THE NORTH ATLANTIC OSCILLATION (NAO) AND THE WATER TEMPERATURE OF THE SAVA RIVER IN SERBIA

The data on the water temperature of the Sava in Serbia (hydrological stations Šabac and Belgrade, period 1961–2015) were used for the research, as well as the data on the surface air temperature. The temperature trends were determined and the significance (at p≤0.05 and p≤0.01) was established on the basis of the t-test. The Pearson correlation coefficient (R) was used for the calculation of the correlation. Increasing trends of the water temperature of the Sava were recorded in all cases at both stations. However, in the case of the HS Šabac, the trends for 6 months (February–April and September–November) were not statistically significant. In the case of the HS Belgrade, all the calculations (except for April) showed statistically significant increasing trends, which can be explained by anthropogenic influence. High level of correlation between the surface air temperature and the water temperature was also determined. In this research, the lowest values of R were recorded for October (0.561 for Belgrade), and on the seasonal level, for autumn (0.625 for Šabac). The research on the correlation between the water temperature of the Sava River and the NAO index showed the highest values of R for January (0.512 for HS Šabac and 0.528 for HS Belgrade). On the seasonal level, the highest values were recorded for winter (0.422 for HS Šabac and 0.432 for HS Belgrade)

Challenges of volume resuscitation in polytraumatized patient following massive transfusion protocol and prolonged mechanical ventilation

Prikaz slučaja 58-godišnje bolesnice, bez dotad poznatih komorbiditeta, stradaloj prilikom pada s 12 metara visine, prilikom kojeg je zadobila nekoliko vitalno ugrožavajućih ozljeda. Tijekom boravka učinjeno je 5 velikih kirurških operacija, a poseban izazov u liječenju predstavljale su volumna nadoknada i prolongirana mehanička ventilacija. Po prijemu u JIL uslijed zadobivenih ozljeda (multifragmentarne frakture zdjelice i laceracija abdominalnih organa), ubrzo dolazi do značajnog pada u krvnoj slici i nastupa hemoragijskog šoka. U tom razdoblju bolesnica je invazivno monitorirana, hitno kirurški zbrinuta, a za vrijeme zahvata zahtijevala je vazoaktivnu potporu noradrenalinom i vazopresinom, te masivnu transfuziju (ukupno 21 doza KE, protrombinski kompleks, 12 doza SSP). 10. dan boravka ponovno je hitno operirana zbog aktivnog krvarenja iz slezene, nakon čega se drastično smanjuje potreba za transfuzijskim liječenjem i svodi se na minimalne korekcije. Boravak se dalje komplicira razvojem ARDS-a zbog traume toraksa, razvojem pneumonije uzrokovane hospitalnim infekcijama, te progresijom obilnih pleuralnih izljeva obostrano s velikim prometom tekućina na drenove. Detaljnijom kardiološkom obradom nađe se i kardijalna podloga izljeva, te se bolesnici učini zamjena mitralne valvule. Postoperacijski dolazi do akutnog renalnog zatajenja, kao posljedica kombinacije faktora koji uključuju traumu organa, primjenu nefrotoksičnih antibiotika, te nezavisne rizike vezane uz kardiokirurški zahvat. Nakon dva ciklusa CVVHDF polagano dolazi do oporavka renalne funkcije. Respiratorni status također je predstavljao izazov u liječenju, budući da je bolesnica primljena s obostranom serijskom frakturom rebara i kontuzijama pluća. Unatoč tome, većinu vremena je spontano disala uz manju potporu respiratora i niski PEEP, te frakcijom kisika do 50%. Nakon 60 dana ovisnosti o respiratoru, postiže se uredno spontano disanje bez potrebe za potporom respiratora. Bolesnica je uz vitalno ugrožavajuće ozljede i brojne komplikacije istih uspješno zbrinuta tijekom 95 dana boravka u JIL-u, te se u adekvatnom kontaktu, hemodinamski i respiratorno stabilna, premješta na odjel, te ubrzo i na kućnu njegu.Case report of a 58-year-old polytraumatized patient, without known prior comorbidities, injured during a fall from a 12 meter height, while sustaining multiple life-threatening injuries. She underwent 5 subsequent serious surgical interventions, followed by special dedication to volume management and prolonged mechanical ventilation. Initially, her injuries led to severe blood loss and onset of haemorrhagic shock, which was temporarily obscured by her compensation mechanisms. On admission the patient had invasive monitoring and temporarily required continuous vasoactive support (norepinephrine and vasopressin). She also required immediate surgical intervention and resuscitation through massive transfusion protocol. On the 10th day of hospitalization, she once again required surgery due to active spleen haemorrhage, after which the need for blood derivates was drastically reduced. Her recovery is further complicated with development of ARDS due to trauma of the thorax and hospital acquired pneumonia, accompanied by bilateral pleural effusions. Detailed cardiac examinations discovered cardiac background to the problem and a mitral valve replacement was mandatory. Postprocedural period was characterized by acute renal failure as a combination of elements which include organ trauma, treatment with nephrotoxic antibiotics, along with independent risks applied to cardiopulmonary bypass during cardiac surgery. After two cycles of continuous haemodiafiltration, renal function shows progressive improvement and recovery. Another challenge in patient´s recovery was her respiratory status and dependence on mechanical ventilation. Despite being admitted with bilateral multiple rib fractures and lung contusions, she was successfully ventilated with minimal pressure support and lower PEEP values for the vast majority of time. After 60 days of mechanical ventilation, spontaneous breathing is successfully established. Despite several life-threatening injuries and numerous following complications, the patient was successfully treated over the course of 95 days in the Intensive Care Unit

