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The aim of study was to estimate the effect of acute exercise on serum growth hormone (GH) and fatty acid (FFA) levels in elite water polo players. Twelve male water polo players (20.50 ± 2.02 years) and eleven non-athletic male subjects (20.55 ± 1.04 years) participated in this study. In order to determine GH and FFA responses to acute exercise, a treadmill-running test was performed following an incremental protocol. Pre-exercise blood samples for both athletes and non-athletes were taken at 9 AM. Post-exercise samples were taken immediately after and 30 min after the treadmill running test. Water polo players had significantly lower baseline values of serum GH concentration compared to controls, whereas serum FFA concentration was significantly higher in water polo players compared to controls (p

Pierachille Santus,1 Fabiano Di Marco,2 Fulvio Braido,3 Marco Contoli,4 Angelo Guido Corsico,5 Claudio Micheletto,6 Girolamo Pelaia,7 Dejan Radovanovic,1 Paola Rogliani,8 Laura Saderi,9 Nicola Scichilone,10 Silvia Tanzi,11 Manlio Vella,11 Silvia Boarino,11 Giovanni Sotgiu,9 Paolo Solidoro12 1Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Division of Respiratory Diseases, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milano, Italy; 2Department of Health Sciences, Università degli Studi di Milano Pneumology, ASST Papa Giovanni XXIII, Bergamo, Italy; 3Department of Internal Medicine (DiMI), Respiratory Unit for Continuity of Care, IRCCS Ospedale Policlinico San Martino, University of Genova, Genova, Italy; 4Department of Translational Medicine, Respiratory Section, University of Ferrara, Ferrara, Italy; 5Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy; 6Cardio-Thoracic Department, Respiratory Unit, University Integrated Hospital, Verona, Italy; 7Dipartimento di Scienze della Salute, Università Magna Graecia, Catanzaro, Italy; 8Department of Experimental Medicine, Unit of Respiratory Medicine, University of Rome ”Tor Vergata”, Division of Respiratory Medicine, University Hospital ”Tor Vergata”, Rome, Italy; 9Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy; 10Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy; 11AstraZeneca Italia, Milan, Italy; 12Department of Medical Sciences, University of Turin, S.C. Pneumologia, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Torino, ItalyCorrespondence: Pierachille Santus, Università degli Studi di Milano, Via G.B. Grassi 74, Milano, 20157, Italy, Tel +39 0239042801, Fax +39 0239042473, Email pierachille.santus@unimi.itObjective: To describe the burden of moderate to severe exacerbations and all-cause mortality; the secondary objectives were to analyze treatment patterns and changes over follow-up.Design: Observational, multicenter, retrospective, cohort study with a three year follow-up period.Setting: Ten Italian academic secondary- and tertiary-care centers.Participants: Patients with a confirmed diagnosis of COPD referring to the outpatient clinics of the participating centers were retrospectively recruited.Primary and Secondary Outcome Measures: Annualized frequency of moderate and severe exacerbations stratified by exacerbation history prior to study enrollment. Patients were classified according to airflow obstruction, GOLD risk categories, and divided in 4 groups: A = no exacerbations; B = 1 moderate exacerbation; C = 1 severe exacerbation; D = ≥ 2 moderate and/or severe exacerbations. Overall all-cause mortality stratified by age, COPD category, and COPD therapy. A logistic regression model assessed the association of clinical characteristics with mortality.Results: 1111 patients were included (73% males), of which 41.5% had a history of exacerbations. As expected, the proportion of patients experiencing ≥ 1 exacerbation during follow-up increased according to pre-defined study risk categories (B: 79%, C: 84%, D: 97.4%). Overall, by the end of follow-up, 45.5% of patients without a history of exacerbation experienced an exacerbation (31% of which severe), and 13% died. Deceased patients were significantly older, more obstructed and hyperinflated, and more frequently active smokers compared with survivors. Severe exacerbations were more frequent in patients that died (23.5%, vs 10.2%; p-value: 0.002). Chronic heart failure and ischemic heart disease were the only comorbidities associated with a higher odds ratio (OR) for death (OR: 2.2, p-value: 0.001; and OR: 1.9, p-value: 0.007). Treatment patterns were similar in patients that died and survivors.Conclusion: Patients with a low exacerbation risk are exposed to a significant future risk of moderate/severe exacerbations. Real life data confirm the strong association between mortality and cardiovascular comorbidities in COPD.Keywords: pulmonary disease chronic obstructive, heart failure, ischaemic heart disease, respiratory medicine, public health

