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Assisted reproduction techniques (ARTs) have given rise to novel, non-traditional family models. Still, among the various applications and approaches of ‘medically assisted procreation’ (MAP), the most divisive one undoubtedly is ‘gestational surrogacy’ (GS), also in light of the rising number of couples who have chosen it over the past twenty years. Another major implication of ARTs is the creation of intentional (or intended) parenthood in addition to genetic one: the genetic parent’s partner is thus defined as the intentional (or second) parent, who by free choice, shares the family project with the genetic parent, even without any biological tie with the child. Hence, the intended parent takes on the same rights and responsibilities towards the child as the biological one. Several countries, including Italy, have enacted norms to discourage cross-border surrogacy, deeming it harmful to the dignity of women and children. Recently, however, the Italian government has decided intensify the fight against this practice: the Chamber of Deputies (Italy’s lower chamber of parliament) has passed a law which punishes couples that resort to surrogacy even if the agreement and the birth take place abroad. Therefore, surrogacy would become a so-called universal crime. In light of the fact that criminalization is a serious and highly consequential step, which may have life-changing consequences for the intended parents, the aim of this paper is to assess whether this may be an effective instrument for regulating the interests at stake and, therefore, whether it would be desirable for other countries to follow such a model. Ultimately, it is worth remarking that for those who seek to achieve parenthood, such a desire is among the most profound aspects of a person’s existential realization. When due to a delicate balance of ethics standards and potentially conflicting rights, lawmakers intervene, an authoritarian approach is unlikely to be beneficial. Offering real alternatives to surrogacy in an organic and pragmatic fashion (i.e. expediting adoption procedures, favoring motherhood at a younger age, when infertility issues are less likely to have set in) may be the best way to disincentivize fertility traveling and make sure the rights, hopes and aspirations of all the parties involved are upheld properly. [ABSTRACT FROM AUTHOR]

The brachial plexus represents a field of many anatomical variations with impor- tant clinical implications, especially in the diagnosis and treatment of the thoracic outlet syndrome (TOS). The case described in this paper presented a novel bilateral variation in the relation of the upper trunk of the brachial plexus to the anterior scalene muscle. The ventral rami of the C5 and C6 spinal nerves perforated the anterior scalene muscle simultaneously through a common opening, and joined to form the upper trunk. Previous literature reports described variations of the brachial plexus and the scalene muscles, as well as the embryological basis for their presence. The case reported herein helps to improve the comprehension of the TOS, as well as the diagnostic and therapeutical approach to this syndrome. [ABSTRACT FROM AUTHOR]

Background: The optic nerve (ON), a major component of the visual system, is divided into four segments: the intrabulbar (IB), the intraorbital (IO), the intraca- nalicular (ICn) and the intracranial (ICr). The ICr ends with the two nerves partially decussating in the optic chiasm (OCh). The purpose of this study is to provide a detailed description of the dimensions of the OC (the diameter and the surface area of its foramina and the central segment, as well as the length of the OC and the thickness of its walls) as well as the ON (the length of the ON segments, the diameter of the ICn segment of the ON, the angle of decussation in the OCh, as well as the distance between the two ON at the cranial foramen of the OC).Materials and Methods: The acquired data was then used to estimate the volu- me of the OC and the ICn segment of the ON. The morphometric research was performed on 25 cadavers (17 male and 8 female) and 30 skulls.Results: The surface area of the central segment of the OC was significantly smaller than the cranial foramen (p = 0.02) and the orbital foramen (p = 0.009). The inferior wall of the OC was significantly shorter than the other OC walls (p < 0.0001). The IO segment of the ON was the longest, where the difference to the ICn and ICr was statistically significant (p < 0.0001). The surface area of the ON at the cranial foramen was significantly larger than the surface area at the central segment of the OC (p = 0.02) and orbital foramen (p < 0.0001). The difference between the surface areas of the ON at the orbital foramen and the central segment of the OC was also statistically significant (p = 0.01). The estimated volume of the OC was calculated to be 190.72 mm3, and the volume of the ICn segment of the ON was estimated to be 50.25 mm3.Conclusions: It is absolutely crucial to open the central segment of the OC when decompressing the ON, due to the narrowing of the OC in this segment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The hypo-osmotic swelling (HOS) test predicts membrane integrity by determining the ability of the sperm membrane to maintain equilibrium between the sperm cell and its environment. The aim of our study was to determine the correlation between selenium and carnitine levels in the seminal fluid with HOS test for sperm membrane in lowgrade varicocele patients. PATIENTS AND METHODS: Study numbered 64 examinees who suffered from low-grade varicocele and were divided into two groups, according tofertility potential and HOS test outcome. The study also included a control group of 64 healthy subjects, with no varicocele. RESULTS: From the Shapiro-Wilk's test, it is clear that carnitine distribution differs significantly from normal (0.938, p = 0.03). In distribution of selenium, Kolmogorov-Smirnov test clearly shows statistically significant deviation from the normal curve (z = 0.225, p < 0.000), likewise Shapiro-Wilk's statistic (0.787, p < 0.000). According to the results, the second group had significantly higher levels of carnitine and selenium than the first group of examinees (p < 0.05); therefore, when we compared epididymal markers with HOS tests outcomes, we found significant differences between the two groups. There were no significant differences between second group and healthy subjects (p > 0.05). CONCLUSIONS: HOS test outcome in varicocele patients is directly proportional to the carnitine and selenium levels, which could play a major role in both determining fertility parameters and in the treatment of its impairment. This result is important for sub-clinical varicocele in infertile patients with normal semen analysis, since there is no evidence of benefit from any treatment sofar. [ABSTRACT FROM AUTHOR]

