Different Ecological Niches of Poisonous Aristolochia clematitis in Central and Marginal Distribution Ranges-Another Contribution to a Better Understanding of Balkan Endemic Nephropathy.

Aristolochia clematitis L. is a perennial herbaceous plant distributed throughout Europe, Asia Minor and Caucasus. It has been used as a medicinal plant since antiquity but not in recent times because it contains poisonous aristolochic acid, causing progressive kidney failure. The aim of this work was to study Aristolochia clematitis ecology on the basis of vegetation plots from the European Vegetation Archive, and to investigate the differentiation of its ecological niche using a co-occurrence-based measure of ecological specialization (ESI). The ecological niche was studied on three spatial scales: on the entire distribution area, its differentiation across 200 × 200 km grid cells and the differences between three central and three marginal regions. Our results suggest that Aristolochia clematitis has a very broad ecological niche occurring in a range of different habitats and climatic conditions, with a trend of a niche width decrease with the distance from the geographical center. The plant prefers more stable communities with less anthropogenic influence moving towards the margin of the distribution area. Specialization towards the marginal area is a result of evolutionary history, which refers to the recent anthropogenically induced spread from its original home range. A high incidence of Aristolochia clematitis in the vegetation of arable lands and market gardens as well as anthropogenic herbaceous vegetation in the distribution center corresponds to the geographical incidence of Balkan Endemic Nephropathy.

Environmental drivers of ground-floor bryophytes diversity in temperate forests.

Bryophytes play important role in forest ecosystem functioning and their distribution and diversity are driven by numerous environmental factors. The aim of the present study was to bring new insights in deeper understanding of terrestrial bryophytes diversity in temperate forests, as well as to determine the environmental factors which have predominant influence on ground-floor bryophytes. The survey was conducted in Fruska Gora Mountain (Serbia) across seven forest sites where ground-bryophytes were sampled. Soil moisture, temperature, and pH were measured as soil characteristics, while herbaceous cover, litter cover, stream distance, number of trees and shrubs were used as characteristics of stand structure. Species richness, Shannon diversity index, and evenness index were used as diversity measures. Generalised linear model and canonical correspondence analysis (CCA) were used to test the influence of environmental variables on bryophyte diversity. Litter cover was the most important explanatory variable, followed by soil moisture, stream distance and tree number, respectively. Overall, the stand structure was found to have a greater impact on ground-floor bryophyte diversity compared to soil characteristics. Identification of the most significant ecological factors affecting the diversity and distribution of bryophytes in forest ecosystems is of great importance in forest ecology with the aim of defining adequate management methods to preserve the biodiversity of forests, with particular emphasis on endangered and rare bryophyte species.

2020 consensus guideline for optimal approach to the diagnosis and treatment of HER2-positive breast cancer in Bosnia and Herzegovina.

The HERe2Cure project, which involved a group of breast cancer experts, members of multidisciplinary tumor boards from healthcare institutions in Bosnia and Herzegovina, was initiated with the aim of defining an optimal approach to the diagnosis and treatment of HER2 positive breast cancer. After individual multidisciplinary consensus meetings were held in all oncology centers in Bosnia and Herzegovina, a final consensus meeting was held in order to reconcile the final conclusions discussed in individual meetings. Guidelines were adopted by consensus, based on the presentations and suggestions of experts, which were first discussed in a panel discussion and then agreed electronically between all the authors mentioned. The conclusions of the panel discussion represent the consensus of experts in the field of breast cancer diagnosis and treatment in Bosnia and Herzegovina. The objectives of the guidelines include the standardization, harmonization and optimization of the procedures for the diagnosis, treatment and monitoring of patients with HER2-positive breast cancer, all of which should lead to an improvement in the quality of health care of mentioned patients. The initial treatment plan for patients with HER2-positive breast cancer must be made by a multidisciplinary tumor board comprised of at least: a medical oncologist, a pathologist, a radiologist, a surgeon, and a radiation oncologist/radiotherapist.

