Background: Acute left ventricular free wall rupture (LVFWR) is a life-threatening complication of myocardial infarction that requires urgent intervention. Surgical repair has continued to be the treatment of choice. Studies suggest a posterolateral or inferior infarction is more likely to result in free wall rupture than an anterior infarction. LVFWR generally results in death within minutes of the onset of recurrent chest pain, and on average was associated with a median survival time of 8 hours. Prompt diagnosis and management can lead to successful treatment for LVFWR. Objective: The aim of this article was to present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Case report: We present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Although dual antiplatelet therapy introduction and good outcome of PCI were achieved, soon after instant thrombosis of both stents appear to result in transmural necrosis and LVFWR. Urgent catheterization was performed and diagnosed in-stent thrombosis where the ventriculography confirmed LVFWR of the posteroinferior wall. Urgent surgery was performed. Transmural necrosis was noticed alongside the incision line. The incision is sawn with 4 U-stitches (Prolen 2.0 with Teflon buttressed stitches). Another layer of fixation was made by Prolen 2.0 running stitches reinforced with Teflon felts from both sides. A large PTFE patch was fixed to epicardium over the suture line by Prolen 6.0 running stitch and BioGlue was injected in-between patch and LV (Figures 8 and 9). After aortic cross-clamp removal, the sinus rhythm was restored. Conclusion: Despite the high mortality, the urgency and the complexity of surgical treatment the early diagnosis plays a key role in the management of postinfarction LVFWR patients presenting a case of preserved postoperative left ventricular function and accomplished good functional status, as presented in our case.

We investigated DAB1-protein deficiency in the inner-ear development of yotari in comparison to humans and wild-type (wt) mice by immunofluorescence for the expression of connexins (Cxs) and the pannexin Panx1. The spatial and temporal dynamics of Cx26, Cx32, Cx37, Cx40, Cx43, Cx45, and Panx1 were determined in the sixth and eighth weeks of human development and at the corresponding mouse embryonic E13.5 and E15.5, in order to examine gap junction intercellular communication (GJIC) and hemichannel formation. The quantification of the area percentage covered by positive signal was performed for the epithelium and mesenchyme of the cochlear and semicircular ducts and is expressed as the mean ± SD. The data were analysed by one-way ANOVA. Almost all of the examined Cxs were significantly decreased in the cochlear and semicircular ducts of yotari compared to wt and humans, except for Cx32, which was significantly higher in yotari. Cx40 dominated in human inner-ear development, while yotari and wt had decreased expression. The Panx1 expression in yotari was significantly lower than that in the wt and human inner ear, except at E13.5 in the mesenchyme of the wt and epithelium and mesenchyme of humans. Our results emphasize the relevance of GJIC during the development of vestibular and cochlear functions, where they can serve as potential therapeutic targets in inner-ear impairments.

Highlights • Gap of public on-the-ground cancer data was addressed through questionnaires to professionals in the SEE region.• There is a lack of diagnostic imaging and radiotherapy modalities in the SEE region in comparison to Western Europe.• The Mortality to incidence ratio correlates inversely with the economic development and the availability of radiotherapy equipment.• The cancer incidence in SEE countries was correlate directly with the life expectancy and the availability of diagnostic equipment.• The need for reliable national and regional cancer registries in SEE countries for data collection and analysis has been emphasized.

Architectural patterns are solutions to common problems in software design. These usually tackle one or more customer requirements (business, functional, or quality requirements). As continuous deployment becomes more important for satisfying customer’s experience in software projects, there is a greater need in supporting continuous integration as its prerequisite. The nature of architectural design patterns is that some are more suitable for continuous integration then others. However, the existing approaches do not prescribe how to tailor architectural design considering integration challenges.To identify patterns suitable for continuous integration, we present a methodology for identification of architectural design patterns that support continuous integration based on continuous assessment. Our methodology, based on Aglie, enables DevOps engineers to assess their integration experience considering design changes, implementation changes, and creation of new version deliverables. The methodology complements common DevOps activities and introduces templates for communicating feedback from DevOps engineers to architects. Architects handle the communicated feedback as requirements and optimise their design accordingly. In this way, the design decisions take shape of solution patterns that, besides other existing requirements, satisfy requirements necessary to facilitate continuous integration.

Abstract Objective: The present study aimed to: i) determine the contractile properties of the major lower limb muscles in female soccer players using tensiomyography; ii) investigate inter-limb differences; and iii) compare inter-limb differences between different selections and playing positions. Methods: A total of 52 female soccer players (A team; U19 and U17) were recruited. The vastus lateralis (VL), vastus medialis (VM), rectus femoris (RF), biceps femoris (BF), gastrocnemius medialis (GM), lateralis (GL) and tibialis anterior (TA) of both lower limbs were evaluated. Results: When the entire sample was assessed regardless of selection or playing position, there were significant inter-limb differences in all measured muscles except BF. Compared to the non-dominant limb, the dominant limb had higher delay time in VL (p=0.008), while showing lower values in VM (p=0.023), GL (p=0.043) and GM (p=0.006). Contraction time was lower in the RF of the dominant limb (p=0.005) and VM (p=0.047), while showing higher values in VL (p=0.036) and TA (p<0.001) as compared to the non-dominant limb. Conclusion: Given the differences found between the limbs in the whole sample studied, it is necessary to examine both limbs to gather a more in-depth understanding of underlying mechanisms related to neuromuscular functions in female soccer players. Level of evidence: Prognostic study, Level II.

