Simple Summary Achieving margins of >5 mm is challenging in the larynx and hypopharynx because resections are constrained by their complex anatomy. The aim of this study was to retrospectively assess the clinical relevance of resection margins defined by the RCP in total laryngectomies (TLs) and total laryngopharyngectomies (TLPs). Similar survival rates for close and clear margins for primary and recurrent LSCC were found. This may suggest that a margin > 5 mm is not clinically relevant in terms of survival, therefore a margin of 1–5 mm should be accepted in certain subsites. Margins < 1 mm are related to significantly worse outcomes and should be avoided. Abstract Background: Laryngeal and hypopharyngeal cancer is complex and resection margins are therefore constrained. The aim of this study was to investigate the clinical relevance of resection margins in laryngeal and hypopharyngeal surgery. Methods: A retrospective cohort study was performed for patients treated with a total laryngectomy (TL) or laryngopharyngectomy (TLP) for laryngeal or hypopharyngeal squamous cell carcinoma (LSCC and HSCC, respectively). Within the groups primary LSCC, recurrent LSCC, primary HSCC, and recurrent HSCC the relationship between the status of the resection margin according to the Royal Collage of Pathology and the recurrence and survival rates were investigated. Results: Positive resection margins were found in 54% for primary LSCC, 29% for recurrent LSCC, 62% for primary HSCC, and 44% for recurrent HSCC. For primary and recurrent LSCC, there was a linear association between total recurrence and narrowing margins (p = 0.007 resp. p = 0.008). Multivariate survival analysis for primary and recurrent LSCC showed a significantly worse disease free and disease-specific survival in case of positive margins compared to clear margins. Conclusion: Similar survival rates were recorded for close and clear margins for primary and recurrent LSCC. This may suggest that a margin > 5 mm is not clinically relevant in terms of survival. Therefore, a margin of 1–5 mm should be accepted in certain subsites. Margins < 1 mm are related to significantly worse outcomes and should be avoided.

Antibiotics are medications that inhibit bacterial growth and are used in the treatment of bacterial infections, both gram-positive and gram-negative. Antibiotics also represent products of metabolism of certain microorganisms that adversely affect the development and reproduction of other microorganisms. They are one of the greatest discoveries of modern medicine; however, in today's age, the greatest challenge is the resistance of bacteria to antibiotics. There are numerous reasons for the emergence of antibiotic resistance. One reason lies in inadequate education about antibiotics, their application, and usage. The aim of this study was to survey students of the University of Sarajevo's Faculty of Health Sciences about their general knowledge of antibiotics and their methods of application. A total of 151 students participated in this study, including 125 females (83%) and 26 males (17%). The questions consisted of two parts: the first part covered general knowledge about antibiotics, while the second part addressed bacterial resistance to antibiotics.

Approximately half of the cases of chronic kidney disease (CKD) in childhood are caused by congenital anomalies of the kidney and urinary tract (CAKUT). Specific genes were identified as having significant importance in regard to the underlying genetic factors responsible for the CAKUT phenotype, and in our research, we focused on analyzing and comparing the expression levels of ectodysplasin A2 receptor (EDA2R), protocadherin9 (PCDH9), and TNF receptor-associated factor 7 (TRAF7) proteins in the cortex and medulla of healthy control kidneys during developmental phases 2, 3, and 4. We also performed an analysis of the area percentages of the mentioned proteins in the cortical and medullary sections of healthy embryonic and fetal kidneys compared to those affected by CAKUT, including duplex kidneys (DK), horseshoe kidneys (HK), hypoplastic kidneys (HYP), and dysplastic kidneys (DYS). We found that the CAKUT candidate gene proteins EDA2R, PCDH9, and TRAF7 are all expressed during normal human kidney development stages. In DYS, the expression of EDA2R was higher than in normal kidneys, likely due to EDA2R’s role in apoptosis, which was upregulated in specific cases and could possibly contribute to the formation of DYS. The expression of PCDH9 was lower in HK, which can be attributed to the possible role of PCDH9 in cell migration suppression. Decreased PCDH9 expression is linked to increased cell migration, potentially contributing to the development of HK. The level of TRAF7 expression was reduced in all examined kidney disorders compared to normal kidneys, suggesting that this reduction might be attributed to the crucial role of TRAF7 in the formation of endothelium and ciliogenesis, both of which are essential for normal kidney development. Further research is required to ascertain the function of these proteins in both the typical development of the kidney and in CAKUT.

