bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of E. coli biofilm as a protective barrier against microbiologically influenced deterioration of concrete (MICD) under mesophilic temperatures
Authors: Soleimani S. , Ormeci B. , Isgor O. B.
Published: July 2013

In this study, Escherichia coli DH5α biofilm was evaluated for its potential to control and minimize microbiologically influenced concrete deterioration (MICD) under mesophilic temperatures (37 °C). Escherichia coli DH5α biofilm was first grown on Portland cement mortar disks for 8 days. Mortar disks were then exposed to two different types of sulfur oxidizing bacteria (SOB) (Thiobacillus neapolitanus and Thiobacillus thiooxidans), which use sulfur compounds as substrate and oxidize them to sulfate and sulfuric acid. The effectiveness of the biofilm against MICD was evaluated by measuring pH, sulfate, calcium concentrations in the reactors and surface analysis of the mortar samples using X-ray diffraction and visual inspection. Overall, the results indicate that the E. coli DH5α biofilm showed good protection against MICD induced by SOB at 37 °C.
Influence of earthworm Eisenia fetida on Iris pseudacorus's photosynthetic characteristics, evapotranspiration losses and purifying capacity in constructed wetland systems
Authors: Xu Defu , Li Yingxue , Fan Xiaolong , Guan Yidong , Fang Hua , Zhao Xiaoli
Published: July 2013

Four constructed wetland systems were studied to investigate the effects of adding Eisenia fetida on the purifying capacity of constructed wetlands. Addition of E. fetida increased the photosynthetic rate (Pn), transpiration rate (Tr) and chlorophyll meter value of leaves of Iris pseudacorus L. in the constructed wetlands by 16, 35 and 7%, respectively. Compared with the substrate only system, evapotranspiration losses were increased by 8, 48 and 56% for the wetland systems with substrate and E. fetida, with substrate and I. pseudacorus, and with substrate, I. pseudacorus and E. fetida, respectively. Addition of E. fetida to the substrate only and substrate and plant wetland systems decreased the substrate bulk density by 3 and 6%, respectively. The addition of E. fetida to the system with substrate and plants increased the removal efficiency of chemical oxygen demand (CODMn), total nitrogen (TN) and total phosphorus by 5, 7 and 22%, respectively. Evapotranspiration losses were significantly positively correlated with the removal efficiency of CODMn (P < 0.01). The significantly negative correlation between the removal efficiency TN and bulk density was found (P < 0.05). Therefore, E. fetida could stimulate I. pseudacorus growth and improve the substrate bulk density in the constructed wetland, resulting in enhanced purifying capacity.
The impact of chlorine disinfection on biochemical oxygen demand levels in chemically enhanced primary treatment effluent
Authors: Dai Ji , Jiang Feng , Shang Chii , Chau Kwok-ming , Tse Yuet-kar , Lee Chi-fai , Chen Guang-Hao , Fang Jingyun , Zhai Liming
Published: July 2013

The response trends of biochemical oxygen demand (BOD) and organic strength after the chlorination/dechlorination process were explored through a 2-year, 5-month chemically enhanced primary treatment (CEPT) effluent onsite monitoring program and a 2-month laboratory-scale study. The monitoring results showed that better instantaneous mixing at the chlorine injection point reduced the effect of chlorination/dechlorination on the 5-day BOD levels. The laboratory study results demonstrated that chlorination did not change the particle size distribution, dissolved organic carbon, or chemical oxygen demand of the organic content of the effluent. Nevertheless, chlorination/dechlorination strongly affected the BOD measurement when nitrification was inhibited by changing bioactivity/biodegradation rates.
Phosphatase activity and specific methanogenic activity in an anaerobic reactor treating sludge from a brackish recirculation aquaculture system
Authors: Zhang Xuedong , Ferreira Rui B. , Spanjers Henri , van Lier Jules B.
Published: July 2013

Anaerobic treatment of high salinity sludge from marine/brackish recirculation aquaculture systems is potentially limited by inhibition of enzymatic activities and cell lysis resulting from high osmotic pressures. To further address these limitations the following investigations were conducted: effect of salinity on phosphatase activity (PA), soluble microbial products (SMP) production, and presence of extracellular polymeric substances (EPS); effect of iron (III) chloride (FeCl3) on PA and specific methanogenic activity (SMA); effect of addition of the compatible solute glycine betaine (GB) and potassium on PA, as well as on SMP and EPS production, all under saline conditions. The results show that salinity has different effects on PA of anaerobes under starvation and feeding conditions. FeCl3 increased the SMA of the sludge by 22.5% at 100 mg FeCl3/L compared with a control group (0 mg FeCl3/L). Furthermore, results of analysis of variance tests show that betaine increased the polysaccharide content of EPS and polypeptide content of SMP. However, addition of 1 mM potassium chloride did not show a significant effect on EPS and SMP composition. In conclusion, anaerobic digestion of salty sludges from a brackish aquaculture recirculation system may not be negatively affected by FeCl3 addition to concentrate waste streams, whereas GB boosts the production of SMP and EPS.
Methane production and hydrolysis kinetics in the anaerobic degradation of wastewater screenings
Authors: Cadavid-Rodríguez L. S. , Horan N.
Published: July 2013

