Small cellular particles (SCPs) are being considered for their role in cell-to-cell communication. We harvested and characterized SCPs from spruce needle homogenate. SCPs were isolated by differential ultracentrifugation. They were imaged by scanning electron microscope (SEM) and cryogenic transmission electron microscope (cryo TEM), assessed for their number density and hydrodynamic diameter by interferometric light microscopy (ILM) and flow cytometry (FCM), total phenolic content (TPC) by UV-vis spectroscopy, and terpene content by gas chromatography-mass spectrometry (GC-MS). The supernatant after ultracentrifugation at 50,000× g contained bilayer-enclosed vesicles whereas in the isolate we observed small particles of other types and only a few vesicles. The number density of cell-sized particles (CSPs) (larger than 2 μm) and meso-sized particles (MSPs) (cca 400 nm–2 µm) was about four orders of magnitude lower than the number density of SCPs (sized below 500 nm). The average hydrodynamic diameter of SCPs measured in 10,029 SCPs was 161 ± 133 nm. TCP decreased considerably due to 5-day aging. Volatile terpenoid content was found in the pellet after 300× g. The above results indicate that spruce needle homogenate is a source of vesicles to be explored for potential delivery use.

Aims The aim of this study is to report the implant survival and factors associated with revision of total elbow arthroplasty (TEA) using data from the Dutch national registry. Methods All TEAs recorded in the Dutch national registry between 2014 and 2020 were included. The Kaplan-Meier method was used for survival analysis, and a logistic regression model was used to assess the factors associated with revision. Results A total of 514 TEAs were included, of which 35 were revised. The five-year implant survival was 91%. Male sex, a higher BMI, and previous surgery to the same elbow showed a statistically significant association with revision (p < 0.036). Of the 35 revised implants, ten (29%) underwent a second revision. Conclusion This study reports a five-year implant survival of TEA of 91%. Patient factors associated with revision are defined and can be used to optimize informed consent and shared decision-making. There was a high rate of secondary revisions. Cite this article: Bone Jt Open 2023;4(2):110–119.

Background: This research paper is an expression of a desire to view COVID 19 from the perspective of a spontaneous hemorrhage induced on different organ systems. Introduction of a stratified approach to the problem of hemorrhage has become an imperative in medical treatment. Aim: To determine the real figure of spontaneous hemorrhage cases in severe forms of infections caused by Covid 19.Material and methods: The research included 745 patients that suffered from severe forms of infections caused by Covid 19 who were treated in a Respiratory clinic in Tuzla University Clinical Center during 2020 and 2021. The spontaneous hemorrhage was determined on the grounds of laboratory parameters of blood counts and CRP, hemodynamic monitoring of TA and pulse, and CT imagining diagnostic technique.Results: The study presents information about the medical treatment outcome in the case of 5 patients (0,67%) who experienced spontaneous hemorrhage as a part of Covid 19 infection in relation to the total number of 745 patients who were treated during that period in the Respiratory clinic as Covid patients with severe forms of infection. Out of 5 patients who acquired spontaneous hemorrhage 3 were operated. For 4 patients the outcome was lethal. One of the female patients who was in the group of those who were not operated and who had undergone a conservative treatment has survived. In our group of analyzed patients two patients suffered from the hematoma of the front abdominal wall, two had retroperitoneal hematoma and one patient acquired hemorrhage in the abdomen and thoracic with the developing DIC.Conclusion: Relatively low percentage of cases developing spontaneous hemorrhage 5 (0, 67%) but relatively high mortality rate in the cases where it did occur, 4 out of 5 monitored patients, requires certain suggestions that are being presented in this study as to how to approach the cases of spontaneous hemorrhage in the severe forms of Covid 19 infections in more consistent manner in order to improve the outcome of the medical treatment of these cases.

