BACKGROUND AND OBJECTIVES: Despite advances in cranial base techniques, surgery of the sellar and parasellar regions remains challenging because of complex neurovascular relationships. Lesions within this region frequently present with progressive visual deterioration caused by distortion and compression of the optic chiasm and nerves. In addition to the direct mass effect from mechanical forces acting on the optic apparatus, these lesions alter blood supply and reduce vascular perfusion, prompting surgical treatment to remove the lesion, alleviate compression, and improve blood flow to the optic nerve. We sought to describe a 2-stage, 4-by-4-step approach, broken down and described as a “four-by-four” technique for optic apparatus decompression and a wide approach to different sellar and parasellar lesions. METHODS: We describe the operative nuances and key anatomic points in the microsurgical removal of sellar and parasellar lesions. The technique is illustrated with examples of different cases with pre- and follow-up MRI imaging and a brief overview of visual outcomes. RESULTS: The described technique has been demonstrated in various lesions in 5 patients. Patients presented with bilateral visual loss in 4 (80.0%) cases and with unilateral visual loss in 1 (20.0%) case. Improvement in visual function was noted in all cases, confirmed with visual acuity and visual field testing. DISCUSSION: The transcranial approach (“from above”) remains an important surgical option for patients with excellent exposure and visualization of the sellar and parasellar regions. It permits early access to the optic canal for careful microsurgical decompression and relaxation of the optic nerve to preserve and improve its microvascularization and ultimately vision. CONCLUSION: The authors augmented the 2-stage, 4-by-4-step technique of decompression with elaborate illustrations of diverse sellar and parasellar lesions to demonstrate the versatility of this approach.

For the successful prevention of chronic diabetic complications, it is crucial to identify novel etiopathogenetic factors that contribute to their development. We evaluated the association of hypothalamus pituitary adrenal axis activity (HPA) with the presence of chronic diabetic complications and glycemic control in 107 patients with type 2 diabetes and 29 healthysubjects, matched for age and sex. The study included 107 type 2 diabetic patients and 29 healthy control subjects who were hospitalized at the Internal Medicine Clinic of the University Clinical Center Tuzla. Patients with diabetes were evaluated for chronic complications and divided into two groups according to the presence (group 1, n = 57) and absence (group 2, n = 50) of complications. We determined the parameters of the HPA axis as follows: a level of 08 h cortisol and ACTH and a level of 09 hcortisol after a short dexamethasone test (DEX cortisol) and compared those among the groups. We determined the parameters of glycemic control and compared them with the parameters of the hypothalamus pituitary adrenal axis. In group 1, the values of cortisol were 454 (368–561), ACTH 12.6 (8.7–23), and DEX cortisol 37.5 (23-52), significantly higher compared to group 2 [320 (230–387), 7.9 (3.3–16.4), 26 (22–36), p <0.05, and higher compared to healthy subjects [312 (233–342), p = 0.001, 12 (6–16.7), p = 0.1, 24 (19–29), p = 0.126, respectively]. Evaluating the parameters of glycemic control, we found a higher HbA1C in group 1, 7.9 (6.55-9.45) compared to group 2, 7.5 (5.97-10), p = 0.498, while correlation analyses showed a significant positive relationship between HbA1C and cortisol (R = 0.242, p = 0.012). CONCLUSION: Patients with type 2 diabetes have HPA axis dysfunction. Higher cortisol levels are associated with poor glycemic control and the presence of diabetic complications. To better understand the etiology and provide practical solutions for addressing this issue, additional studies are required.

Background: The adipose-derived stromal vascular fraction (SVF) plays a crucial role in regenerative medicine owing to its regenerative and immunomodulatory properties. However, the effective utilization of SVF in therapeutic applications requires careful consideration of storage conditions to maintain cell viability. Methods: We conducted a research on 43 patients of different ages and sexes who were older than 18 years. This study explored the impact of different temperatures (‐80, ‐20, and 4 °C) on SVF storage in platelet-poor plasma for 1 and 6 months. SVF extracted using a semi-UNISTATION™ system was subjected to rigorous analysis of cell count and viability using a LUNA-STEM™ Dual Fluorescence Cell Counter. Results: The results indicated a significant correlation between the storage conditions and SVF viability. Notably, storing SVF at 4 °C demonstrated the highest cell viability and count, while ‐80 °C storage exhibited the least favorable outcomes. This study emphasizes the importance of minimizing storage time to preserve SVF viability, as evidenced by a decline in both cell count and viability over a 6-month period. Comparisons with the existing literature underscore the need for precise protocols for SVF storage, with considerations for temperature and cryoprotective agents. These findings provide valuable insights for developing optimal SVF storage protocols to enhance therapeutic outcomes and reduce the need for repeated adipose tissue harvesting. Despite the limitations of the study, such as the use of a cell counter instead of flow cytometry, the results establish the foundation for further research on refining SVF storage methods. Conclusion: The ideal storage temperature is from 4 °C, while the length of storage time inversely affects the viability of SVF; the longer the storage time, the lower the number and the viability of SVF cells, regardless of the temperature at which they are preserved.