OBJECTIVE: An aortic aneurysm is a general term for an enlargement (dilation) of the aorta to greater than 1.5 times normal size. Abdominal aortic aneurysm (AAA) primarily affects the population older than 50 years, with a prevalence of approximately 5%. There are a few theories about AAA etiology. Interest in the relationship between blood type and vascular disease has been established. The aim of our study is to evaluate distribution of blood-groups among the patients with abdominal aortic aneurysm (AAA) as well as to identify any kind of relationship between blood type and AAA. MATERIALS AND METHODS: The design of our research is combination of retrospective and prospective case-control study in a sample of population of Montenegro. Statistical analysis was performed in SPPS v 20.0, using the chi-square test for independent samples, with the probability level at p < 0.05 as significant, and p < 0.01 as highly significant. RESULTS: O blood group was the most frequent among the examination group (53.11 %), and A blood group was the most frequent among group without AAA (43.22 %). Presence of AAA in individuals with O blood type was 1.46 higher than for the other blood types. CONCLUSIONS: This finding leads us to suspect that O blood type can be indicator for AAA. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Malignancies and autoimmune thyroid disease are still controversial, but recent studies prove that a long lasting thyroid disease may be linked with malignancy, e.g. papillary thyroid carcinoma in patients with Hashimoto thyroiditis. Having in mind that thyrotropin is a thyroid growth factor, the relationship between its serum values, as well as the levels of anti-peroxidase and anti-thyroglobulin antibodies and thyroid malignancy in patients with nodular thyroid goiter was examined. PATIENTS AND METHODS: Six-hundredthirty- seven medical records, which included the thyroid fine-needle aspiration cytology were retrospectively evaluated. Patients were grouped regarding the levels of thyrotropin, anti-peroxidase and anti-thyroglobulin antibodies (in or out of the reference ranges) and compared with cytology findings for establishing their prognostic potential for malignancy. RESULTS: Elevated serum thyrotropin (? 4.5 mIU/L) was found in 27.3% of patients with thyroid malignancy compared with 10.8% with benign and 16.1% with unspecified cytology finding (p < 0.01). In the group of patients with malignant cytology findings 7.0% of them had elevated anti-peroxidase antibodies level, and 1.4% had anti-peroxidase antibodies level in reference range. In the group of patients with malignant cytology findings 4.2% of them had elevated anti- thyroglobulin antibodies level, and 1.4% had anti-thyroglobulin antibodies level in reference range. CONCLUSIONS: In patients with elevated serum thyrotropin concentration and/or chronic thyroiditis the occurrence of thyroid malignancy is increased. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Thyroid disease is the second most common endocrine condition in women of childbearing age. Thyroid hormones are involved in control of menstrual cycle and in achieving fertility affecting the actions of folliclestimulating hormone and luteinizing hormone on steroid biosynthesis by specific triiodothyronine sites on oocytes; therefore, affect all aspects of reproduction. It remains controversial if pregnant women should be screened for thyroid dysfunction. Purpose of this review was to examine recent studies on the assessment of thyroid dysfunction in pregnancy, its treatment and newly perspective of thyroid autoimmunity in pregnant euthyroid women in achieving fertility. METHODS: An electronic search was conducted using the internet medical databases: Medline/PubMed, EMBASE, EBSCO, and the Cochrane library. RESULTS: Thyroid gland faces great challenge in pregnancy when many hormonal changes occur. Precondition for normal follicular development and ovulation is pulsate gonadothropin realizing hormone secretion. Thyroid dysfunction in pregnancy is classified as forms of hypothyroidism (positivity of thyroid autoantibody, isolated hypothyroidism, and subclinical or overt hypothyroidism), hyperthyroidism, and autoimmune disease, but also thyroid nodules and cancer, iodine insufficiency and postpartum thyroiditis. These conditions can cause adverse effects on mother and fetus including pregnancy loss, gestational hypertension, or pre-eclampsia, pre-term delivery, low birth weight, placental abruption and postpartum hemorrhage. There is an evidence that thyroid autoimmunity, in thyroid dysfunction adversely affects conception and pregnancy outcomes, but it is unclear what impact has isolated eumetabolic thyroid autoimmunity in achieving fertility, especially in women undergoing in vitro fertilization. Treatment of euthyroid pregnant women with positive thyroid peroxides antibodies is still controverse, but not few studies show that levothyroxine substitution is able to lower the chance of miscarriage and premature delivery. CONCLUSIONS: Further randomized trials are needed to expand our knowledge of physiologic changes in thyroid function during the pregnancy and to reveal mechanisms by which thyroid autoimmunity in euthyroid women affect fertility, especially the success of assisted reproductive technology in achieving the same and validity of levothyroxine administration in thyroid autoimmunity positive women. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Varicocelectomy is the only effective method of treating varicocele. Nowdays, many techniques for varicocelectomy include retroperitoneal, inguinal, and subinguinal varicocele repairs with or without magnification and laparoscopic repair. The advantages of the microsurgical approach to varicocele repairs are reliable identification and preservation of the vascular structures. Thus, our aim is to compare the efficiency of microsurgery over conventional techniques of varicocele repairs. PATIENTS AND METHODS: We have evaluated 105 man divided into three groups of 35 patients surgically treated with open varicocelectomy in the first group, microsurgical varicocelectomy in the second, and laparoscopic varicocelectomy in the third group. Sperm test improvement and complications were then compared. RESULTS: The testicular volume shows a significant increase after all three types of surgery, the highest one being after the laparascopic varicocelectomy (14.47 ± 6.76 vs. 21.8 ± 7.52), whereas the lowest increase was recorded in open varicocelectomy (14.90 ± 6.26 vs. 17.46 ± 5.89). Regarding motility of spermatozoids, the highest postoperative increase of values is after microsurgical varicocelectomy (4.30 ± 2.19 vs. 15.88 ± 3.13). CONCLUSIONS: Our study shows the lowest degree of postoperative complications among patients treated with microsurgical varicocelectomy, and the most frequent complications in those treated by open varicocelectomy. Sperm test outcomes after microsurgical varicocelectomy was better than those after other conventional techniques: significantly higher improvement of sperm quality, shoter postsurgical clinical treatment, and the lowest rate of postsurgical complications. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetic patients have a double higher short-term mortality rate after acute myocardial infarction (AMI) than non-diabetic ones. Admission glucose level has been already concerned as an independent risk factor for the long-term prognosis after myocardial infarction. The aim of this study is to evaluate the influence of admission glucose profile (AGP) and glycosylated hemoglobin (HbA1c) on complications of the AMI in patients with type 2 diabetes. PATIENTS AND METHODS: The study was based on 76 diabetic patients hospitalized with first-ever AMI. Admission glucose profile was estimated as mean value of the first six blood glucose values, since HbA1c was measured from the blood sampled in the first morning after the admission to hospital. All post-infarction complications are divided into electrical and mechanical ones. ROC curves are used to analyze predictive values of admission glucose profile and HbA1c for developing post-infarction complications. RESULTS: Admission glucose profile is a significant (p = 0.001) predictor of electrical complications with 12.25 mmol/L cut-off value (sensitivity 77.3%; specificity 64.5%), while it is not significant (p > 0.05) for mechanical complication (cut-off value 16.85 mmol/L; sensitivity 45.2%; specificity 77.8%). HbA1c is not enough good for the complication prediction (p > 0.05). Considering electrical and mechanical complications aggregately, AGP is even more significant (p = 0.000) with 14.85 mmol/L cut-off value (sensitivity 54.4%; specificity 94.7%), and HbA1c is significant, as well (p = 0.013, too with 9.07 % cut-off value (sensitivity 57.9%; specificity 78.8%). CONCLUSIONS: Comparing the predictability between AGP and HbA1c, in our sample, the first one seems to be the better one. Admission glucose profile and HbA1c should be the obligatory laboratory tests performed at the time of hospital admission after the heart attack. [ABSTRACT FROM AUTHOR]

