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Background: Anterior mitral leaflet prolapse repair is a highly effective procedure, but despite excellent operative results still has an inferior long‐term durability when compared to posterior leaflet repair. Methods: We analysed mitral repair durability in 74 consecutive patients operated for anterior leaflet prolapse between 2010 and 2021. Their pre‐ and postoperative clinical, echocardiographic data and repair durability as well, were compared with 74 randomly assigned posterior leaflet prolapse patients who underwent valve repair during the same period. Results: While groups were of similar age, patients with anterior leaflet prolapse had an inferior preoperative status in terms of functional reserve, atrial fibrillation, operative risk, ejection fraction and had more dilated left heart chambers as well. 1, 5, and 10‐year freedom from repair failure was 87.1 ± 4.6%, 79.8 ± 6.5% and 50.7 ± 12.5% in the anterior, and 98.5 ± 1.5% respectively in the posterior leaflet group. Atrial fibrilation (hazard ratio [HR] 5.365; 95%; confidence interval [CI] 1.093–26.324 p = .038) and left ventricle end‐systolic diameter (HR 1.160 95%; CI 1.037–1.299 p = .010) independently predicted anterior leaflet repair failure. Receiver Operating Curve analysis established left ventricle end‐systolic diameter ≤42 mm as a cut‐off value associated with improved anterior leaflet repair durability. Accordingly, 10‐year repair durability in a subset of patients, with preserved left ventricle end‐systolic diameter (≤42 mm) was 86.4 ± 7.8%. Conclusion: Better long‐term repair durability in patients with anterior mitral leaflet prolapse and preserved sinus rhytm and left‐ventricle diameters justifies early reconstructive approach.

Introduction/Objective. The aim of this study is to identify and evaluate the use of New Mobility Score (NMS) in estimating functional recovery three months after total hip arthroplasty (THA). Methods. In total, 70 patients, aged > 60 years, underwent THA. Treatment group was subjected to the comprehensive rehabilitation program and control group to the standard one. Primary outcome was assessed with Harris Hip Score (HHS) and NMS, and secondary one by Medical Outcomes Health Survey (Short-Form Health Survey ? SF-36). Questionnaires were collected before and three months after hip surgery. Results. Treatment group showed significant improvement three months postoperatively. The correlation in both groups between HHS and NMS was very strong (r > 0.700). Treatment group following surgery showed strong correlation between Recovery through Personal Care Services (PCS) and HHS and NMS (r > 0.700), moderate to strong between pain categories and HHS (r = 0.380; r = 0.583) and NMS (r = 0.424). Control group showed strong correlation between PCS and HHS (r = 0.704), and NMS (r = 0.568) and moderate to pain categories and HHS (r = 0.546; r = 0.466). The area under the curve (AUC) described the inherent validity of all measurement used AUCNMS = 0.724, p = 0.001, AUCHHS = 0.788, p = 0.000 and AUCPCS = 0.747, p = 0.001. Conclusion. The NMS could be successfully used in routine clinical assessment of elderly patients following THA. The trial is registered in ISRCTN Register with https://doi.org/10.1186/ISRCTN73197506.

Background: Transsexuality is explained and defined as a gender-identity disorder, characterised by very strong conviction of belonging to the opposite sex and has been associated with a distinct neuroanatomical pattern. Materials and methods: We performed a structural analysis in search of possible differences in grey matter structures based on magnetic resonance imaging scans of the brains of 26 individuals between 19 and 38 years of age. The participants were divided into two groups of 15 controls and 11 transgender individuals. The segmentation of subcortical grey matter was performed using FIRST model a model-based segmentation/registration tool, from FSL software package. Results: The results showed that the volume of the brain region called nucleus accumbens on the left side was significantly smaller in the group of transgender individuals compared to the control. It was the most important parameter which was shown to make distinction between two examined groups. Conclusions: The results also showed decreased volumes of the left thalamus, right hippocampus and right caudate nucleus.

Background/Aim. Previous studies have confirmed a positive correlation between homocysteine levels and a greater risk for acute coronary syndrome and stroke, but there are no available data to support an association between homo-cysteine and inflammatory markers and the severity of coronary artery disease according to the clinical SYNTAX score in patients with stable angina. The aim was to determine the association between homocysteine and inflammatory biomarker levels: interleukin (IL)-6, high sensitive C-reactive protein (hs-CRP), fibrinogen, erythrocyte sedimentation rate (ESR) and the severity of coronary artery disease according to clinical SYNTAX score. Methods. Eighty-two patients with stable angina pectoris (average age 65 ? 8 years, 28.9% females) underwent coronary angiography and were divided into three groups according to the clinical SYNTAX score: the group I < 22 (39 patients), the group II 23?32 (16 patients), the group III > 33 (27 patients). The severity and complexity of coronary artery disease were calculated by clinical SYNTAX score, multiplying the SYN-TAX score with the modified ACEF score, based on the patients? left ventricular ejection fraction, age and creatinine clearance (derived with Cockcroft?Gault equation). Results. Homocysteine levels were significantly higher in patients with high clinical SYNTAX score [the group I: median (interquartile range ? IQR): 10.20 (3.97), the group II: 10.45 (5.77), the group III: 14.70 (7.50), p = 0.005]. Patients in the group III had significantly higher homocysteine levels compared to the group I (p = 0.001). We also found a posi-tive association between inflammatory biomarkers (IL-6, hsCRP, fibrinogen, ESR) and the severity of coronary artery disease according to the clinical SYNTAX score (p = 0.017, 0.001, 0.032, 0.049 respectively). We detected significantly lower plasma levels of vitamin B12 in the group III and group II in comparison with the group I (the group I: median (IQR): 238 (160), the group II: 171 (160), the group III: 172 (102), p = 0.022), which indicates its important role in homocysteine metabolism. Conclusion. The elevated plasma levels of homocysteine, IL-6, hsCRP, fibrinogen, ESR were detected in patients with high clinical SYNTAX score (> 33). Our results showed that hyperhomocysteinemia and some inflammatory biomarkers can predict more severe and extensive coronary artery disease in stable angina patients.