The aim of the present study was to investigate whether the physiological parameters indicative of cardiorespiratory fitness obtained during the 30-15 intermittent fitness (30-15IFT) test and the multistage laboratory treadmill endurance (TR) test differ. Nineteen elite handball players were recruited for the current study and assigned in a cross-over manner to one of two tests to be performed 48 h apart at each visit to the testing facility. The results showed that VO2max (percentage difference [PC] = 6.1%; p = 0.004) and maximal running velocity (V) (PC = 19.4%; p < 0.001) were significantly higher for the 30-15IFT test than that obtained during the TR test. Furthermore, the onset of blood lactate accumulation was shown to be significantly higher for all measures considered to predict it during 30-15IFT compared to TR as follows: VO2max (PC = 12.6%; p = 0.001), running speed (PC = 33.9%; p < 0.001), and maximal heart rate (PC = 7.5%; p < 0.001). The current study highlights the importance of sport-specific testing, particularly for measuring individual cardiorespiratory fitness in elite handball players, as TR may underestimate crucial variables used for both diagnostics and training prescription.

Background: Stroke patients have sleep-wake disorders, mostly in form of insomnia, excessive daytime sleepiness/fatigue, or hypersomnia (increased sleep needs). Objective: The aim of this study was to analyze types of sleep disorder (SD) and their frequency in patients with sleep apnea and acute stroke in relation to the type of stroke and side of lesion. Methods: The study analyzed 110 patients with sleep apnea and acute stroke hospitalized in the Clinic of Neurology, University Clinical Centre Tuzla. Acute stroke has been verified either by computerized tomography or magnetic resonance imaging of the brain. SD was verified according to the Berlin Questionnaire Test, The Epworth Sleepiness Scale, The Stanford Sleepiness Scale and the General sleep questionnaire. Strokes were divided by: a) type, into hemorrhagic and ischemic, and b) the localization of the stroke, to right and left cerebral hemispheres. Results: Of the total number of respondents, all had some sleep disorder. 20% of respondents had severe level of SD, 35.4% moderate, 37.3% moderate- severe and 7.3% mild problems. There were no statistically significant differences in the frequency of SD among patients with ischemic and hemorrhagic stroke (p = 0.58). In relation to the side of lesion, there was more patient with SD and stroke in the both sides, but there were no statistically significant differences (X2=1.98, p=0.161). According Epworth Sleepiness Scale, Stanford Sleepiness Scale and Berlin Questionnaire test snoring was present in 81% and daytime sleepiness in all patients. Conclusion: SD as a neuropsychological disorder has a significant incidence in the acute phase of stroke in patients with sleep apnea. Sleep disorder is more common in ischemic stroke and stroke in the both hemisphere, but it is not statistically significant difference. Daytime sleepiness, fatigue and snoring are the most common sleep problems in patients with acute stroke and apnea, but it is not statistically significant.

Aim of the study Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study. Material and methods Baseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study’s primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates. Results PTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%. Conclusions PTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis.

This study aimed to analyze treatment guidelines of 12 SEE countries to identify non-pharmacological interventions recommended for schizophrenia, explore the evidence base supporting recommendations, and assess the implementation of recommended interventions. Desk and content analysis were employed to analyze the guidelines. Experts were surveyed across the 12 countries to assess availability of non-pharmacological treatments in leading mental health institutions, staff training, and inclusion in the official service price list. Most SEE countries have published treatment guidelines for schizophrenia focused on pharmacotherapy. Nine countries—Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Moldova, Montenegro, North Macedonia, and Serbia—included non-pharmacological interventions. The remaining three countries—Kosovo (UN Resolution), Romania, and Slovenia—have not published such treatment guidelines, however they are on offer in leading institutions. The median number of recommended interventions was seven (range 5–11). Family therapy and psychoeducation were recommended in most treatment guidelines. The majority of recommended interventions have a negative or mixed randomized controlled trial evidence base. A small proportion of leading mental health institutions includes these interventions in their official service price list. The interventions recommended in the treatment guidelines seem to be rarely implemented within mental health services in the SEE countries.

During 2019, 28 grave constructions were excavated at cemetery Metaljica (Hadzici municipality, Bosnia and Herzegovina). Archaeological excavation have revealed 17 well preserved skeletons that were subjected to anthropological, odontological and genetic analyses. To determine sex by genetic analysis, amelogenin and DYS391 loci were taken into consideration. Concordance between results of anthropological, odontological and genetic analyses applied in this research occurred in one sample out of 17. In four samples, sex was determined only by genetic analysis, since sexual dimorphism indicators were not preserved. Concordance between odontological and genetic determinations was observed in two samples, while affirmative results of anthropological and genetic analysis were obtained in only one sample. Discrepancy in the majority of samples can be atributted to the state of preservation of skeletal remains, interpopulation differences and allele drop-out. Moreover, anthropological and odontological analyses were not applicable to juvenile/subadult skeletons, since sexually dimorphic characteristics relevant for metric and morphological analysis are not developed well at that developmental period. This study emphasizes the importance of combining anthropological, odontological and genetic methods in order to determine sex of archaeological skeletal remains accurately.