Structural size optimization of a device for external bone fixation within a formed iterative hybrid optimization algorithm was presented in this paper. The optimization algorithm was in interaction with the algorithms for generative design and FEM analysis and completely integrated within CATIA CAD/CAM/CAE system. The initial model, representing the current design of the bone external fixation device Sarafix, was previously verified by experimental testing. The formed hybrid optimization algorithm was created as an integration of the global (SA method) and local (CG method) algorithm. The constraints of the optimization model are the clinical limitations of the interfragmentary displacements and the material strength. The optimized design has less weight, greater rigidity and less transverse interfragmentary displacements at the point of fracture compared to the current design.

Abstract In a dynamic market, the city has become a main source of competitiveness, along with financial and economic benefits. Due to the processes of digitalization, a new concept has been developed, namely smart cities. This concept delivers economic and financial potential, not only to cities, but also to urban and local economic development. Therefore, to ensure the establishment of this concept, local government units, i.e., cities, need to have enough financial resources. In addition, the fiscal capacity of their local budgets should be sufficient. The objective of this paper is to evaluate the fiscal capacity of large cities in Croatia over the 2016-2018 period, as well as to present the financial support through funding schemes for the establishment of smart cities. After calculating the level of fiscal capacity of large cities, the analysis revealed interesting results. Only four large cities (Split, Rijeka, Zadar and Pula) achieved positive fiscal capacity in the observed period. This provides evidence of fiscal performance and fiscal capacity for the establishment of smart cities. This concept will enhance the quality of life, stimulate economic growth, sustain local government budgets and create new value for both investors and the local population.

Introduction Results of currently available trials have shown divergent outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Current guidelines do not recommend PCI in patients with diabetes and a SYNTAX score ≥ 23. Aim To compare all-cause 4-year mortality after revascularization for complex coronary artery disease (CAD) in diabetics. Material and methods The study group comprised consecutive patients with three-vessel CAD and/or unprotected left main CAD (≥ 50% diameter stenosis) without major hemodynamic instability, who were treated in two institutions with PCI or referred for CABG. Results Out of 342 diabetics, 177 patients underwent PCI and 165 patients were referred for CABG. The incidence of all-cause death was different between diabetics treated with PCI or CABG at 4 years (16/177, 9.0% vs. 26/165, 15.8%, respectively, p = 0.03). The difference was not evident in non-diabetics (PCI: 41/450, 9.1% vs. CABG: 19/249, 7.6%, p = 0.173). In diabetics, there was a higher incidence of all-cause mortality in PCI patients with intermediate-high (≥ 23) SYNTAX scores compared with those with low (0–22) SYNTAX scores (10/56, 17.9% vs. 6/121, 5.0%, respectively, p < 0.01). On the other hand, diabetics who underwent CABG showed similar mortality rates irrespective of the SYNTAX scores (SYNTAX 0–22: 3/29, 10.3%; SYNTAX ≥ 23: 23/136, 11.9%, p = 0.46). In the subgroup analysis, there was no interaction according to presence or absence of left main CAD (p for interaction = 0.12) as well as according to diabetes status (p for interaction = 0.38), whereas gender and SYNTAX scores were differentiators between PCI and CABG with a p for interaction < 0.1. Conclusions Our analysis supports recent evidence that diabetes is not a differentiator between PCI and CABG.

Systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) are associated with an increased risk of developing cardiovascular diseases as a result of complex interaction between traditional risk factors, chronic inflammation and specific impact of antibodies on endothelium. There are very limited data regarding level of physical activity (PA) in APS patients.To analyze different domains of PA in Serbian APS patients and their possible relationship to clinical and laboratory criteria of the main disease.From a large Serbian APS database comprehending 527 APS patients (371 Primary – PAPS, and 156 APS associated with other autoimmune diseases, predominantly systemic lupus erythematosus (SLE)) we interviewed 51 APS patients, age range of 15-69 years: 29 patients with primary APS (PAPS), 25 women, 4 men, age 44±11.50, and 22 APS/SLE, 18 women, 4 men, age 48.41±11.75, using a long form of The International Physical Activity Questionnaire (IPAQ), translated onto Serbian language. Data on last seven days of PA divided onto leisure time PA, domestic and gardening (yard) activities, work-related PA and transport-related PA were acquired, and proposed scoring method was used. Based on the level of PA, patients were categorized to low, moderate or high level of PA. For the purpose of insight into atherosclerotic progression, we performed color Doppler scan of carotid arteries in all patients and presence of atherosclerotic plaques has been notified.Average total PA score was 7706.18±11771.97 MET-minutes/week. The greatest average values for different PA domains were for work (2733.21±6158.66 MET-minutes/week) and domestic/garden/yard (2522.31±3847.24 MET-minutes/week) and the lowest scores achieved in leisure time (500.87±695.45 MET-minutes/week). Majority of Serbian APS patients had low or moderate level of PA (37.3%, 43.1%, respectively) whereas lowest percentage was in high category of PA (19.6%). All domains of PA were significantly negatively correlated to age and BMI. There were no significant difference regarding PA scores between PAPS and APS/SLE patients. Although higher percentage of PAPS patients had high level of PA (27.65 compared to 9.1% of SLE/APS), the overall difference was not significant. There was no significant difference regarding antiphospholipid antibody (aPL) type or thrombotic/obstetric events presence. Significant difference occurred regarding presence of carotid arteries plaques. APS patients with lower PA scores had significantly higher prevalence of carotid arteries plaque especially for PA in transportation (p=0.004), and total PA (p=0.025)Serbian APS patients at younger age, tend to have low or moderate level of PA, with the lowest level of activity in leisure time. Low level of PA was undoubtedly related to progression of atherosclerosis in these patients, emphasizing a need for PA promotion in APS.Aleksandra Djokovic Speakers bureau: KRKA, Astra Zeneca, Actavis, Ljudmila Stojanovich: None declared, Natasa Stanisavljevic: None declared, Gordana Bogdanovic: None declared, Sandra Djokic: None declared

Abstract Buško Blato Reservoir, the third largest hydro accumulation in Europe, is situated in the south-eastern part of the karstic Livanjsko Polje Valley. This aquatic ecosystem is distinguished by a very rich ichthyofauna and the presence of four endemic fish species. Numerous studies focus on ichthyological researches of Buško Blato Reservoir. Its ichthyofauna has been exposed to changes in ecological factors, which in turn reflected on the structure and composition of fish populations. The main objective of this paper was to assess the current state and predict future trends in the ichthyofauna structure and dynamics based on the field data and comprehensive analyses of literature data. The results of the research indicated the presence of 11 fish species from four families, which is the largest number of fish species ever recorded in this ecosystem. Sander lucioperca, Lepomis gibbosus, Pseudorasbora parva and Tinca tinca were recorded for the first time in this ecosystem, while some previously recorded species were not found. The results of the analyses clearly indicate the presence of natural interspecific competition and significant level of threats to the endemic fish species caused by human activities.

In this paper, the Incremental Conductance maximum power point tracking (MPPT) algorithm is evaluated using an experimental setup consisting of two 75W photovoltaic (PV) panels connected in series. Humusoft MF 634 board is used to obtain and produce signals. The model was tested under changing solar irradiance conditions, and the acquired results show that it is able to respond to these changes appropriately.