Uloga paravertebralnih blokova u ambulatornoj kirurgiji: pregled literature

Ambulatory surgery often involves surgical procedures on the thorax, abdomen and limbs, which can be associated with substantial postoperative pain. The aim of this narrative review is to provide an analysis of the effectiveness of paravertebral block (PVB) alone or in combination with general anaesthesia, in this setting, with an emphasis on satisfactory postoperative analgesia in comparison to other modalities. We have conducted a search of current medical literature written in English through PubMed, Google Scholar and Ovid Medline®. Peer-reviewed professional articles, review articles, retrospective and prospective studies, case reports and case series were systematically searched for during the time period between November 2003 and February 2019. The literature used for the purpose of creating this review showed that utilisation of paravertebral block either alone or in combination with general anaesthesia, has a positive effect on satisfactory analgesia in ambulatory surgery. With a multimodal analgesic approach of PVB and other techniques of anaesthesia and analgesia there is a reduction in postoperative opioid consumption, fewer side effects, lower pain scores, decreased mortality, earlier mobilisation of patients and reduced hospital stay.Ambulatorna kirurgija uključuje kirurške zahvate na udovima, u području prsnog koša i trbuha koji su često povezani s pojavom jake perioperacijske boli. Cilj ovoga narativnog preglednog članka je preispitati učinkovitost primjene paravertebralnoga bloka (PVB) samostalno ili u kombinaciji s općom anestezijom u postizanju zadovoljavajuće perioperacijske analgezije kod ambulatorne kirurgije naspram drugih analgetskih metoda. Proveli smo istraživanje aktualne medicinske literature napisane na engleskom jeziku kroz PubMed, Google Scholar i Ovid Medline®. Recenzirani stručni članci, pregledni članci, retrospektivne i prospektivne studije, prikazi slučajeva i serije slučajeva sustavno su pretraživani u razdoblju između studenog 2003. i veljače 2019. godine. Istraživanja uključena u naš narrative review prikazala su učinkovitost primjene PVB samostalno ili u kombinaciji s općom anestezijom u postizanju zadovoljavajuće perioperacijske analgezije kod ambulatorne kirurgije. Multimodalnim analgetskim pristupom primjene kombinacije PVB s drugim tehnikama anestezije i analgezije postiže se smanjenje potrošnje opioida, manje nuspojava, niže vrijednosti procjene boli na vizualno analognoj ljestvici, smanjenje mortaliteta, brža mobilizacija bolesnika te skraćenje vremena boravka u bolnici

