Predictors of health-related quality of life in Serbian patients with head and neck cancer.

BACKGROUND: The aim of this study was to identify predictors of the Health-Related Quality of Life (HRQoL) in patients with head and neck cancers (HNCs). MATERIAL AND METHODS: In total, 345 patients with HNCs were interviewed. A self-report questionnaire was administered to collect data about demographic characteristics, health status, smoking, alcohol consumption habits, and HRQoL. It were used the EORTC Instruments - Quality of Life Questionnaire-Core 30-questions (QLQ-C30), Quality of Life Questionnaire - Head and Neck Module 35-questions (QLQ-H&N 35) and OHIP-14 instrument for HRQoL assessments. Clinical information and treatment data were collected from medical records. RESULTS: Five groups of HRQoL predictors were identified: demographic, socioeconomic, behavioral, psychophysical, and clinical/treatment. These HRQoL predictors had a strong (i.e., age, level of social support and social contact, level of education, depression, fatigue, presence of gastrostomy, comorbidities, and use of pain medications and supplements), a moderate (i.e., marital status, smoking, sexuality problems, time since diagnosis, presence of tracheostomy, and side effects outcomes of radio and chemotherapy) and a small impact (i.e., employment/financial difficulties, tumor site and stage, and surgical procedure). CONCLUSIONS: Study identified nineteen predictors that had significant, moderate and small impact on the HRQoL of patients with HNCs. Some of the predictors, like levels of social support and social contact, depression, and comorbidities could be targets for innervations to improve HRQoL.

Kidney injury secondary to endovascular treatment of renal artery stenosis. / Povrezhdenie pochki posle éndovaskuliarnogo vmeshatel'stva pri stenoze pochechnoi arterii.

In this paper, we present a case of kidney injury as a complication of renal artery angioplasty in a 54-year-old female patient that suffered from resistant renovascular hypertension. This case emphasises the unpredictable nature of endovascular procedures, the need for careful post-procedure evaluation and the role of 'old fashioned' surgical techniques in resolving complications of endovascular procedures.

Morphologic predictors of in hospital mortality in acute type III aortic dissection. / Morfologicheskie prediktory gospital'noi smertnosti u bol'nykh s ostrym rassloeniem aorty III tipa.

INTRODUCTION: In-hospital mortality of acute aortic type III dissection ranged about 12%. Complicated dissections represent about 18% of all cases, and require open surgery or TEVAR. More morphological predictors of in hospital mortality are needed to differentiate patients who should be selected for immediate, surgical or endovascular intervention. METHODS: From January 2009 to December 2014, 74 patients with acute aortic type III dissection were enrolled at Clinic of Vascular and Endovascular Surgery in Belgrade Serbia and retrospectively analyzed. Every MSCT was observed in regard to morphologic characteristics of dissection. RESULTS: By analyzing morphologic parameters in patients between survival and non-survival group only localization of intimal tear showed statistical significance (p=0,020). The size of the intimal tear didn't reach statistical significance with the tendency of doing so in a larger sample of patients (p=0,063) with the cut-off value of 9.55mm. The shape of the true lumen was on the border of statistical significance (p=0,053). CONCLUSION: Inner curvature intimal tear localization, huge intimal tear as well as elliptic shape of the true lumen together should raise awareness to a subgroup at risk for in hospital mortality. More liberal endovascular treatment in this subgroup of patients is advocated.

Posterior approach for sciatic aneurysm repair - technical note.

Aneurysm of the persistent sciatic artery is a rare cause of limb ischemia, which is a challenge for both diagnosis and treatment. After successful diagnosis adequate treatment may require skills in open and endovascular surgery. We present a patient with the aneurysm of the persistent sciatic artery treated by bypass procedure with PTFE graft using posterior approach. We named this procedure "dorsal bypass". Detailed explanation of clinical presentation, diagnosis and the surgical procedure is given in this paper.

Hippocampal expression of the cannabinoid receptor type 1 in canine epilepsy.

Canine drug-resistant epilepsy is a prevailing issue in veterinary neurology. Alternative or additional treatment with cannabinoids is showing promising results in seizure management. A crucial component of the endocannabinoid system, cannabinoid receptor type 1 (CB1R), is heavily involved in the control of neurotransmitter release. Knowledge of its distribution in the epileptic brain would serve a better understanding of disease pathology and application of cannabinoids in dogs with epilepsy. CB1R distribution was assessed in sub-regions of hippocampus of dogs with idiopathic epilepsy, structural epilepsy and without cerebral pathology. In dogs with idiopathic epilepsy, significantly decreased CB1R expression compared to control animals was observed in CA1. In dogs with structural epilepsy, a significant increase in CB1R signal intensity in comparison to controls was observed. CB1R expression was higher in the structural group as compared to the idiopathic. Double immunofluorescence showed co-localization between CB1R and an astrocytic marker in about 50% of cells, regardless of the diagnosis. In summary, CB1R expression in canine hippocampus undergoes modification by the epileptic process and the direction of this change depends on the etiology of the disease. The distinct disease-associated CB1R expression needs to be considered in new treatment development for dogs with epilepsy.

