Introduction: The most common mental disorders in the elderly are depression and dementia. Objective: Examine the impact of sociodemographic characteristics on the appearance of depression and dementia in elder patients treated in Primary Health Center (PHC), Banja Luka. Method: The study included 208 patients over 65 years of age, selected by random selection method, registered in 6 family medicine teams at the PHC Banja Luka in the period from March to May 2016. Respondents completed the Sociodemographic Questionnaire, Beck’s Depression Inventory, and Folstein Mini-Mental State Examination (MMSE) for dementia assessment. Different statistical procedures were used in the data processing: descriptive analysis in the form of frequencies and percentages, Chi-square test, T-test. The results of the research were statistically analyzed by SPSS 11.5 program. Results: The study included 208 patients older than 65, of whom 38.9% were male. Impaired cognition was found in 7.2% and moderate depression in 24.5% of patients. Dementia was statistically significantly (p = 0.000) more present in the eldest respondents ≥ 81 years, while depression was mostly present in patients aged 76-80. Physically active individuals were significantly less affected by depression (p = 0.001) and dementia (p = 0.000). Dementia and depression occurred more frequently in people living alone and people with a low level of education. Conclusion: A family physician plays an important role in the early detection of depression and dementia in the elderly, the identification of risk factors, prevention, and treatment of these patients.

Summary Intra-tumor heterogeneity (ITH) is a mechanism of therapeutic resistance and therefore an important clinical challenge. However, the extent, origin, and drivers of ITH across cancer types are poorly understood. To address this, we extensively characterize ITH across whole-genome sequences of 2,658 cancer samples spanning 38 cancer types. Nearly all informative samples (95.1%) contain evidence of distinct subclonal expansions with frequent branching relationships between subclones. We observe positive selection of subclonal driver mutations across most cancer types and identify cancer type-specific subclonal patterns of driver gene mutations, fusions, structural variants, and copy number alterations as well as dynamic changes in mutational processes between subclonal expansions. Our results underline the importance of ITH and its drivers in tumor evolution and provide a pan-cancer resource of comprehensively annotated subclonal events from whole-genome sequencing data.

During the last few years, we have witnessed more frequent floods affecting the northeastern part of Bosnia and Herzegovina, the valley of the Spreca River. Flooded soil has undergone various changes, in terms of numerous deficiencies and heavy metal contamination, where such soil represents a great danger both for people and animals. Therefore, in this paper the physicochemical analysis of soil and degree of pollution is determined. The aim of soil sampling and analysis is to determine its status after water withdrawal, in terms of nutrient supply, and to determine possible chemical pollution. Based on the results obtained, agricultural producers will receive recommendations regarding restoration of production on these areas, the choice of cultivated culture, corrective measures or remediation of these areas. As part of the analysis, hygroscopic moisture, acid-base soil status, oxidoreduction potential, organic matter content, carbonate content and heavy metals content were determined. Based on the performed analyzes, the soil was shown to be of neutral character (determined in 1M KCl), and weakly alkaline (determined in distilled H2O) with predominantly reducing condition prevailing in the soil. The conducted analyzes have shown that the soil is very poor in humus, and that the heavy metals content is within the limit values determined by the Rulebook on Determination of Allowed Quantities of Harmful and Dangerous Substances in Soil and Method of Testing there of (“Official Gazette of Federation of Bosnia and Herzegovina”, number 52/09). Therefore, from the aspect of the pollution degree, the soil from this plot belongs to the first class when it comes to iron, manganese, cadmium and lead, to the second class when it comes to zinc, and the third class when it comes to copper.

8548Background: Castleman disease (CD) describes a group of lymphoproliferative disorders that share characteristic histopathology. Unicentric CD (UCD) and idiopathic multicentric CD (iMCD) are dif...

e19291 Background: Invasive lobular carcinoma (ILC), the second most common histological breast cancer type, comprises 10-15% of breast tumors. Although ILC is thought to have a low risk of relapse, patient survival data vary. ILC treatment guidelines mirror those for invasive ductal carcinoma (IDC); however, these were extrapolated from trials that included predominantly IDC. The FLEX Registry captures data from real-world breast cancer patients; the current sub-study evaluated molecular profiles and treatment recommendations in ILC. Methods: The FLEX Registry (NCT03053193) includes stage I-III primary invasive breast cancer patients who receive 70-gene signature (70-GS)/80-gene signature (80-GS) testing and consent to full transcriptome and clinical data collection. This sub-analysis includes 335 ILC patients and 2,179 IDC patients enrolled from 2017 to present. 70-GS stratified tumors by risk of distant metastasis [High (HR), Low (LR), Ultralow (UL) Risk], and 80-GS classified tumors by molecular subtype (Luminal, HER2, or Basal type). Genomic and clinical data were compared for ILC and IDC using chi-square or Fisher’s exact test. Results: ILC represented 13% of FLEX cases (n = 335/2752); 81% were lymph node-negative, 99% ER-positive, and 94% HER2-negative. Clinical risk assessment (MINDACT criteria) classified 61% of ILC and 53% of IDC as low risk (p = 0.03). 70-GS risk distribution in ILC (18% UL, 51% LR, 31% HR) differed from IDC (13% UL, 34% LR, 53% HR; p < 0.01). Discordance between 70-GS and clinical risk was greater in ILC (43%) than IDC (30%, p < 0.01). 80-GS results also differed between ILC (98% Luminal, 1.6% HER2, 0.3% Basal) and IDC (85% Luminal, 3% HER2, 11% Basal; p < 0.01). Inclusion of chemotherapy (CT) in treatment plans was associated with 70-GS risk (p < 0.01); treatment plans that disagreed with 70-GS results were associated with discordant clinical risk (p < 0.05). Treatment plans disagreed with 70-GS in 15% of ILC and 12% of IDC total cases (p = 0.08), and more frequently in HR cases (25% in ILC, 14% in IDC; p < 0.01). Conclusions: The FLEX Registry includes patients with ILC consistent with real-world breast cancer frequencies. ILC demonstrated genomic risk and subtype profiles distinct from IDC. Treatment plans largely agreed with 70-GS results; however, discordance was more frequent in HR ILC than IDC. Future studies will evaluate clinical outcomes; however, these results demonstrate the added value of molecular profiling in ILC and the utility of real-world registry data in evaluating uncommon breast tumor types. Clinical trial information: NCT03053193 .

Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard procedure for the treatment of bile duct stones, and most stones are successfully removed with accessories such as biliary baskets or extraction balloons. Impaction of a biliary basket is not an uncommon complication of this procedure, being reported in 0.8%–5.9% of cases. Mechanical lithotripsy usually solves the problem by crushing the stone, followed by extraction of the stone fragments. However, on rare occasions, fracture of the basket occurs during mechanical lithotripsy, and this can pose a special management problem, depending on where the breakage occurs [1–3]. We report the successful management of an impacted biliary basket after breakage of the basket handle cord during extra-endoscopic mechanical lithotripsy. A 35-year-old man, who had undergone early laparoscopic cholecystectomy in a small regional hospital 1 month before, presented with jaundice and upper right quadrant pain on admission. Laboratory tests revealed obstructive jaundice with raised γ-glutamyl transpeptidase (γGT) and alkaline phosphatase (ALP) and a total bilirubin concentration of 11.11mg/ dL. Apart from a mildly dilated common bile duct (CBD) with stones, computed tomography of the abdomen revealed no E-Videos

Globally, the discipline of neurosurgery has evolved remarkably fast. Despite being one of the latest medical specialties, which appeared only around hundred years ago, it has witnessed innovations in the aspects of diagnostics methods, macro and micro surgical techniques, and treatment modalities. Unfortunately, this development is not evenly distributed between developed and developing countries. The same is the case with neurosurgical education and training, which developed from only traditional apprentice programs in the past to more structured, competence-based programs with various teaching methods being utilized, in recent times. A similar gap can be observed between developed and developing counties when it comes to neurosurgical education. Fortunately, most of the scholars working in this field do understand the coherent relationship between neurosurgical education and neurosurgical practice. In context to this understanding, a symposium was organized during the World Federation of Neurological Surgeons (WFNS) Special World Congress Beijing 2019. This symposium was the brain child of Prof. Yoko Kato—one of the eminent leaders in neurosurgery and an inspiration for female neurosurgeons. Invited speakers from different continents presented the stages of development of neurosurgical education in their respective countries. This paper summarizes the outcome of these presentations, with particular emphasis on and the challenges faced by developing countries in terms of neurosurgical education and strategies to cope with these challenges.

The paper proposes a novel framework for registering and segmenting 3D point clouds of large-scale natural terrain and complex environments coming from a multisensor heterogeneous robotics system, consisting of unmanned aerial and ground vehicles. This framework involves data acquisition and pre-processing, 3D heterogeneous registration and integrated multi-sensor based segmentation modules. The first module provides robust and accurate homogeneous registrations of 3D environmental models based on sensors’ measurements acquired from the ground (UGV) and aerial (UAV) robots. For 3D UGV registration, we proposed a novel local minima escape ICP (LME-ICP) method, which is based on the well known iterative closest point (ICP) algorithm extending it by the introduction of our local minima estimation and local minima escape mechanisms. It did not require any prior known pose estimation information acquired from sensing systems like odometry, global positioning system (GPS), or inertial measurement units (IMU). The 3D UAV registration has been performed using the Structure from Motion (SfM) approach. In order to improve and speed up the process of outliers removal for large-scale outdoor environments, we introduced the Fast Cluster Statistical Outlier Removal (FCSOR) method. This method was used to filter out the noise and to downsample the input data, which will spare computational and memory resources for further processing steps. Then, we co-registered a point cloud acquired from a laser ranger (UGV) and a point cloud generated from images (UAV) generated by the SfM method. The 3D heterogeneous module consists of a semi-automated 3D scan registration system, developed with the aim to overcome the shortcomings of the existing fully automated 3D registration approaches. This semi-automated registration system is based on the novel Scale Invariant Registration Method (SIRM). The SIRM provides the initial scaling between two heterogenous point clouds and provides an adaptive mechanism for tuning the mean scale, based on the difference between two consecutive estimated point clouds’ alignment error values. Once aligned, the resulting homogeneous ground-aerial point cloud is further processed by a segmentation module. For this purpose, we have proposed a system for integrated multi-sensor based segmentation of 3D point clouds. This system followed a two steps sequence: ground-object segmentation and color-based region-growing segmentation. The experimental validation of the proposed 3D heterogeneous registration and integrated segmentation framework was performed on large-scale datasets representing unstructured outdoor environments, demonstrating the potential and benefits of the proposed semi-automated 3D registration system in real-world environments.