Understanding the evolution of immune genes in jawed vertebrates

Driven by co-evolution with pathogens, host immunity continuously adapts to optimize defence against pathogens within a given environment. Recent advances in genetics, genomics and transcriptomics have enabled a more detailed investigation into how immunogenetic variation shapes the diversity of immune responses seen across domestic and wild animal species. However, a deeper understanding of the diverse molecular mechanisms that shape immunity within and among species is still needed to gain insight into-and generate evolutionary hypotheses on-the ultimate drivers of immunological differences. Here, we discuss current advances in our understanding of molecular evolution underpinning jawed vertebrate immunity. First, we introduce the immunome concept, a framework for characterizing genes involved in immune defence from a comparative perspective, then we outline how immune genes of interest can be identified. Second, we focus on how different selection modes are observed acting across groups of immune genes and propose hypotheses to explain these differences. We then provide an overview of the approaches used so far to study the evolutionary heterogeneity of immune genes on macro and microevolutionary scales. Finally, we discuss some of the current evidence as to how specific pathogens affect the evolution of different groups of immune genes. This review results from the collective discussion on the current key challenges in evolutionary immunology conducted at the ESEB 2021 Online Satellite Symposium: Molecular evolution of the vertebrate immune system, from the lab to natural populations

Competition for conceptual urban and architectural design for the development of the Morača riverfront in Podgorica

Стратификација градских амбијената је тема стварања слојевитих садржаја односу на топографију предметног терена, која је доминантно уједначена и препозната као потенцијал. На тај начин уочена је могућност да се формирају различити нивои приватности/природности, односно јавности/урбаности, с тим да се управо пропорционално повећава карактер природноси са већом интимношћу амбијента и обрнуто са већом урбаношћу амбијента се повећава јавност–његовог карактера. Ови нивои градских амбијената формирани су у оквиру цјелокупне зоне конкурсног захвата. На овај начин отворени јавни простори добијају могућност да се слојевито развијају у зони партера, али и у зони јавних тераса ”видиковаца”. Амбијентално унапређење простора подразумијева повећање– естетске вриједности и формирање новог амбијента града уз ријеку који ће представљати центар друштвених збивања и социјалних контаката, активности културе, умјетности и забаве. Новопројектовани објекти обликовани су тако да успоставе јасан однос са постојећим и допринесу формирању јединствене слике о идентитету цјелокупног потеза уз ријеку дискретно се уклапајући у терен. Целокупна зона имала би посебне семантичке вриједности и едукативни– историјски карактер

Understanding the evolution of immune genes in jawed vertebrates.

Driven by co-evolution with pathogens, host immunity continuously adapts to optimize defence against pathogens within a given environment. Recent advances in genetics, genomics and transcriptomics have enabled a more detailed investigation into how immunogenetic variation shapes the diversity of immune responses seen across domestic and wild animal species. However, a deeper understanding of the diverse molecular mechanisms that shape immunity within and among species is still needed to gain insight into-and generate evolutionary hypotheses on-the ultimate drivers of immunological differences. Here, we discuss current advances in our understanding of molecular evolution underpinning jawed vertebrate immunity. First, we introduce the immunome concept, a framework for characterizing genes involved in immune defence from a comparative perspective, then we outline how immune genes of interest can be identified. Second, we focus on how different selection modes are observed acting across groups of immune genes and propose hypotheses to explain these differences. We then provide an overview of the approaches used so far to study the evolutionary heterogeneity of immune genes on macro and microevolutionary scales. Finally, we discuss some of the current evidence as to how specific pathogens affect the evolution of different groups of immune genes. This review results from the collective discussion on the current key challenges in evolutionary immunology conducted at the ESEB 2021 Online Satellite Symposium: Molecular evolution of the vertebrate immune system, from the lab to natural populations