Metamaterials, synthetic materials with customized properties, have emerged as a promising field due to advancements in additive manufacturing. These materials derive unique mechanical properties from their internal lattice structures, which are often composed of multiple materials that repeat geometric patterns. While traditional inverse design approaches have shown potential, they struggle to map nonlinear material behavior to multiple possible structural configurations. This paper presents a novel framework leveraging video diffusion models, a type of generative artificial Intelligence (AI), for inverse multi-material design based on nonlinear stress-strain responses. Our approach consists of two key components: (1) a fields generator using a video diffusion model to create solution fields based on target nonlinear stress-strain responses, and (2) a structure identifier employing two UNet models to determine the corresponding multi-material 2D design. By incorporating multiple materials, plasticity, and large deformation, our innovative design method allows for enhanced control over the highly nonlinear mechanical behavior of metamaterials commonly seen in real-world applications. It offers a promising solution for generating next-generation metamaterials with finely tuned mechanical characteristics.

ABSTRACT Research suggests that serious games can be used as supplementary training tools for young people with complex mental health needs. This study aimed to co-produce a mobile-accessible serious game, ReGoal, in collaboration with young people (11–16 years) and an interdisciplinary team of academic experts and practitioners. ReGoal is aimed to serve as a supplementary tool for improving emotion regulation, goal-orientation, and executive functioning skills. This study consisted of three interlinked co-production phases. First, 122 participants, of which 34% had moderate to high conduct problems, completed an online survey about the role of gaming in managing their emotions. During the second phase, 16 young people attended three focus groups in which their lived experiences shaped the narrative of ReGoal. In the third phase, an online user survey gathered feedback from 72 young people playing the most recent prototype of ReGoal. The key findings suggest that young people valued playing ReGoal as a supplementary aid to improving their mood, increasing empathy towards peers and family, reducing anxiety, anger, and impulsivity, and understanding other people’s emotions. Future research should test the applicability and feasibility of ReGoal in reducing behavioural problems with clinical and non-clinical samples.

Background - Organ donation and organ transplantation refer to a medical treatment approach that involves substituting a diseased or damaged organ or tissue in the human body with a healthy one. Progress in surgical techniques, immunology, and medical science has facilitated the advancement of transplant procedures. Nowadays, a wide range of organs, organ parts, and tissues can be successfully transplanted. Depending on the part of the body in question, the organs that are donated can come from a deceased donor or from a living person. Factors that influence the individual in a positive direction in terms of donating their organs have been presented in previous studies as the socio-economic status of informants, education level, being young, gender, donation to family members and social support. Aim - of this study is to synthesize qualitative and quantitative research on individuals' attitudes and decisions regarding organ donation, as well as the factors influencing these matters. Materials and Methods - A systematic search was conducted on the PubMed, Embase, CINAHL, and Web of Science databases for qualitative and quantitative literature regarding factors influencing an individual to donate their organs to other individuals. An inductive thematic analysis was conducted to generate themes and supporting subthemes. Fifteen studies were included. Results - The three main themes were: socioeconomic and cultural factors, dissatisfaction with, and mistrust of the healthcare system. Unspecified donors demonstrated a deep sense of different factors that influenced the individual to donate their organs to other individuals. Religious factors, fear and prejudices, gender differences, the influence of family members and not being treated well by healthcare professionals were only a few of the factors that were stated in the present study. Conclusion - The results of the present study show that there were many different factors that influenced an individual to decide whether to donate organs. Even though the individuals belong to different religions, come from different cultures, look at family relationships differently and have different degrees of knowledge, the opinions and factors that influence their decision regarding organ donation are the same. Healthcare should work more actively to inform and increase knowledge and consciousness about organ donation among people who are prospective donors. This can mean more information in several different languages, as well as where different religions stand on organ donation. Key words: Organ donation, transplantation, influence, factors, decision, review.

