OBJECTIVE Outpatient anterior cervical discectomy and fusion (ACDF) is becoming more common and has been reported to offer advantages over inpatient procedures, including reducing nosocomial infections and costs, as well as improving patient satisfaction. The goal of this retrospective study was to evaluate and compare outcome parameters, complication rates, and costs between inpatient and outpatient ACDF cases performed by 1 surgeon at a single institution. METHODS In a retrospective study, the records of all patients who had undergone first-time ACDF performed by a single surgeon in the period from June 1, 2003, to January 31, 2016, were reviewed. Patients were categorized into 2 groups: those who had undergone ACDF as outpatients in a same-day surgical center and those who had undergone surgery in the hospital with a minimum 1-night stay. Outcomes for all patients were evaluated with respect to the following parameters: age, sex, length of stay, preoperative and postoperative pain (self-reported questionnaires), number of levels fused, fusion, and complications, as well as the presence of risk factors, such as an increased body mass index, smoking, and diabetes mellitus. RESULTS In total, 1123 patients were operated on, 485 (43%) men and 638 (57%) women, whose mean age was 50 years. The mean follow-up time was 25 months. Overall, 40.5% underwent 1-level surgery, 34.3% 2-level, 21.9% 3-level, and 3.2% 4-level. Only 5 patients had nonunion of vertebrae; thus, the fusion rate was 99.6%. Complications occurred in 40 patients (3.6%), with 9 having significant complications (0.8%). Five hundred sixty patients (49.9%) had same-day surgery, and 563 patients (50.1%) stayed overnight in the hospital. The inpatients were older, were more commonly male, and had a higher rate of diabetes. Smoking status did not influence the length of stay. Both groups had a statistically significant reduction in pain (expressed as a visual analog scale score) postoperatively with no significant difference between the groups. One- and 2-level surgeries were done significantly more often in the outpatient setting (p < 0.001). The complication rate was 4.1% in the outpatient group and 3.0% in the inpatient group; there was no statistically significant difference between the 2 groups (p = 0.339). Significantly more complications occurred with 3- and 4-level surgeries than with 1- and 2-level procedures (p < 0.001, chi-square test). The overall average inpatient cost for commercial insurance carriers was 26% higher than those for outpatient surgery. CONCLUSIONS Anterior cervical discectomy and fusion is safe for patients undergoing 1- or 2-level surgery, with a very significant rate of pain reduction and fusion and a low complication rate in both clinical settings. Outpatient and inpatient groups undergoing 3- or 4-level surgery had an increased risk of complications (compared with those undergoing 1- or 2-level surgery), with a negligible difference between the 2 groups. This finding suggests that these procedures can also be included as standard outpatient surgery. Comparable outcome parameters and the same complication rates between inpatient and outpatient groups support both operative environments.

Background: Dental fear and anxiety (DFA) are present worldwide globally, as well as in children. These psychological clinical entities in its progressive phase lead to avoiding of dentists and dental appointments, and consequtive impairments of oral health. If we ignore these facts, we would have the strenghtening of this relationship in a way of further oral health impairments and lost of dental hard and soft tissues, as well as appearance of dental phobia as the most negative form of psychological reaction to dental stimuli. Original CFSS-DS scale and its modifications, as the most used instruments for evaluation of DFA presence so far, showed various disadvantages. These were the reasons why we wanted to design new psychometric instrument for better evaluation of DFA presence in children compared to evaluation which the existed scales could offer nowadays, in a form of the Modified Version of CFSS-DS scale (CFSS-DS-mod scale). Materials and methods: There were 809 schoolchildren from 8 cities of Bosnia and Herzegovina aged 9-12 years that participated in the study. There was one school per city where the schoolchildren answered to the questions from the CFSS-DS-mod scale. Results: 636 schoolchildren correctly answered to the scale questions. The CFSS-DS-mod scale showed excellent internal consistency reliability values (with Cronbach α>0.9), and also validity results (mostly over 60% of explained variance of obtained results) with two-dimensional concept of DFA presence. Conclusion: The CFSS-DS-mod scale represents good psychometric instrument for evaluation of the DFA presence in 9-12 year old schoolchildren in Bosnia and Herzegovina. Some of normative values of this psychometric instrument should be determined, in order to expand its usage in children.

