Risk factors for recurrence and complications after laparoscopic repair of incisional hernia using a double-layered ePTFE/PP mesh: results of a retrospective study.

BACKGROUND: The objective was to analyse, risk factors for recurrence (primary outcome) and complications (secondary outome) after the implantation of a double layer ePTFE (expanded PolytTetraFluoroEthylene) / PP (PolyPropylene) mesh to treat incisional hernias (IH) using the Intraperitoneal Onlay Mesh (IPOM) technique. METHODS: We included all elective laparoscopic IH repairs with intraperitoneal placement of a ePTFE / PP mesh (Relimesh® - Herniamesh S.r.l.) from January 1, 2010 to December 31, 2017 at Humanitas Mater Domini Clinical Institute in Castellanza (Italy) and at the Centre for Minimally Invasive Surgery of Nis (Serbia). Performance was defined as long-term recurrence rate. RESULTS: A total of 284 patients were enrolled. According to the European Hernia Society (EHS) hernias were classified as: W1 (<4 cm) 60.29%, W2 (≥4-10 cm) 35.02% and W3 (≥10 cm) 4.69%; medial 90.85%, lateral 6.69%, both medial and lateral 2.11%. Average follow-up was 48 (11-110) months. The 30-days complication rate was 4.23%. Hernia recurrence rate was 3.36%. Long-term complication rate was 6.34%. At multivariable analysis, an increased risk of short-term complications was associated to chronic obstructive pulmonary disease (COPD) (OR 7.59 [2.23-25.83], P=0.001); an increased risk of long-term complications was associated to diabetes (OR 6.21 [1.80-21.42], P=0.004), an increased risk of recurrence was correlated to COPD (OR 13.40 [1.36-131.9], P=0.026) and hernia defects larger than 6 cm (OR 19.2 [1.12-329.9], P=0.042). CONCLUSIONS: Elective laparoscopic IH repair with a double-layered ePTFE/PP mesh is safe and effective. Compliance with indications and preoperative patients evaluation are essential to improve outcomes.

Influence of Habitat Types on Diversity and Species Composition of Urban Flora-A Case Study in Serbia.

The aim of this study was to investigate the floristic composition and diversity of seven urban habitat types in 24 Serbian cities with different climatic affiliation. In each of the 24 cities, we selected 1 ha plots representing a habitat from one of the following groups: square, boulevard, residential area with compact and with open building pattern, city park, and sites with early and mid-succession vegetation stages. All vascular plant species that occur spontaneously in these plots were observed. Data on the main climatic characteristics were collected for each plot, and data on the life forms were obtained for each species recorded. Diagnostic species were identified for each habitat type analyzed, and alpha, beta and gamma diversity were calculated. A total of 674 taxa were recorded in the studied area. Significant differences were observed in habitats by diagnostic species and by life form representation. The lowest alpha and gamma diversity and the dominance of therophytes were observed in habitat types with intensive anthropogenic impact, whereas the highest number was recorded in mid-successional sites and residential areas with a compact building pattern. The analysis showed that habitat type influences species composition much more than climate.

Plantago subulata as indicator of potentially toxic elements in the substrate.

Plantago subulata is a facultative serpentinophyte, with predominantly ultramafic distribution in Serbia and Montenegro. The plant samples were collected from ultramafic and non-ultramafic substrate, including two abandoned mining sites, with the aim to assess the accumulation potential of this species. The samples were collected from 10 sites in Serbia and Montenegro and element concentrations in plants and soils were determined. Particularly high concentrations of Fe, Cu, Mn, Zn, and Cd were found in the soil and plant samples from an abandoned iron mining site, Mt. Kopaonik, Suvo Rudiste. The concentrations of Ni, Cr, Fe, Co, and Cd were statistically different between soil and plant samples from ultramafic and non-ultramafic bedrock. Considering the fact that concentrations of Zn, Ni, and Cr in roots and shoots were positively correlated with their respective contents in the soil, i.e., the chemical composition of the plant and soil samples reflected the characteristics of the substrate, and for most of the elements analyzed, P. subulata acted as indicator species. For Cd and Pb, only the root concentrations were positively correlated with soil content, indicating exclusion and root sequestration as the main tolerance strategies for these elements. Although below the hyperaccumulation threshold, a strong accumulation capacity of P. subulata was found for Ni and Cu.