The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants.

INTRODUCTION: The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. OBJECTIVE: The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. STUDY DESIGN: The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-ß1), retinol-binding protein (RBP), and microalbuminuria (µALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro(uretero)nephrosis, 13 cases with grade III bilateral hydro(uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 °C and thereafter analyzed by quantitative enzymatic immunoassay. RESULTS: Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P ≤ 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P ≤ 0.043), NGAL (P ≤ 0.043), KIM-1 (P ≤ 0.03), and TGF-ß1 (P ≤ 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. DISCUSSION: To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-ß1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. CONCLUSIONS: Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention.

Cell cycle-regulated association of E2F1 and Sp1 is related to their functional interaction.

Because of the large number of growth-regulated genes containing binding sites for the transcription factors Sp1 and E2F and the reported ability of E2F to mediate cell cycle (growth) regulation, we studied interactions between E2F1 and Sp1. In transient transfection assays using Drosophila melanogaster SL2 cells, transfection with both Sp1 and E2F1 expression vectors resulted in greater than 85-fold activation of transcription from a hamster dihydrofolate reductase reporter construct, whereas cotransfection with either the Sp1 or E2F1 expression vector resulted in 30- or <2-fold activation, respectively. Therefore, these transcription factors act synergistically in activation of dihydrofolate reductase transcription. Transient transfection studies demonstrated that E2F1 could superactivate Sp1-dependent transcription in a promoter containing only Sp1 sites and that Sp1 could superactivate transcription of promoters through E2F sites, further demonstrating that these physically associated in Drosophila cells transfected with Sp1 and E2F1 expression vectors and in human cells, with maximal interaction detected in mid- to late G1. Additionally, E2F1 and Sp1 interact in vitro through specific domains of each protein, and the physical interaction and functional synergism appear to require the same regions. Taken together, these data demonstrate that E2F1 and Sp1 both functionally and physically interact; therefore this interaction, Sp1 and E2F1 may regulate transcription of genes containing binding sites for either or both factors.

Towards antimicrobial yet bioactive Cu-alginate hydrogels.

The simplest approach to enhance alginate hydrogel characteristics and functional properties is to replace the calcium in the process of alginate gelation with other metallic ions which are essential for living systems. Gelling of alginate with other ions and using modern encapsulation techniques can provide new delivery systems with required properties. Hence, in this study Cu-alginate hydrogels in the form of microbeads were produced by electrostatic extrusion using gelling solutions with Cu(II) concentrations in the range 13.5-270 mM and comprehensively characterized in vitro. The variation of gelling solution concentration influenced the microbead Cu(II) content, size, biomechanical properties, Cu(II) release and subsequently potential biomedical application. The formulations chosen for biomedical evaluation showed potential for antimicrobial and tissue engineering applications. Microbeads with higher Cu(II) loading (~100 µmol g(-1)) induced immediate bactericidal effects against Escherichia coli and Staphylococcus aureus. Conversely, Cu(II) release from microbeads with the Cu(II) content of ~60 µmol g(-1) was slower and they were suitable for promoting and maintaining chondrogenic phenotype of bovine calf chondrocytes in 3D culture. Results of this study have shown possibilities for tuning Cu-alginate properties for potential biomedical applications such as antimicrobial wound dressings, tissue engineering scaffolds or articular cartilage implants.

Targeted disruptions of the murine Hoxa-4 and Hoxa-6 genes result in homeotic transformations of components of the vertebral column.