Background: The World Bank (WB) acknowledged the importance of business regulatory environment and therefore created a metric which ranks 190 countries based on their level of business regulation for domestic firms measured by the Doing Business Index (DBI). Objectives: The question which attracted our attention is whether all the observed entities should be given the same weighting scheme. Methods/Approach: The approach we propose as an answer is two-fold. First, we cluster the countries covered by the DBI. In the next step, we apply the statistical multivariate Composite I-distance Indicator (CIDI) methodology to determine new, data-driven weights for each of the retained clusters. Results: The obtained results show that there is a difference between the weighting schemes proposed by the CIDI methodology. Conclusions: One can argue that one weighting scheme does not fit all the observed countries, meaning that additional analyses on the DBI are suggested to explore its stability and its weighting scheme.

The aim of the study was to investigate the association of Cystatin C (CysC) to biochemical markers of bone turnover and bone mass, and to evaluate its prognostic significance in elderly males with chronic heart failure (CHF).A prospective cohort study was executed on sixtyeight males (mean age 68±7 years) with mild to moderate CHF, together with 19 of corresponding age- and body mass index-matched healthy individuals who underwent cardio vascular, bone mineral density (BMD), and body com position assessment. Biochemical assessment of all subjects included NT-pro-BNP, parathyroid hormone (PTH), 25-hydroxy vitamin D (25(OH)D), CysC, and biochemical markers of bone turnover including osteocalcin (OC), alkaline phosphatase (ALP), β-CrossLaps (β-CTx), osteoprotegerin (OPG), and receptor activator of nuclear factor κB ligand (RANKL).Serum CysC was significantly increased in males with CHF in comparison to healthy control ones. A significant positive association was found between CysC levels and OC in males with CHF, while OC and β-CTx increased in increasing CysC tertiles. In multivariate regression analysis, OC and smoking were a significant determinant of CysC in males with CHF. Level of CysC was found to be positively associated with an increased fatal risk in males with CHF.Serum osteocalcin is an independent predictor of CysC level in elderly males with CHF. Higher CysC level showed a negative relation to survival and bone loss in males with CHF. Further research is needed to confirm the potential role of CysC in the crosstalk between heart, kidney, bone, and energy metabolism in CHF.Cilj studije je bio da se ispita povezanost cistatina C (CisC) i biohemijskih markera metabolizma kosti i mineralne koštane gustine, kao i da se proceni prognostički značaj CisC kod starijih muškaraca sa hroničnom srčanom insuficijencijom (HSI).Ovo istraživanje je prospektivna studija kohorte koju je činilo šezdeset osam muškaraca (prosečne starosti 68±7 godina života) sa blagom do umerenom HSI i 19 zdravih osoba odgovarajuće starosti i indeksa telesne mase. Svi ispitanici su podvrgnuti proceni kardiovaskularnog sistema, mineralne koštane gustine i telesnog sastava. Biohemijska merenja kod svih ispitanika su uključivala određivanje NT-pro-BNP, paratiroidnog hormona (PTH), 25-hidroksi vitamina D (25 (OH) D), CisC i biohemijskih markera metabolizma kosti, uključujući osteokalcin (OC), alkalnu fosfatazu (ALP), beta-CrossLaps (b-CTx), osteoprotegerin (OPG) i ligand za receptor aktivator nuklearnog faktora B (RANKL).Serumski CisC je značajno povećan u muškaraca sa HSI u poređenju sa nivoom kod zdravih osoba. Značajna pozitivna povezanost detektovana je između nivoa CisC i OC kod muškaraca sa HSI, i vrednosti OC i b-CTx su povećane kod pacijenata u rastućim CisC tercijarima. U multivarijantnoj regresionoj analizi je pokazano da su OC i pušenje znač ajne determinante nivoa CisC kod muškaraca sa HSI. Nivo CisC je u pozitivnoj korelaciji sa povećanim rizikom za mortalitet kod muškaraca sa HSI.Serumski osteokalcin je nezavisan prediktor nivoa CisC kod starijih muškaraca sa HSI. Povećan nivo CisC je pokazao negativnu povezanost sa preživljanjem i gubitkom kosti kod muškaraca sa HSI. Potrebno je da buduća istraživanja potvrde potencijalnu ulogu CisC u komunikaciji između srca, bubrega, kosti i energetskog metabolizma u hroničnoj srčanoj insuficijenciji.

Background/Aim. Diabetic nephropathy is one of the leading cause of chronic kidney disease and end-stage renal disease. It occurs in 20%?40% of patients with diabetes mellitus and microalbuminuria is still considered as the first sign of diabetic nephropathy. Low sensitivity and specificity of microalbuminuria lead to more sensitive biomarkers that may be used to detect diabetic nephropathy at an earlier stage with a higher accuracy. This study was carried out to determine whether urinary transferrin can serve as an indicator of diabetic nephropathy. Methods. Our study included 80 type 2 diabetic patients who were classified into two groups: group 1 ? normoalbuminuric patients (albumin excretion up to 30 mg/d); group 2 ? microalbuminuric patients (albumin excretion from 30?300 mg/d), and 10 healthy controls. All patients were older than 18, having the diabetic disease more than one year, glomerular filtration rate more than 60 mL/min/1.73 m2. Serum creatinine, glycosylated hemoglobin (HbA1c), and concentration of transferrin in the 24 h urine samples as well as in spot urine were measured using a highly sensitive one-step sandwich enzyme immunoassay kit. Results. Urinary transferrin was significantly higher in the microalbuminuric patients than in the normoalbuminuric ones and healthy control subjects. When comparing these goups according to the urinary transferrin concentration, we found a statistically significant positive correlation r = 0.584 (p < 0.001). There was no correlation between level of urinary transferrin and glycoregulation, and no correlation was found between transferrin and duration of diabetes. Conclusions. The results from this study provide the evidence that the urinary transferrin levels could be used as an early marker of diabetic nephropathy.