Background/Aim. Postoperative nausea and vomiting (PONV) are one of the most common causes of patient dissatisfaction in the postoperative period after general anesthesia. Hyperoxia may prevent PONV after abdominal surgery, but the effectiveness of intraoperative and early postoperative hyperoxia in preventing PONV after breast cancer surgery has not been fully elucidated. The aim of this study was to assess if the application of intraoperative hyperoxia during surgery could prevent PONV. Methods. Forty female patients with breast cancer were recruited for the study, all of whom underwent surgical treatment of breast cancer with axillary sentinel node sampling or axillary lymph node dissection. A balanced general anesthesia was conducted, which was induced with propofol and maintained with sevofluran. Out of the 40 patients, 20 (in-tervention group) received a volatile gas mixture with a fraction of inspired oxygen (FiO2) of 0.8 L/min intraoperatively and, afterward, 3 L/min of oxygen via face mask for two hours after surgery. The other 20 patients (control group) received a FiO2 of 0.4 L/min during the surgery without further administration of oxygen in the early postoperative period. The presence and severity of PONV were assessed at 30 min, 4, 24, 32, 48, and 56 hrs after surgery with the use of the PONV numerical Intensity Scale by Wengritzky for evaluating clinically significant PONV in the first six hours after surgery. Data were collected in an Excel spreadsheet and analyzed using the independent Student’s t-test. Results. The overall incidence of PONV during the 30 min after the surgery was 17.5% (15% in the group of patients receiving FiO2 of 0.8 L/min and 20% in the group of patients receiving FiO2 of 0.4 L/min intraoperatively). There was no statistically significant difference between the two groups in the frequency of PONV, as well as in the severity of PONV, measured with the PONV Intensity Scale by Wengritzky (p ≥ 0.05). Conclusion. We found no benefit of intra- and post-operative hyperoxia in reducing the incidence of PONV. The data do not support routine administration of hyperoxia, in addition to antiemetics, for the prevention of PONV in patients undergoing breast cancer surgery.

Background: Many studies have shown that geriatric patients with altered nutritional status are at higher risk of developing complications during medical treatment. Our study aimed to examine the role of preoperative nutritional status in developing postoperative complications and the length of hospital stay in geriatric patients who suffer from cancer and undergo major abdominal surgery. Methods: Prospective research was conducted at the Oncology Institute of Vojvodina from January 2020 until April 2021. This study included 82 patients over 65 years old, who were admitted to have radical surgery for gastrointestinal cancer performed. There were 6 patients excluded from the study. Nutritional status analysis was performed using BMI (Body mass index), preoperative serum albumin level, MNA-SF (Mini nutritional assessmentshort form), and GNRI (Geriatric nutritional risk index). The classification of surgical complications was done using the Clavien-Dindo classification scale. Results: Of the total number of patients, 57 of them (75%) developed at least one surgical complication. Nonsurgical complications have been recognized in 28 patients (36.84%). Overweight patients, according to BMI, had a greater chance of developing grade I (p < 0.01) and grade II (p < 0.05) surgical complications of the Clavien-Dindo classification. Patients with normal serum albumin levels had a significantly lower chance of developing surgical complications of any grade (p = 0.00). BMI and MNA-SF were the most important predictors of delirium. Patients without GNRI risk (GNRI: >98) had a significantly lower chance of developing nonsurgical complications regarding comorbidity exacerbation (p = 0.03), and delirium (p = 0.00). Conclusion: None of the nutritional assessment tools used in our study were better or more efficient than the others in our sample of patients. Precise nutritional status assessment is complex and we cannot use only one scoring system or scale to get accurate results.

The intensive form of agricultural production often leads to disruption of physical, chemical and biological properties of the soil. Therefore, in recent years there has been an increasing focus on research and finding ways to preserve the soil with management practices that support soil conservation. The research was conducted on the experimental field of the Institute for Field and Vegetable Crops Novi Sad on Rimski Šančevi. The experiment was set up as a randomized block design. The winter cover crops consisted of the combined intercrops: Triticale (×Triticosecale Wittm. ex A. Camus) and winter pea (Pisum sativum ssp. arvense L.) (T+P), solo winter fodder pea crop (Pisum sativum ssp. arvense L.) (P) and a control without winter cover crops (sole or mixtures)(Ø). The experiment with winter cover crops was divided into two blocks. In the first block, the winter cover crops were chopped and plowed, while treatments in the second block were mowed using a rotary mower and the fodder was removed for feeding ruminants. After ploughing and preparing the soil for sowing, sowing of spring crops (soybean, maize and sudan grass) was carried out on all varieties in the subsequent sowing period. This research aims to determine the influence of different types of winter cover crops and spring crops from subsequent sowing period on the physical properties of Chernozem with a special emphasis on soil structure. It was determined that values of MWD on the treatments where the mixture of cover crops (T+P plowed) ranged from 1.11 mm to 1.39 mm, which indicated a better aggregates stability compared to the control treatments where no cover crops were sown. Due to variable root morphology and water requirements, which may alter soil structure, it is required to pay more attention to the adaptation of management strategies through the use of cover crops as well as the selection of their mixes.

In 2013, the National Assembly of the Republic of Serbia passed amendments to the Budget System Law prescribing the measure of the moratorium on employment in public services. The implementation of this measure was directed towards controlling (i.e. cutting) expenses and reducing the number of employees in the organizations financed from the government budget. Despite the analysis of the measure under scrutiny pointing out a lack of systematic, argumented and reliable reports and objective analyses of both positive and negative consequences of this decision, it appears that its application was associated with more negative consequences than positive ones whilst the largest and most significant effects were suffered by the sectors of healthcare, social protection and education. In addition, the negative consequences of the measure had a direct impact on women and young members of the workforce. The extension of this measure, in several iterations, has manifested itself through significant obstacles in the provision of services as well as a reduction in the quality of these services. Therefore, it is worthwhile to examine the content and the consequences of the application of the measure of the moratorium on public employment, certain legal dilemmas in relation to it, as well as whether the autonomy of public services has been restored following its repeal.