Anaerobic biodegradability and hydrolysis rates of wastewater screenings were determined using the biochemical methane potential test at 37 °C. The extent and rate of screenings conversion to methane of this complex and particulate substrate were investigated and since two stages of hydrolysis were identified, corresponding to the different types of materials in screenings, a linear and non-linear model was used. No accumulation of intermediary products was observed and so it was possible to use the methane production rate and a linear model to estimate the hydrolysis rate in the first phase of hydrolysis. The measured values of 0.061–0.127 d−1 are in the range reported for other comparable organic wastes. It was also observed that the inoculum-to-substrate ratio has a large impact on methane production rate of screenings. The difference in biodegradation rates from the materials in screenings and the overall hydrolysis could be represented by the modified Gompertz non-linear model which was able to describe the methane production rate of screenings with a high confidence. Screenings were found to have 52% biodegradability on average and this shows the potential for volatile solids destruction. A two-stage process with an improved hydrolysis rate is proposed to ensure that the full potential of the material is exploited.
The occurrence and fate of phenolic compounds in a coking wastewater treatment plant
Authors: Zhang Wanhui , Wei Chaohai , Feng Chunhua , Ren Yuan , Hu Yun , Yan Bo , Wu Chaofei
Published: July 2013

The occurrence of 14 phenolic compounds (PCs) was assessed in the raw, treated wastewater, dewatered sludge and gas samples from a coking wastewater treatment plant (WWTP) in China. It was found that 3-cresol was the dominant compound in the raw coking wastewater with a concentration of 183 mg L−1, and that chlorophenols and nitrophenols were in the level of μg L−1. Phenol was the dominant compound in the gas samples, while 2,4,6-trichlorophenol predominated in the dewatered sludge sample. The anaerobic and aerobic tanks played key roles in the elimination of chlorophenols and phenols, respectively. Analysis of daily mass flows of PCs in WWTP showed that 89–98% of phenols and 83–89% of nitrophenols were biodegraded, and that 44–69% of chlorophenols were adsorbed to sludge, indicating that the fate of PCs was highly influenced by their biodegradability and physical–chemical property.
Comparison of short-term rainfall forecasts for model-based flow prediction in urban drainage systems
Authors: Thorndahl Søren , Poulsen Troels Sander , Bøvith Thomas , Borup Morten , Ahm Malte , Nielsen Jesper Ellerbæk , Grum Morten , Rasmussen Michael R. , Gill Rasphall , Mikkelsen Peter Steen
Published: July 2013

Forecast-based flow prediction in drainage systems can be used to implement real-time control of drainage systems. This study compares two different types of rainfall forecast – a radar rainfall extrapolation-based nowcast model and a numerical weather prediction model. The models are applied as input to an urban runoff model predicting the inlet flow to a waste water treatment plant. The modelled flows are auto-calibrated against real-time flow observations in order to certify the best possible forecast. Results show that it is possible to forecast flows with a lead time of 24 h. The best performance of the system is found using the radar nowcast for the short lead times and the weather model for larger lead times.
Field-scale application of spent sulfidic caustic as a source of alternative electron donor for autotrophic denitrification
Authors: Lee Jae-Ho , Park Jeung-Jin , Choi Gi-Choong , Byun Im-Gyu , Park Tae-Joo , Lee Tae-Ho
Published: July 2013

Biological reuse of spent sulfidic caustic (SSC) originating from oil refineries is a promising method for the petrochemical industry because of low handling cost. SSC typically contains high concentrations of sulfur, with the most dominant sulfur compounds being sulfide (S2−). SSC is also characterized by a high pH and elevated alkalinity up to 5–15% by weight. Because of these characteristics, SSC can be used for denitrification of NO3−-N in the biological nitrogen removal process as both the electron donor and buffering agent in sulfur-utilizing autotrophic denitrification. In this study, two kinds of SSC (SSC I, SSC II) produced from two petrochemical companies were used for autotrophic denitrification in a field-scale wastewater treatment plant (WWTP). The effluent total nitrogen (TN) concentration in this process was about 10.5 mg/L without any external carbon sources and the nitrification efficiency was low, about 93.0%, because of alkalinity deficiency in the influent. The injection of SSC I, but not SSC II, promoted nitrification efficiency, which was attributed to the difference in the NaOH/S ratio between SSC I and II. SSC was injected based on sulfide concentration of SSC required to denitrify NO3−-N in the WWTP. SSC I had higher NaOH/S than SSC II and thus could supply more alkalinity for nitrification than SSC II. On the other hand, additional TN removal of about 9.0% was achieved with the injection of both SSCs. However, denitrification efficiency was not proportionally increased with increasing SSC injection because of NO3−-N deficiency in the anoxic tank due to the limited capacity of the recycling pump. For the same reason, sulfate concentration, which is the end product of sulfur-utilizing autotrophic denitrificaiton in the effluent, was also not increased with increasing SSC injection.
Alexithymia Affects Pre-Hospital Delay of Patients with Acute Myocardial Infarction: Meta-Analysis of Existing Studies
Authors: Preti Antonio , Sancassiani Federica , Cadoni Federica , Carta Mauro Giovanni
Published: July 2013

Background:

The time between the onset of symptoms and reperfusion is a critical determinant of the clinical course of patients with acute myocardial infarction (AMI). Any delay in seeking help will affect patient’s outcome. Alexithymia can influence the information processing but also the skills to detect the signal of an ongoing AMI.