Accumulation of trace elements in Tussilago farfara colonizing post-flotation tailing sites in Serbia.

The purpose of this study was to examine the accumulation potential of spontaneously developed Tussilago farfara populations colonizing sites with different levels of anthropogenic pollution. Physical characteristics of the soil are presented, together with the concentrations of macroelements and microelements (Ca, Mg, Fe, S, Al, Pb, Zn, Cu, Cd, Mn, As, Sb, Ag, Ti, and Sr) in both soil and plants. The biological concentration, accumulation, and translocation factors were used to assess the potential for heavy metal accumulation. Considerable differences were found among assessions from unevenly contaminated habitats, particularly in comparison with an unpolluted site. In line with the ore's characteristics, substrate samples from polluted sites were heavily contaminated with Pb, Zn, As, and Sb. Increased levels of microelements were also detected in plant samples from flotation tailings. Despite active absorption of Zn, Cu, Cd, Mn, and Sr by the plants from mining sites, the detected quantities of these elements in all samples were below the hyperaccumulation threshold. However, the obtained results indicate that the use of T. farfara from such sites in traditional medicine could pose a risk to human health due to accumulation of several toxic elements in the plant's aboveground tissues. Additionally, as a successful primary colonizer and stabilizer of technogenic substrates, T. farfara has an important role in the initial phases of revegetation of highly contaminated sites.

Potential of Equisetum ramosissimum Desf. for remediation of antimony flotation tailings: a case study.

A flooding event caused collapsing of the Stolice flotation tailing dam and spilling of large volumes of sludge into environment. Urgent remediation measures have not been applied due to the lack of financial resources. Remediation values for Sb, Zn, and Pb in the flotation tailing samples were exceeded 20.5, 4.2, and 1.15 times, respectively, emphasizing the need for remediation. Plants growing on mine spoils represent useful tools for environmental monitoring and soil remediation. The appearance of Equisetum ramosissimum as a dominant colonizer on the flotation tailings indicates that biological reclamation of the site is possible. Equisetum ramosissimum shows the ability to phytostabilize and immobilize available fractions of Fe, Mn, Zn, Pb, and Sb. Transfer rate of metals from roots to shoots reveals exclusion of elements from the shoots, preventing their further spreading through the food chain. The results of this study show that E. ramosissimum can be an additional tool for environmental monitoring and remediation of flotation tailings after hazardous events.

Micro-edaphic factors affect intra-specific variations in trace element profiles of Noccaea praecox on ultramafic soils.

The aim of this study was to compare trace element profiles of Noccaea praecox (Wulfen) F. K. Mey. growing on ultramafic soils in different habitat types and to observe differences in uptake and translocation of trace elements. Physico-chemical characteristics of the soil and concentrations of P2O5, K2O, Ca, Fe, Mn, Zn, Cu, Ni, Cr, Pb, Cd, and Co in plant samples were presented. Biological concentration, accumulation, and translocation factors were calculated to estimate accumulation potential of different N. praecox accessions. All of the studied accessions were Ni hyperaccumulators (with shoot concentrations up to 14,593 mg kg-1), but with notable differences in accumulation and translocation rates. Significant differences in accumulation and translocation patterns of trace elements were observed among accessions from habitats characterized as serpentine steppes on dry, shallow soils in contrast to the accessions from habitats with higher soil moisture, and higher content of organic matter.

Metal accumulation in populations of Calamagrostis epigejos (L.) Roth from diverse anthropogenically degraded sites (SE Europe, Serbia).