The paper presents the results of research conducted on the population of refugees and internally displaced persons in Kosovo and Metohija, stationed in four collective centers of the second northernmost municipality of Zubin Potok (Gazivode, Velji Breg, Jagnjenica and Donje Varage). The survey was conducted using a questionnaire method with a survey technique using the SILC survey (Income and Living Conditions Survey) on a representative sample. The goal was to collect data from a population that is mostly excluded from social surveys and census surveys, bearing in mind the fact that the aforementioned collective centers are located in Kosovo and Metohija, where official republican surveys of marginal groups have not been conducted for more than two decades. In accordance with the scope of work, the text shows only some indicators that showed the deprivation of the population of refugees and internally displaced persons.

The current acceptance of value orientations by adolescents, changes in acceptance over time, and the connection with changes in social relations are undoubtedly of special interest to researchers, as well as certain segments of society. In this article, the results of the acceptance of the same value orientations at seven points in time, published in the works of different authors starting from 1972 as the first year in which data were available, were compared with the results of their acceptance at the eighth point, i.e., in 2018. The 2018 results were obtained by the author of this article, on a random sample of 832 secondary school students in Belgrade, with the same value orientations as in the previous seven papers: utilitarianism, hedonism, altruism, and activism. The number and type of value orientations are limited by the need to have the same ones throughout the time interval so that comparison is possible. The aim of the paper was: a) to determine the degree of desirability of these value orientations at the time of the research, and b) to determine the desirability changes and possible connection with social changes in the period from 1972 to 2018 (period of 46 years) by comparing the desirability of these value orientations in the same period. The data in previous surveys, before 2018, allowed comparison only in the mean values and calculation of the significance of the differences in them. The results obtained in that way showed the relative stability over time of the hedonic value orientation, a significant increase in the utilitarian value orientation and a significant decrease in the activist and altruistic value orientations. A logical analysis of these changes established their correspondence to the nature and the direction of changes in social relations in that period.

Introduction. Marjolin’s ulcer is a skin malignancy that occurs on a scar or chronic wound. It most commonly occurs on a burn scar. Squamous cell carcinoma is the most common type of this tumor in more than 90% of cases. The rate of this rare malignant transformation is 1–2%. Marjolin’s ulcer is more aggressive than other skin cancers. Wide excision is the treatment of choice. Recurrences are common. We present a large exophytic carcinoma of the lower leg as a rare form of this tumor ac-cording to the size and type together with reconstruction results. Case report. A 52-year-old man was presented with a large exophytic tumor on the left lower leg. The tumor was located at the site of the previous gunshot in-jury. The latent period was 22 years. Tumor size was 14 × 12 cm. Wide excision was performed (2-cm surgical margin), including the deep fascia, and the defect was closed by a split-thickness skin graft from the opposite thigh. Histology showed well-differentiated squamous cell carcinoma. There were no regional or distant metastases. One year after surgery, there was no recurrence of the tumor. Conclusion. Early diagnosis of Marjolin’s ulcer and wide excision are mandatory. Surgical margins for excision should be 2 cm, and excision should include deep fascia. Multiple and repeated biopsies of chronic wounds are advised. There is no consensus on the staging of Marjolin’s ulcer and lymph node dissection.

Taking into consideration that the geographical distribution of the specific wedding terms related to wedding customs and rituals in Serbian ethnic and dialectal regions is still rather unknown, as well as the fact that the ethnological monographic studies contain relatively detailed descriptions of the practices and the "standardized" forms used in naming, this paper presents the inventory of the terms used in naming people who take part in the wedding customs and rituals, based on the ethnic-dialectal materials collected in and around Leposavić, with the aim of placing the linguistic and ethnographic elements in the cultural and areal context.

Retroperitoneal liposarcoma is a rare type of tumor characterized by slow growth and nonspecific symptoms, and is usually diagnosed at an advanced stage. Patients with huge retroperitoneal liposarcoma have a high risk of developing perioperative complications, and require special preoperative preparation and a carefully planned anesthetic approach. We present the case of a 57-year-old man, who was diagnosed with a huge retroperitoneal liposarcoma, 70 cm in diameter, weighing 30.4 kg and planned for surgical resection of the tumor under general anesthesia. Perioperative treatment and anesthesia for this patient were a great challenge for the anesthesiologist. However, due to preoperative preparation, monitoring and fluid replacement, hemodynamic and respiratory stability of the patient was maintained perioperatively.

