrations was done at Pre-PG, at G1, at PGF2α, at 72 h after PGF2α (at timed artificial insemination TAI) and at d 21 after TAI. The pregnancy diagnosis was done at d 21 and d 30 after TAI by ultrasound. The average temperature humidity index (THI) was 79.5±0.6. At G1, the P4 was significantly lower in the PRID group (1.84±0.99 ng/mL) in comparison to the CON group (2.97±1.82 ng/mL). In contrast, at PGF2α, there was a tendency (p=0.09) of increased P4 concentration in PRID group compared with the CON group (4.26±1.68 and 3.74±2.39 ng/mL), respectively. At TAI, more PRID cows (p=0.0001) had a lower P4 (0.06±0.03 ng/mL), in comparison to CON (1.28±2.41 ng/mL). At d 21 and d 30 after TAI, more PRID cows were predicted and diagnosed pregnant (16/27 or 59.25% and 13/27 or 48.14%) compared with the CON group (11/21 or 52.38% and 8/21 or 38.08%) respectively, but without any significant differences. Supplementation of the P4 during the Ovsynch protocol increases the P4 before TAI and reduces the incomplete luteolysis in heat stressed dairy cows.

Hyperadrenocorticism (HAC) in dogs is routinely treated with trilostane single-dose (CTG) which is reported to cause adverse reactions. The current retrospective study of several dogs with terminal stage of HAC aimed to compare the clinical, hematological, and biochemical effects of trilostane titration-dose treatment (TTG) with the single-dose treatment (CTG). All clinical cases (n=7) were confirmed on HAC by anamnestic, clinical, hematology, biochemistry, and low-dose dexamethasone suppression test findings, indicative for Cushing’s disease. Two cases were treated with CTG (2.2-6.7 mg/kg, single dose daily) and their treatment was discontinued on the second week due to adverse reactions. The TTG cases were treated for up to 12 weeks (0.5 mg/kg once daily for 7 days, and then with 0.5 mg/kg twice daily for 7 days). Blood samples and clinical checks were performed on 0., 4., and 12. weeks of the treatment. Hemoglobin was non-significantly higher in TTG at 12 weeks. Alanine transaminase was significantly lower in the TTG cases on the 12. week of the treatment (78.04±15.37 U/L) compared to the 0-week (137.81±24.03 U/L), and 4-week samples (131.92±23.36 U/L). No significant differences were observed with the CTG cases. Alkaline phosphatase was significantly lower on 12-week samples in TTG (251.02±93.06) compared to the 4-week (567.94±283.93 U/L), and 0-week samples (1,341.84 U/L). In conclusion, TTG has indicated to have significantly higher tendency to decrease alanine transaminase and alkaline phosphatase, alleviating the negative effects on the liver. The clinical findings were more adverse for the CTG.

Abstract Experimental autoimmune encephalomyelitis (EAE) induced in inbred rodents, i.e., genetically identical animals kept under identical environmental conditions, shows variable clinical outcomes. We investigated such variations of EAE in Dark Agouti rats immunized with spinal cord homogenate and identified four groups: lethal, severe, moderate, and mild, at day 28 post immunization. Higher numbers of CD4+ T cells, helper T cells type 1 (Th1) and 17 (Th17) in particular, were detected in the spinal cord of the severe group in comparison with the moderate group. In addition, increased proportion of Th1 and Th17 cells, and heightened levels of interferon (IFN)-γ and interleukin (IL)-6 were detected in the small intestine lamina propria of the severe group. A selective agonist of free fatty acid receptor type 2 (Ffar2) applied orally in the inductive phase of EAE shifted the distribution of the disease outcomes towards milder forms. This effect was paralleled with potentiation of intestinal innate lymphoid cells type 3 (ILC3) regulatory properties, and diminished Th1 and Th17 cell response in the lymph nodes draining the site of immunization. Our results suggest that different clinical outcomes in DA rats are under determinative influence of intestinal ILC3 activity during the inductive phase of EAE.