Method:

Systematic review and meta-analysis of studies investigating the role of alexithymia in pre-hospital delay after AMI. Pubmed/Medline and PsychINFO/Ovid search from 1990 until 2012.

Results:

Out of 29 studies investigating the role of psychological factors in pre-hospital delay after AMI, 3 studies specifically assessed alexithymia, involving 258 patients. All studies used the Toronto Alexithymia Scale to group patients into clusters by time to presentation after AMI. Meta-analysis of data showed that the patients with higher emotional awareness (i.e., low alexithymia) had shorter time to presentation after AMI.

Conclusions:

Preliminary evidence indicates that alexithymia may have a role in seeking help delay after AMI. Further studies are necessary to better appreciate how alexithymia influence help-seeking in patients with an evolving AMI and in what extent their ineffective behavior can be changed.
A Unifying Framework of the Demand for Transnational Medical Travel
Authors: Österle August , Johnson Tricia , Delgado Jose
Published: July 2013

Transnational medical travel has gained attention recently as a strategy for patients to obtain care that is higher quality, costs less, or offers improved access relative to care provided within their home countries. This article examines institutional environments in the European Union and United States that influence transnational medical travel, describes the conceptual model of demand for medical travel, and illustrates individual dimensions in the conceptual model of medical travel using a series of case studies. The conceptual model of medical travel is predicated on Andersen's behavioral model of health services. Transnational medical travel is a heterogeneous phenomenon that is influenced by a number of patient-related factors and by the institutional environment in which the patient resides. While cost, access, and quality are commonly cited factors that influence a patient's decision regarding where to seek care, multiple factors may simultaneously influence the decision about the destination for care, including culture, social factors, and the institutional environment. The conceptual framework addresses the patient-related factors that influence where a patient seeks care. This framework can help researchers and regulatory bodies to evaluate the opportunities and the risks of transnational medical travel and help providers and governments to develop international patient programs.
Noncommunicable Diseases: Global Health Priority or Market Opportunity? An Illustration of the World Health Organization at its Worst and at its Best
Authors: Katz Alison Rosamund
Published: July 2013

The promotion of noncommunicable diseases (NCDs) as a global health priority started a decade ago and culminated in a 2011 United Nations high-level meeting. The focus is on four diseases (cardiovascular and chronic respiratory diseases, cancers, and diabetes) and four risk factors (tobacco use, unhealthy diet, physical inactivity, and harmful alcohol use). The message is that disease and death are now globalized, risk factors are overwhelmingly behavioral, and premature NCD deaths, especially in low- and middle-income countries, are the concern. The NCD agenda is promoted by United Nations agencies, foundations, institutes, and organizations in a style that suggests a market opportunity. This “hard sell” of NCDs contrasts with the sober style of the World Health Organization's Global Burden of Disease report, which presents a more nuanced picture of mortality and morbidity and different implications for global health priorities. This report indicates continuing high levels of premature death from infectious disease and from maternal, perinatal, and nutritional conditions in low-income countries and large health inequalities. Comparison of the reports offers an illustration of the World Health Organization at its worst, operating under the influence of the private sector, and at its best, operating according to its constitutional mandate.
Primary Health Care, Now and Forever? A Case Study of a Paradigm Change
Authors: Bhatia Mrigesh , Rifkin Susan B.
Published: July 2013

The year 2008 marked the 30th anniversary of the Alma Ata Declaration that made Primary Health Care (PHC) the global health policy of member states of the World Health Organization (WHO). Why has PHC remained relevant? In part, this is because of growing evidence that health is a result of social, political, and economic environments, not merely of control of diseases and infirmities through interventions based on biomedical science. Using the conceptual framework developed by Thomas Kuhn, this article traces the emergence of PHC as a new paradigm based on social determinants to address poor health among populations (not individuals), especially those that are low-income. It traces the history of PHC over the last 30 years, focusing on policy developments within WHO. It selects three issues: definitions of PHC; financing and delivery of health services, including lay people's involvement in health care, as examples of the new paradigm; and opposition by those whose concept of health is based on the control of disease and infirmities paradigm. The article concludes by asking whether PHC will continue to be relevant and whether the question mark in the title of this article will be removed in the future.
Health Disparities among Wage Workers Driven by Employment Instability in the Republic of Korea
Authors: Jung Minsoo
Published: July 2013

Even though labor market flexibility continues to be a source of grave concern in terms of employment instability, as evidenced by temporary employment, only a few longitudinal studies have examined the effects of employment instability on the health status of wage workers. Against this backdrop, this study assesses the manner in which changes in employment type affect the health status of wage workers. The data originate from the Korean Labor and Income Panel Study's health-related surveys for the first through fourth years (n = 1,789; 1998 to 2001). This study estimates potential damage to self-rated health through the application of a generalized estimating equation, according to specific levels of employment instability. While controlling for age, socioeconomic position, marital status, health behavior, and access to health care, the study analysis confirms that changes in employment type exert significant and adverse effects on health status for a given year (OR = 1.47; 95% CI 1.10–1.96), to an extent comparable to the marked effects of smoking on human health (OR = 1.47; 95% CI 1.05–2.04). Given the global prevalence of labor flexibility, policy interventions must be implemented if employment instability triggers broad discrepancies not only in social standing, wage, and welfare benefits, but also in health status.
Social Change and Women's Health
Authors: McDonough Peggy , Worts Diana , McMunn Anne , Sacker Amanda
Published: July 2013