Combined effects of physical environmental conditions and anthropogenic alterations are associated with macrophyte habitat fragmentation in rivers - Study of the Danube in Serbia.

We hypothesize that the physical features of river habitats and anthropogenic hydromorphological alterations influence macrophyte communities and lead to habitat fragmentation. Sampling included 1081 contiguous survey units positioned in the main channel and side arms along 588km of the Danube River, along its middle course. To identify habitat fragments, Multivariate Regression Tree analysis (MRT) was applied on macrophyte and environmental data. Indicator species analyses were combined with MRT. To identify habitat fragments on a scale larger than final MRT groups, we set thresholds for an MRT complexity parameter. We identified 20 fine, 7 medium, and 3 large scale habitat fragments. Damming was the main fragmentation agent. Macrophyte communities show continuous variation at all scales of habitat fragmentation. High species diversity indicates major anthropogenic alteration of the river's hydrology and decline of the natural riparian zone. Future studies of the macrophyte communities, and their habitat fragmentation must include more factors (e.g. nutrient status, physicochemical quality of the water, etc.), as well as assessment of the importance of tributaries.

A higher-level classification of the Pannonian and western Pontic steppe grasslands (Central and Eastern Europe).

QUESTIONS: What are the main floristic patterns in the Pannonian and western Pontic steppe grasslands? What are the diagnostic species of the major subdivisions of the class Festuco-Brometea (temperate Euro-Siberian dry and semi-dry grasslands)? LOCATION: Carpathian Basin (E Austria, SE Czech Republic, Slovakia, Hungary, Romania, Slovenia, N Croatia and N Serbia), Ukraine, S Poland and the Bryansk region of W Russia. METHODS: We applied a geographically stratified resampling to a large set of relevés containing at least one indicator species of steppe grasslands. The resulting data set of 17 993 relevés was classified using the TWINSPAN algorithm. We identified groups of clusters that corresponded to the class Festuco-Brometea. After excluding relevés not belonging to our target class, we applied a consensus of three fidelity measures, also taking into account external knowledge, to establish the diagnostic species of the orders of the class. The original TWINSPAN divisions were revised on the basis of these diagnostic species. RESULTS: The TWINSPAN classification revealed soil moisture as the most important environmental factor. Eight out of 16 TWINSPAN groups corresponded to Festuco-Brometea. A total of 80, 32 and 58 species were accepted as diagnostic for the orders Brometalia erecti, Festucetalia valesiacae and Stipo-Festucetalia pallentis, respectively. In the further subdivision of the orders, soil conditions, geographic distribution and altitude could be identified as factors driving the major floristic patterns. CONCLUSIONS: We propose the following classification of the Festuco-Brometea in our study area: (1) Brometalia erecti (semi-dry grasslands) with Scabioso ochroleucae-Poion angustifoliae (steppe meadows of the forest zone of E Europe) and Cirsio-Brachypodion pinnati (meadow steppes on deep soils in the forest-steppe zone of E Central and E Europe); (2) Festucetalia valesiacae (grass steppes) with Festucion valesiacae (grass steppes on less developed soils in the forest-steppe zone of E Central and E Europe) and Stipion lessingianae (grass steppes in the steppe zone); (3) Stipo-Festucetalia pallentis (rocky steppes) with Asplenio septentrionalis-Festucion pallentis (rocky steppes on siliceous and intermediate soils), Bromo-Festucion pallentis (thermophilous rocky steppes on calcareous soils), Diantho-Seslerion (dealpine Sesleria caerulea grasslands of the Western Carpathians) and Seslerion rigidae (dealpine Sesleria rigida grasslands of the Romanian Carpathians).

Prevalence and risk factors of vascular calcification in pre-dialysis patients with Balkan endemic nephropathy.