Background and Objectives: Spinal surgery, particularly for cervical pathologies such as myelopathy and radiculopathy, requires a blend of theoretical knowledge and practical skill. The complexity of these conditions, often necessitating surgical intervention, underscores the need for intricate understanding and precision in execution. Advancements in neurosurgical training, especially with the use of low-cost 3D models for simulating cervical spine tumor removal, are revolutionizing this field. These models provide the realistic and hands-on experience crucial for mastering complex neurosurgical techniques, filling gaps left by traditional educational methods. Materials and Methods: This study aimed to assess the effectiveness of 3D-printed cervical vertebrae models in enhancing surgical skills, focusing on tumor removal, and involving 20 young neurosurgery residents. These models, featuring silicone materials to simulate the spinal cord and tumor tissues, provided a realistic training experience. The training protocol included a laminectomy, dural incision, and tumor resection, using a range of microsurgical tools, focusing on steps usually performed by senior surgeons. Results: The training program received high satisfaction rates, with 85% of participants extremely satisfied and 15% satisfied. The 3D models were deemed very realistic by 85% of participants, effectively replicating real-life scenarios. A total of 80% found that the simulated pathologies were varied and accurate, and 90% appreciated the models’ accurate tactile feedback. The training was extremely useful for 85% of the participants in developing surgical skills, with significant post-training confidence boosts and a strong willingness to recommend the program to peers. Conclusions: Continuing laboratory training for residents is crucial. Our model offers essential, accessible training for all hospitals, regardless of their resources, promising improved surgical quality and patient outcomes across various pathologies.

This paper presents an in-depth analysis of the Kopčić House, a significant example of modernist architecture in Sarajevo, Bosnia and Herzegovina, focusing on its structural-specific features and seismic performance. The Kopčić House embodies a confined masonry structure with innovative construction features, combining load-bearing masonry walls with reinforced concrete elements. This architectural approach was pioneering for its time, combining traditional construction methods with innovative materials and techniques. Detailed analysis using numerical modeling techniques, specifically 3D modeling with the 3Muri software (Vers.14.2.0.4), was conducted to assess the seismic resilience of the structure. The analysis considered different load distributions and eccentricities to comprehensively evaluate the building’s response to lateral forces. The findings of this research reveal the structural capacity and potential vulnerabilities of the Kopčić House when subjected to seismic events. While the building demonstrates inherent strength due to its confined masonry design, areas requiring structural strengthening were identified through numerical simulations. This study contributes to the broader understanding of confined masonry construction within the context of modernist architecture. By integrating historical research with advanced structural analysis, this work aims to bridge the gap between architectural heritage and contemporary engineering practices.

This study aimed to develop a rapid method for separation of stigmasterol, campesterol and β-sitosterol in Prunus spinosa L. (sloe) fruit extracts by High Performance Liquid Chromatography system. Samples were prepared by Soxhlet extraction method and separated on a high strength silica C18 column using acetonitrile-methanol mobile phase and Photodiode Array Detector. The optimized method resulted in a linear calibration curve ranging from 1.7 ng mL-1 to 130 ng mL-1 for all three phytosterols. Analyses of internal and external phytosterol standards showed good linearity (R2 of 0.998 to 0.999); LOD and LOQ were determined to be 2.33×10-7-2.18×10-4 and 7.07×10-7-6.60×10-4 mg mL-1, respectively. Repeatability and reproducibility precision analyses showed acceptable values of RSD %. β-sitosterol was the predominant phytosterol (51.53-81.03 % of total) among all samples. Method validation parameters indicated that this analytical method can be applied for accurate and precise determination of campesterol, stigmasterol and β-sitosterol, in selected extracts.

Multilevel image thresholding based on the exhaustive search for the optimal thresholds is computationally expensive. To overcome this drawback this paper investigates the use of the particle swarm optimization (PSO) algorithms with time-varying acceleration coefficients in multilevel image thresholding. Specifically, two multilevel image thresholding methods based on Kapur's entropy and PSO algorithm with time-varying acceleration coefficients are considered. The two methods use different strategies to vary cognitive and social acceleration coefficients within the PSO algorithm. The considered thresholding methods are assessed on five test images. The multilevel image thresholding performance is assessed for varying numbers of thresholds. The performance of the methods under consideration is compared to that of the thresholding method based on the PSO algorithm with constant acceleration coefficients. The experimental results show that the thresholding methods based on the PSO algorithm with time-varying acceleration coefficients can be successfully used to obtain image thresholds across different test images.

The principal challenge addressed in this paper is modifying the standard particle swarm optimization algorithm to achieve improved multilevel image thresholding performance. In this paper, a multilevel image thresholding method that relies on Kapur's entropy and the improved particle swarm optimization algorithm is presented. The improved particle swarm optimization algorithm employs a particular nonlinearly decreasing inertia weight strategy and Gaussian mutation. The performance of the considered multilevel image thresholding method is assessed on five test images. The experimental results demonstrate the successful utilization of the improved particle swarm optimization algorithm for determining image thresholds across different images. This algorithm is shown to enhance the multilevel image thresholding performance over the standard particle swarm optimization algorithm.