Over the past five decades, the organization of women's lives has changed dramatically. Throughout the industrialized world, paid work and family biographies have been altered as the once-dominant role of homemaker has given way to the role of secondary, dual, or even primary wage-earner. The attendant changes represent a mix of gains and losses for women, in which not all women have benefited (or suffered) equally. But little is known about the health consequences. This article addresses that gap. It develops a “situated biographies” model to conceptualize how life course change may influence women's health. The model stresses the role of time, both as individual aging and as the anchoring of lives in particular historical periods. “Situating” biographies in this way highlights two key features of social change in women's lives: the ambiguous implications for the health of women as a group, and the probable connections to growing social and economic disparities in health among them. This approach lays the groundwork for more integrated and productive population-based research about how historical transformations may affect women's health.
Psychosocial Work Environment and Intention to Leave the Nursing Profession: A Cross-National Prospective Study of Eight Countries
Authors: Li Jian , Shang Li , Galatsch Michael , Siegrist Johannes , Müller Bernd Hans , Hasselhorn Hans Martin ,   NEXT Study Group
Published: July 2013

Many countries throughout the world are facing a serious nursing shortage, and retention of nurses also is a challenge. The aim of this study was to compare the predictive contribution of a broad spectrum of psychosocial work factors, including job strain, effort-reward imbalance, and alternative employment opportunity, to the probability of intention to leave the nursing profession. A total of 7,990 registered female nurses working in hospitals in eight countries (Germany, Italy, France, the Netherlands, Belgium, Poland, Slovakia, and China) were included in the one-year prospective study. A standardized questionnaire on job strain, effort-reward imbalance, employment opportunity, and intention to leave the nursing profession was used in the survey. Multilevel logistic regression modeling was used to analyze the data. Results showed that an imbalance between high effort and low reward (in particular, poor promotion prospects) and good employment opportunity at baseline were independently associated with a new intention to leave the nursing profession at follow-up. However, job strain appeared to have relatively less explanatory power. Findings suggest that interventions to improve the psychosocial work environment, especially the reciprocity experienced between effort and reward, may be effective in improving retention of nurses and tackling the international nursing shortage.
Changes in the Health Care Safety Net 1992–2003: Disparities in Access for Uninsured Persons in Florida
Authors: Kuo Tzy-Mey , Mobley Lee R. , Bazzoli Gloria J.
Published: July 2013

A patchwork of services is available to uninsured in the United States through the health care safety net. During 1996–2003, some safety net hospitals (SNHs) closed or converted their ownership status from public or non-profit to for-profit. Meanwhile, the number of community health centers (CHCs) grew as a result of new federal funding. This article examines the impact of these two countervailing events on access to care for the uninsured. Hospital admissions for ambulatory care sensitive conditions relative to marker conditions were used as our access measure. We examined 35,730 discharges for uninsured adults treated in Florida hospitals in the years 1992 or 2003. A generalized estimating equation model was used to assess differential access effects for racial and ethnic groups. We found that in communities with CHC openings but no SNH contractions, uninsured black and white individuals experienced deteriorations in access over time, but the Hispanic uninsured did not. However, in communities where SNHs closed or converted, access deteriorations occurred for all three racial and ethnic groups. Thus, the potentially beneficial effects of CHC expansions on access to primary care for the uninsured Hispanic population in Florida appeared to be offset if contractions in the hospital safety net were present.
Dabigatran and Kidney Disease
Authors: Knauf Felix , Chaknos C. Michael , Berns Jeffrey S. , Perazella Mark A.
Published: July 2013

Dabigatran is an oral direct thrombin inhibitor widely used to prevent and treat various thromboembolic complications. An advantage of this agent over other anticoagulants is that routine laboratory monitoring and related dose adjustments are considered unnecessary. A major disadvantage is the absence of a reliable means of reversing its anticoagulant effect. After U.S. Food and Drug Administration approval, recently emerged data suggest a higher bleeding risk with dabigatran, especially in the elderly. Clinicians are thus faced with caring for patients with serious bleeding events without readily available tests to measure drug levels or the anticoagulant effects of dabigatran and without effective antidotes to rapidly reverse the anticoagulant effect. On the basis of dabigatran's pharmacokinetic profile, hemodialysis and continuous renal replacement therapy have been used to remove dabigatran with the hope, still unproven, that this would rapidly reverse the anticoagulant effect and reduce bleeding in patients with normal and those with reduced kidney function. However, the best clinical approach to the patient with serious bleeding is not known, and the risks of placing a hemodialysis catheter in an anticoagulated patient can be substantial. This article reviews this issue, addressing clinical indications, drug pharmacokinetics, clinical and laboratory monitoring tests, and dialytic and nondialytic approaches to reduce bleeding in dabigatran-treated patients.
Analysis of polymorphism in the survivin gene promoter as a potential risk factor for head and neck cancers development
Authors: Kostic Marija , Nikolic Nadja , Ilic Branislav , Carkic Jelena , Milenkovic Sanja , Vukadinovic Miroslav
Published: July 2013

