METHODS There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center for treating cardiovascular disease in Tuzla, Bosnia and Herzegovina, and the surgical team has been fully trained in offpump coronary artery bypass (OPCAB) surgery. All surgical patients were considered for on-pump CABG (ONCAB) and OPCAB surgical procedures. Minimally invasive direct coronary artery bypass grafting and robotic procedures were done as OPCAB. For multivessel median sternotomy cases, the selection criteria were arbitrary (approximately 50% were performed as ONCAB for perfusionist training). Patients who were scheduled for and began their operations as OPCAB but who were then placed on cardiopulmonary bypass during the surgical procedure were counted as conversions. The outcomes of converted patients were studied and are the subject of this report. RESULTS Of the 784 CABG procedures, 391 (49.6%) were scheduled and performed as ONCAB operations; 357 (45.5%) were performed as OPCAB; and 36 (9.2% of the originally scheduled OPCAB patients or 4.6% of the total number of CABG surgeries) were originally scheduled as OPCAB operations but were converted to ONCAB. Reasons for conversions were hemodynamic instability (21 patients), difficult revision of grafts (8), ventricular fibrillation (5), and poor native vessel (2). Outcomes of patients undergoing conversions were analyzed with respect to the conversion cause. When the cause of the conversion was mild-to-moderate hemodynamic instability or difficult graft revision (n = 27), no adverse ischemic effects were seen; however, when the cause of conversion was severe hemodynamic instability, ventricular fibrillation, or cardiac arrest (n = 9), 6 patients (66.6%) had severe ischemic complications involving the central nervous system or the myocardium. DISCUSSION Myocardial ischemia must be monitored and treated aggressively in OPCAB surgery. In patients with mild hemodynamic instability, conversion did not adversely affect outcome. In patients with severe hemodynamic compromise and cardiac arrest, serious complications of cerebral and myocardial ischemia were observed. The appropriate timing of conversion is essential.

Objectives  Bosnia and Herzegovina is a known endemic region for Hantavirus infection. In this region at least two different Hantaviruses, the Dobrava viruses (DOBV) and Puumala viruses (PUUV) have been found. The aim of the study was to determine glomerular filtration rate (GFR) in patients with a history of hemorrhagic fever with renal syndrome (HFRS) 9 to 10 years after the acute phase of the disease. Design and Methods  We prospectively reviewed clearance of technetium marked diethyl three amino pentacetic acid (Tc99m DTPA) in 42 male convalescents with serologically confirmed HFRS, 13 patients with PUUV infection and 29 patients with DOBV infection. Results  The tubulosecretory phase of the GFR was prolonged in six patients (46%) with PUUV infection and 23 patients (79%) with DOBV infection (P < 0.05). Total and separate clearance EDTA were significantly statistically lower (P < 0.001) in patients with serologically confirmed DOBV infection. In patients with DOBV infection elimination of radio pharmac was prolonged. Conclusions  Hemorrhagic fever with renal syndrome can cause sustained renal damage that very rarely progresses into renal failure. The tubulosecretory DTPA phase was prolonged in 46% of examinees with PUUV and in 79% of examinees with DOBV infection. Elimination of radio pharmac from the kidney was prolonged in both groups of patients. The DTPA clearance rate was lower in patients with serologically confirmed HFRS than in normal populations, especially in patients with DOBV infection.

Objectives  Hepatitis C virus (HCV) infection is spread worldwide with significant geographical differences in the prevalence and genotypes. The aim of this study was to analyse HCV infection in hemodialysis (HD) units in Bosnia and Herzegovina (BH), through genotypes and routes of transmission. Design and Methods  We analysed data from Renal Registry of BH for the years 2002 and 2003 in order to estimate prevalence and incidence of anti-HCV positive patients in 23 HD units in BH (ELISA III). Then we tested 88 anti-HCV positive patients from Tuzla for HCV RNA using reverse transcription polymerase chain reaction (Amplicor Roche diagnostic commercial test) and genotype with method of reverse hibridization of amplified sample material (Innolipa HCV II commercial test). Results  In 2002 we registered a prevalence of 39.1 and an incidence of 3.1% of anti-HCV positive HD patients in 23 HD units, and in 2003 a prevalence of 29.3 and an incidence of 2.04% in 24 HD units. Prevalence of anti-HCV positive patients was significantly different in HD units, from 14.3 to 69.1%. From 88 tested anti-HCV positive HD patients in Tuzla HD unit, we found 76 HCV RNA positive patients (87.36%). The genotype of HCV was analysed in 59 of these patients and we found, unusual for Europe, genotype 4 in 37 (62.7%), genotype 1b in 17 (28.8%) and 1a in five patients (8.5%). A total of 61% of seroconversions happened in 1999, 2000 and 2001. In 2001, we separated dialysis machines for anti-HCV positive and anti-HCV negative patients, and in 2003 we had nine seroconversions (genotype 4 in five patients). These patients had no blood transfusions. Conclusions  Prevalence and incidence of anti-HCV positive hemodialysis patients is still high in BH and origin of genotype 4 HCV is not clear. Nosocomial spreading of HCV plays a significant and probably the most important role in transmission of HCV in HD units.