BACKGROUND: Varicocele associated with infertility has been recognized for years. Referential literature provides few papers, even meta-analyses which did not confirm the success of surgery related to the increasing of the semen quality. AIM: The purpose of the presented paper is referred in arising the quantum of knowledge related to usefulness of surgery in varicocele treatment. PATIENTS AND METHODS: The varococele incidence was established in premature age (7-18) in population of 969 boys. In those who suffered from varicocele, we estimated their semen analysis parameters before and three months after the surgery, and followed up the pregnancy rate in surgically treated subjects many years after the treatment. RESULTS: A prevalence of 9.7% in premature age, significantly raising in the group aged 15-18 was showed. After the laparoscopic varicocelectomy, all of the semen parameters (left testicular volume, pH, sperm count, abnormal forms and viability) were improved, since the semen volume and the progressive motility not significantly. Since we observed adolescent varicocele, some of the semen parameters initialy have not been out of reference limits. Following the surgically treated subjects for next 12-17 years, the pregnancy rate is at least 75%, since not all of them have been married yet. CONCLUSIONS: We recorded improvement of two out of three parameters of fertility after the operation in a group of 23 surgically treated patients. This fact encourages those who advocate surgical treatment of varicocele in adolescents, since the early therapy would prevent fertility disorders. [ABSTRACT FROM AUTHOR]