Introduction. Association studies have shown that gene polymorphisms in
various classes of genes can modulate cancer risk. The -31G/C polymorphism in
the promoter of survivin gene, affects the expression of the anti-apoptotic
protein survivin which in turn may predispose an individual to some types of
cancer. Objective. The aim of the study was to determine whether the survivin
promoter -31G/C polymorphism could be a susceptibility factor for squamous
cell carcinoma (SCC) of the oral cavity and basal cell carcinoma (BCC) of the
skin. Methods. The DNA obtained from 88 patients with SCC, 60 patients with
BCC and 111 healthy individuals was subjected to polymerase chain
reaction-restriction fragment length polymorphism analysis (PCR- RFLP) in
order to determine genotype and allele frequencies in patients and control
groups. Logistic regression was used for cancer risk assessment. Results. The
following distribution of genotypes was obtained: CC genotype 15% in the SCC
group, 13% in the BCC group and 12% in controls; CG genotype 41% in SCCs, 35%
in BCCs, 48% in controls; GG genotype 44% in SCCs, 52% in BCCs and 40% in
controls. Allelic frequencies were as follows: G allele 0.65 in SCCs, 0.69 in
BCCs and 0.64 in the control group; C allele 0.35 in SCCs, 0.31 in BCCs and
0.36 in the control group. There was no statistically significant difference
in allele or genotype frequencies between the patients and controls (p>0.05).
Conclusion. In Serbian population, -31G/C polymorphism in the promoter of the
survivin gene cannot be considered as a risk factor for oral squamous cell
carcinoma and skin basal cell carcinoma.
Virtual histology study of atherosclerotic plaque composition in patients with stable angina and acute phase of acute coronary syndromes without ST segment elevation
Authors: Ivanovic Milos , Rancic Milan , Rdzanek Adam , Filipjak Krzysztof , Opolski Grzegorz , Cvetanovic Jelena
Published: July 2013

Introduction. Rupture of vulnerable atherosclerotic plaques is the cause of
most acute coronary syndromes (ACS). Postmortem studies which compared stable
coronary lesions and atherosclerotic plaques in patients who have died
because of ACS indicated high lipid-core content as one of the major
determinants of plaque vulnerability. Objective. Our primary goal was to
assess the potential relations of plaque composition determined by IVUS-VH
(Intravascular Ultrasound - Virtual Histology) in patients with stable angina
and subjects in acute phase of ACS without ST segment elevation. Methods. The
study comprised of 40 patients who underwent preintervention IVUS
examination. Tissue maps were reconstructed from radio frequency data using
IVUS-VH software. Results. We analyzed 53 lesions in 40 patients. Stable
angina was diagnosed in 24 patients (29 lesions), while acute phase of ACS
without ST elevation was diagnosed in 16 patients (24 lesions). In the
patients in acute phase of ACS without ST segment elevation IVUS-VH
examination showed a significantly larger area of the necrotic core at the
site of minimal lumen area and a larger mean of the necrotic core volume in
the entire lesion comparing to stable angina subjects (1.84?0.90 mm2 vs.
0.96?0.69 mm2; p<0.001 and 20.94?15.79 mm3 vs. 11.54?14.15 mm3; p<0.05
respectively). Conclusion. IVUS-VH detected that the necrotic core was
significantly larger in atherosclerotic lesions in patients in acute phase of
ACS without ST elevation comparing to the stable angina subjects and that it
could be considered as a marker of plaque vulnerability.
Extrahepatic manifestations of chronic hepatitis C and their influence on response to treatment with Pegylated interferon alfa-2a and ribavirin
Authors: Fabri Milotka , Ruzic Maja , Lendak Dajana , Preveden Tomislav , Fabri Izabela , Petric Vedrana
Published: July 2013

Introduction. Thirty to 50% of patients with chronic hepatitis C (CHC) have
one or more extrahepatic manifestations (EHMs) of hepatitis C virus (HCV)
infection. Objective. The aim of this study was to evaluate the frequency of
EHMs and to investigate the efficacy of pegylated interferon (Peg?IFN)???2a
plus ribavirin therapy in patients with HCV?related EHMs. Methods. The study
included 280 patients suffering from CHC and treated with Peg?IFN???2a and
ribavirin. The patients were divided in two groups according to presence or
absence of EHMs. We evaluated virological response to antiviral therapy.
Results. One or more EHMs were found among 27.9% of patients. Most frequently
they had rheumatoid factor in serum (12.5%), organ?nonspecific antibodies ANA
and AGMA (12.4%), thyroid hormone disorders (9.3%), vasculitis (5.7%),
diabetes mellitus (4.65%), glomerulonephritis (0.71%), and porphyria cutanea
tarda (0.36%). Among the patients with EHMs there was 52.6% of females vs.
30.2% of females in the group of patients without EHMs (p=0.001). HCV
genotypes 1 and 4 had 85.9% patients with EHMs vs. 58.4% of patients without
EHMs (p=0.000). Progressive fibrosis and cirrhosis were more frequently
recorded in the EHM group of patients (32% vs. 23.2%), but without
statistically significant difference (p=0.532). Serious adverse events of
Peg?IFN???2a and ribavirin were statistically significantly recorded among
the patients with EHMs (46.1% vs. 12.9%; p=0.000). Sustained virological
response among the patients with and without EHMs rated 56.9% and 70.8%
respectively (p=0.125). Conclusion. Patients with CHC and EHMs treated with
combined Peg?IFN???2a and ribavirin experience handling difficulties, more
often have serious adverse events, while successful outcome is achieved in
about 50% of patients.
Bone mineral density in children with long-term antiepileptic therapy
Authors: Dimic Milena , Dimic Aleksandar , Milosevic Zoran , Vojinovic Jelena
Published: July 2013

