BACKGROUND Severe atherosclerotic internal carotid artery stenosis may progress to complete internal carotid artery occlusion (ICAO). Therefore, ICAO represents an advanced form of carotid artery disease. We sought to investigate the association between ICAO with atherosclerotic disease in other arterial beds and vascular risk factors and to identify the patient implications of the diagnosis of ICAO. MATERIALS AND METHODS Using the term "Internal carotid artery occlusion", a search of PubMed/MEDLINE, Scopus and Embase between 1980 and 2025 revealed 10,588 results. After exclusion of case reports, letters to the Editor and Editorials, 5,771 reports were identified. Following meticulous screening of the identified reports, 28 studies specifically addressing ICAO patient cohorts were included in the final analysis. A quantitative and qualitative synthesis analysis was performed. A questionnaire was subsequently developed and sent out to 63 participants from the United States (n=21) and several European countries (n=42), aiming to achieve consensus regarding the optimal management of patients with ICAO. Three participants did not respond. The Consensus Coordinator abstained from voting to avoid introducing bias, resulting in a final voting panel of 60 participants. RESULTS Across included studies, the proportion of patients with ICAO presenting with neurologic symptoms varied widely, ranging from 38-100%, while approximately 24-27% of patients were asymptomatic at the time of diagnosis. Consensus (≥75%) was achieved in 11 of the 17 (64.7%) pre-specified statements. Most participants agreed that atherosclerotic ICAO represents a systemic manifestation of advanced atherosclerosis rather than isolated cerebrovascular pathology (56/60; 93.3%). Duplex ultrasound should be used as the first-line diagnostic tool for suspected ICAO, with CTA or MRA confirmation if necessary (59/60; 98.3%). Optimal medical therapy (including antiplatelet, antihypertensives, statins, and glycemic control) remains the cornerstone of ICAO management (59/60; 98.3%). Lifestyle and metabolic risk factor optimization, smoking cessation, optimizing body weight, a healthy diet and exercise, should be strongly advised in all ICAO patients (60/60; 100%). Most participants concurred that ICAO revascularization should be centralized in specialized vascular-neuro centers equipped for intra-operative neuromonitoring and advanced hemodynamic control (57/60; 95.0%). Finally, most participants agreed that current evidence for ICAO intervention is insufficient and that a global registry should be created to record outcomes and guide future trials (56/60; 93.3%). CONCLUSIONS This international, multi-specialty consensus highlights ICAO as a marker of advanced, systemic atherosclerosis. Management should emphasize comprehensive evaluation for multisystem vascular disease and aggressive modification of cardiovascular risk factors. Best medical therapy remains the cornerstone of the management of patients with ICAO, with conservative or invasive interventions considered selectively based on symptom status, anatomic considerations, procedural risk, and institutional expertise, to reduce the overall cardiovascular disease burden.

BACKGROUND Developing countries face limited access to targeted treatments for patients with advanced epithelial ovarian cancer (EOC). The CA-125 ELIMination rate constant K (KELIM), calculated from longitudinal CA-125 measurements during the first 100 days of treatment, serves as an early indicator of tumour chemosensitivity. The primary objective of this study was to evaluate the value of the KELIM score in predicting progression-free survival (PFS) and overall survival (OS) in patients with EOC treated with adjuvant or neoadjuvant chemotherapy. METHODS The records of patients with EOC (International Federation of Gynecology and Obstetrics stage II-IV) treated at the University Clinical Hospital Mostar (Bosnia and Herzegovina) between 2013 and 2023 were analysed retrospectively. Patient characteristics, outcomes and KELIM score were assessed during the first 100 days of treatment. KELIM scores were categorized as favourable (≥1.0) or unfavourable (<1.0). RESULTS KELIM scores were assessed in 92 patients: 36 (39 %) were classified in the favourable group and 56 (61 %) in the unfavourable group. Patients in the favourable KELIM group achieved complete cytoreduction significantly more often (p < 0.001) and demonstrated longer platinum-free intervals (PFI), with most having PFI > 12 months (p = 0.005). In contrast to OS (p = 0.442), PFS was significantly longer in the favourable KELIM group [29.0 months, 95 % confidence interval (CI) 8.45-49.55] compared with the unfavourable KELIM group (13.0 months, 95 % CI 10.56-15.44; p < 0.001). CONCLUSION In this real-world cohort from a resource-limited setting, a favourable KELIM score was associated with greater early chemosensitivity, longer PFI, improved PFS, and a higher rate of complete cytoreduction in patients with EOC. The KELIM score has been validated in real-world settings and post-hoc analyses of prospective studies, and can be applied easily in routine clinical practice for patients with EOC treated with adjuvant or neoadjuvant chemotherapy, providing a useful prognostic, predictive, pragmatic and cost-effective tool to support risk stratification and inform therapeutic decision-making. Further prospective validation is still required for biomarker-guided treatment selection.