After a short review of impotence, the definitions of erectants and aphrodisiacs are presented. The Authors propose division of arthropods according to the places of effect. The description of particular arthropods with their pictures and nomenclature, is followed by certain or probable mechanisms of achieving the aphrodisiac and sometimes toxic effect, that were available in the literature since 1929 till nowadays. We mention the most usual locations, mainly in Asia, where they are found and consumed, but also, we describe the manner of preparing and intake. The review includes the following arthropods: lobster, Arizona bark scorpion, deathstalker, banana spider, Mediterranean black widow, Burmeisters triatoma, giant water bug, diving-beetle, Korean bug, diaclina, flannel moth, Spanish fly, migratory locust, red wood ant and honeybee. [ABSTRACT FROM AUTHOR]

BACKGROUND: A small amount of data is already presented in the relevant literature related to the medical facts of scorpionism caused by Yellow scorpion (Mesobuthus gibbosus: M. gibbosus). Undoubtedly, it is considered as dangerous to human health. This paper presents an unusual case of scorpionism after the sting in vein. CASE REPORT: A 25 year old male was bitten by M. gibbosus. He experienced extremely severe intermittent pain in the right feet, followed by pulsating and glowing sensations, cold sweat and paleness. 15 minutes after the sting, the pain started to spread through the medial side of the leg, up to the inguinal region. Patient became excited, and experienced occasional spasms of leg muscles. A month after, the bitten vein of dorsal arch of the foot and v. sephena magna became non-uniformly tortuously spread through the entire length. On physical examination four years after the sting, the enlargement of the veins still exists, periodical tingling, and occasional muscle twitches during the night. CONCLUSIONS: M. gibbosus is endemic in Mediterranean area and represents a real hazard for local inhabitants and tourists. The medical treatment of this type of scorpionism is exclusively symptomatic. [ABSTRACT FROM AUTHOR]

Abstract: Assisted reproduction techniques (ARTs) have given rise to novel, non-traditional family models. Still, among the various applications and approaches of 'medically assisted procreation' (MAP), the most divisive one undoubtedly is 'gestational surrogacy' (GS), also in light of the rising number of couples who have chosen it over the past twenty years. Another major implication of ARTs is the creation of intentional (or intended) parenthood in addition to genetic one: the genetic parent's partner is thus defined as the intentional (or second) parent, who by free choice, shares the family project with the genetic parent, even without any biological tie with the child. Hence, the intended parent takes on the same rights and responsibilities towards the child as the biological one. Several countries, including Italy, have enacted norms to discourage cross-border surrogacy, deeming it harmful to the dignity of women and children. Recently, however, the Italian government has decided intensify the fight against this practice: the Chamber of Deputies (Italy's lower chamber of parliament) has passed a law which punishes couples that resort to surrogacy even if the agreement and the birth take place abroad. Therefore, surrogacy would become a so-called universal crime. In light of the fact that criminalization is a serious and highly consequential step, which may have life-changing consequences for the intended parents, the aim of this paper is to assess whether this may be an effective instrument for regulating the interests at stake and, therefore, whether it would be desirable for other countries to follow such a model. Ultimately, it is worth remarking that for those who seek to achieve parenthood, such a desire is among the most profound aspects of a person's existential realization. When due to a delicate balance of ethics standards and potentially conflicting rights, lawmakers inter-vene, an authoritarian approach is unlikely to be beneficial. Offering real alternatives to surrogacy in an organic and pragmatic fashion (i.e. expediting adoption procedures, favoring motherhood at a younger age, when infertility issues are less likely to have set in) may be the best way to disincentivize fertility traveling and make sure the rights, hopes and aspirations of all the parties involved are upheld properly.