Background/Aim. Immune checkpoint therapy is a well-established therapeutic approach in the treatment of malignant diseases and is thought to be mostly based on facilitating the adaptive immune response. However, the cells of the innate immune response, such as natural killer T (NKT) cells, might also be important for a successful anti-programmed cell death protein-1 (anti-PD-1) therapy, as they initiate the antitumor immune response. The aim of this study was to investigate the influence of anti-PD-1 therapy on the immune response against tumors. Methods. For tumor induction, 4T1 cells synergic to BALB/c back-ground were used, after which mice underwent anti-PD-1 treatment. After the mice were sacrificed, NKT cells, dendritic cells (DCs), and macrophages derived from spleen and primary tumor tissue were analyzed using flow cytometry. Results. Anti-PD-1 therapy enhanced the expression of activating molecules CD69, NKp46, and NKG2D in NKT cells of the tumor and spleen. This therapy activated NKT cells directly and indirectly via DCs. Activated NKT cells acquired tumoricidic properties directly, by secreting perforin, and indirectly by stimulating M1 macrophages polarization. Conclusion. Anti-PD-1 therapy activates changes in DCs and macrophages of primary tumor tissue towards protumoricidic activity. Since anti-PD-1 therapy induces significant changes in NKT cells, DCs, and macrophages, the efficacy of the overall antitumor response is increased and has significantly decelerated tumor growth.

The paper analyses the materials recorded in the regions of the Kosovo-Resava dialect and then used in the relevant monographic studies and dialect related publications with the aim of presenting the inventory and distribution of genitive plural forms. The areal data display contains the plural genitive forms of nouns of all three genders used in the regions where the three sub-dialects of the Kosovo-Resava area are spoken. The map also displays the use of archaic forms in some Kosovo-Resava regions (genitive ≤ locative forms), as well as the influences that other, non-Slavic Balkan languages have on the inflectional system, particularly in the border areas, that is, in the contact zones.

This paper points out the possibilities of better exploitation of marine traffic as well as its connection with other kinds of traffic. Special attention is given to the analysis of 1,081 harbors about their availability during the year. The methods and algorithms used in GIS are buffers, cluster, method of interpolations, and network analysis. The methods used for the purpose of conducting numerical analyses are algorithms that served for the analysis of the network, its transport features, and the connectivity with harbors in terms of geospace. The main results found in this research showed that harbors have good connectivity in the first place with road traffic and after that with air and railroad traffic. According to data from 2019, all traffic lines cover 4.1 × 1015 km, and the road traffic has the most significant potential in connection with the harbors. The most connected harbors and airports are in the east coast of North America, west coast, north Europe, southern Europe, south-east Australia, a central part of Oceania, and south-east Africa. The results in the modified Likert scale between airports and harbors showed medium results. The densest road network is located in the eastern part of USA, western and central part of Europe, and east coast of China. The number of possible connected lines between main road nodes and harbors is 0.8 × 109. This type of traffic showed excellent results and connection with harbors. The number of possible connected lines per month between railroads and harbors is 1.3 × 103. This type of traffic showed low connectivity with the harbors. In the end comparison of harbors with air, road and railroad networks were established. The geographical position of harbors was analyzed, and better understanding was performed on a global scale.

Introduction. An inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor of unclear etiology, which demonstrates myofibroblastic differentiation accompanied by inflammatory cells. IMT is a frequent primary lung tumor in children and is of nonspecific symptomatology and imaging methods. Its definitive diagnosis requires histopathology and immunohistochemistry of the tissue sample obtained after a rigid bronchoscopy or after complete surgical resection. Case report. A 16-year-old male patient was admitted to our clinic for further treatment of IMT verified by rigid bronchoscopy. He had previously been treated at another institution for left-sided pneumothorax with thoracic drainage. Since it had not resulted in lung reexpansion, a chest computed tomography was performed followed by rigid bronchoscopy that eventually established IMT diagnosis in the distal part of the left main bronchus. Since the tumor sur-rounded the left lobar carina and infiltrated the pulmonary artery, pneumonectomy was undertaken. Its morphology and immunoprofile determined the IMT diagnosis. Four years after surgical resection, the patient showed no recidivism of the illness. Conclusion. IMT is one of the most frequent primary lung tumors in children and needs to always be suspected up-on. Pneumothorax can appear as an IMT manifestation. Its occurrence could be the consequence of either a visceral pleura lesion in case of peripheral tumors or a ball valve mechanism in case of endobronchial tumors. Definitive diagnosis of IMT requires not only histopathology but also immunohistochemical analysis. Complete surgical resection results in the best survival rates. Further monitoring of patients is necessary due to the risk of recurrence.

Introduction/Objective. The essence of the treatment of degenerative knee joint diseases is pain relief, restoring motion range and stability of knee joints. Methods. In this study, 35 patients participated after having surgery of the knee joint. The patients had a posterior-stabilized (PS) endoprosthesis in one joint, and a posterior cruciate ligament retaining (CR) endoprosthesis in the other. Kinematic data was collected using a 3D optical system for tracking fluorescent markers in time. Based on these data, the following parameters were determined: degree of flexion, mediolateral (ML) translation, lateral gap, medial gap, and the angle of change between the transtibial and transfemoral axes. Results. The results show a more pronounced flexion degree with the PS prosthesis compared to the CR prosthesis. Also, the results show negligible values of the ML translation, lateral gap, and medial gap in both types of prostheses. Using the non-parameter Wilcoxon test, a substantial difference in the angle change between the transtibial and transfemoral axes was confirmed, that is, in the flexion angles on the CR and PS prostheses. Conclusion. This study shows that there is no great difference in the use of the PS or CR designs of endoprostheses. Better behavior and range of motion in the knee joint were established with the implantation of the PS endoprosthesis. This conclusion is confirmed by the substantial difference in the degree of flexion of the knee joint and in the position of the transversal axes of the tibia and femur.