Introduction: One of the most important goals in rehabilitating patients affected by stroke is re-establishing independent movement by activating as many motor patterns as possible and changing existing preexisting abnormal motor patterns Objective:  To determine recovery level with the accent on motor functions recovery in a patient affected by an ischemic stroke for the first time. The study included patients with anterior circulation syndrome, posterior circulation syndrome, and lacunar syndrome in the acute and post-acute phases of physical therapy and rehabilitation.Material and methods: We conducted a prospective study, which included a total of 90 patients with the first onset of ischemic stroke. The first group consisted of 30 patients with the  anterior circulation syndrome of; the second group of 30 patients with the posterior circulation syndrome and the third group of 30 patients with the lacunar syndrome.  At the beginning of their early rehabilitation treatment at the Clinic of Physical Medicine and Rehabilitation, the Bamford Scale was used in the initial assessment of the clinical classification of stroke. After the rehabilitation treatment and six months after the stroke, an assessment of motor functions and improvement in overall functionality was performed using a six-minute walk test.Results: The six-minute walk test in all the studied groups showed significant improvement six months after the stroke compared to testing done immediately after their rehabilitation treatment (p = 0.01 anterior circulation, p = 0.05 posterior circulation, p = 0.01 lacunar syndrome). The six-minute walk test was statistically significantly better in patients with lacunar syndrome compared to patients with posterior circulation syndrome after the rehabilitation treatment (p = 0.005) and six months after stroke; p = 0.02.Conclusion: The importance of rehabilitation in the acute and post-acute phases of patients with first ischemic stroke is evident. The six-minute walk test in all studied groups showed statistically significant improvement after six months post-stroke period compared to post-rehabilitation testing. The results were statistically significantly better in patients with lacunar syndrome compared to patients with posterior circulation syndrome after the physical treatment and the time period of six months after the stroke.

Purpose: The incidence of sexually transmitted disease (STDs) is being increased in the Mačva district. The aim of this study is to investigate differences in sexual behaviors, knowledge and attitudes related to STDs among female students of health and non-medical studies.Materials and Methods: In the cross-sectional study, an anonymous questionnaire was used specifically designed for the purpose of this investigation, among female students of health and non-medical studies.Results: A total of 394 students of health and non-medical studies (120 and 274, respectively). The majority (94.3%) had heard of STDs, and 76.6% knew STDs could be present without symptoms (90% students of health and 62% non-medical studies; p=0.000). Among the sexually-active students (81.5%), 36.3% reported having used a condom. Most of students (71.9%) were aware that using condoms for STDs prevention was important. One fifth of students of health study were tested for STDs, while the percentage of tested non-medical students was three times lower (p=0.000). Previous education and faculty type were strongly associated with knowledge level and attitudes among students. The primary and secondary school teachers were the main source of information for one-third of students (51.7% medical and 25.2% non-medical).Conclusion: There is a need to revise the existing STD education curriculum in both schools and universities and implement targeted educational measures.Key words: sexually transmitted diseases, attitudes, female students, health education, condom

Background Heart failure due to high cardiac output rarely occurs. Few cases of post-traumatic arteriovenous fistula (AVF) as a cause of high-output failure were reported in the literature. Methods Herein, we report a case of 33-year-old male who was admitted to our institution due to symptoms of heart failure. He reported a gunshot injury of the left thigh 4 months earlier, when he had been shortly hospitalized and discharged 4 days later. Since the gunshot injury he had exertional dyspnea and left leg edema, so the diagnostic procedures were performed. Results Clinical examination revealed distended neck veins, tachycardia, slightly palpable liver, left leg edema, and thrill over the left thigh. Due to high clinical suspicion, duplex ultrasonography of the left leg was performed that verified femoral AVF. Operative treatment of AVF was made with prompt resolution of symptoms. Conclusions This case wants to emphasize the importance of proper clinical examination, and duplex ultrasonography in all cases of penetrating injuries.

Objective: Dysphagia management relies on the evaluation of the temporospatial kinematic events of swallowing performed in videofluoroscopy (VF) by trained clinicians. The upper esophageal sphincter (UES) opening distension represents one of the important kinematic events that contribute to healthy swallowing. Insufficient distension of UES opening can lead to an accumulation of pharyngeal residue and subsequent aspiration which in turn can lead to adverse outcomes such as pneumonia. VF is usually used for the temporal and spatial evaluation of the UES opening; however, VF is not available in all clinical settings and may be inappropriate or undesirable for some patients. High resolution cervical auscultation (HRCA) is a noninvasive technology that uses neck-attached sensors and machine learning to characterize swallowing physiology by analyzing the swallow-induced vibrations/sounds in the anterior neck region. We investigated the ability of HRCA to noninvasively estimate the maximal distension of anterior-posterior (A-P) UES opening as accurately as the measurements performed by human judges from VF images. Methods and procedures: Trained judges performed the kinematic measurement of UES opening duration and A-P UES opening maximal distension on 434 swallows collected from 133 patients. We used a hybrid convolutional recurrent neural network supported by attention mechanisms which takes HRCA raw signals as input and estimates the value of the A-P UES opening maximal distension as output. Results: The proposed network estimated the A-P UES opening maximal distension with an absolute percentage error of 30% or less for more than 64.14% of the swallows in the dataset. Conclusion: This study provides substantial evidence for the feasibility of using HRCA to estimate one of the key spatial kinematic measurements used for dysphagia characterization and management. Clinical and Translational Impact Statement: The findings in this study have a direct impact on dysphagia diagnosis and management through providing a non-invasive and cheap way to estimate one of the most important swallowing kinematics, the UES opening distension, that contributes to safe swallowing. This study, along with other studies that utilize HRCA for swallowing kinematic analysis, paves the way for developing a widely available and easy-to-use tool for dysphagia diagnosis and management.