The recently emerged novel coronavirus, "severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)," caused a highly contagious disease called coronavirus disease 2019 (COVID-19). It has severely damaged the world's most developed countries and has turned into a major threat for low- and middle-income countries. Since its emergence in late 2019, medical interventions have been substantial, and most countries relied on public health measures collectively known as nonpharmaceutical interventions (NPIs). We aimed to centralize the accumulative knowledge of NPIs against COVID-19 for each country under one worldwide consortium. International COVID-19 Research Network collaborators developed a cross-sectional online survey to assess the implications of NPIs and sanitary supply on the incidence and mortality of COVID-19. The survey was conducted between January 1 and February 1, 2021, and participants from 92 countries/territories completed it. The association between NPIs, sanitation supplies, and incidence and mortality were examined by multivariate regression, with the log-transformed value of population as an offset value. The majority of countries/territories applied several preventive strategies, including social distancing (100.0%), quarantine (100.0%), isolation (98.9%), and school closure (97.8%). Individual-level preventive measures such as personal hygiene (100.0%) and wearing facial masks (94.6% at hospitals; 93.5% at mass transportation; 91.3% in mass gathering facilities) were also frequently applied. Quarantine at a designated place was negatively associated with incidence and mortality compared to home quarantine. Isolation at a designated place was also associated with reduced mortality compared to home isolation. Recommendations to use sanitizer for personal hygiene reduced incidence compared to the recommendation to use soap. Deprivation of masks was associated with increased incidence. Higher incidence and mortality were found in countries/territories with higher economic levels. Mask deprivation was pervasive regardless of economic level. NPIs against COVID-19 such as using sanitizer, quarantine, and isolation can decrease the incidence and mortality of COVID-19., (© 2022 Wiley Periodicals LLC.)

Traditionally recognized risk factors for atherosclerosis are not presented in 50% of patients with ischemic heart disease. Chronic inflammation with low pathogenic agents with slightly, or no signs of inflammation is the mainstay of atherosclerosis and could be triggered by an infectious agent, most commonly by Chlamydia pneumoniae. Immunostaning of 33 Chlamydia pneumoniae-positive and 30 Chlamydia pneumoniae- negative quadriple arterial sets were examined for protective Sp110, and atherogenic HSP60 markers, as well as for TNF-α which is inflammatory marker affected by both of them. The Chlamydia pneumoniae-negative deceased subjects were statistically significantly older and their BMI was significantly lower. The results showed that age, hypercholesterolemia, diabetes, arterial hypertension and BMI were negatively correlated with Chlamydia pneumoniae-positivity, while no significant relationship was found between Chlamydia pneumoniae-positivity and a positive family history of cardiovascular diseases, as well as smoking. Significantly higher presence of Sp110 in Chlamydia pneumoniae-negative group versus significantly higer presence od HSP60 in Chlamydia pneumoniae-positive group. Chlamydia pneumoniae-negative plaques showed higher TNF-α expression; difference is present for all arteries examined except the Willis circle. This study may provide a model for further understanding the mechanisms of Chlamydia pneumoniae atherogenesis and evaluating chlamydial intervention strategies for preventing the advancement of atherosclerotic lesions enhanced by bacterial infections.

Objectives: The aim of this research was to determine the attitudes of transplant-related health care workers and the local population of Montenegro toward organ donation and transplantation., Materials and Methods: Our study included 200 transplant-related health care professionals (from the Clinical Center of Montenegro, the only transplant hospital in the country) and 200 volunteers from Podgorica (the capital of Montenegro). Their attitudes were evaluated using an anonymous, self-administered, multiple-choice questionnaire., Results: Most health care workers would donate their organs only on specific occasions (43.6%), whereas the general population was divided between willingness to donate only on specific occasions and the need to consider the decision of donating (34.6% each). Both groups of respondents predominantly claimed that they would donate their organs to any potential recipient, regardless of sensory or physical disability. A positive opinion regarding the promotion of organ donation, as well as the need for legal regulation of the transplant process, was noted in both groups of responders., Conclusions: There is a need to increase the generosity of the Montenegrin population and its health care workers regarding organ donation at all times and not exclusively on specific occasions.

Graves' ophthalmopathy (GO) is an autoimmune disease affecting ocular and orbital tissues. Overproduction of tumor necrosis factor α (TNF-α) in rheumatoid arthritis (RA) and GO has destructive consequences. The subject of this paper is a case of a female patient initially diagnosed with primary hypothyroidism substitution with levothyroxine, and subsequent diagnosis of RA with insufficient therapeutic efficacy of a standard medication. Three years later, the patient presented symptoms and signs of GO. Etanercept was administrated for RA, and after four months, an improvement of the eye symptoms and reduced exophthalmos were observed and confirmed using visual methods. Graves' ophthalmopathy association with primary hypothyroidism is uncommon. The treatment of RA using etanercept led to clinical improvement of GO symptoms, which indicates that RA and GO may share similar pathogenic features. The paper suggests that etanercept may suppress the symptoms and clinical signs of GO. However, controlled trials are needed to further evaluate the effect of TNF-α inhibitors, particularly etanercept, and to compare its side effects with the current options for medical treatment., Competing Interests: The authors declare no conflict of interest., (Copyright © 2019 Termedia.)