Background/Aim. Mechanisms responsible for the beneficial effects of aerobic exercise training on cardiovascular function are well known, but detraining effects on myocardial parameters have not been adequately elucidated. Therefore, the study aimed to determine the occurrence and speed of cardiac adaptation reversibility after the cessation of aerobic exercise and to reveal gender differences in achieved effects of training/detraining. Methods. Fe-male and male Wistar albino rats were divided into the following groups: control, trained, and two detrained groups. Hearts were perfused according to the Langendorff technique and the following cardiodynamic parameters were determined: the maximum and minimum rate of pressure development in the left ventricle (dp/dt max and dp/dt min, respectively), systolic and diastolic left ventricular pressure (SLVP and DLVP, respectively), heart rate (HR), and coronary flow. Results. Training significantly reduced values of dp/dt max, dp/dt min, and SLVP in males and females, and coronary flow in males. Detraining caused a reversion of those changes, which was gender-specific. In females, levels of SLVP were higher after 4 weeks of detraining compred to training, and after 2 weeks of detraining. Values of SLVP were lower in both detraining periods compared to training in males. Males had higher coronary flow after 2 weeks of detraining. Simultaneously, coronary flow was reduced in the 4th week of detraining in females. Conclusion. By using a model of the isolated rat heart, the present study confirmed the existence of training-induced changes in cardiac function. Cessation of training was followed by the loss of those adaptations, faster in males than females.

Background/Aim. Although considered rare, gliomas cause morbidity and mortality disproportionate to their incidence. The aim of the study was to determine whether pre and post-therapeutic metric values, derived from the FDG PET/CT maximal standardized uptake value (SU-Vmax) and calculated ratios between tumor and normal brain tissue, may provide a predictive/prognostic biomarker information in estimating overall survival of glioblastoma patients. Methods. In 26 out of 31 patients with glioblastoma treated with standard Stupp protocol after maximal safe reductive surgery, we performed a baseline 18F-FDG PET/CT examination before commencing combined and concomitant chemotherapy/radiotherapy (pre-therapy FDG PET/CT) and a second examination three months after the therapy completion (post-therapy FDG PET/CT). Two-graded SUVmax values and a calculated ratio of uptake in tumor-to-normal-tissue (T/N ratio) value, divided into two grades by the calculated cut-off value, were measured in all patients at both pre- and post-therapy FDG PET/CT studies. Data sets were statistically analyzed by the Kaplan-Meier survival test and Log-rank was calculated, with the level of confidence determined at p < 0.05. Results. Pre-therapy FDG PET/CT two-grade T/N ratio value and both pre-and post-therapy FDG PET/CT derived two-grade SUVmax values had a strong predictive impact on overall survival of glioblastoma patients. Conclusion. Based on two-grade SUVmax and T/N ratio values assessment, FDG PET/CT could provide valuable predictive survival information in glioblastoma patients and serve as a selection tool for identifying patients at higher risk from worse outcomes and shorter survival time.

Introduction/Objective. This prospective, randomized study was done to determine the efficiency and safety of the administration of intrathecal morphine chloride combined with the local anesthetic levobupivacaine given to female patients subjected to hysterectomy to ensure postoperative analgesia. Methods. The study sample consisted of 50 patients who were to undergo hysterectomy with adnexectomy and they were divided into two groups of 25 each. The patients in group A were given the combination of 0.3 mg of morphine chloride with 1.7 ml of 0.5% levobupivacaine immediately before the surgery, whereas the patients in group B were intravenously administered 5 mg of morphine chloride before the end of surgery, and after the surgery at certain time intervals. The postoperative pain was assessed at the first, sixth, 12th, and 24th hour by Numeric Rating Scale (NRS). Side effects, such as nausea, vomiting, itching and respiratory depressions were followed as well. Results. The postoperative pain was less expressed at any time interval both at rest and on exertion in group A (p < 0.001) and therefore the need for additional analgesia was less in group A (p < 0.001). The subjective feeling of satisfaction with postoperative analgesia was statistically significant in group A (p < 0.001). Conclusion. Intrathecal administration of morphine chloride combined with levobupivacaine ensures better postoperative analgesia after hysterectomy than intravenous morphine chloride, their side effects being equally frequent..

Introduction. Accessory spleen represents ectopic spleen tissue separated from the body of the spleen, with the percentage share of 10–15% in a population. Case outline. We present a female patient in which immune thrombocytopenic purpura was diagnosed 12 years previously and, after a failed initial treatment, it was decided by a hematologist to perform a laparoscopic splenectomy. The mentioned operation was carried out in a safe and efficient manner wherein the accessory spleen was detected and removed intraoperatively. The operative and postoperative course passed without any complications. The definitive histopathological findings confirmed previously set hematological diagnosis. Conclusion. The laparoscopic approach is a superior modality in terms of diagnostic and therapeutic procedures when it comes to surgical removal of the accessory spleen. Taking into consideration the advantages of this approach presented and proven in literature, even in the case of diagnostically or intraoperatively overlooked accessory spleen or de novo discovered after the operation, there should be no dilemma which surgical approach should be applied.

