Evaluation of clinical characteristics linked with the survival of patients with advanced-stage ovarian malignancies.

PURPOSE: To evaluate the potential influence of clinical characteristics on survival of patients with advanced-stage of ovarian malignancies. METHODS: The study included 163 women with FIGO stages 3 and 4 ovarian malignancies. Detailed history (family history of malignancies, age, menopausal status, body mass index (BMI), parity, comorbidities, symptoms/signs) was taken from all patients including tumor histopathological findings. Patients were postoperatively followed up to 5 years and adverse events were recorded. Univariate and multivariate survival analyses were applied. RESULTS: Patient median survival was 22.77 months (range 1-91). Almost 74% of women survived in the first postoperative year, but only 12.9% had 5-year survival. In the postoperative period, each additional 6 months presented significant risk for unfavorable outcome. Women who were menopausal (p=0.033) and especially if older than 65 years (p=0.016) had worse prognosis. Patients with BMI ≤25 kg/m2 had significantly longer postoperative survival (p=0.005; obesity hazard ratio/HR=1.525). Women with other gynecological or chronic illnesses had a significantly shorter postoperative survival (p=0.038; hazard ratio/HR=1.450). There were no significant differences in postoperative survival regarding patients' parity, presence of symptoms or positive family history. Two significant models adjusted for FIGO stage (p=0.046) and histological tumor type (p=0.003) encompassing all assessed patient characteristics that could influence survival were obtained. CONCLUSIONS: The most important clinical characteristics that can be predictors of survival of patients with advanced ovarian malignancies are comorbidities and being overweight.

The effect of clinical, radiographic and functional scores on the total score in the evaluation of congenital clubfoot.

INTRODUCTION: The use of radical surgical treatments in treating congenital clubfoot is decreasing. Minimally invasive surgical treatment (MIST) is a way of treating congenital clubfoot, which is a kind of compromise between a radical surgical treatment and non-operational one. A few protocols of different authors McKay, Macnicol, Stevens, Meyer, G.W.Simons and Laaveg-Ponseti were used in the evaluation of the results. SCIENTIFIC OBJECTIVE: To determine the importance and role of groups of parameters (clinical, radiographic and functional) in the evaluation of the results in patients treated with the two methods (radical operation and MIST). SUBJECTS AND METHODS: This paper covers children who were treated for structural (idiopathic) form of PEVC. The testing is a prospective study and was conducted in two groups of patients. Group A (radical surgical treatment) - control group, where the total number of subjects was 50, out of which 35 male (70%) and 15 female (30%). The number of feet tested was 88. Group B (minimally invasive surgical treatment-MIST)-experimental group. The total number of subjects was 48, out of which 35 male (73%) and 13 female (27%). The number of feet tested was 84. For the analysis of the results, we used a questionnaire. The total number of parameters was fifteen, clinical, radiographic and functional, five parameters of each. Normal findings or measured value was determined by 0 points. The range of the total score (TS-a- total score range) 0-27 points, and the results were sorted out into the folowing categories: good result (0-5) satisfactory (6-11), poor (12-19) and deformity recrudescence (20-27) points. RESULTS: The proportion of good results at 88 feet in group A was 0,477 as at 84 feet in group B it was significantly higher and came to 0,893. The difference between these proportions is statistically highly significant (t = 5.84, p <0.001). Chi-square test (χ2 = 30.083 df = 1 N = 172, p <0.001) indicated that there is a highly significant correlation between the method of treatment used and results of treatment. Good results of treatment in group A were observed in 48% and in group B in 88% of cases. The Charles Spearman nonparametric method showed that the rank correlation coefficients for the group A are positive, quite high (between 0.70 and 0.85), similar and statistically highly significant (p <0.001). The influence of radiographic scores on the total score is the lowest, and clinical score on the overall score is the highest. Rank correlation coefficients for group B were also positive but somewhat smaller than in group A (between 0.55 and 0.75) and statistically highly significant (p <0.001). It is possible to notice the difference here and say that the impact of functional scores on the total score is the highest and of radiographic score the lowest. CONCLUSION: Minimally invasive surgical treatment (MIST) gives better functional results in the treatment of congenital clubfoot than radical surgical treatment. The role of radigraphic parameters in the evaluation of the results of the treatment was the slightest regardless of whether the treatment was radical surgery or MIST. We believe that radiography for routine analysis of the results of treatment need not be used.

Treatment of endometrial cancer in patient with malignant obesity.