Introduction. Vitamin D active metabolites deficit that is altered by
negative calcium and phosphorus balance is a potential complication during
long?term antiepileptic drug therapy. Objective. The aim of this study was to
examine lumbar bone mineral density (BMD) in epileptic children receiving
antiepileptic drug therapy longer than one year. methods. The examined sample
consisted of 34 epileptic children, 18 male and 16 female, aged 6?12
(9.77?2.01) years, treated with carbamazepine, valproate, phenobarbital,
lamotrigine or their combination without vitamin D supplementation. The
lumbar spine BMD (L1?L4) was estimated by a Lunar densitometer and obtained
results were compared with results of 35 matched population of healthy
children from the control group. results. Lumbar BMD Z?score was
significantly lower in female patients treated with antiepileptic therapy
compared with those in the control group (?1.048?1.35 vs. ?0.399?0.518;
p=0.03). Bone mineral density Z?score decrease of both gender groups
receiving antiepileptic polytherapy was significantly lower compared to the
control group (?1.153?0.938 vs. ?0.043?0.815; p=0.007). Therapy duration had
no influence on the lumbar BMD level decrease either in boys (rxy=0.33;
p=0.174) or in girls (rxy=0.02; p=0.935) treated with antiepileptic therapy.
Conclusion. Our results have indicated that antiepileptic drug therapy usage
longer than one year can have adverse affects on the lumbar spine BMD (L1?L4)
in epileptic children, and that prophylactic vitamin D supplementation is
also necessary in these patients.
The efficacy and tolerability of allopurinol dose escalation in patients with gout
Authors: Radak­Perovic Marija , Zlatkovic­Svenda Mirjana
Published: July 2013

Introduction. Allopurinol is still the drug of choice for the longterm
control of hyperuricemia in patients with gout. Objective. The aim of the
study was to investigate the efficacy and tolerability of different
allopurinol doses used in order to attain a target serum uric acid
concentration (SUc) of <6 mg/dl (360 ?mol/L). Methods. Prospective trial was
carried out in patients with primary gout and normal renal function, no
relevant liver disease, and SUc?lowering treatment indications involving 1?2
gout episodes per year, presence of tophus and/or chronic urate arthropathy
or X?ray finding of erosions. The patients were administered allopurinol in a
step?up dose scheme (beginning with 100 mg/ day then raised for 100 mg every
four weeks) until therapeutic goal was achieved or development of adverse
effects. Results. Forty?one patients were enrolled in the study; 27 end? ed
it so far. The treatment target was reached in 19/27 patients using
allopurinol 300 mg/day (70.4%). After the increased dose up to 600 mg/day,
the overall treatment success was reached in 25/27 patients (92.5%). Adverse
drug reactions (ADRs) were evidenced in 12/27 patients; the most frequent
ADRs were gouty flares. The mean SUc reduction from baseline 533.9?83.4
?mol/L to 346.9?87.9 ?mol/L was obtained with allopurinol at a dose of 300
mg/day (p=0.000) as well as at a dose up to 600 mg/day (274.9?92.7 ?mol/L)
(p=0.000). Conclusions. Most of the investigated gouty patients attained
target SUc <360 mmol/L at a 300 mg/day allopurinol dose. However, in 30% of
patients further dose escalation up to 600 mg/day was needed but the
increased dose was well tolerated, and the therapeutic goal was achieved
even in 92.5% of patients. Such doses are in general well tolerated under the
conditions of well preserved renal function.
Collagen type I alpha 1 gene polymorphism in premature ovarian failure
Authors: Vujovic Svetlana , Kanazir Selma , Ivovic Miomira , Tancic-Gajic Milina , Perovic Milka , Baltic Svetlana , Marina Ljiljana , Barac Marija , Ivanisevic Maja , Micic Jelena , Micic Dragan
Published: July 2013

Introduction. Premature ovarian failure (POF) is characterized by amenorrhea,
hypergonadotropism and hypoestrogenism in women bellow 40 years. Osteoporosis
is one of the late complications of POF. Objective. To correlate collagen
type I alpha1 (COLIA1) gene polymorphism with bone mineral density (BMD) in
women with POF. Methods. We determined the COLIA1 genotypes SS, Ss, ss in 66
women with POF. Single nucleotide polymorphism (G to T substitution) within
the Sp 1-binding site in the first intron of the COLIA1 gene was assessed by
polymerase chain reaction (PCR) followed by single-stranded conformation
polymorphism (SSCP) analysis. Bone mineral density (BMD) was measured at the
lumbar spine region by dual X-ray absorptiometry. Statistics: Kruskal-Wallis
ANOVA, Chisquare test, Spearman correlation test. Results. The relative
distribution of COLIA1 genotype alleles was SS - 54.4%, Ss - 41.0% and ss -
4.5%. No significant differences were found between genotype groups in body
mass index, age, duration of amenorrhea or BMD. A significant positive
correlation was observed between BMI and parity. Conclusion. The COLIA1 gene
is just one of many genes influencing bone characteristics. It may act as a
marker for differences in bone quantity and quality, bone fragility and
accelerated bone loss in older women. However, in young women with POF,
COLIA1 cannot identify those at higher risk for osteoporosis.
Etiological aspect of left-handedness in adolescents
Authors: Dragovic Milan , Milenkovic Sanja , Kocijancic Dusica , Sram Zlatko
Published: July 2013

