Background Functional assessment of myocardial bridging (MB) remains clinically challenging because of the dynamic nature of the extravascular coronary compression with a certain degree of intraluminal coronary reduction. The aim of our study was to assess performance and diagnostic value of diastolic‐fractional flow reserve (d‐FFR) during dobutamine provocation versus conventional‐FFR during adenosine provocation with exercise‐induced myocardial ischemia as reference. Methods and Results This prospective study includes 60 symptomatic patients (45 men, mean age 57±9 years) with MB on the left anterior descending artery and systolic compression ≥50% diameter stenosis. Patients were evaluated by exercise stress‐echocardiography test, and both conventional‐FFR and d‐FFR in the distal segment of left anterior descending artery during intravenous infusion of adenosine (140 μg/kg per minute) and dobutamine (10–50 μg/kg per minute), separately. Exercise–stress‐echocardiography test was positive for myocardial ischemia in 19/60 patients (32%). Conventional‐FFR during adenosine and peak dobutamine had similar values (0.84±0.04 versus 0.84±0.06, P=0.852), but d‐FFR during peak dobutamine was significantly lower than d‐FFR during adenosine (0.76±0.08 versus 0.79±0.08, P=0.018). Diastolic‐FFR during peak dobutamine was significantly lower in the exercise‐stress‐echocardiography test –positive group compared with the exercise‐ stress‐echocardiography test –negative group (0.70±0.07 versus 0.79±0.06, P<0.001), but not during adenosine (0.79±0.07 versus 0.78±0.09, P=0.613). Among physiological indices, d‐FFR during peak dobutamine was the only independent predictor of functionally significant MB (odds ratio, 0.870; 95% CI, 0.767–0.986, P=0.03). Receiver‐operating characteristics curve analysis identifies the optimal d‐FFR during peak dobutamine cut‐off ≤0.76 (area under curve, 0.927; 95% CI, 0.833–1.000; P<0.001) with a sensitivity, specificity, and positive and negative predictive value of 95%, 95%, 90%, and 98%, respectively, for identifying MB associated with stress‐induced ischemia. Conclusions Diastolic‐FFR, but not conventional‐FFR, during inotropic stimulation with high‐dose dobutamine, in comparison to vasodilatation with adenosine, provides more reliable functional significance of MB in relation to stress‐induced myocardial ischemia.

OBJECTIVE Appendiceal perforation has significant effects on perioperative morbidity and postoperative outcome. The present study aimed to identify possible predictive factors associated with perforated appendicitis (PA) in children at admission in the emergency department (ED). METHODS In this retrospective observational cohort study, consecutive medical records of children <18 years old with surgically and histopathologically confirmed acute appendicitis (AA) over three years (2013-2015) were analyzed. Patients were divided into two groups: PA and non-perforated appendicitis (NPA). The differences between the two groups and potential predictors of PA were explored using univariate and multivariate analyses. RESULTS During the study period, 295 patients underwent an appendectomy and had confirmatory AA diagnoses. Ninety-two patients had a PA (31.2%). In the univariate analysis, male gender, vomiting, diarrhea, fever, elevated white blood cell count (WBC) levels, and high C-reactive protein (CRP) were identified as predictors of PA. In the multivariate analysis, male gender (odds ratio [OR]: 3.133; 95% confidence interval [CI]: 1.610-6.096); vomiting (OR: 2.346; 95% CI: 1.141-4.822); diarrhea (OR: 4.549; 95% CI: 1.850-11.181); fever (OR: 3.429; 95% CI: 1.765-6.663); elevated WBC (OR: 2.962; 95% CI: 1.491-5.884) and elevated CRP (OR: 3.061; 95% CI: 1.267-7.396) were variables that predicted the PA in children. CONCLUSION Our data indicate that several clinical and biochemical parameters can reliably distinguish between pediatric PA and NPA at admission in the emergency department.