It is becoming clear that Hox genes, which encode transcription factors of the Antennapedia homeodomain family, are key players in establishing the body plan of mammalian embryos. They have already been implicated in the formation of the central nervous system, tissues derived from neural crest, the vertebral column and the limbs. In order to examine the roles of hoxa-4 and hoxa-6 during development, mice with targeted disruptions in these genes were generated. Each shows homeotic transformation of cervical vertebrae, at positions that approximate the anterior borders of expression of these genes in the prevertebrae. Defects were not observed in other tissues that normally express these genes. Hoxa-4-/hoxa-4- mice show, with 100% penetrance, anterior transformations of the dorsal aspects of the third cervical vertebra by acquiring features normally associated with the second cervical vertebra. Mice homozygous for the hoxa-6 mutation show, with incomplete penetrance, even on opposite sides of the same animal, posterior transformations of the seventh cervical vertebra to the first thoracic vertebra. In addition, both hoxa-4-/hoxa-4- and hoxa-6-/hoxa-6- mice show variability in expressivity. These data indicate that alternative genetic pathways can partially, and at times completely, substitute for the function of these two genes. Other members of these two paralogous Hox families are good candidates for providing the substitutions. As paralogous genes lie on different chromosomes, it is possible to examine the degree of redundancy among these genes by intercrossing mice with the appropriate individual disruptions. The analysis of double, triple and even quadruple mutants should determine the ways in which these Hox genes interact in order to specify the multitude of tissues in a restricted region of the developing mouse embryo.

Ex vivo repair of renal artery aneurysm associated with repairing of abdominal aortic aneurysm. Case report.

A case of right renal artery distal aneurysm associated with juxtarenal abdominal aortic aneurysm in a 75-year-old male, who presented with abdominal and back pain and chronic renal failure, is reported. The abdominal aortic aneurysm was repaired with a bifurcated Dacron graft. The right kidney was simultaneously explanted, ex vivo reconstruction of the renal artery with PTFE graft was performed, followed by autotransplantation of the kidney into the right iliac fossa. In the postoperative course the renal function returned to normal.

Aorto-caval fistulas: a review of eighteen years experience.

The operative treatment of 26 aorto-caval fistulas during the last 18 years is reviewed (24 male and two female patients; average of 65.3 year). Out of 1698 cases presenting an abdominal aortic aneurysm, 406 presented with rupture, and 26 had aorto caval fistula. In 24 cases (92.3%) it concerned an atherosclerotic aneurysm. One aneurysm with aorto-caval fistula was secondary to abdominal blunt trauma (3.8%), and one due to iatrogenic injury (3.8%). The time interval between first clinical signs of aorto-caval fistula and diagnosis, ranged from 6 hours to 2 years (average 57,3 days). Clinical presentation included congestive heart failure infive patients (11.5%), extreme leg edema in 13 (50.0%), hematuria in 2 (7.0%), renal insufficiency 2 (7.0%), and scrotal edema in six patients. Diagnosis was made by means of color duplex scan in eight patients (30.7%), CT in seven patients (27%), NMR in three patients (11.5%), and angiography in seven patients (27%). Most reliable physical sign was an abdominal bruit,present in 20 patients (77%). In ten patients (38.4%) correct diagnosis was not made prior to surgery. The operative treatment consisted of transaortic suture of the vena cava (25 pts-96.0%), and aneurysm repair. Five operative deaths occurred (19,2%), and for all of them it concerned a misdiagnosis. Cause of death was myocardial infarction (one patient-3.8%), massive bleeding (one patient-3.8%), MOF (two patients-7, 0%), and colon gangrene (one patient-3.8%). Follow-up period varied from six months to 18 years (mean 4 years and two months). Long term results showed a 96% patency rate. No postoperative lower extremity venous insufficiency nor pelvic venous hypertension was observed post-operatively.

Incidence of and indications for conversion of cervical plexus block to general anesthesia in patients undergoing carotid surgery: a single center experience.

AIM: He aim of this paper was to investigate the incidence of and the indications for conversion to general anesthesia (GA) in a large single-center series of patients undergoing carotid surgery under cervical plexus block (CPB). METHODS: With IRB approval we retrospectively analyzed the medical records of all patients who underwent carotid surgery under CPB from November 2007 to October 2010. Cervical plexus was blocked at both the superficial and deep levels. An intraluminal shunt was inserted in patients who demonstrated signs of inadequate cerebral perfusion upon carotid clamping (CC). Propofol was given to patients reporting pain or discomfort throughout the procedure. The primary outcomes were the number and percentage of conversions to GA as well as the indications for this intervention. The secondary outcome was the incidence of partial cervical block failure, defined as the need for supplemental propofol administration for pain relief during surgery. RESULTS: In total, 1464 carotid surgical procedures were performed under CPB in 1305 consecutive patients during the investigated period. Conversion to GA was required in 17 (1.2%) patients. The most common reason for conversion to GA was persisting neurological deterioration upon CC and intraluminal shunt insertion, which was recorded in 8/17 (47.1%) procedures. Other indications to convert were systemic toxicity of local anesthetics, pain, general discomfort and restlessness during surgery, and acute myocardial infarction. CONCLUSION: Cervical plexus block for carotid surgery is associated with a low rate of conversions to GA. Neurological deterioration upon carotid clamping and local anesthetic toxicity are identified as the most common indications for such intervention.