Introduction First onset of mania in older adults is unusual, and not often mentioned in literature. Studies suggest that new-onset mania in older adults is most commonly secondary due to pharmacological, metabolic or neurologic causes. Objectives Present the case report of a 70-year-old patient with an acute manic episode without previous health issues. Methods Psychiatric interview, laboratory tests, neuroradiological, microbiological and immunological examinations. Results A 70-year-old patient was admitted to a psychiatric hospital for treatment due to altered behavior accompanied by agitation, thought process disorder, presence of paranoid delusions and increased sexual urges. The family provides information that the symptoms have lasted for about a year, but were intense 10 days before admission. In the first days of hospitalization, in addition to psychotic symptoms, strong affective irritability to the level of affective incontinence was noted, which led us to suspect the development of brain damage in the frontotemporal lobe. Information was obtained from family members that the patient had never previously had mental difficulties or been treated by a psychiatrist or other specialists. So far, he has been mostly healthy. Diagnostic tests were performed. Brain CT is completely normal. Laboratory findings show significantly elevated eosinophil values. The patient told us that approximately 8 months ago he ate pork that was not sufficiently heat-treated. An infectious disease specialist was consulted. Microbiological tests for trichinosis, leptospirosis, borreliosis, brucellosis and Q-fever were performed, as well as a series of immunological tests, of which IgE was elevated up to 160. All other tests were negative, except for elevated IgM antibodies to leptospirosis. Further infectious treatment is ongoing. The patient was treated with a mood stabilizer and antipsychotic in lower doses, which resulted in the cessation of psychomotor restlessness, reduction in delusional content and stabilization of affect. A double diagnosis of mania with psychotic symptoms and leptospirosis was made. Conclusions Although rare, first episodes of mania with or without psychotic symptoms also occur in the elderly population and are most often secondary, therefore a detailed diagnostic work-up and careful titration of psychopharmacotherapy is required. Disclosure of Interest None Declared

Electrolysis stacks often exhibit suboptimal performance under constant dc power due to effects such as gas bubbles, making pulsed electrolysis a promising strategy for improving efficiency. However, additional electronic components are required to generate pulsed power, adding cost to the system. Therefore, the cost effectiveness of pulsed electrolysis relative to performance needs to be evaluated to justify the costs. Accordingly, this study presents a techno-economic analysis supported by a case study based on a simple pulsed power topology for large-scale systems. The analysis shows that, in our case study, a modest efficiency gain of 0.8% is enough to justify the additional cost, which is significantly lower than the efficiency enhancement (> 20%) reported in literature. Hence, pulsed electrolysis can be considered a viable solution for enhancing performance of large-scale electrolysis systems.

<p>The paper investigates students&rsquo; perceptions and attitudes toward extracurricular activities (ECAs) organized by the English Language and Literature Department at the University of Zenica (UNZE). While ECAs are widely acknowledged for their pedagogical value, their role in higher education contexts within Bosnia and Herzegovina remains heavily underexplored. In that sense, the study aim was to assess the perceived effect of ECAs, such as quizzes, conferences, and competitions, on students&rsquo; interpersonal, social, and speaking skills, motivation, as well as the practical application of their academic knowledge. Data for this quantitative study was collected through an online questionnaire containing Likert-scale and multiple-choice items, while the respondents included undergraduate students across all four study years. Responses reveal that a majority of students view ECAs positively and show high levels of motivation and willingness to participate in the said activities. In addition, most students recognize that participation in ECAs has enhanced their interpersonal and social skills while many also note improvements in their English speaking skills and increased motivation levels. Hence, study results contribute to discussions on learners&rsquo; motivation in higher education contexts and offer insights that may inform future institutional strategies concerning the general students&rsquo; engagement.</p>