Introduction: Vascular calcifications (VC) are common in patients with chronic kidney disease and present one of manifestations of mineral and bone disorders in these patients. Objective: The aim of this pilot study was to examine the prevalence and risk factors of VC in pre-dialysis patients with Balkan endemic nephropathy (BEN) and other kidney diseases. Methods: The study involved 32 pre-dialysis patients, 15 with BEN and 17 with other kidney diseases. All the patients underwent an interview, objective examination, routine laboratory analyses and measurement of serum concentration of intact parathyroid hormone (iPTH), 25-hydroxyvitamin D3 [25(OH)D3] and osteopontin. VCs in iliac, femoral, radial, and digital arteries were evaluated and Adragao VC score was calculated. The samples of radial artery were collected during the first creation of an arteriovenous fistula, and expression of osteocalcin, bone morphogenic protein-2 osteopontin, and matrix Gla-protein in arterial wall were examined. Results: Patients with BEN were significantly older (71.1 ± 6.1 vs. 54.7 ± 11.1 years), but they had significantly lower systolic and mean blood pressure (95.7 ± 13.2 mmHg vs. 104.3 ± 7.4 mmHg) and lower serum concentration of phosphorus (1.32 ± 0.36 mmol/l vs. 1.65 ± 0.35 mmol/l) and cholesterol (4.3 ± 1.1 mmol/l vs. 5.2 ± 0.8 mmol/l) than patients with other kidney diseases. Mean VC score was significantly lower in patients with BEN than in those with other kidney diseases (2.8 ± 1.7 vs. 4.6 ± 1.8; p = 0.009), but expression of four examined proteins in arterial wall differed insignificantly between the two groups. VC score correlated significantly with serum concentrations of cholesterol, triglycerides (positively), and iPTH (negatively). Conclusion: Pre-dialysis BEN patients had a significantly lower mean score of VC than patients with other kidney diseases.

The Influence of Liners on the Pulp Inflammation.

INTRODUCTION: The study included application of liners and dental composites in to cavities of six experimental animals-rabbits (Oryctolagus cuniculus). OBJECTIVE The aim of the study was to investigate rabbit dental pulp response to different liners. Methods Cavity preparation for class V were made on the maxillary central incisors and one lower incisor, while the second lower incisor served as a control tooth. These teeth were restored with the use of one of the following liners--Calcimol LC, ANA Liner and Fuji II LC Improved, and Ceram-X mono dental composite. After an observation period of five days animals were sacrificed and prepared for histological analysis.The existence and degree of the pulp inflammation was determined by using a light microscope. RESULTS: Results showed that the used liners do not cause distortion of the structure and continuity of the odontoblastic layer. Inflammation was not registered in the control group, while in each group of tested materials one tooth with mild signs of hyperemia was registered. Results showed that all three tested liners demonstrated favorable effects on the pulp of the tooth and did not lead to inflammatory reactions. CONCLUSION: Histological analysis of the dental pulp of experimental animals suggests that the liners used in this study do not compromise the integrity of the odontoblastic layer, if it is applied over a thin layer of dentin. In each group of tested materials one tooth with mild signs of hyperemia and vasodilation was registered.

[Surgical anatomy of the initial segment of the lateral circumflex femoral artery].

INTRODUCTION: The lateral circumflex femoral artery usually originates from the lateral side of the initial part of the deep femoral artery, or less frequently from the femoral artery. If it is a branch of the femoral artery, it arises directly above the point of origin of the deep femoral artery. The aim of this study was to determine the origin of the lateral circumflex femoral artery, its origin distance from the midpoint of the inguinal ligament and the topographical relations of the origin, which have a great significance in clinical work. MATERIAL AND METHODS: A dissection was performed on the autopsy group of 42 thighs, followed by the analysis of anatomical relationships of the lateral circumflex femoral artery. All data were entered into the custom-made protocol, which contained the case number, age and sex, side, topographical-anatomical relations of the lateral circumflex femoral artery, artery dimensions and variations, and the distance between the place of origin of the lateral circumflex femoral artery and the midpoint of the inguinal ligament. RESULTS: In our study, the lateral circumflex femoral artery most frequently originated from the deep femoral artery, i.e. in 78.6% of cases. In 19.0% of limbs, it originated from the femoral artery, and in one case (2.4%) from a common stem of the deep femoral artery and the lateral circumflex femoral artery, coming from the femoral artery. CONCLUSION: In clinical practice, it is of great importance to know the origin variations of the lateral circumflex femoral artery while planning and performing various surgical and invasive diagnostic procedures in the inguino-femoral region.