Metamaterials, synthetic materials with customized properties, have emerged as a promising field due to advancements in additive manufacturing. These materials derive unique mechanical properties from their internal lattice structures, which are often composed of multiple materials that repeat geometric patterns. While traditional inverse design approaches have shown potential, they struggle to map nonlinear material behavior to multiple possible structural configurations. This paper presents a novel framework leveraging video diffusion models, a type of generative artificial Intelligence (AI), for inverse multi-material design based on nonlinear stress-strain responses. Our approach consists of two key components: (1) a fields generator using a video diffusion model to create solution fields based on target nonlinear stress-strain responses, and (2) a structure identifier employing two UNet models to determine the corresponding multi-material 2D design. By incorporating multiple materials, plasticity, and large deformation, our innovative design method allows for enhanced control over the highly nonlinear mechanical behavior of metamaterials commonly seen in real-world applications. It offers a promising solution for generating next-generation metamaterials with finely tuned mechanical characteristics.

Abstract Avoidable disasters are both saddening and baffling. In 2022, 159 people, mostly in their 20s, and 30s were crushed to death in Itaewon’s narrow alleyway amid South Korea’s first pandemic-restrictions-free Halloween celebration. What is particularly sobering about this tragedy is that although many people called police hotlines as crowds became cramped and static, their calls went unheeded for hours. Rather than order independent investigations into the catastrophe (as of January 2024), the President of South Korea at the time focused on superficial issues such as asking the public to refer to the disaster as an “accident” (which it was not, it was an avoidable disaster) and the casualties as “the dead” (who are casualties indeed, instead of victims of a preventable tragedy). In this paper, we examine how officials’ complacency about public health and safety dangers, ineffective disaster prevention, and preparedness systems, as well as the government’s chronic lack of prioritization of public health and safety may have contributed to the disaster. Furthermore, we discuss the importance of creating integrated public health and safety protection systems to prevent similar tragedies from happening.

Objective: Iris species are widely used in pharmaceutical and cosmetic applications owing to their high content of bioactive compounds with anti-inflammatory and antimicrobial properties. This study aimed to investigate the potential antibacterial effect of crude extracts (aqueous, 50% and 80% ethanol) of three Iris species ( I. pumila , while I. reichenbachii and I. illyrica are endemic) from Bosnia and Herzegovina against the multiresistant bacterial strain methicillin-resistant Staphylococcus aureus subsp. aureus ATCC 33591 (MRSA strain). Materials and Methods: The antimicrobial compounds in the crude extracts were identified using High-performance liquid chromatography (HPLC), and their effects on the MRSA strain were tested using agar well diffusion and broth microdilution method. The binding affinities were analysed using molecular docking simulations. Results: We identified bioactive targeted compounds in these extracts, mainly flavonoids named isorhamnetin, hesperidin, quercetin, fisetin, genistein, and kaempferol. Antibacterial assays showed that extracts of all three Iris species inhibited MRSA. The binding affinity analysis showed that isorhamnetin and hesperidin had the highest affinity scores, stronger (isorhamnetin) or the same (hesperidin) as the positive control ceftobiprole. Conclusion: This in vitro and in silico study showed that Iris species represent a valuable source of bioactive compounds that can be used against multidrug-resistant strains such as MRSA. The potential use of these agents in multiple drugs is warranted, and further evaluation for human application is needed.

Background Distal occlusions associated with incomplete reperfusion (expanded Thrombolysis in Cerebral Infarction, <eTICI 3) may not reperfuse spontaneously and thus prompt ischemia (ie, persistent hypoperfusion). We aimed to assess whether the recently reported Distal Occlusion Tracker (DOT) sign on immediate non-contrast post-interventional flat-panel detector computed tomography (FPDCT) is associated with persistent hypoperfusion. Methods Retrospective registry analysis of patients undergoing endovascular therapy between July 2020 and December 2022, with available immediate post-interventional FPDCT and 24 hours follow-up perfusion imaging. Persistent hypoperfusion was defined as a perfusion deficit at 24 hours directly corresponding to the area of incomplete reperfusion on final angiography run. The DOT sign was defined as a punctiform or tubular hyperdense signal increase on FPDCT indicative of a residual occlusion. Association between the DOT sign (present/absent) with the occurrence of persistent hypoperfusion and poor outcome (modified Rankin scale (mRS) score 3–6) was evaluated using logistic regression analysis. Results Of 292 patients included (median age 73 years; 47% female), 209 had incomplete reperfusion. Among patients with incomplete reperfusion, 61% had a present DOT sign and 46% had persistent hypoperfusion. In the overall cohort, but also within each eTICI stratum, a present DOT sign was associated with persistent hypoperfusion on 24±12 hours follow-up perfusion imaging (adjusted odds ratio (aOR) 4.8, 95% confidence interval (CI) 2.0 to 12.3 for patients with eTICI 2 a-2c). A present DOT sign was also associated with poor outcome (aOR 2.6, 95% CI 1.1 to 6.2). Conclusion Patients with <eTICI 3 and a present DOT sign have a higher likelihood of persistent hypoperfusion and might constitute a subgroup that could particularly benefit from additional reperfusion attempts.