Background/Objectives: Besides a multitude of consequences patients on chronic renal replacement therapy have, anemia is one of the most prominent factors making a significant number of patients dependent on erythropoiesis-stimulating agent (ESA) therapy. The aim of this study was to examine the relationship between the levels of a broad spectrum of thrombo-inflammatory and oxidative stress-related biomarkers and the presence and level of ESA hyporesponsiveness in patients undergoing regular chronic hemodialysis. Methods: This cross-sectional study included 96 patients treated with chronic hemodialysis. Levels of several thrombo-inflammatory and oxidative stress-related biomarkers, as well as demographic, clinical, and laboratory analyses, were collected and analyzed based on the calculated value of the ESA-hyporesponsiveness index (EHRI). Results: In the analyzed sample, 58 patients received ESAs. Of all the investigated parameters, only body mass index (BMI), level of plasminogen activator inhibitor-1, and level of L-type fatty acid binding protein (L-FABP) were observed as significant predictors of EHRI. A significant diagnostic potential for ESA resistance has been observed in BMI and L-FABP between ESA-resistant and ESA-non-resistant groups of patients (p = 0.004, area under the curve 0.763 and p = 0.014, area under the curve 0.712, respectively) with the cut-off values of 25.46 kg/m2 and 5355.24 ng/mL, respectively. Having a BMI of 25.46 kg/m2 or less and an L-FABP level higher than 5355.24 ng/mL were observed as significant predictors of ESA resistance (odds ratio 9.857 and 6.125, respectively). Conclusions: EHRI was positively predicted by low BMI and high levels of plasminogen activator inhibitor-1 and L-FABP. High levels of L-FABP and low BMI have been observed as strong predictors of ESA resistance.

Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), represents a substantial healthcare challenge. Provoked and unprovoked DVT cases carry distinct risks and treatment considerations. Recognizing the limitations of this classification, molecular markers may enhance diagnostic precision and guide anticoagulation therapy duration relying on patient history and risk factors. This preliminary, open-label, prospective cohort study was conducted including 15 patients (10 provoked DVT and 5 unprovoked DVT) and a control group of healthy plasmatic subjects. Plasma levels of 9 biomarkers were measured at diagnosis (baseline, day 0, and D0) and after 30 days (day 30-D30). Patient demographics, clinical data, and biomarker concentrations were analyzed. Serum concentrations of D-dimer, von Willebrand factor, C-reactive protein, and Anti-Xa were elevated in DVT groups at D0 compared to controls. No significant differences were observed between the provoked and unprovoked groups on the day of diagnosis and 30 days later. Over 30 days, the provoked group exhibited significant biomarker changes related to temporal assessment. No significant differences were noted in the biomarker profile between provoked and unprovoked DVT groups. This study is indicative of the concept of individualized thrombosis assessment and subsequent treatment for VTE. Larger cohorts are warranted to validate these findings and further define the most appropriate use of the molecular markers.

Although it is a condition of older adults, diverticular disease (especially of the right colon) is sometimes seen in patients under 50 years old. In the past two decades, reports on right-sided colon diverticulitis in the young population have increased. Therefore, we aimed to review the latest literature regarding this disease. Etiological and epidemiological studies give us partial answers on the occurrence of this condition. The sidedness and the fact that it occurs in younger populations make this condition important in terms of early and proper diagnosis to avoid unnecessary surgical explorative laparoscopies, laparotomies, appendectomies, etc. Most cases with acute right-sided colonic diverticulitis are mild, thus requiring a conservative treatment. However, complicated right-sided colonic diverticulitis is treated with some intervention (percutaneous drainage or surgery). No treatment guidelines are present yet, and the approach should be individualized and tailored according to the patient’s condition and the severity of the diverticulitis. In case of clinical deterioration, surgery should be considered regardless of whether it is open or minimally invasive.

Brilliant cresyl blue (BCB) staining is a method used for selection of developmentally competent porcine oocytes, in addition to the standard morphological classification. The aim of the current study was to assess the relationship between BCB staining in porcine oocytes with high and low morphological characteristics and its maturation rate. In the first part of the study, cumulus-oocytes complexes (COCs) (n=434) were aspirated from 60 ovaries. According to the morphological classification and BCB staining, they were divided in 4 groups: COC+/BCB+, COC-/BCB+, COC+/BCB-, and COC-/BCB-. In the second experiment, COCs (n=445) were categorized into 3 groups: control, BCB+, and BCB-. Significant differences in the maturation rate were observed between COC+/BCB+ and COC-/BCB- (66% vs. 23%), and between COC+/BCB+ and COC-/BCB+ (66% vs. 38%) (p

In the production of refined sunflower oil, waxes are removed during the winterization stage, and wax crystals are separated through filtration assisted by filtration aids. Commonly used filtration aids in oil refining include perlite and diatomaceous earth. After winterization, a significant amount of filter cake remains as a by-product and is treated as waste. Today, natural cellulose fibers are being promoted as filtration aids. Their advantages are numerous, both in the production process and from an environmental perspective. However, their only disadvantage is their higher cost. Therefore, in this study, 57 filtration cycles during the industrial sunflower oil winterization step using cellulose-based filtration aids were monitored. Different process parameters, including the pressure differential on the filter, the flow rate of filtered oil, constant pressure period, the quantity of filtered oil, filtration time, the quantity of pre-coating and dosing filtration aids, the volume of filtered oil, the concentration of dosing filtration aid, as well as the mass of separated waxes, were observed. Additionally, artificial neural networks were applied to predict process parameters, optimize the process, and, above all, determine the dosage of filtration aids, which will make the process more economical. The optimal filtration process is performed at a pressure differential of 3.3 bar, lasting a total of 39 h, with 32 h at constant pressure, resulting in 322,503 kg of filtered oil and 90.41 kg of waxes. The optimal quantity of cellulose-based filtration aids employed for pre-coat was 80 kg, and for dosing, 375 kg, with an optimal concentration of 0.12% w/w.

