Flail chest, often defined as the fracture of three or more ribs in two or more places, represents the most severe form of rib fractures. Conservative treatment, consisting of respiratory assistance with endotracheal intubation and mechanical ventilation (internal pneumatic stabilization) and pain control, are the current treatments of choice in the majority of patients with multiple rib fractures. However, the use of mechanical ventilation may create complications. In selected patients, operative fixation of fractured ribs within 72 h post injury may lead to better outcomes. We conducted a retrospective analysis of a series of nine cases of patients who developed flail chest after blunt trauma, and were treated with surgical osteofixation of the chest wall and postoperative epidural analgesia at the University Clinical Center of the Republic of Srpska during the period from January 2015. to December 2016. Two patients had trauma to the chest only, and the other patients had associated injuries to the head, abdomen, spine, and fractures of the pelvis and long bones. In the majority of patients (77.7%), surgical stabilization of the chest was performed on the second day following the injury, (mean, 2.33 days) and no later than 5 days after the injury. All patients received epidural analgesia with 0, 25% bupivacaine and 0, 01% morphine and intravenous multimodal analgesia, beginning 6 h after thoracotomy. The average length of ICU stay was 14.7 days (range 2–36), while the average number of days of mechanical ventilation was 8.1. The average duration of hospitalization was 25.4 days. Tracheotomy was performed in 33.3% of study patients. Mortality in the observed group was 44.4%. This study shows that surgical stabilization and epidural analgesia reduced ventilator support, shortened trauma intensive care unit stay, and reduced medical costs vs internal pneumatic stabilization.

: In the last ten years, digital technology has significantly contributed to the change of people's lives worldwide, because its application has caused a rapid transformation of all aspects of human life, and especially fast transformation in the design, production, operation and maintenance of the production system, which caused an unexpected jump in productivity. It can be said that fourth industrial revolutions on-going process, which can be labelled a variety of ways, such as "intelligent factory", "smart industry" or "advance manufacturing". Development of the digital technologies in the last twenty years has introduced us from third in the fourth industrial revolution. The first time the term “Industry 4.0” appears in the Germany in year 2011 whose government promotes automation of production processes by introducing digital technologies. Germany is one of the most technologically developed countries in the world and it is logic that this revolution begins there. This example follows the other countries in the world. Fourth technological revolution depends on a number of new and innovative technological achievements. It is necessary to integrate production processes in all production phases and further applications by using ICT technologies for digitalization. The automation of production processes must include advanced sensors and intelligent robots that can be self-configured to be able to make specific product. It is necessary to collect large amounts of data to be analysed and used in the production processes.

Two interesting and rarely occurring species of fungi from the order Pezizales found in Bosnia and Herzegovinaare presented here. Ecology, morphology, microscopic characters and conservation status of Pezizamontirivicola and Trichophaea flavobrunnea are briefly discussed in the paper. Notes on the similar speciesof operculate discomycetes are given.

This work addresses the problem of object delivery with a mobile robot in real-world environments. We introduce a multilayer, modular pushing skill that enables a robot to push unknown objects in such environments. We present a strategy that guarantees obstacle avoidance for object delivery by introducing the concept of a pushing corridor. This allows pushing objects in scattered and dynamic environments while exploiting the available collision-free area. Moreover, to push unknown objects, we propose an adaptive pushing controller that learns local inverse models of robot-object interaction on the fly. We performed exhaustive tests showing that our controller can adapt to various unknown objects with different mass and friction distributions. We show empirically that the proposed pushing skill leads towards successful pushes without prior knowledge and experience. The experimental results also demonstrate that the robot can successfully deliver objects in complex scenarios.

