Correlation of the inclination of the tentorium cerebellum and the volume of the posterior cranial fossa.

Aim To investigate the influence of the inclination and insertion of the cerebellar tentorium on the posterior cranial fossa (PCF) volume. Methods A retrospective, non-randomized study including 174 patients (117 females and 57 males) who underwent magnetic resonance imaging in the period from 31 December 2020 to 1 June 2021 under the indication (mostly headache) set by a competent ordinary. Acute or chronic intracranial events were not verified in the patients. Results The average value of the PCF volume was 138.93 cm3 and the slope of the tentorium was 44.15°. Comparing the volume of the PCF and the slope of the tentorium in males and females no significant difference was found. A correlation was found in the females age groups 18-24 and 45-54 years. Conclusion Understanding dimensions of the posterior cranial fossa morphometry has clear implications for reducing morbidity and mortality in surgery, especially in the case of applying lateral approaches and their variations.

Survey of attitudes towards curriculum reforms among medical teachers in different socio-economic and cultural environments.

BACKGROUND: Curriculum reforms in medical schools require cultural and conceptual changes from the faculty. AIMS AND METHODS: We assessed attitudes towards curriculum reforms in different academic, economic, and social environments among 776 teachers from 2 Western European medical schools (Belgium and Denmark) and 7 medical schools in 3 countries in post-communist transition (Croatia, Slovenia, Bosnia and Herzegovina). The survey included a 5-point Likert-type scale on attitudes towards reforms in general and towards reforms of medical curriculum (10 items each). RESULTS: Teaching staff from medical schools in Bosnia and Herzegovina had a more positive attitude towards reforms of medical curriculum (mean score 36.8 out of maximum 50 [95% CI 36.1 to 37.3]) than those from medical schools in Croatia or Slovenia (30.7 [29.8 to 31.6]) or Western Europe (27.7 [27.1 to 28.3]) (P < 0.001, ANOVA). Significant predictors of positive attitudes towards medical curriculum reform in post-communist transition countries, but not in Western European schools, was younger age, as well as female gender in Bosnia and Herzegovina. CONCLUSIONS: Factors influencing faculty attitudes may not be easy to identify and may be specific for different settings. Their identification and management is necessary for producing sustainable curriculum reform.

EXPRESSION OF COLLAGEN TYPE I IN UNALTERED AND OSTEOARTHRITIC MENISCI OF KNEE JOINT.

INTRODUCTION: Knee osteoarthritis is a progressive degenerative disease which affects meniscal tissue. The aim of this study was to determine the differences in collagen type I expression in macroscopically unaltered and osteoarthritic menisci, and correlate the expression with the grade of macroscopic damage, age and body mass index of patients, preoperative condition of anterior cruciate ligament, angulation and knee contracture. MATERIAL AND METHODS: The control group consisted of 10 macroscopically unaltered menisci, while the experimental group had 35 osteoarthritic menisci. Besides macroscopic grading of meniscal damage, the analysis of collagen type I expression was determined by immunohistochemical staining with the corresponding antibody using semiquantitative scale scores and quantitative parameters: intensity of expression and stained area size. RESULTS: The results of semiquantitative evaluation showed a statistically significant decrease in collagen type I expression in osteoarthritic menisci, which correlated with an increase in macroscopic damage grade. The results of quantitative evaluation did not show a statistically significant decrease in the expression. In posterior meniscal horns, a more intense collagen type I expression was seen in the women, as well as a positive correlation of quantitatively evaluated expression with body mass index. Collagen type I expression in the anterior horns was significantly lower in varus alignment. CONCLUSION: In the semiquantitative evaluation, collagen type I expression in osteoarthritic menisci was significantly lower compared to macroscopically unchanged menisci. The decrease in the expression level correlates with the increase in the grade of macroscopic meniscal damage. There was no statistically significant difference in the quantitative evaluation of expression.

[Quantitative analysis of vascular network of oculogyric nerve nuclei].

INTRODUCTION: Nuclei of oculogyric nerves (principal oculomotor nucleus, trochlear nucleus and abducens nucleus) are densely vascularized brainstem structures. The aim of this study was to determine quantitative characteristics of the vascular network of these nuclei. MATERIAL AND METHODS: The study was done on 30 adult brainstems, both male and female, without diagnosed neurological disturbances. Three-millimetre-thick stratums were taken in transversal plane and cut in 0.3 micrometer semi-serial sections stained with Mallory method. The images of studied nuclei were taken with "Leica" DM 1000 microscope and "Leica" EC3 digital camera under 400x magnification, and analyzed by ImageJ software with A 100 grid. The statistical analysis was performed by Statistical Package for the Social Sciences software with 5% level of significance. RESULTS: A statistically significant difference was found in the volume and surface density between principal oculomotor nucleus and trochlear nucleus, and between trochlear nucleus and abducens nucleus. No difference was found in the length density. DISCUSSION: The results of this research match the results of studies on characteristics of vascular network of oculogyric nerve nuclei, while the comparison of vascular networks of these nuclei, substantia nigra, vestibulocochlear nuclei and precentral gyrus illustrates differences in quantitative characteristics of blood vessels in these structures. CONCLUSION: Blood vessels of principal oculomotor nucleus and abducens nucleus have similar dimensions and approximately the same arborization pattern, while vessels of trochlear nucleus have significantly smaller dimensions and density.