Rowing races require extreme physical and psychological effort from every athlete. This study aimed to determine the dynamics of the salivary cortisol and alpha-amylase, as well as blood lactate throughout the specific load represented by a 6 km rowing race, conducted on a rowing ergometer. The sample consisted of 11 junior and senior rowers from HVK Gusar in Split (n = 11) who actively competed at club and international levels. Variables consisted of three repeated oral samples of the hormone cortisol and the enzyme alpha-amylase determined in saliva and three repeated blood lactate samples. Potential differences in the levels of the studied variables at different time points were determined using a repeated-measures ANOVA test. The results showed different dynamics of hormonal (cortisol) and metabolic (alpha-amylase and lactates) variables. All variables experienced a significant post-race increase, while other changes were not significant. The results highlighted that high-intensity rowing causes an increase in the body’s cortisol, alpha-amylase, and lactate levels. This should be implemented in rowing training to find the right balance between high and low-intensity rowing, enabling athletes’ progression while reducing the risk of overtraining.

Complete Freund’s adjuvant (CFA) is used as a standard adjuvant for the induction of experimental autoimmune encephalomyelitis (EAE), the most commonly used animal model in multiple sclerosis studies. Still, CFA induces glial activation and neuroinflammation on its own and provokes pain. In addition, as CFA contains Mycobacteria, an immune response against bacterial antigens is induced in parallel to the response against central nervous system antigens. Thus, CFA can be considered as a confounding factor in multiple sclerosis–related studies performed on EAE. Here, we discuss the effects of CFA in EAE in detail and present EAE variants induced in experimental animals without the use of CFA. We put forward CFA-free EAE variants as valuable tools for studying multiple sclerosis pathogenesis and therapeutic approaches.

Tumour budding (TB) in cancer is a phenomenon of tumour cells forming clusters, and it is associated with an epithelial-mesenchymal transition into the extracellular matrix of the tumour. It has been shown that the presence of TB in colorectal cancer (CRC) is associated with worse overall survival, higher possibility for vessel invasion, lymph node involvement, and distant metastases appearance. In this retrospective study TB presence in operated patients for CRC is analysed. In the data from 81 patients, 26 presented with TB. Analysis revealed high statistical significance of the effect of TB presence on the number of metastatic lymph nodes, and the lymphovascular and perineural invasion. A statistically meaningful correlation was found between the presence of TB and CRC survival ( p = 0.016). Patients with right-sided colon cancer presented with worse overall survival ( p = 0.011). The patients who presented lymph node metastases and TB presence had worse overall survival ( p = 0.026 and p = 0.021, respectively). Tumour budding, tumour location, and age over 64 years are found to be the independent prognostic factors in CRC patients. Tumour budding is an important prognostic factor in CRC patients that will contribute to treatment. Pathological examination must consider TB in detail.

Background and Objectives: This study analyzed the frequency of factors influencing the course and outcomes of out-of-hospital cardiac arrest (OHCA) in Serbia and the prediction of pre-hospital outcomes and survival. Materials and Methods: Data were collected during the period from 1 October 2014, to 31 September 2023, according to the protocol of the EuReCa_One study (clinical trial ID number NCT02236819). Results: Overall 9303 OHCA events were registered with a median age of 71 (IQR 61–81) years and 59.7% of them being males. The annual OHCA incidence was 85.60 ± 20.73/100,000. Within all bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation in 15.3%. Within the resuscitation-initiated group, return-of-spontaneous circulation (ROSC) on scene (any ROSC) was present in 1037/4053 cases (25.6%) and ROSC on admission to the nearest hospital in 792/4053 cases (19.5%), while 201/4053 patients survived to hospital discharge (5.0%). Predictive potential on pre-hospital outcomes was shown by several factors. Also, of all patients having any ROSC, 89.2% were admitted to the hospital alive. The probability of any ROSC dropped below 50% after 17 min passed after the emergency call and 10 min after the EMS scene arrival. These time intervals were significantly associated with survival to hospital discharge (p < 0.001). Five-minute time intervals between both emergency calls and any ROSC and EMS scene arrival and any ROSC also had a significant predictive potential for survival to hospital discharge (p < 0.001, HR 1.573, 95% CI 1.303–1.899 and p = 0.017, HR 1.184, 95% CI 1.030–1.361, respectively). Conclusions: A 10-min time on scene to any ROSC is a crucial time-related factor for achieving any ROSC, and indirectly admission ROSC and survival to hospital discharge, and represents a golden time interval spent on scene in the management of OHCA patients. A similar effect has a time interval of 17 min from an emergency call. Further investigations should be focused on factors influencing these time intervals, especially time spent on scene.