Objective: The aim of this study was to evaluate corelation of serum level of NGAL to severity of hypertension and diastolic disfunction in patients with ST- segment elevation myocardial infarction treated with fibrinolytic therapy. Design and method: We included 54 consecutive ST-segment elevation myocardial infarction patients treated with fibrinolytic therapy (alteplase). The median follow-up time was 6 days (interquartile range, 5 to 7 days). Blood samples were drawn immediately after admission prior to fibrinolytic administration. The endpoints were mean systolic and diastolic pressure (continuously monitored) and mean E/A ratio as a measure of diastolic function. Results: Patients with high NGAL (above 134,05 &mgr;g/l; 75th percentile) had significantly higher mean systolic and mean diastolic blood pressure compared to patients with low NGAL (under 134,05 &mgr;g/l; 75th percentile), p = 0,001 and p = 0,003; respectively. Patients with high NGAL (above 134,05 &mgr;g/l; 75th percentile) had significantly lower E/A ratio compared to patients with low NGAL (under 134,05 &mgr;g/l; 75th percentile), p = 0,004. Conclusions: High NGAL significantly corelates with severity of hypertension and diastolic dysfunction in patients with acute STEMI.

Background Several manifestations strongly associated with APS have been excluded as classification criteria.1 2 Objectives The aim of this study was to investigate correlation between circulating immune-complexes of IgG or IgM antibodies bound to B2GPI (B2G-CIC and B2M-CIC) and clinical manifestations in Serbian cohort of APS patients. Methods A total of 57 patients with APS were evaluated: 35 with PAPS and 22 patients with SAPS. Mean age was 47.6±1.6 years; 36 (63.2%) were women. All patients have met the 2006 revised Sydney criteria for APSQuantification of B2G-CIC and B2M-CIC levels was performed as previously, for detect B2G-CIC was used anti-human IgG HRP-conjugate and for B2M-CIC human IgM HRP- conjugate, both from INOVA (INOVA Diagnostics Inc., San Diego, CA, USA). Results In our cohort Serbian APS patients the prevalence of CIC was 19.29% (11/57); 8 patients with B2M-CIC and the remain 3 patients with B2G-CIC. Livedo reticularis was diagnosed with higher prevalence in patients with CIC compared with patients without CIC; 63.6% and 23.9%, respectively (OR: 5.57, p=0.01). In patients with CIC, thrombocytopenia and leukopenia were more prominent; 54.4% vs 17.4% (OR: 5.70, p=0.01) and 45.5% vs 13.0% (OR: 5.56, p=0.01), respectively. Ophthalmic sicca was more prevalent in patients with CIC; 54.4% vs 8.7% (OR: 12.6, p<0.001). Although complement consumption was more frequent in patients with CIC (figure 1). Figure 1 Mean levels of C3 (A) and C4 (B) complement in groups. Mean levels of C3 (115.6±9.2 mg/dL and 140.9±4.3 mg/dL, group-1 and group-2 respectively) and mean levels of C4 (140.9±4.3 mg/dL and 30.8±1.6 mg/dL, group-1 and group-2, respectively). Conclusions B2G-CIC and B2M-CIC are strongly associated with clinical manifestations related to APS. Widening the APS spectrum is indispensable to better understand this syndrome. References [1] Stojanovich L, Kontic M, Djokovic A, Marisavljevic D, Ilijevski N, Stanisavljevic N, et al. Association between systemic non-criteria APS manifestations and antibody type and level: results from the Serbian national cohort study. Clin Exp Rheumatol. 2013 Mar-Apr;31(2):234–42. [2] Stojanovich L, Markovic O, Marisavljevic D, Elezovic I, Ilijevski N, Stanisavljevic N. Influence of antiphospholipid antibody levels and type on thrombotic manifestations: results from the Serbian National Cohort Study. Lupus. 2012Mar;21(3):338–45. Acknowledgements This work was supported by research grant number 175041, and TR 32040 for 2011–2018, issued by the Ministry of Science of the Republic of Serbia. Disclosure of Interest None declared