Our 60-year-old patient menarche in 13-year, two delivery, last menstruation in 53-year, without uterine bleeding or any kind of symptomatology. The gynecological transvaginal ultrasound examination showed hyperplasio endometrii (20 mm). After curettage, pathological examination was diagnostic polypus carcinomatoides. The patient with HTA and obesity was admitted to and operated on at the Gynecological Department due to endometrial carcinoma (FIGO stage IA1). Because of her giant obesity, BMI - 71.50 kg/m2, weight 219 kg and height 175 cm, surgery by the abdominal approach was very difficult to perform, so vaginal hysterectomy was carried out. The procedure was completed within 127 minutes without any intraoperative complications. Blood loss was less than 100 ml. The patient was discharged on postoperative day 7. The patient was followed up for 6 months after surgery. No complications or recurrence were reported during the 6-month follow up.

Characterization and Environmental Evaluation of Recycled Aggregates from Construction and Demolition Waste in Belgrade City Area (Serbia).

Sustainable consumption of construction materials is an important segment of sustainable development goals towards reducing climate change. Since the consumption of natural aggregates raises environmental concerns, there is an increasing demand for use of recycled aggregates (RAs), as it enhances social and environmental benefits and creates a market opportunity. This paper presents the practice of using recycled construction and demolition waste (CDW) in the Belgrade city area (Serbia) as a resource. Two groups of CDW from Vinca landfill site near Belgrade are analyzed: raw material before, and RAs after, construction of a recycling facility on site. Comprehensive characterization is performed (including particle size distribution, density, water and organic pollutants content, various mechanical resistances, flakiness index, etc.) and compilation of samples analyzed and compared to show a holistic overview. The test outputs in both groups show acceptable values and meet required standards, indicating that recycled CDW generated in the Belgrade area can be used as a substitute to natural aggregates. In addition to that, the environmental and economic benefits from this use as a substitute are analyzed and discussed, proving the substantial income from sold Ras and the landscaping benefits, as well as ecological and economic benefits from energy savings.

Overexpression of MRP1/ABCC1, Survivin and BCRP/ABCC2 Predicts the Resistance of Diffuse Large B-Cell Lymphoma to R-CHOP Treatment.

BACKGROUND: Approximately 40% of patients with diffuse large B-cell lymphoma (DLBCL) experience treatment resistance to the first-line R-CHOP regimen. ATP binding cassette (ABC) transporters and survivin might play a role in multidrug resistance (MDR) in various tumors. The aim was to investigate if the coexpression of ABC transporters and survivin was associated with R-CHOP treatment response. METHODS: The expression of Bcl-2, survivin, P-glycoprotein/ABCB1, MRP1/ABCC1, and BCRP/ABCC2 was analyzed using immunohistochemistry in tumor specimens obtained from patients with DLBCL, and classified according to the treatment response as Remission, Relapsed, and (primary) Refractory groups. All patients received R-CHOP or equivalent treatment. RESULTS: Bcl-2 was in strong positive correlation with clinical parameters and all biomarkers except P-gp/ABCB1. The overexpression of MRP1/ABCC1, survivin, and BCRP/ABCC2 presented as high immunoreactive scores (IRSs) was detected in the Refractory and Relapsed groups (p < 0.05 vs. Remission), respectively, whereas the IRS of P-gp/ABCB1 was low. Significant correlations were found among either MRP1/ABCC1 and survivin or BCRP/ABCC2 in the Refractory and Relapsed groups, respectively. In multiple linear regression analysis, ECOG status along with MRP1/ABCC1 or survivin and BRCP/ABCG2 was significantly associated with the prediction of the R-CHOP treatment response. CONCLUSIONS: DLBCL might harbor certain molecular signatures such as MRP1/ABCC1, survivin, and BCRP/ABCC2 overexpression that can predict resistance to R-CHOP.

Liver hydatidosis - surgical treatment.