Although population health cannot be measured in exact measurable form, a large number of concepts have been developed, and measurements have been framed through the presence of many different indicators. The impact of the environment on human health is well known. However, attention should be paid that no significant number of papers focused on the co-occurrence of environmental and lifestyle determinants on health status. This paper aims to emphasize the joint influence of environmental and lifestyle determinants on the European population's health status. The study was based on the World Health Organization statistical data, and 50 European countries were included. Three data sets were observed: Health status, Environmental, and Lifestyle indicators. Taking into account a large number of data, multivariate analyzes were applied. Results indicate that co-occurrence of environmental and lifestyle determinants have a significant impact on the health status in Europe.

We aimed at evaluating androgen status (serum testosterone [TT] and estimated free testosterone [eFT]) and its determinants in non-diabetic elderly men with heart failure (HF). Additionally, we investigated its associations with body composition and long-term survival.Seventy three non-diabetic men with HF and 20 healthy men aged over 55 years were studied. Echocardiography, 6-min walk test, grip strength, body composition measurement by DEXA method were performed. TT, sex hormone binding globulin, NT-proBNP, and adipokines (adiponectin and leptin) were measured. All-cause mortality was evaluated at six years of follow-up.Androgen status (TT, eFT) was similar in elderly men with HF compared to healthy controls (4.79 ± 1.65 vs. 4.45 ± 1.68 ng/ml and 0.409 ± 0.277 vs. 0.350 ± 0.204 nmol/l, respectively). In HF patients, TT was positively associated with NT-proBNP (r= 0.371, p = 0.001) and adiponectin levels (r = 0.349, p = 0.002), while inverse association was noted with fat mass (r = -0.413, p 0.001). TT and eFT were independently determined by age, total fat mass and adiponectin levels in elderly men with HF (p 0.05 for all). Androgen status was not predictor for all-cause mortality at six years of follow-up.In non-diabetic men with HF, androgen status is not altered and is not predictive of long-term outcome.

Age is an important risk factor for cardiovascular disease in the general population and in dialysis patients. The aim of this study is to investigate the influence of age on the cardiovascular status of asymptomatic predialysis patients with chronic kidney disease (CKD). Echocardiography and carotid ultrasound were performed in 61 patients with CKD stages 4–5, who were divided by age into two groups: group 1 (≥65 years, n = 31) and group 2 (

The use of cardiac biomarkers in prognostic purposes has been widely studied in the general population and the population of hemodialysis patients but not in patients with early-stage chronic kidney disease (peptide (BNP), N-terminal fragment of BNP (NTproBNP-a), troponin T (TnT), troponin I (TnI) CKD). The aim of this study was to determine the prognostic value of cardiac biomarkers [B-type natriuretic and highly sensitive C-reactive protein (hsCRP -a)] for cardiovascular mortality in asymptomatic predialysis CKD patients, stage IV and V. The study included 61 CKD patients (34 M, average age 62.6 ± 13.6 years, GFR 15.8±5.7 ml/min). All subjects underwent clinical evaluation, laboratory testing, echocardiographic examination and carotid artery ultrasound examination of the carotid arteries. During the period of follow-up (median 28 months), there were 18 deaths of which 9 were cardiovascular in origin. In a multivariate Cox regression analysis, BNP (p = 0.004), aortic calcification (p = 0.005), the TnT (0.018) and serum urea (p = 0.046) showed the independent predictive value for cardiovascular mortality. The optimal cut-off value of BNP for predicting _ cardiovascular mortality rate was 220.8 pg/ml. with a sensitivity of 85.7% and specificity of 78% (AUC = 0.831; p = 0.005) while the TnT cut off value of 0.05 ng / ml was also found to be significant with a sensitivity of 77.8% and a specificity of 78.8% (AUC = 0.798; p = 0.005). In stratified analysis, Kaplan-Meier curves showed _statistically significant differences in cardiovascular survival in patients with different levels of BNP (p = 0.024), TnT (p = 0.001) and NTproBNP (p = 0.033). As independent predictors of cardiovascular mortality, BNP and TnT can be used to stratify CV risk in asymptomatic patients with advanced HBS who have not started dialysis treatments yet.

The use of multidetector computed tomography (MDCT) is an integral part of contemporary diagnostics of Graves‘ orbitopathy. Th e aim of this study was to assess proptosis measurement by MDCT and to compare it to the current standard, Hertel exophthalmometry. A crosssectional study was conducted at the Clinical Centre of Serbia and included 91 patients (19 male and 72 female) with verified Graves‘ orbitopathy. Globe protrusion measured by MDCT (globe protrusion, GPR) was correlated to Hertel measured protrusion (HR). Th ere was no constant or any systematic bias between the two methods. GPR significantly correlated with the best-corrected visual acuity, while HR did not. Age, body mass index and duration of the disease did not influence proptosis measurement by either method. Proptosis was significantly larger in males. According to our results, GPR compared to HR provides better assessment of the protrusion in Graves‘ disease. GPR measurement is simple and should always be part of the radiological assessment of orbits in Graves‘ disease.

