Aim To investigate the usage of chest computed tomography (CT) scan score for improvement in diagnostic and treatment efficacy of repetitive pleural effusion. Methods CT scan scoring system was used as a part of diagnostic procedures in patients with repetitive pleural effusion. Patients with at least two pleurocentesis were included in the study. Chest and abdominal ultrasound, chest x-ray, bronchoscopy, biochemical, microbiological and cytological analysis of pleural fluid specimen were performed for all patients. Results In a two-year period (during 2017-2018) 79 patients were analysed, 27 (34.17%) female and 52 (65.82%) male patients. Malignant pleural diseases were confirmed in 32 cases (40.5%), nonmalignant pleural effusions in 38 (48.1 %) cases, and nine (11.4%) patients rested without exact cause of pleural effusion after two pleurocenteses. Binary regression model showed odds ratio of 1.314; CI 95% 1.119-1.543) (p=0.00088). Confirmed malignancies with pleural effusion were in high correlation with the number of points in CT scan score. Conclusion CT scan scoring system was helpful for diagnostic and treatment decision making in patients with repetitive pleural effusion.

Background: Measurements of electrode impedance values are routinely performed after cochlear implantation. The primary objective of the study was to determine if pediatric, prelingually deafened patients with different postoperative performances showed significantly different impedance values one year after implantation. Methods: This study comprised 42 pediatric cochlear implant recipients provided with the device in a single academic tertiary referral center between 1 January 2000, and 31 December 2016. Medical chart analysis was performed in order to assess evolution of impedance values during the first postoperative year on a monthly basis. Electrode impedance values measurements one year postoperatively were compared between children with successful and unsuccessful auditory and language skills development assessed using the EARS protocol (a name of a performance test). Furthermore, values were compared among recipients of different implant types and among different cochlear segments. Results: A gradual rise of average impedance values was found during the first months of implant use (1st month, 7.32 kΩ; 3rd month, 7.86 kΩ) with the peak at the 4th postoperative month (7.96 kΩ), followed by a gradual decrease towards the 12th month (6th month, 7.62 kΩ; 12th month, 6.86 kΩ). Lower values at the 12th postoperative month were observed in recipients with successful development compared to patients presented with unsuccessful development (6.22 kΩ vs. 7.82 kΩ; p = 0.001). Mean impedance values were different when compared among cochlear segments and among different implant types. Conclusion: High electrode impedance values one year after implantation in pediatric patients may imply insufficient auditory and language skills development. Further studies are needed in order to validate our results.

Introduction: Tumors of Fallopian tubes are rare in general, and they are the rarest tumors of female genital tract. According to clasification of World health organisation (WHO), papillomas, cystadenoma, adenofibroma, cystadenofibroma (CAF), metaplastic papillary tumors and endometrioid polyps belong to group of benign tumors. Serous papillary cystadenofibroma (SPCAF) is rare tumor and it is ususally located on fimbrial end of the tube and it is considered that it has „Müllerian“ origin. Aim: The aim of this article is to show a rare case of cystadenofibroma of Fallopian tube which was found as random sample during histopathological analysis of specimen which was extracted during laparatomy due to the large tumor mass in abdomen. Case report: A 43-year-old patient underwent surgery for a large tumor mass in the abdomen, unknown lesions and pathohistology, which was radiologically verified four years before hospitalization. We removed the specimen that made up the tumor, along with the uterus and adnexes, weighing 14 kg and sent for histopatology. A large tumor mass is made up of a giant uterine myoma, and in the analysis of the other preparation, in addition to endometrial adenocarcinoma, there is also a rare Fallopian tube cystadenofibroma. On the sixth day of hospitalization, the patient is discharged home. At control after three months, the patient was without problems, with ongoing adjuvant brachytherapy. Conclusion: Improvement of prevention measures and work on the continuing education of patients and physicians at the primary care level are needed to ensure that patients receive the best treatment in a timely manner. Cystadenofibroma is a rare tumor in general and gynecologic oncology, and as authors it is a great honor for us to contribute to the world literature and to present the twentieth case of this tumor.

Abstract Multi-criteria decision-making (MCDM) methods are very useful tools for daily decision-making in different fields. In addition, determining an acceptable solution with respect to different factors is certainly a very demanding and difficult task. In this paper, a new Measurement of Alternatives and Ranking according to COmpromise Solution (MARCOS) method for a sustainable supplier selection in the healthcare industry (in a polyclinic) in Bosnia and Herzegovina is developed. The advantages of the developed method are: the consideration of an anti-ideal and ideal solution at the very beginning of the formation of an initial matrix, closer determination of utility degree in relation to both solutions, the proposal of a new way to determine utility functions and their aggregation, the possibility to consider a large set of criteria and alternatives while maintaining the stability of the method. Supplier selection is very important for organizations in the medical industry. Sustainability in the supplier selection process in the medical industry is a strategically important issue, and poorly implemented in the private medical sector. Therefore, the example explains how to use the MARCOS method to select sustainable suppliers in the private medical sector. A case study of a sustainable supplier selection for the healthcare industry (a polyclinic) includes ranking of eight alternatives with regard to 21 criteria for all aspects of sustainability. The results and verification of the new method are carried out throughout a comprehensive sensitivity analysis. 21 scenarios with changes in the weight values of criteria were established, the measurement scale from 1 to 9 was changed to 1–5, a comparison with six other MCDM methods was performed, and it was verified in dynamic conditions which implied a change of the elements of the initial decision-making matrix. All phases of the sensitivity analysis showed the validity of MARCOS method. The obtained results and all scenarios in sensitivity analysis show that A2 remains the best alternative.