We propose a new variant of the Adam optimizer [Kingma and Ba, 2014] called MICROADAM that specifically minimizes memory overheads, while maintaining theoretical convergence guarantees. We achieve this by compressing the gradient information before it is fed into the optimizer state, thereby reducing its memory footprint significantly. We control the resulting compression error via a novel instance of the classical error feedback mechanism from distributed optimization [Seide et al., 2014, Alistarh et al., 2018, Karimireddy et al., 2019] in which the error correction information is itself compressed to allow for practical memory gains. We prove that the resulting approach maintains theoretical convergence guarantees competitive to those of AMSGrad, while providing good practical performance. Specifically, we show that MICROADAM can be implemented efficiently on GPUs: on both million-scale (BERT) and billion-scale (LLaMA) models, MicroAdam provides practical convergence competitive to that of the uncompressed Adam baseline, with lower memory usage and similar running time. Our code is available at https://github.com/IST-DASLab/MicroAdam.

Background/Objectives: Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a “component disorder“ of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods: The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results: Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions: Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.

The expansion of the open-pit exploitation of mineral raw materials, and especially the energy resources of fossil fuels, makes open-pit coal mines spatially dominant objects of large mining basins. Exploitation activities are accompanied by negative ecological impacts on the environment, which requires the integral planning, revitalization, reclamation, and rehabilitation of the disturbed area for human use in the post-exploitation period. The post-exploitation remediation and rehabilitation of open-pit mining areas and disposal sites, i.e., space disturbed by mining activities and accompanying facilities, are complex synthetic multidisciplinary multiphase engineering project tasks. In this paper, a hybrid fuzzy MCDM model (Multiple-Criteria Decision-Making) was developed for the selection of a reclamation solution for the Tamnava-West Field open-pit mine. IMF SWARA (Improved Fuzzy Stepwise Weight Assessment Ratio Analysis) was applied to define the weights of 12 criteria of different structures used in the evaluation of reclamation solutions. The Fuzzy ROV (Range of Value) method was applied to select the reclamation solution from a total of 11 solutions previously obtained using a process approach. The results of the hybrid IMF SWARA—Fuzzy ROV model show that forestry is the best solution for the Tamnava-West Field open-pit mine. After the results had been obtained, verification analyses of the proposed model were performed and the best stable proposed reclamation solution was determined.

Background: The primary goal of this study was to investigate the relationship between body composition and motor coordination performance, and the secondary goal was to determine sex differences in body composition and motor coordination of preschool children. Methods: Forty-eight children (23 boys and 25 girls) underwent assessments for body composition and motor coordination using the Köperkoordinationstest für Kinder (KTK). Results: Linear regression analysis revealed significant associations between body composition and motor coordination in boys (p < 0.05) but not in girls. In boys, Body height (p = 0.01), Total muscle mass (p = 0.03), Total fat (p = 0.03), and Total water (p = 0.02) show statistically significant influence on single-leg jumps. Similar results were obtained for lateral jumps where there was a statistically significant influence of Body height (p = 0.01), Total muscle mass (p = 0.03), and Total water (p = 0.02). Interestingly, predictive variables showed no statistically significant influence on KTK overall score in boys (p = 0.42) nor in girls (p = 0.90). Conclusions: The predictive system of morphological variables demonstrated significance only among boys in this age group and sample. Girls outperformed boys due to early maturation, resulting in better average KTK scores.

BACKGROUND Left atrial stiffness index (LASI), defined as the ratio of early diastolic transmitral flow velocity/lateral mitral annulus myocardial velocity (E/e') to peak atrial strain, reflects reduced left atrial (LA) compliance and represents an emerging marker that can be used for noninvasive measurement of fibrosis of LA in patients with mitral regurgitation (MR). OBJECTIVE To investigate the impact of chronic MR in children and adolescents on the remodeling and function of the LA, quantified through strain parameters and diastolic function. METHODS The study included fifty patients (n= 50) diagnosed with primary and secondary chronic MR lasting at least 5 years. The echocardiographic recordings were performed by a third party, two cardiologists actively engaged in echocardiography on a daily basis. RESULTS Older participants had higher values of the LASI (r= 0.467, p= 0.001). Participants with higher LASI values had a smaller LA reservoir (r= 0.784, p= 0.0001) and smaller LA conduit values (r=-0.374, p= 0.00). Participants with higher LASI values had a larger LA diameter (r= 0.444, p-value= 0.001) and higher average E/e' ratio (r= 0.718, p= 0.0001). There was a significant difference (p= 0.04) in the LASI among participants based on the MR jet area (< 20.85 cm2/⩾ 20.85 cm2), LASI was higher in participants with an area greater than 20.85 cm2. Differences in other parameters such as LA reservoir, LA conduit, LA contractile were not statistically significant. CONCLUSION Increased LA stiffness is associated with diminished atrial compliance and reservoir capacity, and LASI has a potential to as an early marker for assessing disease severity and progression in pediatric MR.