Objective. Evaluation of the efficiency of practicing step-by-step (SBS) BLS/AED (basic life support/automatic external defi-brillator) sequence by emergency medical technicians (EMT) and ambulance drivers (AD) working in medical transport teams. Methods. A prospective two-month study was conducted in which EMTs and ADs working in medical transport teams per-formed their regular 4-hour annual train-ing (1 h of lectures, 1.5 h of practical train-ing and 1.5 h of testing). Each participant performed SBS of BLS/AED sequences in front of a three-member team of instruc-tors. The implementation of BLS/AED se-quence was evaluated by scoring from 0 to 2 (0 – not, 1 – partially, 2 – properly), sepa-rately for EMTs, ADs and in total. The final analysis compared a properly implement-ed SBS sequence (S1-S36) of actions: IA - initial assessment (S1-S10), BLS (S11-S18), AED (S19-S25), RP - recovery position (S26-S32) and FBAO - foreign body airway obstruction (S33-S36) for use by the BLS/AED between EMTs and ADs. The crite-rion for a completed regular training was at least 47 (65.0%) of the total number of points won for properly implemented pro-cedures.Results. The study involved 31 EMTs and 63 Ads, regardless of gender and average age, with EMTs having slightly longer work experience (p>0.05). The results of our study show that EMTs are more skilled at IA, cardiopulmonary resuscitation (CPR) and AED, whereas ADs were better at im-plementing RP and performing the Heim-lich maneuver (p

Evaluation of secondary hyperparathyroidism (SHPT) and its prognostic impact on all-cause mortality in elderly males with heart failure (HF). Seventy three males (67 ± 7 years old) with systolic HF were included. Baseline PTH was measured. Patients were grouped according to PTH cut-off levels of 65 pg/ml (>65 pg/ml = SHPT vs. normal PTH). All-cause mortality was evaluated at 6-year follow-up. SHPT was diagnosed in 43 (59 %) patients. They were more severe compared to the patients with normal PTH regarding NYHA functional class (2.4 ± 0.5 vs. 2.1 ± 0.2, p = 0.001), quality of life score (34 ± 14 vs. 24 ± 12, p = 0.005), 6-min walking distance (378 ± 79 vs. 446 ± 73 m, p

Initiating the process of new product development based on consumer needs and by satisfying their expectations, as required by the concept of marketing, emphasizes indubitable significance and contribution of consumer behaviour in marketing. However, insufficient or inadequate application and understanding of the consumer has been observed in the practice, in the process of innovation. Therefore, managers of the two companies that were involved in the process of new instant coffee development were interviewed. Secondary data, concerning the brand performance are data of the longitudinal studies of market research agencies. The paper shows that insufficient attention paid to consumers in the new product development impacts the success of the product. It has been confirmed that the marketing managers rely on consumer behaviour and that they are aware of its importance, but use it quite superficially. The conclusion is that, in practice, enterprises in Serbia, in addition to the insufficient application of consumer behaviour in the new products development, face the shortcomings related to the process itself, such as the lack of marketing concept acceptance, production of certain formal documents, strategic planning as well as consumer research. The paper proposes a modification of the new products development model that insists on the four observed shortcomings.

Composite indexes have become a valuable asset for stakeholders as they provide ranks of entities and information upon which decisions are made. However, certain questions about their development procedure have been raised recently, especially regarding the weighting process. To tackle the observed issue, in this paper we propose a new multivariate approach for defining weights. Namely, the model based on the Data Envelopment Analysis (DEA), the Benefit-of-the-Doubt (BoD) model, has been used with significant success in the process of composite index development. On the other hand, the Composite I-distance Indicator (CIDI) methodology stands out as an impartial method for assigning weights to indicators. By combining these two approaches, some of the limitations of the original BoD model could be overcome. As a result, new entity-specific weights which maximize the value of the composite index can be proposed. As a case study, we analysed the Quacquarelli Symonds (QS) World University Rankings by Subject in the field of statistics and operational research. The obtained results, which are based on the data-driven weights, can provide new insights into the nature of the observed ranking. The approach presented here might provoke further research on the topic of composite index weights and on the university rankings by subject.

Very few research papers and case studies have shown successful integration of both Facebook and Moodle in the educational experience of students. This study sought to evaluate the educational benefits of the increasingly popular Facebook—which plays an important role in students’ social life as well as their academic life—and to compare it with the widely used course management system Moodle. In this study, the authors surveyed students of the University of Belgrade’s Faculty of Organizational Science in Serbia on their attitude toward Facebook and Moodle as productive online tools for teaching and learning. An analysis of the results was carried out using the SPSS software package. The results of this research answer the question of whether or not using Facebook as an educational tool is more effective than using Moodle and how it affects students’ everyday learning activities.

Aim: To further examine the neurobiological mechanisms and their outcomes responsible for the PTSD sequelae induced by laboratory animal model and to explore the effects of chronic psychosocial paradigm. We tested the hypothesis that our animal model of PTSD would display abnormalities in glucocorticoid levels that are manifest in people with PTSD and that psychosocially stressed rats exhibit a significantly greater suppression of corticosterone levels than control rats following the administration of dexamethasone.Methods: Animals were divided into two groups. The experimental group was scheduled to exposure to two types of stressors: double exposure to acute immobilization stress, and combined predator-threat stress and daily social stress. There was also administration of dexamethasone in combination with stress exposure.Results: There was a statistical difference between masses of thymus in the stress group and stress group with dexamethasone appliance (p=0.024). We found statistical significance between baseline cortisol and stress induced levels of cortisol and between stress induced group and return to baseline group.Conclusion: Significant changes in HPA activity, reductions in basal glucocorticoid levels and enhanced dexamethasone induced inhibition of glucocorticoid levels have been manifested. All of this is manifested in PTSD patients also as many other stress induces changes.

