The aim of this study was to evaluate outcomes of surgical correction of penile curvature using autologous graft materials in patients with Peyronie’s disease, with emphasis on functional recovery, penile length changes, cosmetic results and patient-reported satisfaction. Due to unavailability of commercial extracellular matrix grafts, autologous materials including buccal mucosa, rectus fascia, fascia of the tensor fasciae latae and saphenous vein were utilized. This study included male patients treated for penile curvature due to Peyronie’s disease at the Department of Urology, Clinical Centre University of Sarajevo between 2018 and 2023. All patients had stable disease for more than 12 months. Preoperative assessment included penile Doppler ultrasonography, curvature measurement and flaccid penile length evaluation. Erectile function was measured using the validated International Index of Erectile Function (IIEF-5), and disease burden was assessed via the Peyronie’s Disease Questionnaire (PDQ). A postoperative patient satisfaction survey was performed combining validated components (Erection Hardness Score and EDITS satisfaction elements) with a graft-specific preference scale. Patients were divided into four groups based on graft type. Groups 3 and 4 demonstrated superior functional and cosmetic outcomes following surgery (p<0.05). There were no significant differences in complication rates among groups (p>0.05). Curvature recurrence was more frequently observed in Group 4, although not statistically significant (p>0.05). Penile shortening occurred more often in Groups 1 and 2 (p<0.05). Improvement in postoperative IIEF-5 scores was most pronounced in Groups 3 and 4. The patient satisfaction survey showed that patients reported higher postoperative satisfaction, better perceived length preservation, and greater overall acceptability when buccal mucosa was used as graft material compared to other autologous grafts. In settings where commercial grafts are unavailable, autologous graft materials represent a viable option for surgical correction of Peyronie-related curvature. Based on postoperative functional outcomes and validated patient satisfaction measures, buccal mucosa and saphenous vein grafts demonstrated the most favorable profiles and should be considered preferred autologous grafting options. No

Field-of-view (FoV) prediction is critical for reducing device energy consumption and enhancing user quality of experience (QoE) in immersive streaming. To address the high computational and energy costs of standard DL-based FoV prediction, we propose PRECEPT, an energy-efficient, system-oriented two-stage framework. PRECEPT splits the prediction pipeline by adding a lightweight, CPU-based classifier to identify tile change. PRECEPT's classifier successfully filters approximately 80% of “no-change” events. PRECEPT activates the resource-intensive DL model only during identified tile change. This design reduces the average inference delay and energy consumption by up to 69% in a real mobile deployment. PRE-CEPT's two-stage design enables sustainable, high-performance FoV prediction on resource-constrained devices.

This study examines spatial marginalization in Bosansko Grahovo, one of the most depopulated and socio-economically underdeveloped municipalities in Bosnia and Herzegovina, located on the EU border with Croatia. Using a mixed-methods approach, the study integrates a previously developed Geographical Marginalization Index (GMAR) with survey data and interviews. The findings reveal a strong convergence between quantitative indicators of marginalization and residents’ perceptions, supporting the interpretation of Bosansko Grahovo as an example of double periphery defined by geographical remoteness and systemic exclusion. While the border itself is not perceived as the primary driver of decline, post-war legacies, institutional fragmentation and infrastructural deficits interact cumulatively to produce what is conceptualized as a selfreinforcing vicious circle of marginalization. Combining quantitative indicators with perception-based evidence allows for a better understanding of how marginalization persists in peripheral border areas.

Background: The diagnosis of urinary tract infection (UTI) remains a clinical challenge, with urine culture as the gold standard. In developing countries like Bosnia and Herzegovina, a high prevalence of antimicrobial resistance and frequent empirical treatment pose significant clinical challenges. Automated urine flow cytometry has emerged as a rapid tool to optimize diagnostic processes. Objectives: To determine the correlation of age, gender, and laboratory parameters—such as white blood cell (WBC) count, neutrophil count, and C-reactive protein (CRP)—with both urinary bacterial counts and urine culture results. Methods: This retrospective study analyzed 200 adult patients (≥18 years) with symptoms suggestive of UTI at the University Clinical Center Tuzla. Data on age, gender, WBC, neutrophils, CRP, and urine flow cytometry (Sysmex UF-4000) were collected. Statistical analysis was performed using R software (version 4.5.1), utilizing logistic regression models via the ‘glm’ function to identify independent predictors, with statistical significance set at p < 0.05. Results: The mean age of the population was 68.61 ± 15.19 years. Logistic regression demonstrated that WBC count (OR = 1.06, p = 0.004), neutrophil count (OR = 1.04, p = 0.014), and patient age (OR = 1.03, p = 0.001) were significant independent predictors of UTI. Furthermore, patients with a urinary bacterial count > 1200/μL had 83 times higher odds of a positive urine culture (OR = 83, 95% CI 32.25–200, p < 0.001). Conversely, CRP levels and gender were not significant predictors (p > 0.05). Conclusions: Patient age, WBC, and neutrophil counts are key factors for predicting UTIs. Integrating these parameters with urine flow cytometry bacterial counts can significantly enhance diagnostic accuracy and rapid screening in clinical practice.