Objectives: The aim of this study was to characterize the safety and efficiency of a strategy employing the limit of detection (LoD) of high-sensitivity troponin T (hs-TnT) as a gatekeeper for coronary computed tomography angiography (CCTA) in suspected acute coronary syndrome (ACS) patients in the emergency department (ED). Methods: We included suspected ACS patients who underwent CCTA and were evaluated with hs-TnT. Patients were categorized as below the LoD and at or above the LoD. The primary outcome was 30-day major adverse cardiac events (MACEs), defined as all-cause mortality, ACS, or coronary revascularization. Results: The study population consisted of 177 patients (mean age 55 ± 10 years, 50.3% women), and 16 (9.0%) patients reached the primary outcome. None of the patients died, while 13 had an adjudicated diagnosis of ACS, and 3 underwent elective coronary revascularization. There were 77 patients (44%) with an hs-TnT value below the LoD (MACEs; n = 1 [1.3%]) and 100 (56%) with at or above the LoD levels (MACEs; n = 15 [15%]). None of 67 patients with an hs-TnT value below the LoD and <50% stenosis on CCTA experienced MACEs. Out of the 10 patients with an hs-TnT value below the LoD and ≥50% stenosis on CCTA, 1 patient underwent elective percutaneous coronary revascularization. In patients with an hs-TnT value at or above the LoD, 74 patients had <50% stenosis on CCTA, and 2 patients (3%) were diagnosed with myocardial infarction without obstructive coronary artery disease confirmed on invasive angiography. Thirteen (50%) patients with an hs-TnT value at or above the LoD and ≥50% stenosis on CCTA experienced MACEs (11 ACS and 2 elective percutaneous coronary revascularizations). Conclusion: Our findings support that implementing the LoD of hs-TnT as a gatekeeper may reduce the need for CCTA in suspected ACS patients in the ED.

The reproductive performance of ruminants is economically significant, and its improvement is a primary goal of the livestock industry to ensure its sustainability. Several approaches have been developed to use phytogenics as feed additives for several proposes, such as reducing methane emissions, and as an alternative to antibiotics. Phytogenics have potent antioxidant, anti-inflammatory, immunomodulatory, and metabolism-regulatory properties, and they are present at high levels in animal feeds. This current review considers the potential use of medicinal herbs on the reproductive performance of animals. The influence of diet on the fertility complications commonly noted in ruminants is of global interest. Although the effects of phytogenics on ruminant digestion and absorption are well-explored, their impact on reproductive performance remains poorly investigated. This review focuses on the influence of phytogenics on semen quality, hormonal profiles, and hematobiochemical indices in male ruminants. Based on available data, phytogenics are perceived to improve oocyte quality, reproductive performance, and pregnancy. However, further more comprehensive research on the benefits and potential hazards of the use of phytogenics is required to improve reproductive performance in ruminants.

ABSTRACT The aim of this study was to establish an evidence-based guideline for the antibiotic treatment of Corynebacterium striatum infections. Several electronic databases were systematically searched for clinical trials, observational studies or individual cases on patients of any age and gender with systemic inflammatory response syndrome, harboring C. striatum isolated from body fluids or tissues in which it is not normally present. C. striatum had to be identified as the only causative agent of the invasive infection, and its isolation from blood, body fluids or tissues had to be confirmed by one of the more advanced diagnostic methods (biochemical methods, mass spectrometry and/or gene sequencing). This systematic review included 42 studies that analyzed 85 individual cases with various invasive infections caused by C. striatum. More than one isolate of C. striatum exhibited 100% susceptibility to vancomycin, linezolid, teicoplanin, piperacillin-tazobactam, amoxicillin-clavulanate and cefuroxime. On the other hand, some strains of this bacterium showed a high degree of resistance to fluoroquinolones, to the majority majority of β-lactams, aminoglycosides, macrolides, lincosamides and cotrimoxazole. Despite the antibiotic treatment, fatal outcomes were reported in almost 20% of the patients included in this study. Gene sequencing methods should be the gold standard for the identification of C. striatum, while MALDI-TOF and the Vitek system can be used as alternative methods. Vancomycin should be used as the antibiotic of choice for the treatment of C. striatum infections, in monotherapy or in combination with piperacillin-tazobactam. Alternatively, linezolid, teicoplanin or daptomycin may be used in severe infections, while amoxicillin-clavulanate may be used to treat mild infections caused by C. striatum.