Background N-terminal pro-brain natriuretic peptide (NT-proBNP) is used as a biomarker to differentiate congestive heart failure from lung disease in adults and children. The clinical significance of its use in term neonates has not yet been extensively studied. Methods NT-proBNP level was measured in 62 term neonates admitted for respiratory distress (RD): 38 with congenital heart disease (CHD) and 24 with pulmonary disease. The control group consisted of 28 healthy neonates. Findings of auscultation, chest radiography, Silverman–Anderson score and echocardiography were recorded for each patient. Blood samples for measuring NT-proBNP were collected on admission, when blood sampling was indicated for the clinical management of the newborn. Results In the control group NT-proBNP was significantly higher during the first week of life compared to the rest of the neonatal period (P < 0.001). The RD group, regardless of etiology, had significantly higher NT-proBNP than the control group (P < 0.001). Neonates with more severe RD had significantly higher NT-proBNP (P = 0.002). No significant difference was found between the RD group with CHD and those with pulmonary disease. Neonates with CHD and myocardial hypocontractility had significantly higher NT-proBNP than those with normal contractility (P = 0.022). Conclusion Term neonates with RD have significantly higher NT-proBNP than healthy neonates. A single measurement of NT-proBNP level cannot be used as the sole biomarker for distinguishing between cardiac and pulmonary cause of RD in term neonates.

Socio-economic development of countries is a complex problem that has been constantly elaborated upon over the past few decades. An analysis of a country's welfare cannot be limited to either economic or social factors; it must be determined by combining both of these aspects. As technology has advanced, those indicators crucial for describing this phenomenon have also changed. internet connectedness has been introduced as an indicator of socio-economic development. Furthermore, the development of a health system is essential for a country's development. The aim of this paper has been to present one synthesized indicator that is able to quantitatively demonstrate any country's welfare. The statistical I-distance method is thoroughly explained and has been applied to 22 countries. Crucial indicators for ranking are also elaborated.

Reduced peripheral muscle mass was demonstrated in patients with chronic heart failure (HF). Adipokines may have potent metabolic effects on skeletal muscle. The associations between adipokines, peripheral muscle mass, and muscle function have been poorly investigated in patients with HF.We measured markers of fat and bone metabolism (adiponectin, leptin, 25-hydroxy vitamin D, parathyroid hormone, osteoprotegerin, RANKL), N-terminal pro B-type natriuretic peptide (NT-pro-BNP) in 73 non-cachectic, non-diabetic, male patients with chronic HF (age: 68 ± 7 years, New York Heart Association class II/III: 76/26%, left ventricular ejection fraction 29 ± 8%) and 20 healthy controls of similar age. Lean mass as a measure of skeletal muscle mass was measured by dual energy X-ray absorptiometry (DEXA), while muscle strength was assessed by hand grip strength measured by Jamar dynamometer.Serum levels of adiponectin, parathyroid hormone, osteoprotegerin, RANKL, and NT-pro-BNP were elevated in patients with chronic HF compared to healthy controls (all p0.0001), while no difference in serum levels of leptin, testosterone or SHBG was noted. Levels of 25-hydroxy vitamin D were reduced (p=0.002) in HF group. Peripheral lean mass and hand grip strength were reduced in patients with HF compared to healthy subjects (p=0.006 and p0.0001, respectively). Using backward selection multivariable regression, serum levels of increased adiponectin remained significantly associated with reduced arm lean mass and muscle strength.Our findings may indicate a cross-sectional metabolic association of increased serum adiponectin with reduced peripheral muscle mass and muscle strength in non-cachectic, non-diabetic, elderly HF patients.

Although there are many models for ranking higher education institutions, the SCImago Institutions Rankings methodology stands out for its ability to present quantitative and qualitative indicators of scientific output. Besides Total number of published papers, several indicators are concerned with quality dimensions of published papers, such as International collaboration, Scientific leadership or High quality publications . However, official rankings are provided solely on the basis of one indicator: Output (total number of published papers ). This paper presents a statistical I-distance method that integrates all the indicators into one value, which therefore represent a rank and show which of the input indicators is the most important for the process of ranking. Our results clearly showed that Excellence with Leadership occupies the most significant spot.

Background/Aim. Posterior breast cancers are located in the prepectoral region of the breast. Owing to this distinctive anatomical localization, physical examination and mammographic or ultrasonographic evaluation can be difficult. The purpose of the study was to assess possibilities of diagnostic mammography and breast ultrasonography in detection and differentiation of posterior breast cancers. Methods. The study included 40 women with palpable, histopathological confirmed posterior breast cancer. Mammographic and ultrasonographic features were defined according to Breast Imaging Reporting and Data System (BI-RADS) lexicon. Results. Based on standard two-view mammography 87.5%, of the cases were classified as BI-RADS 4 and 5 categories, while after additional mammographic views all the cases were defined as BIRADS 4 and 5 categories. Among 96 mammographic descriptors, the most frequent were: spiculated mass (24.0%), architectural distortion (16.7%), clustered microcalcifications (12.6%) and focal asymmetric density (12.6%). The differentiation of the spiculated mass was significantly associated with the possibility to visualize the lesion at two-view mammography (p = 0.009), without the association with lesion diameter (p = 0.083) or histopathological type (p = 0.055). Mammographic signs of invasive lobular carcinoma were significantly different from other histopathological types (architectural distortion, p = 0.003; focal asymmetric density, p = 0.019; association of four or five subtle signs of malignancy, p = 0.006). All cancers were detectable by ultrasonography. Mass lesions were found in 82.0% of the cases. Among 153 ultrasonographic descriptors, the most frequent were: irregular mass (15.7%), lobulated mass (7.2%), abnormal color Doppler signals (20.3%), posterior acoustic attenuation (18.3%). Ultrasonographic BI-RADS 4 and 5 categories were defined in 72.5% of the cases, without a significant difference among various histopathological types (p = 0.109). Conclusion. Standard two-view mammography followed by additional mammographic projections is an effective way to demonstrate the spiculated mass and to classify the prepectoral lesion as category BI-RADS 4 or 5. Additional ultrasonography can overcome the mimicry of invasive lobular breast carcinoma at mammography.