<p>Masovna upotreba generativne vje&scaron;tačke inteligencije u obrazovanju softverskog inženjerstva zahtijeva pristup koji istovremeno omogućava iskori&scaron;tavanje prednosti alata i sprječava prekomjerno oslanjanje studenata na automatizirana rje&scaron;enja. U ovom radu kombinujemo anketno istraživanje provedeno među studentima (N = 79) i hibridni fuzzy&ndash;genetski (GA) model odlučivanja koji kvantificira potrebu za pedago&scaron;kom intervencijom kao funkciju učestalosti upotrebe i percipiranog rizika. Neparametrijska analiza ukazuje na statistički značajne razlike u odnosu na karijerne orijentacije (H = 14,192; p = 0,028) i obrasce učestalosti kori&scaron;tenja, pri čemu intenzivniji korisnici primjenjuju alate u &scaron;irem spektru aktivnosti (učenje programskih jezika, generisanje rje&scaron;enja i razvoj prototipova). Fuzzy sistem zasnovan na devet pravila i<br />trapeznim/trougaonim funkcijama pripadnosti defuzificira izlaz na skali 0&ndash;10 (&bdquo;nisko&ldquo; do &bdquo;urgentno&ldquo;), dok genetski algoritam (GA) optimizira granice funkcija pripadnosti i pragove odlučivanja. Optimizirani model ostvaruje nisku prosječnu gre&scaron;ku predikcije i konzistentno identificira scenarije &bdquo;visoka izloženost + (umjeren ili visok) rizik&ldquo; kao prioritete za intervenciju,<br />čime podržava AI-obogaćeni PBL pristup u kojem veliki jezički modeli preuzimaju rutinske zadatke, a studenti zadržavaju fokus na validaciji, evaluaciji i dizajnu rje&scaron;enja. Rezultati daju jasnu empirijsku i matematičku osnovu za plansku i kontrolisanu integraciju vje&scaron;tačke inteligencije u nastavni plan i program, te nagla&scaron;avaju potrebu sistematskog, dugoročnog praćenja efekata primjene kroz vi&scaron;e predmeta i različite obrazovne institucije.</p>

<p>University language centres (ULCs) are often positioned as auxiliary service units responsible for foreign language instruction and proficiency testing. Yet, intensified internationalisation, the spread of English-medium instruction (EMI), and rising expectations for academic staff to teach and publish in English have expanded their role to staff development, language policy implementation, and research-quality support. Building on language policy theory, the multicompetence<br />perspective, and recent scholarship on EMI and university language centres, this review synthesises key strands of research and policy and proposes a conceptual framework that repositions ULCs as strategic institutional infrastructures. Evidence is drawn from peer-reviewed studies, cross-sector policy reports on institutional language policy in European higher education,<br />and illustrative institutional policies and organisational models. The analysis highlights five interlinked domains of ULC contribution: (1) internationalisation at home and campus multilingualism; (2) learner and staff language development for EMI; (3) assessment, certification, and quality assurance; (4) academic literacy and research communication; and (5)<br />language-policy mediation and governance. Persistent tensions between Englishisation and multilingual commitments, uneven governance visibility, and resourcing constraints remain key challenges. The paper concludes with propositions and a framework that can guide universities in integrating language centres into institutional strategy and quality assurance.</p>

<p>This study investigates the usage patterns, attitudes, and perceived effectiveness of mobile devices for learning English as a Foreign Language (EFL) among secondary school students in a traditional religious educational context in Bosnia and Herzegovina. Data were collected through a structured questionnaire administered to 323 students at Elči Ibrahim-pa&scaron;ina Madrasa in Travnik, measuring efficiency, engagement, motivation, and accessibility. The data were analyzed using descriptive statistics, independent samples t-tests, and Spearman&rsquo;s rank correlation. The findings indicate predominantly positive attitudes toward Mobile-Assisted Language Learning (MALL), with high levels of autonomous learning both within and beyond the classroom. Notably, general mobile use for entertainment showed no significant negative relationship with perceived educational value. The results suggest that students perceive mobile learning as a motivating and personalized supplement to traditional instruction. The study highlights strong readiness for MALL integration, while emphasizing the need for improved institutional infrastructure, particularly reliable internet access.</p>

Understanding students’ environmental values and behaviors is important for fostering sustainable practices through education. In this study, we investigated the measurement properties and structural relationships of the Students Value Environmental Preservation and Environmentally Responsible Behaviors scales from Trends in International Mathematics and Science Study (TIMSS) 2023 within the Norwegian context, using data from students in Grades 5 and 9. Confirmatory factor analysis (CFA) supported the hypothesized factor structure of both scales, indicating good reliability and validity. Multigroup CFA established partial measurement invariance across genders and showed that girls score significantly higher on environmental values and environmentally responsible behaviors than boys, with the gender gap more pronounced in Grade 9. In a series of structural equation models, we demonstrated that environmental values are a strong, consistent predictor of environmentally responsible behaviors across grades and gender. In contrast, science achievement showed weak or negative associations with responsible behaviors, particularly for Grade 9 boys, suggesting that academic success in science does not necessarily translate into pro-environmental behaviors. These findings highlight the importance of cultivating environmental values as a foundation for responsible behaviors and underscore the need for gender-responsive science education that connects values with real-world applications.