Heavy metal accumulation is recognized as a very important global pollution problem in the last decades. Plant species have been recognized as natural bioindicators of environmental pollution, especially the amount of heavy metals in soils. Moreover, only a limited number of plant species can survive in highly contaminated soils. It is also known that metal accumulation can vary greatly among different populations of the same species. This study examines the chemical composition and accumulation potential of the expansive clonal grass Calamagrostis epigejos at five localities exposed to different levels of anthropogenic pressure. Considerable differences were observed between uptake, translocation, and accumulation of total and available heavy metals, such differences corresponding to soil physico-chemical characteristics and the level of site pollution. The results indicate that Calamagrostis epigejos uptakes a significant portion of the available fraction of heavy metals in the soil and stores it in the roots, thereby exhibiting a certain potential for metal phytostabilization.

An approach for the improved immobilization of penicillin G acylase onto macroporous poly(glycidyl methacrylate-co-ethylene glycol dimethacrylate) as a potential industrial biocatalyst.

The use of penicillin G acylase (PGA) covalently linked to insoluble carrier is expected to produce major advances in pharmaceutical processing industry and the enzyme stability enhancement is still a significant challenge. The objective of this study was to improve catalytic performance of the covalently immobilized PGA on a potential industrial carrier, macroporous poly(glycidyl methacrylate-co-ethylene glycol dimethacrylate) [poly(GMA-co-EGDMA)], by optimizing the copolymerization process and the enzyme attachment procedure. This synthetic copolymer could be a very promising alternative for the development of low-cost, easy-to-prepare, and stable biocatalyst compared to expensive commercially available epoxy carriers such as Eupergit or Sepabeads. The PGA immobilized on poly(GMA-co-EGDMA) in the shape of microbeads obtained by suspension copolymerization appeared to have higher activity yield compared to copolymerization in a cast. Optimal conditions for the immobilization of PGA on poly(GMA-co-EGDMA) microbeads were 1 mg/mL of PGA in 0.75 mol/L phosphate buffer pH 6.0 at 25°C for 24 h, leading to the active biocatalyst with the specific activity of 252.7 U/g dry beads. Chemical amination of the immobilized PGA could contribute to the enhanced stability of the biocatalyst by inducing secondary interactions between the enzyme and the carrier, ensuring multipoint attachment. The best balance between the activity yield (51.5%), enzyme loading (25.6 mg/g), and stability (stabilization factor 22.2) was achieved for the partially modified PGA.

Influence of different methods of internal bone fixation on characteristics of bone callus in experimental animals.

INTRODUCTION: Correct choice of osteosynthesis method is a very important factor in providing the optimal conditions for appropriate healing of the fracture. There are still disagreements about the method of stabilization of some long bone fractures. Critically observed, no method of fracture fixation is ideal. Each osteosynthesis method has both advantages and weaknesses. OBJECTIVE: The objective of this study was to compare the results of the experimental application of three different internal fixation methods: plate fixation, intramedullary nail fixation and self-dynamisable internal fixator (SIF). METHODS: A series of 30 animals were used (Lepus cuniculus) as experimental animals, divided into three groups of ten animals each. Femoral diaphysis of each animal was osteotomized and fixed with one of three implants. Ten weeks later all animals were sacrificed and each specimen underwent histological and biomechanical testing. RESULTS: Histology showed that the healing process with SIF was more complete and bone callus was more mature in comparison to other two methods. During biomechanical investigation (computerized bending stress test), it was documented with high statistical significance that using SIF led to stronger healing ten weeks after the operation. CONCLUSION: According to the results obtained in this study, it can be concluded that SIF is a suitable method for fracture treatment.

Relation between edaphic factors and vegetation development on copper mine wastes: a case study from Bor (Serbia, SE Europe).