Objective To evaluate short- and long-term outcomes after modified Stage I palliation for hypoplastic left heart syndrome. Methods This retrospective single-center study analyzed 128 patients with hypoplastic left heart syndrome treated between 1993 and 2023. Patients were divided into 2 groups: Era I (n = 36), from 1993 to 2001, included patients who underwent the classic Norwood procedure, and Era II (n = 92), from 2002 to 2023, included patients who underwent modified Stage I palliation. Postoperative outcomes, including the need for postoperative extracorporeal membrane oxygenation, peritoneal dialysis, recoarctation rate, and overall survival, were compared between eras. Results Median follow-up was 9.7 years, with 100% completeness for survival data, and ranged from 0.9 to 30.9 years. Ninety-day survival improved from 69.4% in Era I to 95.7% in Era II (P < .001). Transplant-free survival improved from 47% to 84% at 5 years (P < .001) and from 42% to 71% at 20 years (P < .001). Only 1 patient in Era II required postoperative extracorporeal membrane oxygenation. The use of peritoneal dialysis decreased from 86.1% to 22.8%, and recoarctation rate decreased from 13.9% to 7.6%. Conclusions On the foundation of important developments in perioperative care across the study period, the introduction of modified Stage I palliation may have contributed to improved survival and reduced postoperative morbidity, and may represent an alternative to centralization of care.

Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as “new racism”. Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems.

Abstract Introduction Rheumatic connective tissue diseases (RCTDs) are chronic systemic autoimmune disorders frequently complicated by cardiovascular involvement, which represents a major cause of morbidity and mortality. Subclinical cardiac manifestations may remain unrecognized and may be associated with systemic inflammation and laboratory abnormalities. Objective To evaluate the prevalence and characteristics of cardiac manifestations in patients with RCTDs and to assess their association with serological status and selected hematological and biochemical parameters. Methods This observational study included 110 adult patients hospitalized and treated for rheumatic connective tissue diseases over a one-year period. Patients were classified into seropositive and seronegative groups based on autoantibody profiles. All participants underwent clinical evaluation, electrocardiography, and transthoracic echocardiography. Hematological, inflammatory, biochemical, electrolyte, enzyme, and serum protein parameters were analyzed. Results Cardiac involvement was more frequently observed in seropositive patients and increased significantly with age. Ventricular hypertrophy and atrioventricular or intraventricular conduction disturbances were the most common abnormalities in this group. Seropositive patients showed significantly lower hematocrit, hemoglobin, calcium, and albumin levels, as well as higher erythrocyte sedimentation rate, fibrinogen, triglycerides, lactate dehydrogenase, and serum urea levels. In the seropositive group, demonstrated significant negative correlations with hematocrit, hemoglobin, albumin, and calcium. Conclusion Seropositive rheumatic connective tissue diseases are associated with a higher prevalence of subclinical cardiac involvement and distinct laboratory abnormalities reflecting chronic inflammation and myocardial remodeling. Integrated cardiovascular assessment combined with laboratory evaluation may facilitate early detection of cardiac involvement in this patient population.