Background Although the majority of previous findings unequivocally confirmed the existence of systemic oxidative stress in chronic heart failure (CHF) patients, data on prognostic potential of biomarkers of oxidative lipid and protein damage are limited. We aimed to address the relation of oxidative stress markers to severity and prognosis in CHF secondary to ischemic cardiomyopathy. Methods and Results Plasma malondialdehyde (MDA), protein thiol groups (P-SH), reactive carbonyl derivatives (RCD), together with glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were determined in 120 CHF patients and 69 healthy controls. Increased lipid peroxidation (MDA) and oxidation of plasma proteins (RCD; P-SH) s well as downregulated GSH-Px activity were found in CHF patients compared with controls. Significant correlation was obtained only for RCD content and remodeling indices (LVEDV: r = 0.469, P = .008; LVESV: r = 0.452; P = .011). Cox regression analysis demonstrated only MDA (HR = 3.33; CI: 1.55–7.12; P = .002) as independent predictor of death, whereas SOD was associated with unstable angina pectoris (HR = 2.09; CI: 1.16–3.78; P = .011). Conclusions In the course of CHF progression, carbonyl stress is implicated in the LV remodeling. Malondialdehyde level might be a useful parameter for monitoring and planning management of CHF patients.

– First experiments with the new technology in the healthsystem were recorded in sixties. It was the first time to de-velop computerized tomography, as a new diagnosticmethod, by combining medical equipment with computers.At that time was one of the first Clinically-oriented HospitalComputer Information Systems (HCISs) established. It wasTechnicon Medical Information System (TMIS). TMIS de-velopment began in 1965 as a collaborative project betweenLockheed and EI Camino Hospital in California

Book review of: Global Inequality: A New Approach for the Age of Globalization by Branko Milanovic. Harvard University Press, Cambridge, Massachusetts, 2016. 320pp. ISBN: 978-0-674737136 JEL Classification: Y30

OBJECTIVE To present outcomes of a minimally invasive inguinal technique for the separation of the distal part of ureters in duplex systems and for the extravesical ureteroneocystostomy of only the pathologically involved ureter. MATERIALS AND METHODS From November 2001 to February 2007, we performed extravesical reimplantation of only the involved ureter in 21 duplex systems, of which 14 were refluxing (megaureters) and seven had obstruction of the ureterovesical junction. The mean (range) age of the patients was 39 (17-59) months. In seven patients, ureterocutaneostomy (of the involved ureter only) was performed first, with reimplantation 3-6 months later, after the diameter of the ureter had decreased, to ensure safe reimplantation. The mean (range) postoperative follow-up was 28 (12-47) months. RESULTS Postoperative voiding cysto-urethrograms (VCUGs) and magnetic resonance imaging (MRI), showed an absence of vesico-ureteric reflux (VUR) or obstruction in the ureters of the first 10 patients. In the remaining 11 patients, there was no ultrasound detectable dilatation, but symptomatic urinary tract infection developed in two of these patients. Subsequent VCUG and MRI results showed no obstructions or VURs. CONCLUSION Our results showed that the minimally invasive inguinal approach to separation of ureters in duplex systems and single ureteroneocystostomy of only the pathologically involved ureter represents a viable treatment option.

The aim of this article is to present new ideas in evaluating Shanghai University's Academic Ranking of World Universities (ARWU). One issue frequently put forth in various publications is that the Shanghai rankings are sensitive to the relative weight they attribute to each variable. As a possible remedy to this issue, the statistical I-distance method is proposed to be used. Based on a sample containing the top 100 ranked universities, the results show a significant correlation with the official ARWU list. However, some inconsistencies concerning European universities have been noticed and elaborated upon.

Background: Prolactin-raising antipsychotics, risperidone (antidopaminergic activity), may be associated with low bone mass. On the other hand, risperidone may cause an increase in body weight thought to be favorable for bone. Objectives: (1) To determine bone remodeling parameters and bone mass in patients with schizophrenia on long-term treatment with long-acting injectable risperidone (LAIR) in naturalistic settings, and (2) to evaluate the change in body weight, metabolic profile and neuroendocrine status in these patients. Design: This was a prospective, cross-sectional study. Patients: Patients included 26 outpatients with controlled schizophrenia in real-life conditions (age 31.3 ± 1.3 years, BMI 28.1 ± 1.0) on long-term maintenance therapy with LAIR for a mean of 18.0 ± 1.6 months (range 6–36) with a mean dose of 38 ± 2 mg. 35 subjects matched for sex, age, BMI and education served as healthy controls. Methods: Serum osteocalcin, C-terminal telopeptide of type I collagen (CTx), vitamin D, leptin, prolactin, sex steroids, and parathyroid hormone were assessed. Indices of insulin sensitivity and resistance were determined following an oral glucose tolerance test (OGTT). Bone mineral density (BMD) was measured by dual X-ray absorptiometry at the lumbar spine (LS) and femoral neck (FN). Results: Mild to moderate hyperprolactinemia (1,000–2,000 mU/l) was associated with asymptomatic hypogonadism. Prolactin values >2,000 mU/l occurred in a few female patients. Hypogonadism leads to a slight increase (upper limit of normal) in bone resorption marker (CTx) in patients with schizophrenia (p = 0.023). As for bone mass, although lower at the spine than in healthy subjects, it did not reach statistical significance (p = 0.094), while at the FN, BMD was not different from healthy subjects. Body weight increased on average 8.7 ± 1.6 kg in more than 50% of patients. Leptin levels adjusted for BMI in females were significantly higher in patients than in healthy female subjects (p = 0.018), while in males there was no difference between the groups (p = 0.833). A high prevalence of low vitamin D levels and more current smokers were found in patients with schizophrenia. As for the metabolic profile during treatment with risperidone, the low Matsuda index of insulin sensitivity (p = 0.039) confirmed insulin resistance in these patients. Conclusion: A potential long-term consequence of asymptomatic hypogonadism due to risperidone-induced hyperprolactinemia might cause a slight rise in bone resorption marker (CTx). On the other hand, by increasing body weight, risperidone could have a protective effect on the bone and thus no change in bone mass was recorded when compared with healthy controls.