The relationship between edaphic characteristics and vegetation growing on mine wastes in the Bor region (East Serbia, SE Europe) was studied using multivariate statistical analysis. The influence of edaphic factors on the composition of plant life-forms was also investigated, since it could reflect strategies for the avoidance of or tolerance to disturbances of ecosystems. The goal was to provide potential models for the restoration and management of this and similar mine waste areas. The results of this study imply that soil textures, nitrogen contents, reclamation technology and the presence of hydrothermally altered andesite as the type of bedrock significantly influenced plant colonization and vegetation composition of the Bor mine wastes. These edaphic factors explained 30.3 % of the total variation in the vegetation data set. It was also revealed that the pattern of plant life-forms found on the considered site groups corresponded to the soil texture. Based on their relative abundance on the investigated sites and relationships with soil properties it is concluded that therophytes and geophytes are unsuccessful primary colonizers of the Bor mine wastes. Hemicryptophytes of psammophytic character were the most successful primary colonizers and therefore potential candidates for anthropogenically-assisted natural recovery. This study suggested that an assessment of edaphic factors should be widely used in the characterization of mine wastes prior to reclamation. Estimation of their role in the development of existing mine vegetation should predate reclamation procedures. Thus, approaches based on adequate plant life-forms should have a more prominent role in future mine reclamation schemes.

Bioaccessibility of uranium in soil samples from Port Hope, Ontario, Canada.

Adequate assessment of human health risk of uranium contamination at hazardous waste sites, which is an important step in determining the cleanup strategy, is based on bioavailability data. Bioavailability of uranium from contaminated soil has not been properly determined yet. Bioaccessibility is an in vitro conservative estimate of bioavailability and is thus frequently used for site-specific risk assessment. Bioaccessibility of uranium was measured in 33 soil samples from the Port Hope area in Ontario, Canada, by the physiologically based extraction test (PBET). Higher bioaccessibility values in the gastric plus intestinal phase, 48.4% ± 16.8%, than in the gastric phase, 20.8% ± 11.7%, are very probably the result of more efficient extraction of uranium from soil by intestinal fluid rich in carbonate ions. The observed variability of measured bioaccessibility values is discussed in light of the results of scanning electron microscope examination of the soil samples. Uranium bioaccessibility values in both gastric (acidic) and gastric plus intestinal (neutral) phases are higher in soil samples with smaller uranium-bearing particles and lower in samples where the uranium-bearing particles are larger. We postulate that the most important reason for variability of measured bioaccessibility values in Port Hope soil samples may be the difference in particle size of uranium-bearing particles.

Patient dose measurements in diagnostic radiology procedures in Montenegro.

It was the aim of the study presented here to estimate for the first time patient dose levels in conventional diagnostic radiology in Montenegro. Measurements of patient dose in terms of entrance surface air kerma (ESAK) and kerma-area product (KAP) were performed on at least 10 patients for each examination type, in each of five randomly selected health institutions in Montenegro, so that a total of 872 patients for 16 different examination categories were included in the survey (817 patients for 1049 radiographies and 55 fluoroscopy patients). Exposure settings and individual data were recorded for each patient. Mean, median and third quartile values ESAK of patient doses are reported. The estimated mean ESAK values obtained are as follows: 4.7 mGy for pelvis anteroposterior (AP), 4.5 mGy for lumbar spine AP, 7.8 mGy for lumbar spine lateral (LAT), 3.1 mGy for thoracic spine AP and 4.3 mGy for thoracic spine LAT. When compared with the European diagnostic reference values, the mean ESAK for all studied examination types are found to be below the reference levels, except in chest radiography. Mean ESAK values for chest radiography are 0.9 mGy for posteroanterior (PA) projection and 2.0 mGy for LAT. The results exhibit a wide range of variation. For fluoroscopy examinations, the total KAP was measured. The mean KAP value per procedure for barium meal is found to be 22 Gy cm(2), 41 Gy cm(2) for barium enema and 19 Gy cm(2) for intravenous urography. Broad dose ranges for the same types of examinations indicate the necessity of applying practice optimisation in diagnostic radiology and establishment of national diagnostic reference levels.