In this paper we establish equivalence between a theory of fuzzy functional dependences and a fragment of fuzzy logic. We give a way to interpret fuzzy functional dependences as formulas in fuzzy logic. This goal is realized in four steps. Truth assignment of attributes is defined in terms of closeness between two tuples in a fuzzy relation. A corresponding fuzzy formula is associated to a fuzzy functional dependence. It is proved that if a relation satisfies a fuzzy functional dependence, then the corresponding fuzzy formula is satisfied and vice verse. Finally, equivalence of a fuzzy formulas and a set fuzzy functional dependence is demonstrated. Thus we are in position to apply the rule of resolution from fuzzy logic, while calculating fuzzy functional dependences.

In the Zenica-Doboj Canton, 1106 hepatitis A virus (HAV) infections were reported during 2000 (an incidence rate of 252/100 000 population), with 996 (90.1%) cases occurring in nine community-wide outbreaks. Analysis of water supplies showed that 398 (19.1%) samples contained coliforms, including 202 (50.8%) that were contaminated with thermotolerant Escherichia coli. Sewage sanitation systems were absent or substandard in 53 910 (81.8%) rural households. The group most affected during outbreaks comprised children aged 7-14 years (incidence rate of 598/100 000). The development of health promotion and prevention initiatives in schools, combined with rigorous hygiene measures, will be necessary to achieve control of the spread of HAV.

Introduction  Uremia is associated with different endocrinologic abnormalities, which in some cases induce polyendocrinopathia. Female patients on dialysis are often subject to menstrual disorders that are variously manifested. The aim of our paper is to evaluate the etiology of menstrual dysfunctions in female dialysis patients. Material and methods  Anamnesis, clinical and hormonal tests were performed on 25 female patients that were in chronic dialysis programs 4 hours, 3 times per week. Oligomenorrhea is considered as menstrual interval between 35 and 90 days and amenorrhea as cease of menstruation in the last six months. Results All patients had had normal menstrual cycles before the dialysis. Mean age of patients was 42.7 ± 9.96 years and mean dialysis duration was 75.5 ± 62.41 months. Out of the 25 patients, 10 developed amenorrhea when beginning dialysis and 5 of them regained regular menstrual cycle after one year. Seven patients had oligomenorrhea and 8 patients had an early menopause. Prolactin concentration was significantly higher in the group which developed menopause (N = 8), cpr = 1222.3 ± 1013.4, amenorrhea (942.2 ± 1061.2), oligomenorrhea (860.4 ± 897.2), compared to the group with a regular menstruation cycle (444.8 ± 299.7). The luteinizing hormone (LH) level in serum was increased in all groups. FSH was insignificantly higher in groups with oligomenorrhea and amenorrhea and amounted to 51.1 ± 69.9, while β-estradiol and progesterone were in normal ranges. Hemodialysis duration influenced the prolactin level and after one year of follow up prolactin level significantly decreased in the group with amenorrhea that regained regular menstruation (cpr = 596.2 ± 297.2). Conclusion  Different menstrual disorders are developed in dialyzed patients. Hyper prolactinemia was present in our dialysis population. Significant lowering of prolactin level in 20% of patients led to normalization of menstrual cycle.

When released into an appropriate environment, mammalian spermatozoa begin to capacitate and then continue until fully capacitated and able to fertilize. During capacitation in vitro, some cells 'over-capacitate' and undergo spontaneous acrosome reactions; this would be highly undesirable in vivo since already acrosome-reacted spermatozoa are non-fertilizing. Recent studies have revealed that seminal plasma contains several small molecules that bind to specific receptors on the sperm plasma membrane and act as 'first messengers', causing biologically important changes in availability of the 'second messenger' cAMP. Fertilization promoting peptide (FPP), calcitonin and adenosine all regulate cAMP production, stimulating it in uncapacitated spermatozoa and then inhibiting it in capacitated cells; in contrast, angiotensin II stimulates cAMP throughout capacitation. The molecules that regulate cAMP appear to do so via G protein-modulated changes in membrane associated adenylyl cyclases (mACs). Both mouse and human spermatozoa have been shown to have Galphas and Galphai2, as well as several isoforms of mAC, located in the same regions as the specific receptors. Thus spermatozoa possess the required elements for several separate signal transduction pathways, many of which regulate mAC/cAMP and so maintain sperm fertilizing ability. In vivo, such responses could increase the chances of successful fertilization.

This paper deals with the design and implementation of a visual control of a robotic system composed of a dexterous hand and video camera. The aim of the proposed system is to reproduce the movements of a human hand in order to learn complex manipulation tasks or to interact with the user. A novel algorithm for robust and fast fingertips localization and tracking is presented. A suitable kinematic hand model is adopted to achieve a fast and acceptable solution to an inverse kinematics problem. The system is part of a cognitive architecture for posture learning that integrates the perceptions by a high-level representation of the scene and of the observed actions. The anthropomorphic robotic hand imitates the gestures acquired by the vision system in order to learn meaningful movements, to build its knowledge by different conceptual spaces, and to perform complex interactions with the human operator.

This book discusses the role of technology in managing knowledge. Based on the most recent research and experience, the book brings together, in a logical sequence, diverse information and communication technologies and systems currently seen in knowledge management research and practice, incorporating the most important and representative examples into an integrated framework. With its largely empirical focus, the book provides much needed evidence regarding the true potential of technology for managing knowledge in organizations.