This study aimed to determine the effectiveness of airbags and seatbelts in the prevention of facial fractures and slight facial injuries in relation to the speed and kinetic energy experienced in frontal collisions. All cases of vehicle occupants who had been in frontal collisions and had subsequently been examined in the Institute for Emergency Medical Assistance and the Clinical Center of Montenegro in 2017 were analyzed. There were 29 cases of facial fractures (Group 1), 35 cases of slight facial injuries (including nondisplaced nasal fractures) (Group 2), and 26 cases of occupants who had suffered no facial injuries (control Group 3). In all assessed cases all of the subjects had been wearing a seatbelt and the airbag had deployed at the time of impact. A frontal collision is defined as a collision in which the principal force acts within a range of 90° from the longitudinal axis of the vehicle. Using the mass and the speed of the vehicles, the total kinetic energy (KE) of all frontal collisions being analyzed was calculated. The cut-off value of total KE in frontal collisions that were associated with either facial fractures or slight facial injury was estimated using a receiver operating characteristic (ROC) curve. The cut-off amounts of KE were then used to calculate the barrier equivalent velocity (BEV). The BEV for a vehicle of average mass was estimated to be 55.7 km/h (34.6 mph) in Group 1, and 49.2 km/h (30.6 mph) in Group 2. Airbags and seatbelts are effective in preventing facial injuries in vehicles of average mass that are traveling at speeds under 49.2 km/h (30.6 mph) at the point of impact, but they do not protect from facial fractures when the vehicle speed exceeds 55.7 km/h (34.6 mph).

The superficial palmar branch (SPB) of the radial artery (RA) is an important blood vessel in plastic surgery procedures of the hand. It is used as the axial artery in a free flap used for finger reconstruction. The occurrence of this arterial branch is variable, as well as its diameter and course. The aim of this study was to determine the occurrence and measure the external diameter of the SPB, as well as the external circumference of the RA. All results were analyzed with the intent to determine a possible correlation between RA and SPB size, as well as between SPB occurrence and the cadavers' sex and height. The study was conducted on both upper extremities of 60 cadavers (31 male and 29 female), of 35-55 years of age (average age was 46.5 years). A radial artery sample was taken at the level of the wrist, together with its superficial palmar branch. The samples were preserved in 4% formaldehyde for four weeks. After the fixation, the external circumference of the radial artery and the external diameter of the superficial palmar branch were measured with a Vernier caliper and an operating microscope. Bilateral SPB absence was the most common variant of SPB occurrence in our material. There was no linear correlation between the size of the RA and the SPB, nor was there any relationship between SPB occurrence and the cadavers' age and height. Also, the correlation between the cadavers' height and the size of both blood vessels was not linear. We conclude that the SPB diameter and occurrence are independent of the other factors described in this study., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

The hyoid bone consists of a body and two pairs of processes: the greater cornua (GC) and the lesser cornua. The GC is connected to the superior thyroid cornu (STC) by the lateral thyrohyoid ligament. The GC and the STC share a common embryological origin from the third pharyngeal arch. During anatomical dissection of a male cadaver of 56 years of age, a combined variation of the GC and the STC was found. The left GC was 27.7 mm long, and the right GC was 30 mm long. The left GC axis was in the same plane as the hyoid body, while an angle of 33° was between the right GC axis and the hyoid body plane. The left STC was 17.6 mm long, and the right STC was 25.8 mm long. The angle of left STC medial inclination was 70°, while the right STC was perpendicular to the horizontal plane of the larynx. Anatomical variations of the hyoid bone and the laryngeal cartilages have possible clinical implications, such as Eagle syndrome and the STC syndrome. The case we described may inspire the anatomists to research the occurrence of combined variations of the larynx and the hyoid bone.

Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.

Introduction: Acute aortic type III dissection is one of the most catastrophic events, with in-hospital mortality ranging between 10% and 12%. The majority of patients are treated medically, but complicated dissections, which represent 15% to 20% of cases, require surgical or thoracic endovascular aortic repair (TEVAR). For the best outcomes adequate blood transfusion support is required. Interest in the relationship between blood type and vascular disease has been established. The aim of our study is to evaluate distribution of blood groups among patients with acute aortic type III dissection and to identify any kind of relationship between blood type and patient's survival., Material and Methods: From January 2005 to December 2014, 115 patients with acute aortic type III dissection were enrolled at the Clinic of Vascular and Endovascular Surgery in Belgrade, Serbia and retrospectively analyzed. Patients were separated into two groups. The examination group consisted of patients with a lethal outcome, and the control group consisted of patients who survived., Results: The analysis of the blood groups and RhD typing between groups did not reveal a statistically significant difference ( p = 0.220)., Conclusions: Our results indicated no difference between different blood groups and RhD typing with respect to in-hospital mortality of patients with acute aortic dissection type III., Competing Interests: The authors declare no conflict of interest.