[The importance of cytology in diagnosing rare breast carcinoma--two case reports].

INTRODUCTION: This paper presents two cases of very rare tumors of breast: breast sebaceos carcinoma, which has rarely been described in medical literature, and breast carcinosarcoma. Morphological characteristics and biological behavior of sebaceos carcinoma are still rather vague. Carcinosarcoma of the breast is a rare malignancy with distinct cell lines described as a breast carcinoma of ductal type with a sarcoma-like component. CASE REPORT: The first presented case is a 73-year-old female referred to our hospital in January 2008 with tumor of the right breast in the upper outer region of the breast and enlarged lymph nodes in the right axillary region. The second presented case is a 51-year-old female with carcinosarcoma, also a very rare primary breast tumor. She was admitted to our hospital in June 2011 with history of lump in the upper and lower outer quadrant of the left breast. In both cases, biopsy of tumor tissue was carried out with a thin needle, i.e. the aspiration cytology was applied as a diagnostic method, and during the operation the fast diagnostics of frozen sections and cytologic diagnostics were done. Although this methodology is important in diagnosis, in both cases it showed certain limitations in diagnosing such rare tumors. The final diagnosis was made after carefully synthesizing the histological findings and immunohistochemical phenotype. CONCLUSION: An accurate classification of breast tumors on cytological preparations is not possible in case of poorly differentiated and rare tumors. A careful and accurate classification of these tumors is necessary.

[Massive hemorrhage of upper gastrointestinal tract caused by gastrointestinal stromal tumor of the stomach--case report].

INTRODUCTION: Acute bleeding from the upper gastrointestinal system is a medical emergency which is followed by high mortality rate, ranging from 6 to 15% in spite of modern diagnostic methods and treatment. Bleeding from the upper gastrointestinal system may be caused by gastrointestinal stromal tumors of the stomach, which are mainly characterized by occult bleeding, while profuse bleeding rarely occurs accompanied by hemorrhagic shock. Gastrointestinal stromal tumors of stomach are the most common mesenchimal tumors of the gastrointestinal tract. CASE REPORT: In our study we showed a 60-year-old female patient with profuse bleeding from the stomach and the clinical picture of severe hemorrhagic shock, caused by gastrointestinal stromal tumor. An ovoid junction, raised towards the lumen, covered with ulcerated mucosa in several places and followed by massive arterial bleeding was found intraoperatively, after the performed gastrotomy. Histopathological examination with immunohistochemical analysis confirmed that this was a gastrointestinal stromal tumor of the stomach. DISCUSSION: Acute bleeding from the digestive system is a sudden and serious condition of the body. Urgent esophagogastroduodenoscopy is a sensitive and specific diagnostic and therapeutic method of choice. Massive bleeding from the upper gastrointestinal tract is very rarely caused by gastrointestinal stromal tumors, whose clinical picture is very heterogeneous and depends on tumor size and location. Abundant bleeding from the tumor is an indication for urgent surgical intervention. CONCLUSION: According to the literature massive hemorrhage of the upper digestive system can rarely be caused by gastrointestinal stromal tumor of the stomach. It is shown that abundant hemorrhage of the upper digestive tract can be caused with gastric gastrointestinal stromal tumor. Surgical resection is the main form of treatment of gastrointestinal stromal tumors of the digestive system and bleeding from these tumors caused by failure of endoscopic hemostasis.