Introduction: Optical coherence tomography angiography (OCT-A) is a useful diagnostic tool for assessing eyes’ health in patients with chronic diseases, such as diabetes, hypertension, Parkinson’s disease and chronic kidney disease (CKD). Aim: To detect changes in macular structure and retinal vascular meshwork in the macular area and peripapillary in patients with chronic kidney disease (CKD). Methods: This cross-sectional study included 80 eyes of patients with CKD in stages 2, 3 or 4, who were followed-up in the Nephrology Clinic of University Clinical Center Sarajevo. All patients were categorized according to the stage of CKD. All patients were scanned by a high-speed 840-nm-wavelength spectral-domain optical coherence tomography instrument (RTVue XR Avanti; Optovue, Inc, Fremont, California, USA). Blood flow was detected using a split-spectrum amplitude-decorrelation angiography algorithm. A fully automated microstructural analysis of the foveal avascular zone (FAZ), FAZ perimeter, foveal vessel density in a 300-μm area around the FAZ (FD), nonflow area, flow index in superficial and deep vascular plexus, choriocapillary flow, vascular density, radial peripapillary capillary density was performed. Results: When comparing patients with CKD stage 2 and stage 3 there were no statistically significant changes in microvascular parameters on OCT angiography, as well as when comparing patients with CKD stage 3 and stage 4. But in the comparison between patients with less developed CKD (stage 2) and terminal CKD (stage 4) there was a significant difference between some microvascular parameters such as FAZ area, FAZ perimeter, choriocapillary flow. Conclusion: Many studies demonstrated that evaluation of the microvascular changes in different retinal layers using SS-OCTA may be considered as a key to assessing the systemic perfusion status. Evaluation of retinal microvasculature may ease the management and approach of patients with CKD, having in mind that the retinal and the kidney vascular network are, concerning structure, development and the function, very similar.

Women represent an increasing proportion of the overall rheumatology workforce, but are underrepresented in academic rheumatology, especially in leadership roles [1].The EULAR Task Force on Gender Equity in Academic Rheumatology has been convened to establish the extent of the unmet need for support of female rheumatologists, health professionals and non-clinical scientists in academic rheumatology and develop a framework to address this through EULAR and EMEUNET.To investigate gender equity in academic rheumatology, an anonymous web-based survey was targeted at the membership of EULAR and Emerging EULAR Network (EMEUNET) and their wider networks. The survey was developed based on a narrative literature review [1], best practice from The Association of Women in Rheumatology, a survey of task force members and face-to-face task force discussions. Personal experiences were explored and 24 potential interventions to aid career advancement were ranked. Statistics were descriptive with significance testing for male/female responses compared using chi-squared/t-tests. The level of significance was set at p<0.001.A total of 301 respondents from 24 countries fully completed the survey. By profession, 290 (86.4%) were rheumatologists, 19 (6.3%) health professionals, and 22 (7.3%) non-clinical scientists. By gender, 217 (72.1%) were women, 83 (27.6%) men, and 1 (0.3%) third gender. By age, 203 (67.5%) were 40 or under. By ethnicity, 30 (10.0%) identified themselves as ethnic minority. A high proportion of respondents reported having experienced gender discrimination (47.2% total: 58.1% for women and 18.1% for men) and sexual harassment (26.2%: 31.8% and 10.8% respectively) (Figure 1). Chi-squared tests on the numbers on which these proportions were based showed statistically significant differences between women and men in having experienced gender discrimination (Χ2=36.959 (df=1), p <0.001) and sexual harassment (Χ2=12.633 (df=1), p <0.001). The highest-ranked interventions for career advancement regardless of respondents’ gender included: leadership skills training; speaking/presentation/communication skills training; information on training/career pathways; effective career planning training; support on grant writing applications; and high-impact scientific writing master-classes (Figure 2). Only 8 of 24 proposed interventions showed a significantly higher ranking (p<0.001) by female respondents and these typically related to promotion of female role models and gender-balance in committees, editorial boards and research funding (Figure 2).Figure 1.Perceived gender discrimination and sexual harassment, 301 responsesFigure 2.Mean perceived utility of potential interventions for career advancement by gender and statistically significant gender differences (p<.001), 300 responsesThe results of the survey will inform the development of task force policy proposals for interventions to support career advancement among EULAR and EMEUNET members. The identified interventions have potential to support career advancement of all rheumatologists, health professionals and non-clinical scientists regardless of gender.[1]Andreoli L, Ovseiko PV, Hassan N, Kiltz U, van Mens L, Gossec L, et al. Gender equity in clinical practice, research and training: Where do we stand in rheumatology? Joint, Bone, Spine: Revue du Rhumatisme. 2019;86(6):669-672.We gratefully acknowledge the rheumatologists, health professionals and non-clinical scientists who responded to the survey.Pavel V Ovseiko: None declared, Laure Gossec Grant/research support from: Lilly, Mylan, Pfizer, Sandoz, Consultant of: AbbVie, Amgen, Biogen, Celgene, Janssen, Lilly, Novartis, Pfizer, Sandoz, Sanofi-Aventis, UCB, Laura Andreoli: None declared, Uta Kiltz Grant/research support from: AbbVie, Amgen, Biogen, Novartis, Pfizer, Consultant of: AbbVie, Biocad, Eli Lilly and Company, Grünenthal, Janssen, Novartis, Pfizer, UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer, Roche, UCB, Leonieke van Mens: None declared, Neelam Hassan: None declared, Marike van der Leeden: None declared, Heidi J Siddle: None declared, Alessia Alunno: None declared, Iain McInnes Grant/research support from: Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Janssen, and UCB, Consultant of: AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly and Company, Gilead, Janssen, Novartis, Pfizer, and UCB, Nemanja Damjanov Grant/research support from: from AbbVie, Pfizer, and Roche, Consultant of: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Speakers bureau: AbbVie, Gedeon Richter, Merck, Novartis, Pfizer, and Roche, Florence Apparailly: None declared, Caroline Ospelt Consultant of: Consultancy fees from Gilead Sciences., Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Elena Nikiphorou: None declared, Katie Druce Speakers bureau: Pfizer and Lilly, Zoltán Szekanecz Grant/research support from: Pfizer, UCB, Consultant of: Sanofi, MSD, Abbvie, Pfizer, Roche, Novertis, Lilly, Gedeon Richter, Amgen, Alexandre Sepriano: None declared, Tadej Avcin: None declared, George Bertsias Grant/research support from: GSK, Consultant of: Novartis, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Anne Maree Keenan: None declared, Laura C Coates: None declared