Introduction/Objective. This study aimed to investigate the effects of preoperative dexamethasone use on the incidence and severity of postoperative nausea and vomiting (PONV), postsurgical pain, and vocal impairment after thyroid surgery. Methods. We performed a prospective, randomized, double-blind study with 50 patients who underwent thyroid surgery. Group A patients (n = 25) received 0.9% NaCl solution (2 ml) before anesthesia, patients in Group B (n = 25) were administered 8 mg of dexamethasone. All the patients preoperatively received 4 mg of ondansetron. During the first 48 hours after surgery, postoperative complications were monitored in defined periods. Results. PONV rate and severity was significantly lower in Group B than in Group A (p < 0.05). Patients in Group B reported less pain in resting and in activity (p < 0.05) and lower vocal impairment (p < 0.05) than patients in Group A in each defined time period. Conclusion. Preoperatively adding dexamethasone to ondansetron is more effective than use of ondansetron alone in the prevention of PONV. Dexamethasone significantly reduces the pain and improves voice function; therefore, we could advise routine single-dose dexamethasone use before thyroid surgery.

In this paper we are analyzing the idea of the Brusseles agreement as a political idea which was supposed to normalize ethnic relations between Serbia and "Kosovo", with everyday ethnic relations in the Kosovo and Metohija region. According to documents from " Republic od Serbia's report on the progress in the Belgrade - Pristina dialogue", there is visible contradiction for the reader where progress in the dialogue in Brusseles resulted in regression in ethnic relations. On the account of numeros acts of violence by Albanian extremists to Serbian minorty, such as house burning, rapeing, kidnapping women and children and tearing down religious and cultural monuments thruout the Brusseles agreement, with benevolent watch international community and EU, comes the conclusion that the agreement is mildly said an insufficient solution for the Kosovo situation. Besides that, constant outbursts of violence explicitly on Serbian people, with elements of destroying Serbian nationality. Subsequently saying, this problem demands compromised solution with effective participation of the International community in finding a solution.

Background/Aim. Gastric cancer (GC) is fourth most frequent malignant tumor worldwide, frequently diagnosed at advanced stages with poor prognosis. The aim of study was to determine expression of interleukin (IL)-32, proinflammatory and angiogenic mediators in the tumor, peritumor and healthy tissue, in patients with intestinal gastric cancer and the relationship with the disease severity. Methods. The tissue samples of intestinal type of the tumor of 60 patients with GC were analyzed. Expression of IL-32, vascular endothelial growth factor (VEGF), IL-17 and CD31 were measured by immunohistochemistry. Results. IL-32, VEGF and IL-17 expression as well as microvascular density (MVD) were diminished in adjacent tumor tissues compared with the tumor ones. Further, more intense expression of IL-32 and VEGF and enhanced MVD were noticed in patients with severe (TNM stages III and IV) and more progressive GC (lymph vessel invasion). Conclusion. Higher expression of IL-32, VEGF and intense MVD in the tumor tissue of GC patients with detectable lymph vessel invasion may be considered as a sign of the tumor’s malignant progression. This indicates a protumorogenic and proangiogenic role of IL-32 in biology of intestinal type of gastric cancer.

High flexibility of hydrometallurgical operations as well as economic and environmental acceptability, offer the opportunity to selectively obtain metals in the early stages of the processing. This enables the application of hydrometallurgical operations in processing of ores which, due to their complex composition or low copper content, are not suitable for pyrometallurgical treatment. In contrast to sulfide minerals, leaching of oxide ores does not requires presence of oxidizing agent. This paper presents the results of influence of temperature on the leaching degree of copper from pyritechalcopyrite concentrate by sulfuric acid solution at atmospheric pressure. According to the obtained results, it was found that an increase in the leaching temperature significantly contributes to the increase in the leaching efficiency, where after 6 hours of leaching at 40°C achieved efficiency was 90.6%.

Background/Aim. In colon and rectal cancer surgery, resection is considered radical when circumferential, proximal and distal resection margins are without the presence of tumor cells. Concept of total mesorectal excision in rectal surgery involves complete removal of the tumor with mesorectal fascia which surrounds lymph nodes, lymphatics and blood vessels. The aim of this study was to determine whether laparoscopic approach provides all parameters of oncological radicality as open surgery of colorectal cancer. Methods. The study included 122 patients with carcinoma of colon and rectum, divided into two equal groups: patients operated on by laparoscopic and those operated on by open approach. In colon surgery we analyzed proximal and distal resection margins, and the number of removed lymph nodes, and in rectal surgery: proximal, distal and circumferential resection margins, and the number of removed lymph nodes. Results. Both groups were comparable in age, sex, American Society of Anesthesiologists (ASA) score, tumor localization, tumor size, and type of surgical operation performed. According to localization of the tumor, the most commonly performed operation was anterior resection of the rectum (60.7% vs. 59%). There was no case of the tumor involvement of the distal margin. Average proximal distance from the tumor on the fixed specimen was 100 vs. 120 mm with statistical significance (p < 0.001). Distal margins were not significantly different, 40 mm in both groups (p = 0.143). In two cases we had circumferential resection margin (CRM) of 1 mm (7.7%) in the laparoscopic group, and in three cases operated conventionally CRM was 1 mm (8.8%). The average number of removed lymph nodes was 15 vs. 16, respectively. Length of hospital stay for patients assigned to the laparoscopic surgery was significantly shorter than for patients operated on by the open approach. Concerning postoperative complications, no significant difference was found between groups. The overall postoperative morbidity was 18% vs. 21.3%, respectively. Conclusion. With laparoscopic approach it is possible to provide all parameters of oncological radicality similarly to the open surgery of colorectal cancer.