Background/objectives: Aneurysmal subarachnoid hemorrhage (aSAH) is a neurosurgical emergency associated with cerebral vasospasm, representing an important complication. This study assessed the association between cerebrospinal fluid (CSF) interleukin-6 (IL-6) levels and cerebral vasospasm after aSAH. Methods: This prospective single-center observational study with repeated measurements included 56 patients among 74 screened patients with aSAH; 18 patients were excluded according to predefined exclusion criteria, including infection, unavailable CSF samples or requirement for CSF diversion within the first seven days of onset. The samples were obtained via lumbar puncture on post-hemorrhage days 3 and 7. IL-6 was quantified using an electrochemiluminescent immunoassay. Radiological vasospasm (RV) was assessed by computed tomography angiography, while clinical vasospasm (CCV) was defined as new neurological deterioration unexplained by other causes. Results: Median IL-6 levels were 423.5 pg/mL on day 3 and 726.0 pg/mL on day 7. Day 7 IL-6 levels were associated with RV (p = 0.045) and CCV (p = 0.010), while day 3 IL-6 was associated with CCV only (p = 0.035). Day 7 IL-6 showed modest discriminatory performance for CCV: AUC = 0.722, cut-off 460 pg/mL, sensitivity 75.0%, and specificity 68.8%; for RV: AUC = 0.659, cut-off 451 pg/mL, sensitivity 81.8%, and specificity 56.5%. Conclusions: Elevated CSF IL-6 levels were associated with cerebral vasospasm after aSAH, with a more consistent association observed for CCV than for RV; however, these findings are hypothesis-generating and require validation before clinical applicability can be determined.

Spinal injuries represent a significant public health concern, causing severe impairments in bodily functions, including disrupted postural control and the loss of the ability to maintain an upright position. These functional difficulties substantially affect patients' quality of life and their engagement in daily activities. Traditional rehabilitation approaches often demonstrate limited effectiveness in achieving functional recovery. Consequently, recent years have witnessed rapid advancements in technological innovations within the rehabilitation process for spinal injuries. The integration of robotic systems, wearable technologies, and neurostimulation, presents new opportunities for improved therapeutic outcomes. These innovations not only enhance the precision of therapy but also enable personalized approaches tailored to the specific needs of each patient. Particular emphasis is placed on technological advancements that facilitate verticalization and improve postural control, as these functions are crucial for maintaining balance and participating in everyday activities. This paper aims to present and analyze some of the technological innovations in the rehabilitation of individuals with spinal injuries, with a particular focus on verticalization and postural control. Future research should concentrate on optimizing technological solutions, developing personalized therapeutic approaches, and ensuring accessibility to maximize functional benefits for individuals with spinal injuries. Keywords: technological innovations, verticalization, postural control, spinal cord injury

Per- and polyfluoroalkyl substances (PFAS) are highly persistent environmental pollutants that bioaccumulate in living organisms and are increasingly implicated in metabolic dysfunction-associated steatotic liver disease (MASLD). Mitochondria, as central regulators of energy and lipid metabolism, represent key subcellular targets of PFAS toxicity. While emerging studies have examined PFAS-induced mitochondrial dysfunction using whole-cell analyses, studies focusing on mitochondria-enriched cellular fractions and their functional alterations under steatotic conditions, despite their clinical significance, remain limited. Here, we analyzed mitochondria-enriched cellular fractions and the extracellular secretome from human HepaRG hepatocytes exposed to a PFAS mixture under both steatotic and non-steatotic conditions by using liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS). The PFAS mixture composition and concentrations reflected those commonly reported in human epidemiological data. We observed PFAS- and steatosis-driven effects on metabolism, including lipid buildup in mitochondria-rich fractions due to mitochondrial-lipid droplet contact, disturbances in cardiolipin levels, and increased extracellular abundance of acylcarnitines. Notably, PFAS-induced impact on mitochondrial metabolism was exacerbated in steatotic hepatocytes. Pathway analysis identified disturbances in lipid metabolism and inflammation-related pathways, including leukotriene metabolism, squalene and cholesterol biosynthesis, highlighting a shared metabolic signature across the PFAS-steatosis axis. Functional mitochondrial assays further showed that PFAS exposure suppressed respiratory capacity under both conditions, whereas steatosis alone increased basal mitochondrial activity but nearly abolished spare respiratory capacity. Together, these findings indicate that steatosis is associated with greater PFAS-related alterations in mitochondrial respiration and metabolic composition within the mitochondria-enriched fraction, supporting heightened susceptibility of steatotic hepatocytes to acute PFAS exposure.