Background Vancomycin is associated with disruption of the indigenous microbiota, potentially predisposing patients to overgrowth of endogenous pathogens. Our objective was to determine whether high-dose oral vancomycin is associated with cultures growing gram-negative organisms in adult patients with Clostridioides difficile infection (CDI). Methods This is a retrospective cohort study of 632 adult patients with CDI from January 2015 to December 2017. The primary outcome was prevalence of cultures growing gram-negative organisms within 6 months after onset of the first episode of CDI. A multivariate logistic regression analysis was used to determine predictors of the outcome. Results One hundred fifty-three patients (24.2%) had cultures growing gram-negative organisms after onset of CDI, where urine (97, 63.4%) and blood (27, 17.7%) were the most common sources. The most commonly isolated gram-negative organisms were Escherichia coli (49, 32.0%) and Klebsiella species (34, 22.2%). A total of 38 (38/100, 38.0%) and 48 (48/199, 24.1%) of the patients who received high- and standard-dose oral vancomycin, respectively, had gram-negative organism growth on culture (odds ratio [OR], 2.22, 95% confidence interval [CI], 1.41–3.5; P = 0.02). The multivariate analysis showed that high-dose oral vancomycin (OR, 2.21; 95% CI, 1.29–3.79; P = 0.004) and recent use of antibiotic therapy within 3 months (OR, 2.11; 95% CI, 1.27–3.52; P = 0.004) were associated with positive cultures growing gram-negative organisms. Conclusions High-dose oral vancomycin therapy for CDI was associated with increased risk of gram-negative organisms probably throughout disruption of the indigenous microbiota.

The “Tendinitis of Achilles tendon” (TAT) or "Achilles tendon ruptures" (ATR) symptom is a very delicate problem which needs to be solved as soon as the first symptoms appear. It is necessary to conduct a correct anamnesis of the problem, to determine the diagnosis and method of treatment, as well as the introduction of controlled exercises that can contribute to a faster recovery so that the sportsman, an athlete can bring their body to its form and continue training and competition. Athletes often develop inflammation of tendons called tendinitis. This disease can affect only the tendon or tendon wrap or both at the same time. In the case of isolated inflammation of the tendon wrap, what hap-pens is swelling and thickening, which makes sliding (moving) of the tendon within its shell difficult, causing creaking or cracking (crepitation). The most common locus of inflammation of the tendon is on the back side of the lower half of the forearm and lower leg. Tendinopathy of Achilles tendon predominantly occurs in the jumpers (long jump, triple jump), javelin throwers, runners on tracks from 200m to 1500m and long-distance runners.

Abstract Glioblastoma, also known as glioblastoma multiforme, is an aggressive type of cancer that is made up of abnormal astrocytic cells, but also contain a mixture of different cell types (including blood vessels) and areas of necrosis. It is often seen in the brain and spinal cord, but glioblastomas are rarely found in the third ventricle. In this case, it was diagnosed in a 22-year-old male patient and we intended to draw attention to its atypical localization and surgical access to this third ventricle glioblastoma.

Two-wave with diffuse power (TWDP) is one of the most promising models for description of a small-scale fading effects in the emerging wireless networks. However, its conventional parameterization based on parameters K and Δ is not in line with model’s underlying physical mechanisms. Accordingly, in this paper, we first identified anomalies related to usage of conventional TWDP parameterization in moment-based estimation, showing that the existing Δ-based estimators are unable to provide meaningful estimates in some channel conditions. Then, we derived moment-based estimators of recently introduced physically justified TWDP parameters K and Γ and analyzed their performance through asymptotic variance (AsV) and Cramer–Rao bound (CRB) metrics. Performed analysis has shown that Γ-based estimators managed to overcome all anomalies observed for Δ-based estimators, simultaneously improving the overall moment-based estimation accuracy.