A key mutational process in cancer is structural variation, in which rearrangements delete, amplify or reorder genomic segments that range in size from kilobases to whole chromosomes1–7. Here we develop methods to group, classify and describe somatic structural variants, using data from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA), which aggregated whole-genome sequencing data from 2,658 cancers across 38 tumour types8. Sixteen signatures of structural variation emerged. Deletions have a multimodal size distribution, assort unevenly across tumour types and patients, are enriched in late-replicating regions and correlate with inversions. Tandem duplications also have a multimodal size distribution, but are enriched in early-replicating regions—as are unbalanced translocations. Replication-based mechanisms of rearrangement generate varied chromosomal structures with low-level copy-number gains and frequent inverted rearrangements. One prominent structure consists of 2–7 templates copied from distinct regions of the genome strung together within one locus. Such cycles of templated insertions correlate with tandem duplications, and—in liver cancer—frequently activate the telomerase gene TERT. A wide variety of rearrangement processes are active in cancer, which generate complex configurations of the genome upon which selection can act. Whole-genome sequencing data from more than 2,500 cancers of 38 tumour types reveal 16 signatures that can be used to classify somatic structural variants, highlighting the diversity of genomic rearrangements in cancer.

Advances in cloud computing make cloud services as an appealing solution for enabling services flexibility and availability on demand to accommodate users' needs. The terms and the guarantees of service provision are negotiated and then stated in a Service Level Agreement (SLA). To facilitate a wider acceptance of such services, beside the standard properties, security has to be taken into consideration as well. One way to facilitate this is to provide a corresponding security assurance case. For that purpose, in this work we propose to split the security service assessment between an independent third party and a service user, where the former assess a security assurance case and the latter negotiates particular security solutions implemented for a service. For the systematic part of the security process that is independently assessed, in this paper we focus on the formal realizability check of service constraints expressed within an SLA. To enable this, we formalize the check at both service design-, and run-time, needed due to frequent updates required to maintain an agreed security level. The formalization is tailored for the SLAC language specifically, which is extended to cover a proposed set of security objectives. Moreover, we use an example of an SLA expressed in terms of SLAC language, which includes security guarantees to illustrate the approach.

Abstract The skin, as the largest and most accessible organ in the human body, contains biofluids rich in biomarkers useful not only in diagnosis and monitoring of diseases, but also in profiling an individual’s wellbeing. Advancements in micro- and nanotechnology research have underpinned the development of multifunctional wearable sensing devices. Those sensors may allow monitoring of physiological parameters from different skin sections such as epidermis, dermis and hypodermis by sampling various bodily fluids. Our review summarizes current advances in wearable biosensors for on-skin analysis of sweat, transdermal monitoring of interstitial fluid and analysis of subcutaneous fluids via implanted devices. The review is divided into three main parts describing biosensors acting on the different skin sections. Each part focuses on recent scientific and technological advancements in the wearable biosensing field by highlighting critical challenges as well as providing information on how these barriers are being addressed by the research community.

In the past decades, insulation materials such as petrochemical and inorganic have been used for building insulation. The production of these insulation materials consumes a large amount of energy, which has a significant effect on the environment throughout the life cycle. Comparative performance analyses of renewable (natural) insulation materials for building application in terms of their impact on the environment, the useful lifetime, cost, insulation performance, thermal diffusivity water vapor resistance and flammability were analyzed using statistical tools. It was found that renewable insulating materials have competitive performances with traditional nonrenewable materials in terms of heat insulation performances, fire resistance and cost. Also it was found that renewable materials have significantly better performances such as less impact to the global warming, longer useful lifetime, and lower thermal diffusivity.