In patients with heart failure with reduced ejection fraction (HFrEF), the angiotensin receptor-neprilysin inhibitor sacubitril-valsartan has consistently demonstrated a beneficial therapeutic effect, vastly in non-Chagas trials. Less is known about the efficacy and safety of sacubitril-valsartan compared with standard of care in patients with Chagas cardiomyopathy, a common but often neglected etiology of nonischemic HFrEF. We aimed to perform a systematic review and meta-analysis to investigate whether sacubitril-valsartan is superior to enalapril in patients with heart failure (HF) due to Chagas cardiomyopathy. PubMed, Embase and Cochrane database were searched for randomized controlled trials (RCTs) that compared sacubitril-valsartan with enalapril in patients with HF due to Chagas cardiomyopathy. Efficacy outcomes were (1) cardiovascular (CV) death; (2) HF hospitalization; (3) relative change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) from baseline; and safety outcomes were (4) serious adverse events (SAEs); and (5) drug discontinuation due to adverse events (AEs). Cochrane's Review Manager Version 7.2.0 (RevMan, 2024) was used for all statistical analyses. Heterogeneity was examined with I² statistics. Hazard ratios (HR), risk ratios (RR), and mean differences (MD) with 95% confidence intervals (CIs) were pooled using an inverse-variance random-effects model. Three RCTs comprising 1,112 patients were included, of whom 463 (38%) were females. A total of 615 (50.02%) patients received sacubitril–valsartan, while 610 (49.8%) were treated with enalapril. The mean age was 63.67±10.6 years, and the mean left ventricular ejection fraction (LVEF) was 29.8%±7.2%. There was no statistically significant difference in CV death (HR 0.92; 95% CI 0.72 to 1.18; p=0.51; I²=0; Figure 1A) and HF hospitalization (HR 0.93; 95% CI 0.72 to 1.20; p=0.59; I²=0; Figure 1B) between sacubitril-valsartan and enalapril groups. However, there was a statistically significant reduction in NT-proBNP favoring enalapril over sacubitril-valsartan (MD 0.68; 95% CI 0.63 to 0.73; p<0.00001; I²=0; Figure 1C). No statistically significant difference in SAEs was found between the two treatment arms (RR 0.90; 95% CI 0.79 to 1.03; p=0.12; I²=0; Figure 2A), but there was a trend towards fewer drug discontinuations due to AEs with sacubitril–valsartan compared with enalapril (RR 0.51; 95% CI 0.26 to 1.01; p=0.05; I²=32% Figure 2B). In this meta-analysis of 1,112 patients with HF due to Chagas cardiomyopathy, sacubitril-valsartan did not statistically significantly reduce CV death or HF hospitalization, relative to enalapril. There was a significant difference between groups in terms of NT-proBNP reduction favoring enalapril. Moreover, sacubitril-valsartan was not superior to enalapril with respect to safety outcomes.Figure 1.Efficacy outcomes.For image description, please refer to the figure legend and surrounding text.Figure 2.Safety outcomes.For image description, please refer to the figure legend and surrounding text.

Inclisiran effectively reduces low-density lipoprotein cholesterol (LDL-C) by suppressing proprotein convertase subtilisin/kexin type 9 (PSCK9) in patients on maximally tolerated statins with atherosclerotic cardiovascular disease (ASCVD) or risk equivalent. However, less is known about the efficacy of inclisiran as a monotherapy strategy for LDL-C reduction in patients with elevated levels but who are not on statins, ezetimibe, or any other lipid-lowering therapy (LLT). To investigate whether the lipid-lowering efficacy of inclisiran in LDL-C reduction indicates a significant pharmacodynamic effect regardless of baseline cardiovascular risk in patients with hypercholesterolemia without any LLT. We conducted a comprehensive search of PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) comparing inclisiran sodium at dose of 300 mg (equivalent to 284 mg inclisiran) with placebo in adults with hypercholesterolemia who were not on statin, ezetimibe, nor any other LLT at baseline for evaluating the lipid-lowering efficacy of inclisiran as monotherapy. Outcomes of interest were (1) primary efficacy endpoint as percentage change in LDL-C from baseline, in patients without any background LLT and in those without statin use, and (2) percentage change in PCSK9 levels from baseline. R software version 4.3.1 was used for statistical analysis to estimate pooled effects of mean difference (MD) and 95% confidence intervals (CI) under e random-effects model. Heterogeneity was examined with I² statistics. We included five RCTs comprising 540 patients, of whom 311 (58%) were treated with inclisiran monotherapy, and the remaining 229 (42%) received placebo. Median follow-up ranged from 6 to 18 months (or 183 to 540 days). When compared with placebo, patients treated with inclisiran monotherapy who were not on any LLT had a significant decrease in percentage change in LDL-C from baseline (MD −46.24%; 95% CI −51.35 to −41.12; p<0.01; Figure 1A), with no significant difference when stratified by low risk versus high-risk population (test for subgroup difference p=0.33; Figure 1A). Similarly, inclisiran monotherapy lowered the LDL-C from baseline in patients without statin at baseline by about 53% more compared with placebo (MD −52.57%; 95% CI −62.34 to −42.80; p<0.01; Figure 1B). Moreover, the inclisiran group showed a significant 77% reduction in PCSK9 levels compared with the placebo group (MD −77.29%; 95% CI −84.31 to −70.27; p<0.01; Figure 2A). In this meta-analysis of RCTs evaluating patients with hypercholesterolemia without any background LLTs, inclisiran monotherapy significantly reduced percentage change in LDL-C from baseline, regardless of ASCVD risk. These findings were consistent in a sensitivity analysis only in patients without statin use at baseline, as well as in reduction of PSCK9 levels.Inclisiran Figure 1For image description, please refer to the figure legend and surrounding text.  Inclisiran Figure 2For image description, please refer to the figure legend and surrounding text.