Signal, image and Synthetic Aperture Radar imagery algorithms in recent time are used in a daily routine. Due to huge data and complexity, their processing is almost impossible in a real time. Often image processing algorithms are inherently parallel in nature, so they fit nicely into parallel architectures multicore Central Processing Unit (CPU) and Graphics Processing Unit GPUs. In this paper image processing algorithms were evaluated, which are capable to execute in parallel manner on several platforms CPU and GPU. All algorithms were tested in TensorFlow, which is a novel framework for deep learning, but also for image processing. Relative speedups compared to CPU were given for all algorithms. TensorFlow GPU implementation can outperform multi-core CPUs for tested algorithms, obtained speedups range from 3.6 to 15 times.

The paper analyzes the problem of the construction of utility-scale solar photovoltaic power plants (US-PV). Two main problems of this construction are: occupying usable areas and the connection and integration of the power plant into the electricity system. The construction of US-PV power plants on water accumulations of existing hydro power plants was analyzed, as one of the solutions to these problems. The Jablanica Lake was taken as an example. Jablanica Lake is an artificial accumulation lake on the river Neretva with an area of 13 km2 within the hydroelectric power plant (HPP) Jablanica with 180 MW of installed power. It was shown that on a surface of less than 3% of the total area of the accumulation of HPP Jablanica, there could be built a floating photovoltaic (PV) plant with a power of 30 MW. This power would add another generator of 30 MW to HPP Jablanica, which would increase the current number of the 6 generators to 7. This would enable significantly better exploitation of the Neretva and Rama river basins, and increase production in the summer period with a decrease in lake level oscillations. Suitable locations for the installation of floating solar power plant were analyzed. Locations are selected on the basis of requirements for the preservation of existing lake functions, and provide the possibility of installing a 3 MW power plant. 10 of these plants, connected by a 20 kV power grid, represent one US-PV 30 MW plant, which at one point connects to the transmission network of 220 kV. The specifications of one 3 MW power plant are given in terms of the required area, number of modules and number of inverters. A preliminary techno-economic analysis of the total plant was carried out. In this analysis, the possible production, the indicative price of the plant, and the price of the produced kWh of electricity are calculated.

The aim of this research is to determine the elastic (repulsive) properties of the futsal ball depending on the air pressure in it. Futsal ball of standard dimensions was released on the fl at solid surface from the height of nine meters for four times. At the fi rst release the air in the ball was under prescribed pressure. At the second release the pressure in the pumped ball is reduced by 5%, at the third reduced by an additional 5%, at the fourth reduced by another 5%. The setting of the experiment was carried by cinema shooting of free fall of the prescribed futsal ball and a series of rebounds after the rejection of solid surfaces. One can conclude that the distance crossed and the total duration of four successive bouncing mostly dependent on inner pressure. In this study, the initial speed of a futsal ball was unchanged and only inner pressures were changed. It was determined how much the height of the rebound is reduced and the duration of the rebound, respectively, depending on the reduction of inner pressure. Overall, it can be concluded that the initial speed of the ball can be increased by increasing the inner pressure in the ball.