Aim To determine stereological structural parameters of the parenchymal part of the placenta, placental weight and volume of adolescent pregnant women and their correlation with newborns' birth weight. Methods This prospective study was conducted on a total of 60 human placentas of term pregnancy, divided into two groups according to the age of pregnant women. Experimental group consisted of 30 placentas of pregnant women aged 13-19 years. Control group consisted of 30 placentas of pregnant women aged 20-35 years. Stereological analysis was performed. Results Volumetric density of terminal villi of adolescent placentas was significantly higher than the one of control group (p <0.0001). The volumetric density of fibrinoid of adolescent placentas was significantly lower than of the control group (p <0.0001). Total volume of terminal villi of adolescent placentas was significantly higher than of the control group (p<0.0001). The total volume of fibrinoid of adolescent placentas was significantly lower than of the control group (p<0.0001). Newborns of adolescent pregnancies had in average lower birth weight of 439.01 g compared to the newborns of the control group (p <0.00001). Conclusion Adolescent pregnancy affects placental structure, weight and volume. Newborns of adolescent pregnancy have optimal body weight.

Aim To compare the quality of the conditions for endotracheal intubation and muscle relaxation between rocuronium bromide and vecuronium bromide using the ''timing principle'' method for induction in anaesthesia. The "timing principle" includes the administration of muscle relaxants before the hypnotic agent during induction in anaesthesia. Method Sixty patients who had undergone elective surgery were randomly allocated into two equal groups using muscle relaxants: rocuronium (group R) and vecuronium (group V). The intubation conditions were assessed using Cooper's scoring system, based on jaw relaxation, vocal cords position and response to intubation. The quality of muscle relaxation was evaluated by recording the time of clinical weakness, a count of ''train of four'' (TOF) twitches at intubation, the time of loss TOF response and duration of direct laryngoscopy. Results The intubation conditions were excellent in 100% of patients in the group R versus excellent in 80% and good in 20% of patients in the group V (p<0.05). The time of clinical weakness was statistically significantly shorter in the group R than in the group V (p<0.000). The time of loss of TOF response was statistically significantly shorter in the group R (p<0.000). The absence of TOF twitches (the level of muscle relaxation of 100%) at intubation recorded in 25 (83.3%) patients in the group R versus five (16.7%) patients in the group V (p<0.000). Duration of direct laryngoscopy did not significantly differ between the groups. Conclusion Rocuronium bromide provides better intubation conditions and greater quality of muscle relaxation than vecuronium bromide using ''timing principle'' technique.

Aim To present combined measles cases data and phylogenetic analysis of the virus circulated in 2018 in the Federation of Bosnia and Herzegovina (FB&H, the entity of Bosnia and Herzegovina), in order to analyse endemic transmission patterns of circulating strains and its implications for elimination efforts. Methods The data were derived from epidemiological case investigations and laboratory diagnoses based on serology, molecular detection and genotyping of the measles virus. Results During 2018 16 measles cases were reported in FB&H, of which five were classified as laboratory confirmed cases, one was an epidemiologically linked case and 10 were clinically compatible cases. Among them 12 (75.00%) cases were unvaccinated or had unknown vaccination status. The most affected population was up to 14 years of age (13/16; 81.25%). None of the cases was fully vaccinated. Viruses of other genetic lineages had been introduced in FB&H in the recent period. Two virus lineages of genotype B3 were identified. Phylogenetic analysis indicated the presence of a unique sequence of measles B3 virus in FB&H (Sarajevo). Conclusion Further strengthening of measles surveillance system and renewed efforts to increase vaccination levels are necessary to prevent disease and for elimination setting.

Aim To determine differences in quantitative traits of digital dermatoglyphics between breast cancer women and the women in the control group (healthy women). Methods This case-control study included digital dermatoglyphics of 50 patients with confirmed breast cancer diagnosis compared with 50 healthy examinees with the absence of familial history of any type of cancer. Collecting samples was performed among Bosnian-Herzegovinian population by Printake method. The comparison of the mean values between the examined groups was made by the Student's t-test and Mann-Whitney U test. Results The results showed that, with regards to the pattern intensity, no statistically significant difference was detected between the two examined groups (p>0.05).The absence of any significant difference in the number of papillary ridges on an individual finger between the breast cancer patients and the control group was found (p>0.05), although the total number of papillary ridges on all ten fingers had somewhat lower values in the examined group. Conclusion This research confirms the existence of genetic predisposition for breast cancer development, emphasizing the relevance of hereditary factors in the ethiopathogenesis of this disease. The quantitative traits of digital dermatoglyphics were not a reliable and predictive tool for detecting a potential risk for breast cancer in small populations.

One of the frequently occurring tasks during the development of a warehouse management system is the implementation of a routing algorithm of some kind. Whether it is for guiding workers during order picking, routing delivery vehicles or for routing company representatives, this task has proven to be challenging in the technical as well as the social sense. In other words, the task is heavily dependent on various company-specific constraints and it directly dictates the way employees should do their job. This paper describes a strategic approach to the development and gradual integration process of such algorithms which makes sure that all constraints are satisfied and, more importantly, ensures that route suggestions are viewed by the employees as a helpful tool rather than a threat to their job. Described through a real-world case study in a medium-to-large warehouse, the routing efficiency is almost doubled in comparison to the previous approach and critical factors are analysed and discussed throughout different stages of the process.