Current autopsy principles for evaluating the existence of brain edema are based on a macroscopic subjective assessment performed by pathologists. The gold standard is a time-consuming histological verification of the presence of the edema. By measuring the diameters of the cranial cavity, as individually determined morphometric parameters, a mathematical model for rapid evaluation of brain edema was created, based on the brain weight measured during the autopsy. A cohort study was performed on 110 subjects, divided into two groups according to the histological presence or absence of (the - deleted from the text) brain edema. In all subjects, the following measures were determined: the volume and the diameters of the cranial cavity (longitudinal and transverse distance and height), the brain volume, and the brain weight. The complex mathematical algorithm revealed a formula for the coefficient ε, which is useful to conclude whether a brain edema is present or not. The average density of non-edematous brain is 0.967 g/ml, while the average density of edematous brain is 1.148 g/ml. The resulting formula for the coefficient ε is (5.79 x longitudinal distance x transverse distance)/brain weight. Coefficient ε can be calculated using measurements of the diameters of the cranial cavity and the brain weight, performed during the autopsy. If the resulting ε is less than 0.9484, it could be stated that there is cerebral edema with a reliability of 98.5%. The method discussed in this paper aims to eliminate the burden of relying on subjective assessments when determining the presence of a brain edema., (Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

The aim of this study is to establish the scientific benefit of royal jelly (RJ) on prostatic-specific antigen (PSA), post-void residual (PVR) volume and International Prostate Symptom Score (IPSS) in benign prostatic hyperplasia. For the study, a group of 40 men were administered 38 mg of RJ over a period of three months, their PSA values, prostate volumes and the volumes of their transitory prostate zones, PVR and IPPS values were measured at the end of the first month, and at the end of the third month. The results of this study confirm the potential of RJ in reducing PSA scores and improving IPSS values. Since the use of RJ did not lead to any significant reduction in PVR, prostate volume, or to any involution of the transitory zone, it appears that it may only affect the blood marker of prostatic hyperplasia and to improve quality-of-life (QoL) in those patients. Overall, in comparison to phytotherapy and conventional therapy, RJ had similar positive effects on QoL in patients with BPH, however it exhibited markedly better effects on reducing PSA levels in blood. The therapeutical use of RJ exhibited no side effects.

Among various reasons, colon injuries may be caused by low- or high-energy firearm bullets, with the latter producing a temporary cavitation phenomenon. The available treatment options include primary repair and two-stage management, but recent studies have shown that primary repair can be widely used with a high success rate. This paper investigates the differences in performance of primary repair on these two types of colon injuries. Two groups of patients who sustained colon injuries due to single gunshot wounds, were retrospectively categorized based on the type of bullet. Primary colon repair was performed in all patients selected based on the inclusion and exclusion criteria (Stone and Fabian's criteria). An almost absolute homogeneity was attained among the groups in terms of age, latent time before surgery, and four trauma indexes. Only one patient from the low-energy firearm projectile group (4%) developed a postsurgical complication versus nine patients (25.8%) from the high-energy group, showing statistically significant difference (p = 0.03). These nine patients experienced the following postsurgical complications: pneumonia, abscess, fistula, suture leakage, and one multiorgan failure with sepsis. Previous studies concluded that one-stage primary repair is the best treatment option for colon injuries. However, terminal ballistics testing determined the projectile's path through the body and revealed that low-energy projectiles caused considerably lesser damage than their high-energy counterparts. Primary colon repair must be performed definitely for low-energy short firearm injuries but very carefully for high-energy injuries. Given these findings, we suggest that the treatment option should be determined based not only on the bullet type alone but also on other clinical findings., Competing Interests: The authors of this paper hereby declare that have not received nor shall receive any financial benefits from publishing the paper, neither they have received any financial incentive from a third party. We, the author and co-authors, hereby solemnly declare that we are not in any situation which could give rise to a conflict of interest., (Copyright © 2016 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