Introduction. Lateralization of brain functions such as language and manual
dominance (hand preferences and fine motor control) are most likely under
genetic control. However, this does not preclude the effect of various
environmental factors on functional brain lateralization. A strong
association of non-right-handedness (left- and mixed-handedness) with various
neurodevelopmental conditions (e.g. schizophrenia, autism, Rett syndrome)
implies that in some cases, non-right-handedness may be acquired rather than
inherited (i.e., pathologically determined). Objective. The aim of the study
was: (a) re-investigation of several known risk factors for left-handedness
(age of mother and/or father, twin pregnancies, and birth order), and (b)
examination of hitherto uninvestigated factors (type of birth, Apgar score,
maternal smoking during pregnancy). Methods. Putative, causative
environmental agents for this shift in manual distributions are explored in a
sample of 1031 high school students (404 males and 627 females) from
Belgrade. Both pre-existing (age of parents, twin pregnancy, and birth order)
and new (Apgar score, maternal smoking, type of birth) putative agents are
examined. Results. We found that maternal smoking and low Apgar score (2-6)
can significantly increase risk for left-handedness (p=0.046 and p=0.042,
respectively). The remaining factors showed no significant association with
left-handedness in adolescents. Conclusion. Our study clearly demonstrates
that left-handedness may be related to maternal smoking during pregnancy and
a low Apgar score on birth.
Serbian translation of the 20-item toronto alexithymia scale: Psychometric properties and the new methodological approach in translating scales
Authors: Trajanovic Nikola , Djuric Vladimir , Latas Milan , Milovanovic Srdjan , Jovanovic Aleksandar , Djuric Dusan
Published: July 2013

Introduction. Since inception of the alexithymia construct in 1970?s, there
has been a continuous effort to improve both its theoretical postulates and
the clinical utility through development, standardization and validation of
assessment scales. Objective. The aim of this study was to validate the
Serbian translation of the 20-item Toronto Alexithymia Scale (TAS-20) and to
propose a new method of translation of scales with a property of temporal
stability. Methods. The scale was expertly translated by bilingual medical
professionals and a linguist, and given to a sample of bilingual participants
from the general population who completed both the English and the Serbian
version of the scale one week apart. Results. The findings showed that the
Serbian version of the TAS-20 had a good internal consistency reliability
regarding total scale (?=0.86), and acceptable reliability of the three
factors (?=0.71-0.79). Conclusion. The analysis confirmed the validity and
consistency of the Serbian translation of the scale, with observed weakness
of the factorial structure consistent with studies in other languages. The
results also showed that the method of utilizing a self-control bilingual
subject is a useful alternative to the back-translation method, particularly
in cases of linguistically and structurally sensitive scales, or in cases
where a larger sample is not available. This method, dubbed as
?forth-translation?, could be used to translate psychometric scales measuring
properties which have temporal stability over the period of at least several
weeks.
Optimal postoperative radiotherapy treatment of orbital rhabdomyosarcoma
Authors: Petrovic Borislava , Djan Igor , Markov Borislav , Petrovic Milovan , Erak Marko , Teodorovic Milan , Baucal Milutin
Published: July 2013

Introduction. Rhabdomyosarcoma (RMS) is the most common sarcoma of the soft
tissue, mostly affecting the region of head and neck (orbit, paranasal
sinus). Histological types include embryonal (66?70%) with better prognosis,
and alveolar type (20%) with poorer prognosis. There are also diffuse
anaplastic and undifferentiated sarcomas (10%). Due to multimodal therapy
approach (surgery, chemotherapy and radiotherapy), RMS survival rate is
considerably improving. Nevertheless, early diagnosis of RMS is of crucial
importance for the outcome of treatment. Standard conformal radiation therapy
is very complex due to closeness of many critical structures of head and
neck, thus limiting optimal tumor dose coverage. Case Outline. Patient aged
59 years, surgically treated for RMS of nasal cavity several times before
radiation therapy treatment. Due to relapse, patient was re?operated, when
subtotal re?resection of the maxilla with exenteration of the right orbit was
done. The patient received IV cycles of polychemotherapy postoperatively.
Standard procedure and planning for conformal radiation therapy did not lead
to acceptable irradiation plan, and hence modification in the patient?s
preparation was done, resulting in optimal therapeutic plan according to
internationally recognized recommendations. Conclusion. The reported case
shows a rare pediatric tumor, which often occurs in children but extremely
rare in adults. The problem of inadequate isodose distribution obtained by
standard conformal plan was solved by placing bolus material into the orbital
cavity. The outcome of the treatment plan showed much better isodose
distribution and tumor bed coverage.
Solid and cystic pseudopapillary tumor of the pancreas: A case report
Authors: Milosevic Bojan , Markovic Rade , Cvetkovic Aleksandar
Published: July 2013