Metal complexes due to their antibacterial, antifungal, antitumor and antioxidant properties have been extremely studied today. A large number of metal complexes have the ability to neutralize free radicals, which most often occur as a result of metabolic processes in the body, smoking, exposure to radiation and chemical substances. Testing the antioxidant capacity of metal complexes can be tested by various methods in vitro and in vivo. This paper will present the efficiency of neutralization of free radicals by metal complexes synthesized in the past few years using different ligands, as well as the most commonly used methods for testing the antioxidant capacity of this group of compounds. 

Introduction: Thyroid dysfunction (TD) and diabetes mellitus (DM) are the two most common chronic endocrine disorders with variable prevalence among different populations. Both insulin and thyroid hormones are affected by autoimmune pathology and they do affect cellular metabolism, being a part of the metabolic syndrome. However, the correlations between T2DM and TD have not yet been sufficiently defined, followed by ambivalent results from previous studies.Objectives: The study was conducted to compare the metabolic parameters of patients with T2DM with and those without AITD so as to determine the existence of a correlation between these and hormonal parameters (TSH, FT4).Design and methods: This are documented observational case-control study that included 31 subjects with T2DM and AITD and 25 with T2DM without AITD. Sessions were conducted at the Clinic for Internal Medicine of the University Clinical Center in Tuzla. Individual metabolic parameters were analyzed, and in a broad evaluation, the values of hormonal and immune parameters were monitored and documented.Results: There were no differences in age, gender and BMI of the examined groups. There was a statistically significant difference between the values related to OS, SKT, DKT, PGN, 2h ppPG, and HbA1c. A statistically significant correlation was found between TSH and females, FT4 and BMI (rS = 0.375 pvalue = 0.045) as wellas a correlation between TSH and HbA1c (rS = 0.313 pvalue = 0.019) and TSH and 2x ppPG (rS = 0.281, pvalue = 0.036).Conclusion: The expression of metabolic control parameters is strongest in the group of patients with diabetes and AITD. Their identification as a risk factor and the detection of their subclinical signs are extremely important for the early implementation of preventive and therapeutic strategies, which could change the course of diabetic complications and significantly improve prognosis of diabetes.

Stress fractures of the femur are relativly uncommon. They can mimic other pathological entities, such as tumors, and can be the sourse of some diagnostic problems. The cause of stress fractures is often multifactorial and various modifiable and non-modifiable factors have been proposed to play a role: ethicity, high bone turnover, vitamin D insufficiency, nicotine and alcohol abuse, steroid use, low bone density, low adult weight, anorexia, or bisphosphonate therapy. Hence they might be missed in other groups of patients that present with anterior thigh pain without history of significant trauma. We report a stress fracture that mimicked tumoral process of the long bone, but patho-histological analysis revealed that it was a non-specific inflammation. Symptoms often mislead the clinicians, and because they mimic other conditions, a high index of suspicion/indication is required to uncover the true diagnosis. The importance of early detection and management needs to be conveyed, with a view to prevent complete fracture and bonedisplacement or, asin our reported case, to avoid un-necessery exploration. 

Background: More than 50% of stroke patients have sleep-disordered breathing.Aim: To determine whether the location and type of stroke affect the occurrence of sleep apnea.Patients and methods: We analyzed 110 patients with acute stroke and verified sleep apnea. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. Average age was 65.13±9.27 years and it was 59% men. Number of patients without apnea in control group was the same as well as gender distribution, with average age 64±8.69 years.Results: Apnea was verified in 22% patients. The largest number of patients with and without apnea had ischemic stroke 83.6%, while 16.4% of patients had hemorrhagic stroke. Of these, there were 86.2% men and 80% women with ischemic and 13.8% men and 20% women with hemorrhagic stroke. With apnea, the largest number had a lesion in two or more places 51.8%,as well as without apnea 45.45%, but the difference was not statistically significant. According to the acute stroke, the largest number of patients with and without apnea had lesions in the left and right hemispheres 45.4%. There was no statistically significant association between apnea and localization of stroke in the left or in both hemispheres. There is a statistically significant association of AS localization in the right hemisphere with the occurrence of apnea.Conclusion: There is a statistically significant association between the localization of stroke in the right hemisphere and the occurrence of apnea.