Introduction. Unilateral absence of pulmonary artery is a rare vascular malformation. Because of this anomaly, the lungs are supplied by the system of collateral arteries. Case outline. We present a case of the right pulmonary artery agenesis in a female patient. She was admitted to the hospital because of hemoptysis. A computed tomography scan revealed a congenital malformation – the right lung was smaller in size, the right principal pulmonary artery had not been developed along with aberrant tortuous blood vessels. Conclusion. Symptomatic therapy was applied in the case of our patient. There was no need for any surgical treatment. However, in case of massive hemoptysis embolisation or lobectomy/ pneumonectomy will probably be applied.

Drug abuse is an important problem of the modern age. Impact that drug abuse has on society, the state and the health of individuals requires fundamental and urgent scientific research on all its aspects. Research into the etiology of drug abuse in the youth population in Serbia is one of such projects. This research was carried out on a representative sample of 1,287 secondary school students in Belgrade, divided into two groups: drug abusers and those who do not have contact with drugs. The aim of this paper was to identify risk factors within peer groups that could have a predictive value and serve as a basis for preventive interventions. Data analysis was done with canonical discriminant analysis, separately for boys and girls. The results of the study have shown that among adolescents there are three forms of drug abuse: 1) use only, 2) use and distribution, and 3) drug distribution only. The predicates of these behaviors belonging to peer groups are: the pressure by group on members to use drugs, the perception of an individual that members of the group use drugs, the use of alcohol in the group, the involvement of certain members of the group in crime, and the positive attitude of members of the group towards law violations. Predictive effects of these variables vary depending on the type of drug abuse and of the gender of respondents.

Considering their incomplete psychophysical, ethical, social and intellectual development, minors under the age of 15 may not be employed. Young persons aged 15 to 18 are allowed to enter into an employment agreement under rectrictive conditions, designed in such a way as to protect their personality and interests concerning the choice of job or employment, health, morality, and education. A person who has turned 15 is allowed to sign an employment contract if the type of work does not endanger his/her health, ethics or education, i.e provided that such work is not prohibited by law; moreover, an employment relationship may be established only with a written consent of a legal representative and on the basis of the findings of the authorized health authority confirming that the younger person is able to perform the job as described in the agreement, and that the job is not harmful for his health. If these conditions are fulfilled, the employment relationship is established by signing an employment agreement.

Housing tradition is an important aspect of life in the country. It reflects the living standard of the household, personal attitudes towards the living space and the ways to furnish it. The paper analyses important aspects of the housing tradition and organization of life within the households in Valjevska Podgorina. The inventory of lexemes, terms related to house and household, bears testimony to a traditional culture that combines a variety of historical, ethnocultural, and linguocultural elements and factors.

Introduction: Preoperative examination and recognizing the risk factors for a difficult airway gives us the time for optimal preparation for difficult airway management. For goiter patients, in addition to the standard risk factors, there are goiter-related factors that may address to suspect of difficult intubation. Case report: Through this case report we summarize the presentation, airway examination and management of a patient with huge goiter. About 25-years earlier he noticed a swelling on the neck which increased in size progressively. Over the years he developed compressive symptoms, such as dysphagia, hoarseness and change in voice quality. All classical risk factors for difficult intubation, as well as goiter-related factors, were preoperatively evaluated. The neck circumference, the left displacement of the larynx and the radiological findings all pointed to a possible difficulty in airway management. The plan was to perform a direct laryngoscopy using a video-laryngoscope, without using a muscle relaxant, whereas the alternate plan was to use a flexible fibreoptic bronchoscope. The patient's airway was anesthetized with lignocaine spray into the laryngo-pharynx 30 minutes and 10 minutes before intubation. Oxygen was administered via facemask. The nasal catheter was placed to provide apnoic oxygenation during laryngoscopy and intubation. After induction of anesthesia a smooth video laryngoscopy was performed without using a muscle relaxant. A reinforced endotracheal tube with an intubating stylet was inserted without any difficulties in passing and placing the tube. Conclusion: Careful planning and detailed preoperative preparation are of crucial importance for a safe intraoperative and postoperative outcome in thyroid patients.

Stara Moldava is a micro area of speech in Banatska Klisura (Clisura Dunării) which is a subject of disputes in dialectology. As a contribution to the study of southern speeches in Romanian Banat, the paper analyses some significant morphological features of this speech by using the materials collected and recorded in the given area.