This study is aimed to investigate whether simvastatin induces cardiomyocytes survival signaling in endotoxin (lipopolysaccharide, LSP)-induced myocardial injury, and if so, further to determine a role of survivin in simvastatin-anti-apoptotic effect. Wistar rats were pretreated with simvastatin (10–40 mg/kg po) before a single non-lethal dose of LPS. In myocardial tissue, LPS induced structural disorganization of myofibrils with significant inflammatory infiltrate (cardiac damage score, CDS = 3.87 ± 0.51, p < 0.05), whereas simvastatin dose-dependently abolished structural changes induced by LPS (p < 0.01). Simvastatin in 20 mg/kg and 40 mg/kg pretreatment, dose dependently, attenuated myocardial apoptosis determined as apoptotic index (28.8 ± 4.5% and 18.9 ± 3.5, p < 0.05), decreased cleaved caspase-3 expression (32.1 ± 5.8%, p < 0.01), along with significant Bcl-xL expression in the simvastatin groups (p < 0.01). Interestingly, in the simvastatin groups were determined significantly increased expression of survivin (p < 0.01), but in negative correlation with cleaved caspase-3 and apoptotic indices (p < 0.01). Simvastatin has a cardioprotective effects against LPS induced apoptosis. The effect may be mediated by up-regulation of survivin via activation of NF-κB, which leads to reduced activation of caspase-3 and consequent apoptosis of cardiomyocytes in experimental sepsis.

Abstract Studies have shown that second language (L2) motivation can have an impact on L2 learning processes. The aim of this study was to investigate gender differences in L2 motivation among Croatian university students from the perspective of the L2MSS. The results indicated that females were more motivated than males to learn English, had higher levels of interest in English, while differences in L2 anxiety were somewhat ambiguous. Females also demonstrated that their L2 motivation was linked to motives related to the avoidance of negative outcomes suggesting that females are perhaps more conscientious learners compared to males. These findings point to a complex motivational state among females, which may indicate important gender-based differences in language learning.

Introduction: Lumbar pain syndrome is one of the most common conditions in clinical practice, more common than 290 other pathological conditions, which affect up to 84% of adults in a certain period of their life. The origin of the lower back pain can be classified as mechanical, neuropathic and secondary due to another illness. Patient education and information, muscle strengthening exercises, maintenance of routine daily physical activity and pain therapy are the basis of acute non-specific pain syndrome therapy. Aim: To determine the success of the motion therapy procedure in the prevention of lumbar pain syndrome relapse. Material and methods: The research is prospective, longitudinal, manipulative and controllable. It was conducted in the private practice “Praxis - dr. Pecar” in the period from June 20, 2014 to June 1, 2016, and included 200 respondents with symptoms of lumbar pain syndromes divided into the experimental (n=100) and control (n=100) groups. The presence of lumbar pain syndrome relapse in respondents experimental and control group was recorded in the second and third clinical examination. Results: In the second examination, 4 (4%) of the respondents from experimental group and 37 (37%) of the control group responded had LBS relapse. In the third examination, the number of respondents with recurrent LBS in the experimental group was 4 (4%), while in the control group was 17 (17%). After the study, no statistically significant difference was observed in the mean age of respondents who had LBS relapse compared to respondents without LBS relapse, as well as significant influence of sex structure on relapse in the experimental and control group during the second and third examination. Conclusion: After the second examination, the relapse rate in the experimental group was statistically significantly higher in the respondents withstanding jobs, while there was no statistically significant difference in the control group and both groups after the third examination.

Background: The aim of the article was to define etiological factors for the occurrence of thromboembolism venous and arterial segments and preview of the sensitivity and specificity of diagnostic procedures in the treatment algorithm. Patients and Methods: The study included 60 patients during the 4-year period. The patients are classified into two groups according to the type of thromboembolism, in the group under the diagnosis of venous thromboembolism and group under the diagnosis of arterial thromboembolism. Results: Statistical analysis showed that arterial thromboembolisms occurred statistically significant later in comparison to venous (t = 4.0969; P = 0.0001). The mortality relationship with all analyzed parameters (age, erythrocytes, hemoglobin, platelets, gender, D-dimer, fibrinogen, immobility, veins surgery, pregnancy, smoking, orthopedic trauma, neoplasms, and pulmonary embolism) showed that statistically significant association was observed only in the case of pulmonary embolism. Conclusion: Biochemical parameters of the blood of patients; red blood cell count, hemoglobin concentration, and platelet counts in the study conducted showed a positive relationship with the occurrence of venous thromboembolism while D-dimer and fibrinogen present in increased values in most patients with venous and arterial thromboembolism. Pulmonary embolism directly affects the outcome of patients with thromboembolic diseases taking into account that in the study conducted in venous thrombosis complicated pulmonary embolism resulted in deaths.