Introduction. Solid and cystic pseudopapillary tumor of the pancreas is a
rare tumor of the pancreas, for the first time described by Frantz et al. in
1959. The majority of patients are young females and most of them are
asymptomatic. Case Outline. We report a case of 25-year old woman who was
admitted to our institution with abdominal pain and a palpable mass in the
left hypochondrial area. US and CT scan revealed a solid and cystic
pseudopapillary tumor in the head of the pancreas. The patient was treated by
Whipple procedure, modification Longmire-Traverso. There was no metastatic
disease either in the liver or peritoneum. Histologically the tumor was
diagnosed as a solid and cystic pseudopapillary tumor of the pancreas.
Conclusion. The unclear pre-operative diagnoses, together with incidence of
potential malignancy as well as good outcome with resection, suggest that all
suspected cystic tumors of the pancreas should be resected. The exact
diagnosis is based on histological findings.
Treatment of infantile tibia vara - 18-year follow-up: A case report
Authors: Vukasinovic Zoran , Stefanovic Branko , Seslija Igor , Pavlovic Mladen , Zivkovic Zorica
Published: July 2013

Introduction. Blount disease is developmental disorder of the lower leg,
manifested by multiplanar deformity. Surgical treatment includes corrective
osteotomy, lateral hemiepiphisyodesis, distraction of the proximal tibial
physis, physeal bar resection and elevation of the medial tibial plateau.
Case Outline. A case of a 4-year-old girl with bow legs is presented.
Condition was recognized as Blount disease, type five. Both lower legs were
operated by medial methaphyseal semi-osteotomy of the proximal tibia with the
elevation of the medial tibial plateau. Prospectively, bilateral proximal
hemiepiphysiodesis was done. Total follow-up period was eighteen years. The
patient has no disturbances, clinical and radiographic findings are
excellent. Improvement of the femoro-tibial angle is 22? on the right side,
and 21? on the left side. Improvement of the varus angle is 7? on the right
side, and 27? on the left side. Medial plateau depression is completely
bilaterally reduced; improvement on the right side is 46?, and 51? on the
left side. Conclusion. It is known today that multiplanar deformity is a part
of the disease; varus, antecurvatum and internal rotation of the lower leg.
By elevation of the medial plateau varus of the lower and antecurvatum
component of deformity can be solved, while internal torsion cannot be
solved. This deformity has to be either skillfully neglected, or corrected by
an additional osteotomy by the elevation of the medial tibial plateau.
Lateral hemiepiphysiodesis serves as extra stabilisator of the achieved
result, and it is recommended to be done in combination with surgical
elevation of the medial tibial plateau and derotative corrective osteotomy of
the tibia.
Dilemmas in zirconia bonding: A review
Authors: Obradovic-Djuricic Kosovka , Medic Vesna , Dodic Slobodan , Gavrilov Dragan , Antonijevic Djordje , Zrilic Milorad
Published: July 2013

This article presents a literature review on the resin bond to zirconia
ceramic. Modern esthetic dentistry has highly recognized zirconia, among
other ceramic materials. Biocompatibility of zirconia, chemical and
dimensional stability, excellent mechanical properties, all together could
guarantee optimal therapeutical results in complex prosthodontic
reconstruction. On the other hand, low thermal degradation, aging of zirconia
as well as problematic bonding of zirconia framework to dental luting cements
and tooth structures, opened the room for discussion concerning their
clinical durability. The well known methods of mechanical and chemical
bonding used on glass-ceramics are not applicable for use with zirconia.
Therefore, under critical clinical situations, selection of the bonding
mechanism should be focused on two important points: high initial bond
strength value and long term bond strength between zirconia-resin interface.
Also, this paper emphases the use of phosphate monomer luting cements on
freshly air-abraded zirconia as the simplest and most effective way for
zirconia cementation procedure today.
The role of breast magnetic resonance imaging in the diagnosis of ductal carcinoma in situ
Authors: Nadrljanski Mirjan , Milosevic Zorica , Plesinac­Karapandzic Vesna , Goldner Branislav
Published: July 2013

Ductal carcinoma in situ (DCIS), the noninvasive breast malignant tumor
originates from the terminal ductal?lobular units (TDLU). The typical feature
of DCSI is the formation of calcifications. Up to 90% of DCIS are diagnosed
on mammographic examinations, as clinically asymptomatic. Between 10% and 20%
of DCIS remain mammographically occult due to the lack of calcifications and/
or small tumor dimensions. Contrast?enhanced breast magnetic resonance
imaging (MRI) detects mammographically occult breast lesions, thus defining
morphologic features of the lesion and the dynamics of signal intensity
changes due to contrast enhancement. Distribution of contrast enhancement -
signal intensity increase in DCIS most frequently includes segmental, ductal
and linear patterns, followed by regional enhancement pattern, while the
intralesional contrast uptake most frequently includes the nodular pattern
with the areas of confluence. Post? contrast signal intensity increase in
DCIS is most frequently fast in the initial phase (wash?in), while the whole
dynamic of contrast?enhancement includes either of the three possible
time?intensity curve (TIC) types (persistent, plateau or washout), although
the plateau TIC is considered to be more frequent. Breast MRI has high
sensitivity in the diagnosis of invasive breast cancer, varying from 90% to
100%; the sensitivity in the diagnosis of DCIS is lower (77?96%). For the
time being, the primary role of MRI in DCIS is planning of breast?conserving
surgery (BCS) for the evaluation of lesion extension. Further development of
MRI in the diagnosis of DCIS includes the implementation of the principles
of functional and molecular imaging.