The incidence of clinical mastitis (CM) in small and large-scale dairy cow farms can be highly variable and can be affected by age, parity, post-calving status, and atmospheric conditions. The current study aimed to assess the CM-incidence and its association with the post-calving days, number of lactations, season, and number of affected udder quarters in dairy cows in small-scale dairy farms. The study was conducted within one calendar year in 177 small-scale farms with 864 dairy cows. Clinically confirmed CM cows (n=72) were sampled from each udder quarter and processed for bacteriology examination. The CM-positive samples were grouped according to the season (spring, summer, autumn, and winter), the number of days after calving (180), the number of lactations (1-st, 2-5-th, and >6-th), and the number of affected udder quarters (one, two, three, and four). The CM-positive samples (n=72, 8.3%) were confirmed on bacteriology examination in significantly lower count (n=56, 6.5%). The 2-5-th lactations cows (n=35, 68.6%) were significantly more compared to the first lactation (n=6, 11.8%), and >6-th lactation cows (n=10, 19.6%). CM cows with infection of one udder quarter (n=40, 78.4%) were significantly more than the cows with two (n=6, 11.8%), and four infected quarters (n=5, 9.8%). The CM-incidence in small-scale dairy cow farms in North Macedonia was 8.3% and 6.5% by clinical and bacteriology examination, respectively. The highest CM susceptibility was observed in the cows between the second and fifth lactations. One udder quarter was most frequently affected in CM-positive cases.

This paper presents research on hydrodynamics and mass transfer in a packed absorption column. Experimental data on dry column pressure drop, flooding point, and efficiency of absorption of CO2 in water is obtained on a lab-scale absorption column packed with Raschig rings. Auxiliary parts of equipment together with chemical analyses provide simple monitoring and collecting the data. All obtained data were used to test different mathematical models for a given problem, i.e. for determination of the dry column pressure drop, flooding point and the overall gas transfer unit height. For dry column pressure drop, models developed primarily for packed columns described the data the best, with the Billet model generating a 6.54 % mean error, followed by Mackowiak and Stichlmair models. In flooding point calculations, empirical models were tested and models of Lobo, Leva and Takahshi gave the best results. Mass transfer (absorption) experiments gave expected results, since absorption efficiency increased with the increase in the liquid/gas flow rate ratio, i.e. with approaching the flooding point. The Onda’s model was used to calculate partial mass transfer coefficients in liquid and gas phases based on which the height of the overall gas transfer unit was estimated and subsequently compared with the experimental data. Deviation of calculated and experimental results for the height of the overall gas transfer unit is in the expected range of 0-20 %, with mean value of 15.5 %. In conclusion, the available models for determination of the investigated hydrodynamics and mass transfer parameters in packed absorption columns gave adequate results in comparison to the experimental values.

Background: Neoadjuvant chemoradiotherapy prior to surgery is the standard treatment for locally advanced rectal cancer. This consists in the patient’s complete pathological response being achieved with no residual tumor presence in the resected specimen, which results in survival improvement. Methods: This retrospective study aimed to examine the rate of complete pathological response in patients with advanced rectal cancer treated with neoadjuvant long-course chemoradiotherapy and to examine the survival differences between the different tumor regression grade (TRG) scores. Results: A total of 154 patients were operated prior to long-course chemoradiotherapy with a total of 50 Gy plus FOLFOX protocol. Complete pathologic response was achieved in 29 (18.8%) patients. There was no statistical difference for the different pathologic responses according to gender, type of surgery, and number of harvested lymph nodes. Mean survival for all the groups was 37.2 months. Survival within a different TRG score exhibited statistical significance (p = 0.006). Overall, the survival rate during the follow-up period was of 81.8%. Conclusions: The complete pathological response rate in this study was of 18.8%. High tumor regression grade scores (TRG0 and TRG1) had a survival rate of over 90% during follow-up. Multivariate analysis identified perineural invasion and tumor regression grade as independent factors that affect survival.