Introduction: Heart rhythm disorders are quite common in the clinical course of acute myocardial infarction and have a significant influence on the prognosis of the disease. Aim: To investigate the type and frequency of ventricular arrhythmias in patients with acute myocardial infarction (AMI) by sex and age, according to localization of myocardial infarction, and correlated with troponin and C reactive protein (CRP). Material and Methods: A prospective, analytical, comparative clinical study was performed. A total of 100 patients was included who were hospitalized at the Clinic for Heart Disease and Rheumatism at the Clinical Center University of Sarajevo for a period of 6 months, of both sexes, aged from 20 to 90 years. The occurrence of ventricular arrhythmias, CRP and troponin, were observed in relation to the localization (anterior and inferior myocardial wall). Results: It was found that men are more represented in comparison to women and that the largest number of males were in the age group of 51-60 years of life and women in the age group of 71-80 years. It has been established that there is no significant difference between ventricular arrhythmia according to localization of AMI. By determining the mean CRP and troponin levels, a positive correlation was found between CRP and troponin values and recorded ventricular arrhythmias. Conclusion: There is a positive correlation between the troponin and CRP values and ventricular arrhythmias, not related to the localization of AMI, which is important in prevention and planning the treatment of complications of potentially malignant ventricular arrhythmias and fatal outcome at AMI.

The reform of the higher education system and the introduction of the Bologna Process throughout the University of Bosnia and Herzegovina, the PhD study became the next step in education after the completion of an integrated study of medicine.

Background: Chemical pleurodesis is generally accepted palliative dyspnea therapy and preventive of re-accumulation of pleural fluid in patients with malignant pleural effusions. Aim: Comparative analyses of efficiency of chemical pleurodesis between Video Assisted Thoracoscopic Surgery (VATS) and standard thoracostomy. Methods: From 01.01.2016-01.01.2017 at the Clinic for Thoracic Surgery of University Clinical Center (UCC) Sarajevo retrospective analysis was performed. Studied patients underwent VATS pleurodesis (G1) and standard thoracostomy pleurodesis (G2), with 60 in each group, respecting defined inclusion and exclusion criteria. Pleurodesis success was examined radiologically over the next three months. Results: Average age of all patients was 63.97±8.75 years. Gender related, 45% were men and 55% were women (F/M=1.47:1). Average hospitalization was 7.22±1.37 (G1: 6.68±1.16; G2: 7.44±1.40; Mann-Whitney U-test: p=0.0016) days. Average thoracic drainage duration was 5.45±1.69, (G1: 4.28±1.15,G2: 6.05±1.58; Mann-Whitney U-test p<0.0001) days. Pleurodesis success after first month was 98.30% in G1, 91.60% in G2 (G1 vs. G2; p=0.2089); after second month was 98.30% in G1, 78.30% in G2 (G1 vs. G2; p=0.0011) and after three months was 91.60% in G1, 63.30% in G2(G1 vs. G2; p=0.0006). Average dyspnea degree (0-5) after the pleurodesis was 0.050±0.22 in G1 and 0.62±0.76 in G2 (Mann-Whitney U-test; p=0.0001). Complication were noticed in 9.2% patients, in G1 3.3%, 15.0% in G2. Conclusion: Difference in pleurodesis efficiency between the G1 and G2 was established after second month and was even more evident after third month in favor of G1. Results show the significant statistical improvement of the degree of dyspnea in G1 as opposite to the G2.