Increasing attention has been paid to the possible link between periodontal disease and atherosclerosis over the past decade. The aim of this study is to investigate the presence of five periopathogens: Porphyromonas gingivalis (P.g.), Aggregatibacter actinomycetemcomitans (A.a.), Tannerella forsythia (T.f.), Treponema denticola (T.d.), and Prevotella intermedia (P.i.) in atheromatous plaques obtained from the carotid and coronary arteries in patients who underwent coronary artery bypass graft surgery and carotid endarterectomy. Group I (carotid arteries) consisted of 30 patients (mean age: 54.5 ± 14.8), and group II (coronary arteries) consisted of 28 patients (mean age: 63 ± 12.1). Clinical periodontal examinations consisted of plaque index, gingival index, sulcus bleeding index, and periodontal probing depth and were performed on the day of vascular surgery. The presence of periopathogens in periodontal pockets and atherosclerotic vessels was detected using polymerase chain reaction. In both subgingival plaque and atherosclerotic plaque of carotid arteries, P.g., A.a., T.f., T.d., and P.i. were detected in 26.7%, 6.7%, 66.7%, 10.0%, and 20.0%, respectively, while for coronary arteries, P.g. was detected in 39.3%, A.a. in 25%, T.f. in 46.4%, T.d. in 7.1%, and P.i. in 35.7%. The presence of five periopathogens in carotid and coronary atherosclerotic vessels showed correlation in regard to the degree of periodontal inflammation. The present study suggests the relationship between periodontal pathogenic bacteria and atherogenesis. Further studies are necessary in relation to the prevention or treatment of periodontal disease that would result in reduced mortality and morbidity associated with atherosclerosis.

There is no doubt that milk and dairy products have a high nutritional value. However, their current consumption is increasingly dependent on their dietary and health properties. It is noticeable that in recent years, increasing popularity is given to those dairy products that have a positive effect on the human body. The aim of this study was to determine the fatty acid composition of sheep's milk from the area of Livno and Travnik (Vlašić), with special reference to the content of bioactive fatty acids that have a positive effect on human health. The fatty acid composition of the tested milk samples was specific due to the content of fatty acids which have been proven to have an extremely beneficial effect on human health. Concentrations of most bioactive fatty acids varied between areas, and the differences were statistically significant for arachidonic, eicosapentaenoic, docosahexaenoic, and rumenic. Milk samples from the tested areas had an almost ideal ratio of n-6/n-3 fatty acids, which makes them very favorable foods from a health point of view.

Dairy cattle breeding is one of the most important branches of livestock production, which has been facing, for several decades, the chronic problem of declining reproductive performance. In 2005, the number of cattle worldwide was about 1,370,000,000, while in 2015 that number dropped below one billion, and in 2021 it shows a slight recovery as it was 1,000,970. This indicates the importance of applying different reproductive protocols in order to increase the number of cows in production. The type of bedding on which the animals stay, as well as the characteristics of the lying area itself, shows a significant impact on numerous physiological functions such as food intake, chewing, milk yield, but also levels of sex hormones. The type of bedding and lying area, which causes chronic pain and stress, leads to disorders of physiological and reproductive processes, since stress has direct negative impact on numerous cellular functions. A total of 66 dairy cows, 50 Holstein-Friesian cows kept on PD Butmir and 16 Simmental cows kept on a private mini farm, were included in the study. At PD Butmir, cows were kept in tie-stall housing system, while on a mini-farm they were kept free. Hormonal protocols of estrus and ovulation synchronization were used in April, May and June 2019. Cows were subjected to two estrus synchronization and ovulation protocols, Ovsynch and Cosynch72. At PD Butmir, 25 cows were subjected to Ovsynch and Cosynch72 protocols, respectively. At the mini-farm only Ovsynch protocol was applied. The Ovsynch protocol applied on PD Butmir had success in conception rate of 12% (n = 3), while the Cosynch72 protocol gave a score of 36% (n = 9). On the mini-farm, Ovsynch resulted in a conception of 25% (n = 4). Based on our results, the Cosynch72 protocol, compared to the Ovsynch protocol, was a better choice in the case of Holstein-Friesian cows kept in the tie-stall housing system. In the Simmental cows kept in the free stall system, the Ovsynch protocol proved to be better choice in achieving conception, compared to the Holstein-Friesian cows. Therefore, it is necessary to test several different protocols of estrus and ovulation synchronization, in order to find the most optimal one for a certain breed, type of keeping and breeding.