Measurements of radon concentrations in drinking waters conducted on wider territory of the town of Kruševac included 16 public fountains, of which 4 are in the city itself and 12 in the surrounding area. Measurements of radon concentrations in water were carried out using radon detector RAD7 (DURRIDGE Co.). The values of radon concentrations in water are in the range of (5.3 ± 0.8) Bq l-1 to (71.0 ± 7.2) Bq l-1 and are below the reference level of 100 Bq l-1, recommended by the European Commission. Since radon represents one of the most important causes of malignant diseases, annual effective doses of ingestion and inhalation are determined, whose mean values are in the range of 0.04 mSv y-1 to 0.52 mSv y-1, and from 14.84 μSv y-1 to 198.8 μSv y-1, respectively. During sampling, water temperatures and their pH values were measured. These results are the first results of measuring radon in water in this area by this method. The aim of this paper is to evaluate whether there is, or not, a radiological risk to people's health due to the use of water primarily for drinking, but also for other purposes.

Marco Mantero,1,2 Dejan Radovanovic,3 Pierachille Santus,3 Francesco Blasi1,2 1Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; 2Internal Medicine Department, Respiratory Unit and Regional Adult Cystic Fibrosis Center, IRCCS Fondazione Ca’ Granda Ospedale Policlinico, Milan, Italy; 3Department of Biomedical and Clinical Sciences (DIBIC), Pulmonary Unit, University of Milan, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Milan, Italy Abstract: The major determinant of the decline in lung function, quality of life, and the increased mortality risk in patients with COPD is represented by severe acute exacerbations of the disease, that is, those requiring patients’ hospitalization, constituting a substantial social and health care burden in terms of morbidity and medical resource utilization. Different long-term therapeutic strategies have been proposed so far in order to prevent and/or reduce the clinical and social impact of these events, the majority of which were extrapolated from trials initially focused on the effect of long-acting muscarinic antagonist and subsequently on the efficacy of long-acting β2-agonists in combination or not with inhaled corticosteroids. The option to employ all three classes of molecules combined, despite the limited amount of evidence in our possession, represents a choice currently proposed by international guidelines; however, current recommendations are often based mainly on observational studies or on the results of secondary outcomes in randomized controlled trials. The present narrative review evaluates the available trials that investigated the efficacy of inhaled therapy to prevent COPD exacerbations and especially severe ones, with a particular focus on beclomethasone dipropionate/formoterol/glycopyrronium bromide fixed dose combination, which is the first treatment that comprises all the three drug classes, specifically tested for the prevention of moderate and severe COPD exacerbations. Keywords: hospitalization, COPD, triple therapy, inhaled corticosteroids, formoterol, glycopyrronium

Drawing on the materials that treat dialects collected in the region of Valjevo Podgorina, the author of the paper considers the presence of the u + genitive form that is regularly used in this area to express possession and spatiality. The use of this and the competing forms in three speech areas of Podgorina provides the grounds for linguo-geographic analysis, not only with relation to these speech areas, but also within a wider (north)west Serbian region and over the regional boundaries. In addition, the analysis shows that the situation in Serbian dialects represents a fragmented continuation of a number of elements rooted in the historical background. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 178020: Dijalektološka istraživanja srpskog jezičkog prostora]

Background/Aim. Multimodal approach to locally advanced rectal cancer treatment results in better disease outcome. Preoperative chemoradiotherapy improves disease local control, reduces risk of local recurrence and in the majority of patients with complete or substantial regression of the tumors significantly improves survival rates. According to the literature data, approximately 20% of patients had achieved complete histopathological response (pCR) after neoadjuvant chemoradiation therapy. The aim of this study was to evaluate overall survival in rectal cancer patients treated with preoperative chemoradiotherapy and sphincter preserving surgery. Methods. This retrospective study included 191 patients. Patients received preoperative radiation therapy and chemotherapy-chemoradiation therapy (CRT) followed by operation that favorized sphincter preservation with total mesorectal excision (TME) from June 2000 until December 2010. Diagnosis was established according to the following algorithm: patient history, digital rectal examiantion, colonoscopy with biopsy and histopathology verification, and preoperative clinical staging. Patients with tumors located below promontorium were included in the study and patients with metastatic disease and local recurrence were excluded from the study. For tumors located below the promontorium preoperative radiotherapy was used with total dose of 50.4 Gy, divided into daily doses of 1.8 Gy, during 28 days. Chemotherapy followed radiotherapy with 5- fluorouracil and folic acid (Leucovorin®) on days 1, 2, 10, 11, 20 and 21. Six to ten weeks after neoadjuvant therapy, magnetic resonance imaging (MRI) to restage tumors and operation were performed. Results. Of all patients that received preopertive chemoradiation, 163 had radical sphincter preservig surgery and 28 patients had paliative operations. Histopathological examination of the specimens showed that the complete histopathological regression was achieved in 21.4% of the patients, downstaged was found in 63.2% of them and unchanged stage was found in 15.3% of the patients. The five-year survival rate was 63.3% and 50.5 % in the patients with pCR and patients with incomplete histopathological regression, respectively. Survival rates between two groups were not statistically significant (p > 0.05). Conclusion. The preoperative chemoradiotherapy is very important in achieving optimal clinical care for patients with locally advanced rectal cancer.