Background: Rheumatoid arthritis (RA) is a debilitating chronic disease with an unmet need for additional therapeutic approaches. Activating neuro-immune reflex pathways by stimulation of the vagus nerve (VNS) could represent a novel means of treating RA [1] and other immune-mediated inflammatory diseases. Last year we reported a 12-week proof-of-concept study using a VNS device, approved for drug-resistant epilepsy, showing reduction in the DAS28-CRP clinical disease activity score, with concomitant reductions in TNF and IL-6 levels [2]. Objectives: To understand the long term safety and efficacy of this novel treatment approach, we followed the patients in a 24 months long-term extension study and report on the safety and clinical efficacy data. Methods: VNS devices were implanted into 17 RA patients, mostly with insufficient response to multiple conventional and biologic disease-modifying antirheumatic drugs (DMARDs), on stable background of methotrexate (≤25 mg weekly) therapy. The devices electrically stimulated the vagus nerve, 1–4 min/day, over a 12 week open label period. On completion, subjects were offered to enroll into a follow-up study, where the study physicians were given flexibility to alter VNS dosing parameters and/or to add a biologic DMARD to the treatment regimen. DAS28-CRP and Health Assessment Questionnaire-Disability Index (HAQ-DI) were collected over 2 years. Results: All subjects electively continued on VNS treatment through 24 months of the long term follow-up study. Biologic DMARDs were started in 1 and restarted in 8 of 17 subjects; of these, 4 were non-responders to VNS, and 5 had stable improvement but had not yet achieved disease remission on VNS alone (table 1). At the start of the follow-up study, the mean DAS28–28 and HAQ-DI were significantly reduced compared to the pre-implant baseline (mean difference±SE in DAS28-CRP=-1.60±0.37, p<0.0001; mean difference±SE in HAQ-DI = -0.44±0.21, p<0.037), and the depth of effect was retained through 24 months. At 24 months, there was no significant difference in DAS28-CRP between the subjects using VNS monotherapy or those using a combination of VNS and biologic DMARDs (VNS monotherapy= 3.76±1.77 vs. VNS and biologic DMARD= 3.21±1.44, p<0.54). No difference in the adverse events profile between the two groups was seen.Table 1 Two Year Efficacy of VNS Treatment. Mean DAS28-CRP at primary study baseline (month -3-5) and at visits over 2 years of long term follow up (months 0-24). Conclusions: The data presented here demonstrate that VNS in subjects with RA is associated with a substantial reduction in disease activity that is sustained for 24 months without untoward safety signals. In addition, the data suggest that biological DMARDs can be initiated safely in combination with VNS treatment, though this requires further study in larger cohorts. These results support further development of VNS devices as an alternative therapeutic approach for RA treatment, which potentially can safely be combined with biologic DMARDs. References [1]Van Maanen M, et al. The cholinergic anti-inflammatory pathway: towards innovative treatment of rheumatoid arthritis. Nat Rev Rheumatol2009;5:229–32. [2]Koopman FA, et al. Vagus nerve stimulation inhibits cytokine production and attenuates disease severity in rheumatoid arthritis. Proc Natl Acad Sci USA2016;113(29):8284–9. Disclosure of Interest: F. Koopman: None declared, A. Musters: None declared, M. Backer: None declared, D. Gerlag Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, which has an interest in SetPoint, S. Miljko: None declared, S. Grazio: None declared, S. Sokolovic: None declared, Y. Levine Shareholder of: SetPoint Medical, Employee of: SetPoint Medical, D. Chernoff Shareholder of: SetPoint Medical, Adamas Pharmaceuticals, OLLY Nutrition, NAIA Pharma, Aquinox Pharma, Consultant for: Adamas Pharmaceuticals, OLLY Nutrition, NAIA Pharma, Aquinox Pharma, Crescendo BioScience, Employee of: SetPoint Medical, N. de Vries Grant/research support from: Abbvie, Janssen Biologics BV, Ergomed Clinical Research, GlaxoSmithKline, Pfizer, Boehringer Ingelheim, Roche, Consultant for: MSD, Pfizer, P.-P. Tak Shareholder of: GlaxoSmithKline, Employee of: GlaxoSmithKline, which has an interest in SetPoint