<p><strong>Introduction. </strong>Tibial bone defects, particularly those caused by infections, represent one of the most complex challenges in orthopedics. Given the severity of complications such as limb function loss or even amputation, the need for innovative and reliable treatment methods is crucial. Medial fibular transport using the Ilizarov apparatus offers a successful solution to these problems, preserving limb functionality and integrity.<br /><strong>Case report.</strong> This paper presents the case of a 76-year-old patient with chronic osteomyelitis and infected tibial pseudarthrosis. Following radical debridement and sequestrum removal, a significant partial bone defect measuring 8 cm remained. Treatment was performed using medial fibular transport with the Ilizarov apparatus. The reconstruction process lasted eight months, after which complete bone consolidation, infection elimination, and restoration of limb function were achieved.<br /><strong>Conclusion. </strong>The medial fibular transport technique has proven to be an effective and safe method for treating large tibial defects associated with infection, enabling limb preservation and significantly improving patients&rsquo; quality of life.</p>

<p><strong>Introduction. </strong>The COVID-19 pandemic has had a significant impact on the mental health of individuals with chronic diseases. Contributing factors include limited access to healthcare during lockdowns, fear of infection, and heightened stress due to poorer outcomes of COVID-19 infection in this population. The aim of this study was to examine the presence of depression, anxiety, and stress in the second year of the COVID-19 pandemic among individuals with pre-ex<br />isting cardiovascular, malignant, chronic respiratory diseases, or diabetes mellitus.<br /><strong>Methods. </strong>A cross-sectional study was conducted among the general population of the eastern region of Republic of Srpska during December 2021 and January 2022. Depression, anxiety, and stress were assessed using the DASS-21 scale, while data on comorbidities were collected through a questionnaire from an epidemiological population-genetic study conducted concurrently.&nbsp;<br /><strong>Results.</strong> A total of 1,372 participants from the eastern region of Republic of Srpska were included in the study, consisting of 40.0% males and 60.0% females. Participants were aged 20 years and older, with an average age of 50.6 years. The study found that depression, anxiety, and stress were statistically significantly more prevalent among participants with pre-existing cardiovascular or chronic respiratory diseases compared to those without such conditions. Additionally, participants with a history of malignant diseases or diabetes mellitus were significantly more depressed and anxious than&nbsp;<br />those without these conditions.<br /><strong>Conclusion. </strong>The findings of this study may contribute to the development of policies aimed at improving mental health and preventing mental disorders in individuals with comorbidities.</p>

<p style="text-align: justify;">The growing trend of securing private industry funding for biomedical research, particularly from pharmaceutical and medical device companies, has raised significant ethical concerns. Since the 1980s, private industry has become the primary funder of biomedical research, surpassing government funding in the U.S. and other developed countries. This shift introduces potential ethical violations, including hidden conflicts of interest, data manipulation, disregard for ethical guidelines, non-disclosure of negative results, and compromised research independence. These issues can undermine research integrity, compromise patient safety, and erode public trust in scientific findings. Effective measures to prevent ethical violations include strengthening transparency, enhancing research independence, promoting ethical education, and reinforcing regulatory frameworks. By fostering open dialogue, implementing stringent disclosure requirements, and ensuring independent oversight, participants can uphold ethical standards in sponsored research. Addressing these challenges is essential to maintaining the credibility of biomedical research, protecting participant rights, and ensuring that research outcomes reliably contribute to evidence-based medicine and public health.</p>

Background: The development of novel medical imaging technologies and treatment procedures hinges on the availability of accurate and versatile phantoms. This paper presents a cost-effective approach for creating anthropomorphic abdominal phantoms. Methods: This study proposes a cost-effective method using 3D printing and readily available materials (beeswax, plaster, and epoxy resin) to create high-fidelity anthropomorphic abdominal phantoms. The three-dimensionally printed phantoms exhibited X-ray attenuation properties closely matching those of human tissues, with measured Hounsfield unit (HU) values of −115.41 ± 20.29 HU for fat, 65.61 ± 18.06 HU for muscle, and 510 ± 131.2 HU for bone. These values were compared against patient images and a commercially available phantom, and no statistically significant difference was observed in fat tissue simulation (p = 0.428). Differences were observed for muscle and bone tissues, in which the 3D-printed phantom demonstrated higher HU values compared with patient images (p < 0.001). The 3D-printed phantom’s bone simulation was statistically like that of the commercially available phantom (p = 0.063). Conclusion: This method offers a cost-effective, accessible, and customizable alternative for abdominal phantoms. This innovation has the potential to accelerate advancements in abdominal imaging research, leading to improved diagnostic tools and treatment options for patients. These phantoms could be used to develop and test new imaging techniques with high accuracy.