Expression of vascular endothelial growth factor in melanocytic nevi.

Melanocytic nevi represent a benign neoplastic proliferation of melanocytes. The level of vascular endothelial growth factor expression in these proliferations is low in most cases; whereas an increased expression of this factor may be an indicator of pre-neoplastic changes in melanocyte lesions. We performed a semi-quantitative assessment of the level of vascular endothelial growth factor expression (score 0 to 3) on samples taken from 34 patients with benign melanocyte alterations of the skin. Melanocytic nevi showed an expression of vascular endothelial growth factor in 79.41% of the cases. The low level of expression (score 1) was seen in 70.59% cases. The results showed no statistically significant difference in the presence and level of vascular endothelial growth factor expression in relation to the following morphological parameters: histological type, a defect in the surface, density of inflammation infiltrate, mitotic index, growth phase and cell type.

Significance of vascular endothelial growth factor expression in skin melanoma.

BACKGROUND/AIM: Melanoma is a heterogeneous disease of skin and mucous membranes which shows significant increase in incidence worldwide in the past decades. In the process of forming new blood vessels stimulators of angiogenesis participate. There is an increase production of vascular endothelial growth factor (VEGF-C and VEGF-D), which expression cause change of endothelial cells, and higher degree of tumor's aggressiveness. The aim of this research was to determine the level of VEGF expression in skin melanoma in different body regions and in different primary stages of the disease. METHODS: The research was conducted on bioptic materials of skin in 39 patients. On excision-made materials a routine histological preparation was done and following parameters were determined: histological type, alteration thickness (according to Breslow), Clark level, TNM (Tumor Nodus Metastasis) stage (pT), alteration width, thickness of lymphocytic infiltration in the tumor, mitotic index, phase of the tumor growth, presence of ulcerations, cellular type of the tumor, localization and level of VEGF expression. RESULTS: Analysis confirmed that 61.54% of skin melanoma showed a high VEGF expression. Nodular and acral lentiginous melanomas showed more frequently a high level of VEGF expression, while superficial spreading melanoma showed a lower level of VEGF expression (p = 0.032, p < 0.05). A higher level of expression was present in thicker melanomas (higher in the Breslow stage; p = 0.011, p < 0.05). The width of the lesion did not have an influence on the level of VEGF expression in melanoma (U =142.000, p = 0.273). CONCLUSION: Melanomas show a higher level of VEGF expression. Nodular and acral lentiginous types of melanoma show a high level of VEGF expression, while superficial spreading melanoma shows a lower level of VEGF expression. Melanomas in higher-stage disease (Breslow, Clark, pTNM) show a higher level of VEGF expression.

A comprehensive assessment of medical schools in Bosnia and Herzegovina.

OBJECTIVES: To perform internal and external evaluations of all 5 medical schools in Bosnia and Herzegovina against international standards. METHODS: We carried out a 2-stage survey study using the same 5-point Likert scale for internal and external evaluations of 5 medical schools in Bosnia and Herzegovina (Banja Luka, Foca/East Sarajevo, Mostar, Sarajevo and Tuzla). Participants consisted of managerial staff, teaching staff and students of medical schools, and external expert assessors. Main outcome measures included scores on internal and external evaluation forms for 10 items concerning aspects of school curriculum and functioning: 'School mission and objectives'; 'Curriculum'; 'Management'; 'Staff'; 'Students'; 'Facilities and technology'; 'Financial issues'; 'International relationships'; 'Internal quality assurance', and 'Development plans'. RESULTS: During internal assessment, schools consistently either overrated their overall functioning (Foca/East Sarajevo, Mostar and Tuzla) or markedly overrated or underrated their performance on individual items on the survey (Banja Luka and Sarajevo). Scores for internal assessment differed from those for external assessment. These differences were not consistent, except for the sections 'School mission and objectives', 'Curriculum' and 'Development plans', which were consistently overrated in the internal assessments. External assessments was more positive than internal assessments on 'Students' and 'Facilities and technology' in 3 of 5 schools. CONCLUSIONS: This assessment exercise in 5 medical schools showed that constructive and structured evaluation of medical education is possible, even in complex and unfavourable conditions. Medical schools in Bosnia and Herzegovina have successfully formed a national consortium for formal collaboration in curriculum development and reform.