Introduction Corresponding to the process of globalization, the so-called information capitalism is also developed, initiating new forms of social divide and class polarizations (Castells, 1996). This type of divide is nowadays called digital divide. This complex term implies different types of polarizations. On one side, that is polarization between highly developed, usually wealthy countries and regions that are connected to a global computer network and poorly developed and very often poor parts of the world, that are due to their elementary problems still far away from that kind of connection. That is also a kind of polarization, which is monitored within a given society on different levels: between highly educated elite and low educated parts of population, gender polarization, polarization of the young regarding to the older population, as well as the polarization of the rich at one side and the poor at the other. These polarizations are monitored and analyzed by setting and comparing the level of ICT accessibility, the level of ICT use, the level of ICT literacy etc. in different social groups or in different countries and regions. Studying and measuring of digital divide between countries and regions is significant from the aspect of discovering the capacity of one nation to participate in the global information society. When digital divide is monitored within one country, it is possible to affect the design and the change of the current developing strategies, by measuring the gap between different socio-economic groups in the context of their potentials to participate in ICT application. The precise indicators and appropriate measures of this complex social phenomenon enable quantitative expression of its movement in time or space. Using them, the preconditions for its regular monitoring and affecting its further course are provided. The paper offers suggestion of one methodology, by which the social polarization on population, induced by different opportunities of social groups to participate in transition towards information society, is quantitatively expressed. Digital Divide: The Meaning, Types, and Measurement The term digital divide denotes the gap between individuals, households, enterprises or geographical regions that are on different levels of socio-economic development, which is monitored through their possibilities for the access to ICT, as well as their use of Internet in private, social and business activities (OECD, 2001). The achievement of "information society for all" presents one of political priorities of the European Union, which is emphasized in the European Union project, with the same name (European Commission, 2000, 2002). This political priority determines setting clear goal of minimizing all forms of digital divide. As opposed to digital divide, the terms participation and inclusion are introduced. In the working documents of European Union bodies these terms are used when defining goals such as designing rightful society, with such socio-economic environment in which all citizens, or at least the majority, will be able to enjoy the advantages of information society (European Commission, 2001). Digital divide presents a complex, multidimensional social phenomenon that is noticed at different levels of monitoring and that causes many consequences on society (Economic and Social Commission for Western Asia, 2005). Its effect is seen in international context, when it is monitored and measured among different countries, as well as in national framework, within a particular country. It is noticed through differences concerning availability of ICT infrastructure, ways of its use and possibility of enjoying the advantages that ICT use provides. Digital divide usually refers to population domain. However, it is also possible to measure and express digital divide among business entities, applying the appropriately defined criteria and measuring models. …

Brain detrimental effects are under-recognised complication of chronic heart failure (CHF). One of the major causes may be cerebral hypoperfusion. This study was designed to investigate the relationship between cerebral blood flow (CBF) and severity of CHF as well as to evaluate its determinants among different parameters of cardiac dysfunction.Seventy-one CHF males with NYHA class II and III and 20 control subjects age ≥ 55 years were recruited. CBF was evaluated by colour duplex sonography of extracranial arteries. Echocardiography, 6-min walk test, quality of life and endothelial function were also assessed. Serum NT-pro-BNP and adipokines levels (adiponectin and leptin) were measured.CBF was significantly reduced in elderly patients with CHF compared to healthy controls (677 +/- 170 vs 783 +/- 128 ml/min, p=0.011). Reduced CBF was associated with reduced left ventricular ejection fraction (LVEF) (r=0.271, p=0.022), lower 6-min walk distance (r=0.339, p=0.004), deteriorated quality of life (r= -0.327, p=0.005), increased serum adiponectin (r= -0.359, p=0.002), and NT-pro-BNP levels (r= -0.375, p=0.001). In multivariate regression analysis, LVEF and adiponectin were independently associated with reduced CBF in CHF patients (R(2)=0.289).CBF was reduced in elderly males with mild-to-moderate CHF, and was associated with factors that represent the severity of CHF including high serum adiponectin and NT-pro-BNP levels, decreased LVEF, impaired physical performance, and deteriorated quality of life.

Background The aim of the study was to investigate the associations of adiponectin and leptin to bone mass and bone specific surrogates in elderly males with chronic heart failure (CHF). Methods and Results Seventy-three males (mean age 68 ± 7 years) with stable mild to moderate CHF and 20 healthy individuals age- and body mass index–matching underwent dual energy x-ray absorptiometry measurements (bone mineral density (BMD) at hip and lumbar spine, total bone mineral content, and body composition); echocardiography; 6-minute walk test; grip strength; and biochemical assessment including adiponectin, leptin, bone specific surrogates (osteocalcin, β-CrossLaps, osteoprotegerin [OPG], receptor activator of nuclear factor κB ligand [RANKL]), parathyroid hormone, 25-hydroxy vitamin D, testosterone, sex hormone-binding globulin, and NT-pro-BNP. Serum adiponectin, osteocalcin, β-CrossLaps, OPG, RANKL, and parathyroid hormone were significantly increased in CHF patients, whereas 25-hydroxy vitamin D was significantly lower compared to healthy controls. The significant positive association was found between adiponectin level with osteocalcin, β-CrossLaps, OPG, and RANKL among CHF patients. In multivariate regression analysis, adiponectin was a significant determinant of total hip BMD, although the variance was small ( r 2 = 0.239), whereas leptin was determinant for total bone mineral content ( r 2 = 0.469) in patients with CHF. Conclusions Serum adiponectin is an independent predictor of BMD in elderly males with mild to moderate CHF, and showed a positive correlation to bone specific surrogates. Adiponectin, as cardioprotective hormone, seems to be able to exert a negative effect on bone mass in chronic heart failure. Further research is needed to confirm the potential for adipokines in the crosstalk between bone and energy metabolism in CHF patients.