Multiple sclerosis (MS) is a chronic, inflammatory, (auto) immune disease of the central nervous system (CNS). The aim of the study was to determine the distribution of cognitive disorders in MS in relation to demographic parameters, degree of clinical disability and depression. The prospective study included 135 subjects with MS in the Clinic of Neurology of the University Clinical Center in Tuzla. The first group consisted of women (101 respondents) and the second of men (34 respondents). Clinical assessment instruments were: Expanded Disability Status Scale Score, Mini Mental Status, Beck Depression Scale, Battery of Cognitive Function Assessment Tests: Wechsler Intelligence Scale, Revised Beta Test, Raven Coloured Progressive Matrix, Wechsler Memory Verification Scale, Audio Memory Test learning, Rey-Osterriecht complex character test, verbal fluency test. There were no significant differences between the mentioned groups in age, level of education, duration of the disease, severity of disease symptoms or in the prevalence of certain forms of MS. Cognitive disorders are present in 40-60 % of subjects with MS. Visuospatial, visuoconstructive, visuoperceptive functions, mnestic functions were most affected in both groups of respondents. There was no difference in the level of depression in relation to sex. Poor results of cognitive parameters in 32.7 % can be considered the cause of high scores of EDSS in female patients and in 29.2 % in patients, which is not statistically significant. The correlation between depression and EDSS is positive but not statistically significant in both sexes. Cognitive disorders are heterogeneous regardless of sex. Cognitive impairment in MS patients is related to impairment of working ability and memory, executive functions and attention. Subjects with a more severe degree of clinical disability had poorer cognitive functions.

Background Bosnia and Herzegovina (BiH) and Serbia are countries in the Western Balkans that share parts of their social and political legacy from the former Yugoslavia, such as their health care system and the fact that they are not members of European Union. There are very scarce data on COVID – 19 pandemic from this region when compared to other parts of the world and even less is known about its impact on the provision of renal care or differences between countries in the Western Balkans. Materials and methods This observational prospective study was conducted in two regional renal centres in BiH and Serbia, during the COVID – 19 pandemic. We obtained demographic and epidemiological data, clinical course and outcomes of dialysis and transplant patients with COVID – 19 in both units. Data were collected a via questionnaire for two consecutive time periods: February – June 2020 with a total number of 767 dialysis and transplant patients in the two centres, and July – December 2020 with a total number of 749 studied patients, corresponding to two of the largest waves of the pandemic in our region. Departmental policies and infection control measures in both units were also recorded and compared. Results For a period of 11 months, from February to December 2020, 82 patients on in-centre haemodialysis (ICHD), 11 peritoneal dialysis patients and 25 transplant patients who tested positive for COVID-19. In the first study period, the incidence of COVID – 19 positive in Tuzla was 1.3% among ICHD patients, and there were no positive peritoneal dialysis patients, or any transplant patients who tested positive. The incidence of COVID-19 was significantly higher in both centres in the second time period, which corresponds to the incidence in general population. Total deaths of COVID-19 positive patients was 0% in Tuzla and 45.5% in Niš during first, and 16.7% in Tuzla and 23.4% in Niš during the second period. There were notable differences in the national and local/departmental approach to the pandemic between the two centres. Conclusion There was poor survival overall when compared to other regions of Europe. We suggest that this reflects the lack of preparedness of both of our medical systems for such situations. In addition, we describe important differences in outcome between the two centres. We emphasize the importance of preventative measures and infection control and highlight the importance of preparedness.

Domain-specific languages (DSLs) are able to provide intuitive high-level abstractions that are easy to work with while attaining better performance than general-purpose languages. Yet, implementing new DSLs is a burdensome task. As a result, new DSLs are usually embedded in general-purpose languages. While low-level languages like C or C++ often provide better performance as a host than high-level languages like Python, high-level languages are becoming more prevalent in many domains due to their ease and flexibility. Here, we present Codon, a domain-extensible compiler and DSL framework for high-performance DSLs with Python's syntax and semantics. Codon builds on previous work on ahead-of-time type checking and compilation of Python programs and leverages a novel intermediate representation to easily incorporate domain-specific optimizations and analyses. We showcase and evaluate several compiler extensions and DSLs for Codon targeting various domains, including bioinformatics, secure multi-party computation, block-based data compression and parallel programming, showing that Codon DSLs can provide benefits of familiar high-level languages and achieve performance typically only seen with low-level languages, thus bridging the gap between performance and usability.