Gill reaction to pollutants from the Tamis River in three freshwater fish species, Esox lucius L. 1758, Sander lucioperca (L. 1758) and Silurus glanis L. 1758: a comparative study.

The study evaluated the effects of waterborne pollutants from the Tamis River on gill histology and possible differences in gill reaction patterns between three freshwater fish species, pike Esox lucius L. 1758, pike-perch Sander lucioperca (L. 1758) and wels catfish Silurus glanis L. 1758 from the Tamis River. Gills from analysed fish species showed moderate to intense histopathological alterations. The most frequent progressive alteration was hyperplasia of epithelium, whereas the most frequent regressive alteration was epithelial lifting. Circulatory disturbances were most often manifested in the form of hyperaemia. During comparative analysis, differences in gill indices, reaction and alteration indices, as well as in gill and filament prevalence between analysed species, were observed. Although all analysed fish species did show both progressive and regressive alterations, there was a significant difference in the level of expression of these reaction patterns. Gill index obtained for pike clearly stands out as the lowest. Wels catfish showed the highest progressive reaction index, significantly higher in comparison with the other two species (P < 0.05), while pike-perch showed the highest regressive reaction index, also significantly higher in comparison with the other species (P < 0.001). These results may implicate species-specific gill reactions and thus present a useful tool for better understanding toxic mechanisms of various pollutants.

Intestinal absorption, serum clearance, and interactions between lutein and beta-carotene when administered to human adults in separate or combined oral doses.

Single equimolar doses (0.5 mumol/kg body wt) of lutein and/or beta-carotene in true solution in oil were given to eight adult subjects and 13 blood samples were taken during the subsequent 840 h. Whereas the mean serum concentration of lutein showed a single maximum at 16 h, that of beta-carotene peaked at 6 h and then again at 32 h. Subsequently, lutein and beta-carotene were cleared at approximately the same rate from the serum. The mean (+/- SEM) areas under the curve (AUCs) for lutein and beta-carotene during the first 440 h differed significantly: 59.6 +/- 9.0 and 26.3 +/- 6.4 mumol.h/L, respectively (P < 0.005). AUC values did not correlate with initial serum concentrations of the given carotenoid or with the order of dosing. When combined in the same dose, beta-carotene significantly reduced the serum AUC values for lutein to 54-61% of control values (P < 0.025), whereas lutein reduced the AUC value for beta-carotene in five subjects but enhanced it in three subjects. Effects of lutein on the AUC for beta-carotene were inversely related to the AUC for beta-carotene alone. Thus, carotenoids clearly interact with each other during intestinal absorption, metabolism, and serum clearance, although individual responses can differ markedly.

Characteristics of the brain tissue disialoganglioside G2a.

Disialoganglioside G2a was separated by one dimensional two-step TLC between the two ganglioside fractions using long plate precoated with silica H+ florisil in the particular solvent system. Behaviour of this fraction to the enzyme effect and molecule percentages of its components showed the characteristics of the ganglioside containing two N-acetylneuraminic acids. Synthesis dynamics of this fraction in rat brain was very intensive in the myelination period and it practically ended in 40th day. In mutant "Jimpy" mice brain ganglioside G2a served as an indicator of the normal ganglioside synthesis in relation to the changes in myelin sphingolipid molecular structure. Comparative brain studies undertaken in various species, intracellular rat brain fractions, various structures of Torpedo ocellata electric fish, emphasized the importance of this ganglioside in cell membrane formation where it is obligatory component. Quantitative determination of this fraction in Astrocytoma with various malignancy degree offers great help in differential diagnosis.

Post-traumatic AV fistulas and pseudoaneurysms.

METHODS: The authors present the surgical treatment of 20 post-traumatic arteriovenous fistulas and 33 arterial pseudoaneurysms that have been treated in the last 5 years in the Centre for Vascular Surgery of the Institute for Cardiovascular Diseases, Clinical Centre of Serbia in Belgrade. Five women and 45 men (mean age 31.7 years) were examined. There were 28 war and 22 non-combatant injuries. In most cases superficial femoral artery and vein were involved. The average time elapsed from the moment of injury until the operation started, was 9 months in patients with AV fistulas, and one month for patients with pseudoaneurysms. RESULTS: In all of the patients with AV fistulas, arterial and venous reconstructions were performed, except in 4 cases where the veins were ligated. Surgical reconstruction was performed in 26 patients with pseudoaneurysms, while in 7 cases the artery was ligated. There were no cases of postoperative ischemia in patients due to arterial ligation. Patients were followed for 2 years and 2 months postoperatively. As far as the reconstructive operations are concerned, the postoperative patency rate was 100%, while limb salvage was achieved in 96.9%. Namely, one amputation was done in spite of high arterial patency rate, which was indicated by massive bone-muscle tissue loss, occurring during mine explosive injury. CONCLUSIONS: Because of the rapid disease progress, the authors suggest that the operative treatment of post-traumatic AV fistulas and pseudoaneurysms should be performed as soon as possible. This was supported by good follow-up results in operatively treated patients.