BACKGROUND/AIMS: Hydatid disease is a concealed parasite illness that spreads over all organs and tissues. It is a difficult and widespread invasive illness which occupies a special place in pathology of hepato-billious tract. METHODOLOGY: This study includes analysis of 103 patients operated from liver hydatidosis during a 15 year period. RESULTS: Ratio between female and male patients was 2:1, with a female predominance. The patient's age ranged from 19 to 65 years old, i.e. they were still capable of working, with an average age of 47 years. The patient's were mostly housewives, farmers and cattle breeders (71 or 68.9%). The most frequent method we used was pericystectomy with omentoplastics applied in (51 or 49.5%) cases, then pericystectomy with drainage applied in (31 or 30.1%) cases, followed by extirpation of the cyst applied in (11 or 10.7%) cases, liver resection was performed in only (7 or 6.8%) cases, marsupielisation was performed in (3 or 2.9%) cases, but out of necessity. The most frequently used approaches were the right subcostal ones, medial and Orh's cut - (95 or 92.2%) cases. Postoperative complications occurred in (39 or 37.9%) cases. Lethal result occurred in (2 or 1.9%) cases. CONCLUSIONS: Our opinion is that a total cystopericystectomy with omentoplastics, which is a method of choice, decreases hospitalization period and complications.

Cervical length measured by transvaginal ultrasonography and cervicovaginal infection as predictor of preterm birth risk.

INTRODUCTION: The study shows possibilities of transvaginal sonographic measurement of the cervix in prediction of premature birth risk. GOALS: The aim of the study was to follow up the cervical length in the pregnant from 16(th) to 37(th) week, as well as to do a microbiological analysis of the vaginal and cervical flora and to identify relation between the cervical shortening and microbiological flora as well as with a premature birth. MATERIAL AND METHODS: The investigation was conducted as a prospective study on two groups of female patients in Clinical Centre of Banja Luka. In the high risk group we had 8% of patients with cervical length bellow than 15mm, 30% of patients with cervical length from 15 to 25m and 62% of patients with cervical length bigger than 25mm. In the low risk group we had no patients with cervical length bellow 15mm, 95% of patients had cervical length bigger than 25mm and 5% of patients had cervical length from 15 do 25mm. RESULTS: The regression coefficient of the cervical length in the high risk group was 0.44mm, while in the low risk group it was 0.26mm. In the high risk group 67.56% patients had a positive cervical smear finding, while in the low risk group it was 4%. A high premature birth (defined as birth before 36.6 weeks) incidence of 50% was presented in patients with cervical length bellow 15mm. In the group of patients with cervical length up to 25mm the premature risk incidence was 10.52±0.05. In the high risk group of patients with a positive cervical smear finding, regarding the cervical length the percentage was as follows; in the subgroup of 15mm length 88,89±11,87, in subgroup from 15 to 25mm was 62,07±11,43 and in the subgroup bigger than 25mm, 60.06±8.05. CONCLUSION: By the analysis of the first and second goal of our study we can conclude that ultrasound assessment of cervical length is simple and feasible in the 16(th) week of pregnancy in both groups, with high and low risk. The length of the cervix in this period is shorter in the high risk group compared with the low-risk group. This difference was not statistically significant, however, it clearly demonstrated connection between shorten length of the cervix with the preterm birth. A regression analysis shows that the shortening of the cervix length is more frequent in high risk group which is to be expected, bearing in mind that in this group, the risk of preterm delivery was significantly higher.

Nano-structural and compositional basis of devitalized tooth fragility.

OBJECTIVE: Increased tooth fragility after devitalization is commonly observed but there is no definite mechanistic explanation for such phenomenon. Therefore, it is important to analyze more profoundly structural and compositional properties of this altered form of dentin. The present study investigates the differences between normal and devitalized dentin using advanced techniques. METHODS: Atomic force microscopic imaging (AFM), energy dispersive X-ray analysis (EDX) and micro-Raman spectroscopy were performed on 16 dentin specimens, eight vital and eight that underwent root-canal treatment at least two years before extraction and had no infection in root canals before or after devitalization. RESULTS: The mean size of mineral crystals showed by AFM was larger in devitalized than in healthy dentin in the same age category. AFM phase shifts in devitalized cases revealed altered mechanical characteristics and suggested differences in composition of material between devitalized teeth and healthy controls. No significant difference in Ca/P ratio between vital and devitalized teeth was found using EDX. However, micro-Raman analyses showed that in devitalized teeth, apart from hydroxyapatite, dentin contained significant amounts of apatite phases with lower calcium content: octacalcium phosphate, dicalcium phosphate dihydrate and tricalcium phosphate. SIGNIFICANCE: Differences between vital and devitalized dentin bring new insights into the basis of devitalized tooth fragility. Larger mineral crystals could account for decreased mechanical strength in devitalized teeth. Moreover, calcium-phosphate phases with lower Ca content have lower material strength, and the presence of these phases in devitalized teeth may explain their increased fragility.