A case of bus rollover into the canyon, 40 m down the road, with 47 occupants out of which 18 were fatally injured, was used to compute the Injury Severity Score (ISS) for each passengers as well as the equivalent free fall for this particular accident, to be compared to the height of fall as estimated by the Lau's model based on ISS, resulting the conclusion whether Lau's model and the computation of ISS can be considered reliable to estimate the height of fall in any other case. Dealing with this, we would be also able to assess a protective potential of the bus on occupants while it falls from the height. By using classic energy-related mechanical formulas the presented rollover down the cliff has been transferred into a corresponding free fall from the height (10 m). ISS for each passenger has been used to establish height bands of the corresponding free fall. The analysis of the presented case showed that only 30% of bus passengers sustained injuries similar to the injuries expected in the fall from height in the range of 10-20 m. The chances to be non-severely injured as a consequence of the fall in a bus is 43%, but still remains a very high chance (27%) to sustain injures more severe than expected for the equivalent free fall from height out of a vehicle. Moreover, eight passengers sustained pulmonary detraction which is characteristic of the fall above 40 m. The conclusion is that this mathematical computing for transferring one way of motion into another one may be useful for any other event similar to the fall from height and further usage of Lau's modules. Also, estimated severity of the injuries expressed through ISS can be merely an approximating indicator of the height of the fall of the bus, so ISS is not able to estimate the exact height. Finally, in majority of cases the protective potential of the bus may preserve from severe body damage, but the mortality rate still stands on a very high level., (Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.)

Background: Male infertility is a common and complex problem and, despite much research in this field, the major cause of infertility unfortunately remains unknown. Genital infection and varicocele are important causes of infertility., Aims: To compare the influence of genital infection and varicocele individually on male infertility based on semen analysis., Study Design: Cross-sectional study., Methods: The study included 120 infertile patients divided into two groups according to the presence of genital infection or varicocele. The first group included 60 examinees with proven genital infection, but without varicocele formation. The second included 60 patients with varicocele, regardless of the varicocele grade, but without genital infection. The fertile parameters were compared and an assessment was performed on the impact on quality of spermatogenesis due to infection and varicocele., Results: There is a statistically significant difference regarding abnormal forms of spermatozoids (45.94±9.79 vs. 25.27±6.54) and progressive motility (8.15±1.24 vs. 24.95±7.2), between two groups of patients. However, acidity of ejaculates, minimum sperm concentration, total spermatozoid motility and ejaculate volume showed no statistically significant difference., Conclusion: The study showed a stronger negative influence of genital infection on fertile parameters over varicocele. The significance of our study is the lack of contemporary researches comparing varicocele and genital infection influence on male infertility individually.

Introduction: The aim of this study is to test the hypothesis that the cessation of sports training in young athletes reduces the prevalence of varicocele., Material and Methods: 1,013 young males were divided into three age-matched groups based on their sport activity. The first group consisted of 305 athletically active boys in basketball, volleyball, handball, or football; the second of 44 active water-polo players, and the third of 664 sport-inactive controls. All participants had been initially examined for the presence of varicocele, and positive ones were submitted to orchidometry and seminal fluid analysis. Those with varicocele were then asked to cease all sport activity for the following six months, and the reassessing was performed., Results: The results showed a significantly higher percentage of varicocele present in the first group than in the control group (p < 0.49), while the percentage of young males diagnosed with varicocele in the second proved to be even lower than that of the control group (9.09% vs. 12.35%). After the 6-month period of cessation and abstention from all sporting activity, every parameter of the seminal fluid analysis improved in the first group, wherein statistical significance for both sperm concentration (p < 0.001) and sperm motility (p < 0.023) was found. The testicular volume was found not to have increased significantly in either group (p > 0.05)., Conclusions: The study shows that sport-associated varicocele has a positive prognosis when diagnosed early and upon the cessation of sports training.

Air guns (air pistols and rifles) are already recognized as being potentially lethal. The diabolo pellet has a calibre of .177 (4.5 mm), a 1250 fps velocity, is high energetic, and is most commonly used in such weapons. In the presented case, the victim sustained an air rifle injury to the neck. The pellet passed through the thyroid cartilage, subsequently causing the extensive laryngeal swelling with haematoma around the pellet channel which fatally obstructed the airway. It is estimated microscopically that at least a number of hours must have passed from the injury to the time of death. For this case, a shooting distance was estimated by using experimental shooting values compared to physics formulas for accelerated motion. The case under question has confirmed an applicable legal approach that can be utilized by countries to classify air rifles as being as harmful as other firearms, especially those with high muzzle velocities., (© The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

In this report we review the unusual case of a patient with a common hepatic artery aneurysm presenting 30 years after a Billroth's II resection. A 65-year-old man with epigastric pain and 10 kg of weight loss in the previous 6 months was referred to our clinic. Computed tomography revealed the presence of an aneurysm of the common hepatic artery (HAA) of 35 mm. This HAA was surgically excluded by aneurysmectomy and prosthetic bypass. Intraoperatively we observed extensive peritoneal adhesions and connective tissue formation in the region of the hepatoduodenal and hepatogastric ligaments, and the outer wall of the HAA was tightly affixed to the root of the transverse mesocolon by connective adhesions. Retraction of the adhesions slowly brought about a continued stretching and thinning of the arterial wall likely caused the HAA., (Copyright © 2014 Elsevier Inc. All rights reserved.)