Regional tritrophic relationship patterns of five aphid parasitoid species (Hymenoptera: Braconidae: Aphidiinae) in agroecosystem-dominated landscapes of southeastern Europe.

A regional survey of the complex tritrophic associations (parasitoid-aphid-plant) of aphid parasitoids (Hymenoptera: Braconidae: Aphidiinae) was carried out to determine and explore the patterns of those associations in various types of environments. Here, we present trophic relationship patterns of the five aphid parasitoid species in crop and noncrop habitats in southeastern Europe, and we contrast them in a regional (Mediterranean [MED] versus continental [CNT]) context. In total, 79 aphid host taxa were identified in this survey. Forty-two of these were recorded from noncrop plants only, 21 from crop plants only, and 18 were present on both types of plants. This means that approximately 74% of all the parasitoid-aphid trophic interactions that support the persistence of the five selected parasitoids are entirely (54%) or partially (20%) associated with noncrop plants. The correspondence of parasitoid-aphid combinations among habitat/region combinations is very high and specific. Our results suggest that Mediterranean and continental regions are clearly distinguished by a contrasting pattern of trophic interactions in crop habitats, whereas the noncrop habitats contribute in lesser degree to these differences. For the crop/noncrop breakdown, the number of nonspecific interactions was larger than expected in crop habitats, whereas in noncrop habitats the abundance of partially specific and specific interactions was larger. The analysis of variance for the regional and habitat distribution of mean aphid host number per parasitoid was highly significant. When both regions were analyzed separately, the parasitoid/crop design showed significant parasitoid effects as well as interactions, whereas the habitat effect was not significant for the Mediterranean region and highly so for the continental region. This highly complex pattern suggests that the mean number of parasitized aphid species is not distributed among parasitoids, regions, and habitats in a similar manner. Even with these complexities taken into account, the overall trend is that noncrop habitats support more parasitoid-aphid combinations and more so in the continental than in Mediterranean regions, although not always statistically significant. As mentioned, large number of noncrop aphid hosts, especially for Lysiphlebus fabarum (Marshall), Praon volucre (Haliday) and Aphidius colemani Viereck, can significantly enhance the population buildup for these important parasitoids around agroecosystems. These facts can be important in biological aphid pest control in the region. Although not easily quantified, the overall positive effects of larger parasitoid diversity in noncrop habitats are undoubtedly related to the distribution and structure of noncrop habitat patches in agroecosystems at a landscape scale.

Evaluation of genotoxic effects of Apitol (cymiazole hydrochloride) in vitro by measurement of sister chromatid exchange.

Apitol, with cymiazole hydrochloride as the active ingredient, is used in bee-keeping against the ectoparasitic mite Varroa destructor. The preparation was evaluated for genotoxicity in cultured human peripheral blood lymphocytes. Sister chromatid exchange, the mitotic index and the cell proliferation index were determined for three experimental concentrations of Apitol (0.001, 0.01 and 0.1 mg/ml). All concentrations significantly (p < 0.001) increased the mitotic index (MI = 7.35+/-0.18%, 8.31+/-0.20% and 12.33+/-0.25%, respectively), the proliferative index (PI = 1.83+/-0.01, 1.84+/-0.01 and 1.88+/-0.02, respectively) and the frequency of sister chromatid exchange (SCE = 8.19+/-1.81, 8.78+/-1.80 and 13.46+/-1.88, respectively), suggesting that cymiazole hydrochloride has genotoxic potential.

[Systemic inflammatory response syndrome in surgical patients with sepsis]. / Sindrom sistemskog zapaljenjskog odgovora kod hirurskih bolesnika sa sepsom.

Systemic inflammatory response syndrome and sepsis are common in surgically treated patients. Systemic inflammatory response syndrome represents a major factor of morbidity and mortality in these patients. The pathogenesis of these syndromes has been increasingly clarified. The objective of this review is to present an overview of our current understanding of the physiology underlying these conditions.