Introduction The paper explains the importance and the role of content management systems, gives an overview of the functionality required by such systems and makes a categorization of existing content management systems, thus performing, to some extent, a systematization of this area. Internet technologies and e-business Electronic business is a set of business activities that occur by ICT, especially Internet. CMS existence is conditioned by the development of Internet technology. Basic terminology, problem and solution The basic terms of which problems are considered in this paper are Content, Content Management and Content Management System. Content management systems demand Content management systems demand is reflected in the following: (1) complex structure and a hierarchy of target groups are major challenges for the selection and implementation of an adequate system of content management in decision-making processes; (2) timely adoption of key decisions and their implementation is currently a considerable advantage over competitors; (3) by applying modern information and communication technologies and service-oriented architecture, content, especially documents, management provides security and protection of information in the process of content managing. Content management systems types This article describes the following types of content management systems: Document Management System, Digital Asset Management, Web Content Management and Learning Content Management. Content management systems basic parts The main parts of the content management system are: (1) Content integration, including any content manipulation (input, processing, display); (2) Version control, older versions of files are stored in the database (date of creation/change, and optional comment). Thanks to version control, web site can be restored later (rolled-back) to the previous version; (3) Workflow, allows defining processes in a few steps concerning the creation, review and approval of content publishing; (4) Content repositorium (relational, object or XML databases) greatly improves reuse and content management, especially when these items have a high repetition level; (5) Users management and their privileges; (6) User interface. Display of client and administrative console is done through a web browser; (7) Applications represent an addition to content management systems (business rules, API functions, search, forum, etc.) Content management systems classification Content management systems classification can be performed by different elements: (1) by type, where the content management system is a framework or system; (2) by license; (3) by used technology; (4) by price. The paper briefly explains the classification. Conclusion Future direction of research of content management system applications in the Serbian Army would be based on the advantages and disadvantages of electronic document management system repositories, for example realistic management processes and data flows within the command and information system. .

Blindfold chess is a special type of chess game where both the board and pieces are not visible to its players. This paper aims to determine whether the quality of the game played blindfolded is lower than when played under normal conditions. The best chess program was used to analyze games played by the world's top Grandmasters under both conditions. We have analyzed the Monaco 1993-1998 data set introduced by Chabris and Hearst (2003). The results showed that although a larger number of mistakes occurred while playing blindfolded, no significant statistical difference between the rapid and blindfold games has been found. Nevertheless, by applying the same methodology to the Monaco 2002-2007 data set a substantial difference between the blindfold and the rapid chess game was noticed. In this paper, we have addressed the possible improvement of the chess game quality and the advances in chess programs that may be responsible for detecting more blunders.

Background: To determine the long-term outcome of patients admitted with acute severe colitis (ASC) who avoided colectomy on the index admission, a retrospective cohort study was performed. Methods: Patients admitted for intensive treatment of ASC in 1992–1993 previously described for a predictive index of short-term outcome in severe ulcerative colitis (UC) were followed for a median 122 months (range 3–144). Complete responders (CR) to intensive therapy had

During the planning and implementation of Information and Communication Technologies solutions in the healthcare system, attention should be focused on the interests of citizens, healthcare employees, and the public. The project 'Development of the Healthcare Information System for Basic Healthcare and Pharmaceutical Services' demands the implementation of Electronic Healthcare Documentation in the Healthcare Information System of Serbia. This article represents a short overview of previous development of the healthcare information system. Electronic health documentation needs to represent basic health process of every single user. Healthcare Information Systems is based on patients, medical documents, information exchange about patient's health between health's, insurances and financials institutions, with primary goal to made healthy population with less cost.

Objective Genetic heterogeneity and incomplete phenotype penetrance complicate genetic analysis of Crohn's disease (CD). Studies in western Europe have shown that CARD15 polymorphisms increase susceptibility to CD, but frequencies vary within different European populations. The aim here was to evaluate the prevalence of CARD15 mutations and their phenotypic correlation in a Serbian population. Materials and methods 131 patients with CD, 65 patients with ulcerative colitis, and 88 healthy controls were genotyped for three common mutations (R702W, G908R, Leu1007insC) by PCR-restriction fragment length polymorphism. Χ 2 and Student's t-test were used for statistical assessment. Results At least one CARD15 disease-associated allele was found in 35.11 % patients with CD, 14.77% of healthy controls (P= 0.001), and 7.69°/o patients with ulcerative colitis (P=0.0001). The L1007fs mutation showed a significant association with CD (P

To compare the effects of antenatal administration of corticosteroids used in two different regimens, on fetal biophysical profile (BPP), baseline fetal heart rate (BFHR), nonstress test (NST) and perinatal outcomes.We evaluated the effects of single direct intramuscular (i.m.) fetal dose of dexamethasone (4 mg/kg), or four doses of 6 mg dexamethasone given to the mother 12 hours apart on the parameters of fetal BPP 0-4 hours before and after antenatal contraction stress (ACST). We evaluated two groups of 41 fetuses in the 31st gestation week at risk of fetal hypoxia at the Department of Gynecology/Obstetrics, Clinical Center of Serbia in 2013.In fetal ACST group, we found significantly different changes in fetal breathing movement before (D0-f) and after therapy (D1-f), p = 0.019 (-11.75; -1.12), 95% confidence interval (CI), as well as in the maternal ACST group, p = 0.001; (-11.75; -1.12), 95% CI. We found significant difference between BPP 0-m and BPP1-m in the maternal group, p = 0.000. Neonatal asphyxia occurred more often with the increased frequency of fetal breath movements after both ACST (p = 0.04 versus p = 0.07).Fetal ACST results in increased fetal breathing movements. Maternal ACST can result in changes to BPP. The increase in fetal breathing movements determinates neonatal asphyxia regardless of the ACST.