Kinetic determination of traces of iodide by its catalytic effect on oxidation of sodium pyrogallol-5-sulfonate by hydrogen peroxide.

The kinetic method is based on a catalytic effect on the oxidation of sodium pyrogallol-5-sulfonate by hydrogenperoxide. The reaction is followed spectrophotometrically at 436.8 nm. The kinetic parameters of the reaction are reported and a rate equation is suggested. The calibration graph is linear in the range 10-200 ng cm(-3). The effects of certain foreign ions upon the reaction rate were determined for the assessment of the selectivity of the method. This method has high sensitivity and good selectivity when anions are concerned as well. That is why it can be successfully applied to determination of iodide in real samples (mineral water and soil) directly after the elimination of cations, which interfere. The method was applied to determine iodide in natural waters and soil.

Reduction of serum retinol levels following a single oral dose of all-trans retinoic acid in humans.

Following a single oral dose of all-trans retinoic acid (RA) (0.167 mmole) in corn oil to 6 healthy human subjects, the mean serum retinol (ROL) level fell by approximately 20% within 1 h and remained depressed for 24 h. After dosing, RA appeared in the blood within 30 min, peaked at 0.3-0.5 mumol/l, and then declined to very low concentrations after 7 h. All-trans retinoyl beta-glucuronide (RAG) appeared simultaneously with RA in the plasma, albeit more sporadically, whereas only traces of 4-oxoretinoic acid (4-oxoRA) were detected. Some possible physiologic consequences of therapeutic uses of all-trans RA are discussed.

Repair of abdominal aortic aneurysms in the presence of the horseshoe kidney.

AIM: Horseshoe kidney is the most common congenital kidney anomaly, occurring in 0.15-0.25% of all newborns. A medial fusion of the kidneys, mostly anteriorly to the aorta, is the main characteristic of this anomaly. The co-existence of abdominal aortic aneurysm (AAA) and horseshoe kidney is rare, occurring only in 0.12% of patients. The aim of this paper is to define the optimal management of patients with AAA associated with the horseshoe kidney. METHODS: This paper presents the analysis of patients operated at the Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia in Belgrade due to AAA associated with the horseshoe kidney as well as the analysis of the previously published literature data regarding this topic. RESULTS: Between 1985 and 2011, data were collected retrospectively on 25 patients with the horseshoe kidney who underwent aortic surgery. Out of them, 6 patients had aortoiliac occlusive disease and 19 patients had aortic aneurysm. More detailed analysis of the aneurysmatic group was performed. Among them there were 16 male and three female patients, with the average age of 63.8 (50-76) years. Two patients had type IV of thoracoabdomial aortic aneurysm (TAA) according to Crawford-Saffi classification, while 17 had infrarenal abdominal aortic aneurysms. There were 15 elective and four urgent procedures due to aneurismal rupture. The presence of the horseshoe kidney was detected in 16 patients before surgery (84.2%) by means of Duplex ultrasonography, angiography, computed tomography and intravenous urography. Multiple renal arteries were presented in 12 (63.2%) cases. A transperitoneal approach was used in 16 cases with abdominal aortic aneurysm, while left retroperitoneal approach with partial extrapleural removal of the 11th rib was performed in two cases of thoracoabdominal aneurysm and in one patient with AAA. In 18 cases, kidney tissue transection was successfully avoided with vascular graft placement beneath the horseshoe kidney. In one case only, the division of the renal isthmus was performed. In all 12 cases with detected anomalous renal arteries, their reattachment into vascular graft has been performed. Two patients (10.5%) died during perioperative period. One of them had ruptured type IV TAA. Seventeen patients who survived were followed from one to twenty years (mean 6.6 years). During the follow up period we lost track of 4 patients. In this period there were no signs of graft occlusion, or renal failure. CONCLUSION: Repair of an abdominal aortic aneurysm in the presence of the horseshoe kidney is a truly particular surgical challenge. It is associated with three main problems: choice of the surgical approach; the procedure regarding kidney isthmus preservation as well as recognition and reattachment of all significant anomalous renal arteries.