High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world. From 1980 to 2018, the levels of total and non-high-density lipoprotein cholesterol increased in low- and middle-income countries, especially in east and southeast Asia, and decreased in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe.

The accumulation of organochlorines (OCs) in mussel tissue depends on the physiological and biochemical status of the organism and its interaction with the environment. Mytilus galloprovincialis, 2- and 1-year-old mussels, sampled from Mali Ston Bay, a reference area, and transplanted to Kaštela Bay in cages, were used for the assessment of OC levels and influence of biological parameters on accumulation. Results of bimonthly exposures during one year highlighted that OC accumulation decreases with increasing mussel age. Polychlorinated biphenyls (PCBs) and p,p′-dichlorodiphenyltrichloroethane (p,p′-DDTs) increased, while organochlorine pesticide (OCP; i.e., HCB, lindane, heptachlor, and aldrin) variations were very low. Statistical analysis generally did not confirm the significant effect of lipid content on the accumulation of OCs in mussel tissue. OC levels in mussels were below the maximum permitted levels for human consumption (European Commission).

INTRODUCTION Hepatitis C Virus (HCV) is the leading cause of chronic liver disease and is a serious global health problem. Hepatitis C infection is highly prevalent in patients with end stage renal disease (ESRD), due to frequent exposure to blood and blood products, nosocomial transmission of HCV, and prolong hemodialysis duration. The aim of the study was to evaluate the influence of IL-33/ST2 signaling pathway on severity of the liver disease in ESRD HCV+ patients. METHODOLOGY Blood samples from patients with end stage renal disease (ESRD) and hepatitis C infection (HCV), 20 patients with HCV infection, 20 patients with ESRD and 20 healthy control donor patients were taken for the examination of biochemical parameters, for the determination of the serum cytokine concentration, and for the molecular diagnostics of HCV. RESULTS Systemic sST2 positively correlated with serum level of urea and creatinine, respectively. Serum sST2 was significantly increased in ESRD HCV+ patients in comparison to HCV+ group. sST2/IL-1, sST2/IL-4 and sST2/IL-23 ratios were significantly increased in serum of ESRD HCV+ patients in comparison to HCV+ patients. Significantly higher systemic level of sST2 and sST2/IL-1 and sST2/IL-4 ratios were measured in ESRD patients compared to non-ESRD patients. CONCLUSION These results suggested that elevated level sST2, as the consequence of renal failure, causes less destruction of liver in HCV infection.