Oral anticoagulation (OAC) and antiplatelet therapy (APT) represent a well-established preventative strategy against stroke, stent-related, and coronary ischemic events in patients with atrial fibrillation (AF) and coronary artery disease (CAD) following percutaneous coronary intervention (PCI). Less is known about the efficacy and safety of OAC as monotherapy compared with combined antithrombotic therapy in the subgroup of patients with drug-eluting stent (DES) implantation. To investigate whether deescalating from combination therapy of OAC with single APT to OAC monotherapy provides similar protection from major ischemic and bleeding endpoints in patients with AF and stable CAD following DES implantation. We systematically searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) that compared OAC monotherapy (vitamin K antagonist or direct oral anticoagulant) with combination antithrombotic therapy of OAC plus single APT in patients with AF and CAD who underwent PCI with DES and reported the efficacy and safety composite outcomes of mortality, ischemia (myocardial infarction, stroke, or systemic embolism), and major bleeding or clinically relevant bleeding (CRNB). Cochrane's Review Manager Version 7.12.0 (RevMan, 2024) was used for statistical analysis to estimate pooled effects of hazard ratio (HR) with 95% confidence intervals (CI) under a random-effects model. Heterogeneity was examined with I² statistics. We included four RCTs comprising a total of 2570 patients, of whom 1302 (51%) were treated with OAC monotherapy, and the remaining 1268 (49%) were treated with combination therapy of OAC+APT. Median follow-up ranged from 12 to 30 months. There was no statistically significant difference in the efficacy endpoints of major ischemic composite (HR 0.94; 95% CI 0.65 to 1.36; p=0.75; Figure 1A) and the net clinical composite (HR 0.77; 95% CI 0.37 to 1.60; p=0.49; Figure 1B) between OAC monotherapy and OAC+APT combination therapy. However, there was a statistically significant reduction in the safety endpoint composite of major bleeding or CRNB with OAC monotherapy (HR 0.47; 95% CI 0.30 to 0.75; p=0.001; Figure 2A) compared with OAC+APT combination therapy, which was consistent in a sensitivity analysis of patients treated with predominantly new-generation DES (HR 0.38; 95% CI 0.25 to 0.59; p<0.0001; Figure 2B). Among patients with AF and prior PCI with DES implantation, OAC monotherapy statistically significantly reduced major bleeding or CRNB endpoint by 52% compared with combined antithrombotic therapy, but there was no significant difference between groups in terms of major ischemia or net clinical benefit.OAC Figure 1For image description, please refer to the figure legend and surrounding text.  OAC Figure 2For image description, please refer to the figure legend and surrounding text.

Commercially available graphene quantum dots (GQDs) are promising nanomaterials for applications in research and preclinical diagnostics, drug delivery, and bioimaging. Their bioactivity is highly dependent on dose, route of exposure, duration, cell type, uptake mechanisms, tissue and cellular distribution, and physicochemical properties. This study aimed to evaluate genotoxic, cytotoxic, and cytostatic endpoints of blue- (B-GQDs) and green-emitting (G-GQDs) GQDs in human blood and salivary leukocytes. GQDs were tested at concentrations ranging from 2.5 to 100 µg/mL using distinct treatment periods. Fourier transform infrared spectroscopy (FTIR), trypan blue exclusion, comet, and cytokinesis-block micronucleus cytome (CBMN cyt) assays were performed. FTIR analysis revealed that G-GQDs, unlike B-GQDs, exhibit an absorption band typically associated with amine functional groups, which may contribute to their pronounced genotoxic effects. Peripheral blood mononuclear cells and salivary leukocytes showed higher sensitivity to G-GQDs compared to whole blood samples. Although no cytotoxic effects were observed, both GQDs induced significant DNA damage, with G-GQDs demonstrating greater genotoxic potential. These findings demonstrate that GQDs can induce DNA damage in the absence of detectable cytotoxic effects under the conditions tested, highlighting the importance of considering both physicochemical properties and cellular models in the safety assessment of nanomaterials.

Evidence suggests psychological factors including personality traits can have impact on the development and course of irritable bowel syndrome (IBS) and associated health‐related quality of life (HrQoL), with large individual heterogeneity. Main aim of this study was to examine between‐persons associations and within‐sample concurrent associations of the personality traits neuroticism, extraversion, conscientiousness, openness and agreeableness with gastrointestinal (GI) symptoms, psychological factors and HrQoL in IBS‐patients.