The influence of information technology in determining the model for sustainability of freight forwarding

Freight forwarding as a factor for growth of the economy, industry and in particular the trade of the Republic of Macedonia and abroad, requires adapting to new conditions resulting from the global economic crisis. The fact that freight forwarding is an integral part of logistics need: To improve performance and to adjust to new conditions (legislation, international agreements and implementation of information technologies). This scientific paper gives a model of sustainable development of freight forwarding where the main accent is placed on the input of information technologies as one of the elements that affect it. From the given data we has analyze and forecast the influence of IT elements of the development on freight forwarding for the period from 2005 to 2015

Use of chronic lymphocytic leukemia-international prognostic index in patient risk stratification-single center experience

Background: Several prognostic factors have been identified to predict the outcome of patients with chronic lymphocytic leukemia (CLL). To predict the time to first treatment (TFT) we integrated the data of clinical and biological markers in CLL-International prognostic index (CLL-IPI). Aim of the study was the determination of the impact of CLL-IPI in prediction of TFS in CLL patents.Methods: The study was set up retrospectively and included 90 patients with CLL diagnosed and treated at the university clinic of hematology for a period of time from January 2012 to January 2020. We incorporated the data of Binet staging system, most adverse cytogenetic marker and mutational status of immunoglobulin heavy chain in CLL-IPI.Results: The statistical data of the 90 patients showed that the median TFS for low CLL-IPI (N=24), intermediate CLL-IPI (N=40), high risk CLL-IPI (N=17) and very high risk group (N=9) according to the CLL-IPI scoring system was 20.1, 17.6, 7.1 and 5.8 months, respectively. Multivariate analysis indicated that del 17p (p<0.008) was independent prognostic factors of TFS.Conclusions: CLL-IPI is a powerful risk stratification tool for CLL patients and this system has also provided treatment recommendations for different patient risk subgroups.

Spatial patterns of diatom diversity and community structure in ancient Lake Ohrid

[EN] The extraordinary diversity in long-lived lakes is largely driven by distinct eco-evolutionary processes. With their unique biota and numerous endemic taxa, these lakes are key settings for fundamental studies related to ecology, diversity, and evolution. Here, we test how the environment shapes diatom diversity and community patterns over space in ancient Lake Ohrid. By applying Bray–Curtis similarity analyses of diatom community data, including widespread and endemic taxa, we identified two major zones: littoral and sublittoral. The latter one is being characterized with higher endemic diversity. The a and b diatom diversity and community distribution in the northern and eastern part of the lake are influenced by the presence of vertical (bathymetrical) and horizontal barriers. The zonation of the diatom communities appears driven by two large-scale factors: (i) water depth, and (ii) water chemistry, primarily, the concentration of total phosphorus, nitrogen ammonia, and conductivity. Both drivers appear to equally influence diatom diversity and community patterns. We present initial data on diatom–environment relations, where the results support earlier ecological studies emphasizing the relevance of ongoing human-induced eutrophication in the northern lake area. This study provides background information on the role of the environment in structuring contemporary diatom diversity. However, future research needs to focus on the biotic component including species competition in order to reveal the mechanisms driving spatial community dynamics in Lake OhridSIThe presented study would not have been possible without the support of the Western Balkan Environmental Network project (www.newenproject.org

Улогата на некои инфламаторни маркери, цитокини и тумор маркери во дијагноза на ендометриозата

Endometriosis is a multifactorial disease which etiopathogenesis has not been elucidated. One of the theories of etiopathogenesis is the inflammatory theory. Aims of the study: To develop a practical non-invasive test for the diagnosis of endometriosis by examining some inflammatory markers and cytokines; to compare the highly sensitive C-reactive protein (hsCRP), cytokines (interleukin-6-IL-6 and tumor necrotizing factor alpha) and the tumor marker cancer antigen 125 (CA-125) among healthy patients and patients with endometriosis; to determine the sensitivity and specificity of each biomarker separately in the diagnosis of endometriosis and to determine their role in the diagnosis of endometriosis. Materials and methods: In a prospective study conducted at the University Clinic for Gynecology and Obstetrics, Ss. Cyril and Methodius University in Skopje, North Macedonia 138 patients were included of a reproductive age between 18-50 years (83 with diagnosis endometriosis operated laparoscopically or with laparotomy) and a control group of 55 healthy women, in a period between 01.09.2018 to 01.05.2021. Serum levels of IL-6, TNF-α, hs-CRP and tumor marker CA-125 were evaluated in both groups. Results: Serum levels of CA-125, IL-6 and TNF-α and hs-CRP were significantly higher in patients with endometriosis compared to the control group. The surface under the ROC curve (AUC) for IL-6, CA-125, hs-CRP, and TNF-α has shown that as individual markers they all have a discriminatory capacity to diagnose patients with endometriosis. Conclusions: Results obtained in our study showed statistically significantly higher serum concentrations of CA-125, IL-6 and TNF-α and hs-CRP in patients with endometriosis compared to the control group of patients. However, none of these biomarkers showed a high sensitivity for diagnosis of endometriosis. It is necessary to find a panel combination of biomarkers with a high sensitivity of about 100% that will enable early diagnosis of endometriosis.Ендометриозата е мултифакторно заболување, чија етиопатогенеза не е разјаснета. Една од теориите за етиопатогенезата е инфламаторната теорија. Цели на истражувањето: Да се развие практичен неинвазивен тест за дијагноза на ендометриозата со иследување нанекои инфламаторни маркери и цитокини; да се направи споредба на&nbsp; високосензитивниот Ц-реактивен протеин&nbsp; (hsCRP), цитокините (интерлеукин 6 –IL-6 и тумор-некротизирачки фактор алфа - TNF-α) и туморскиот маркер cancer antigen 125 (CA-125) кај здрави пациентки и пациентки со ендометриоза; да се утврди сензитивноста и специфичноста на секој биомаркер посебно во дијагнозата на ендометриозата и да се утврди нивната улога во дијагноза на ендометриозата. Материјал и методи: Во проспективна студија спроведена на Универзитетската клиника за гинекологија и акушерство, Универзитет „Св. Кирил и Методиј“ во Скопје, Северна Македонија беа вклучени 138 испитанички на репродуктивна возраст помеѓу 18-50 години (83 со дијагнозa ендометриоза, оперирани со лапароскопија или лапаротомија) и контролна група од 55 здрави жени, во период од 01.09.2018 година до 01.05.2021. Серумските вредности на интерлеукин 6 (IL-6), тумор-некротизирачки фактор алфа (TNF-α), високоспецифичен Ц-реактивен протеин (hsCRP) и туморскиот маркер CA-125 беа евалуирани во двете групи. Резултати: Серумските вредности на CA-125, IL-6 и TNF-α и hsCRP беа сигнификантно повисоки кај пациентките со ендометриоза во споредба со оние во контролната група. Површината под ROC кривата (AUC) за IL-6, CA-125, hs-CRP и TNF-α покажа дека како поединечни маркери сите имаат дискриминаторен капацитет за дијагноза на пациентки со ендометриоза. Заклучоци: Иследувањата во нашата студија покажаа статистички сигнификантно повисоки концентрации на CA-125, IL-6 и TNF-α и hs-CRP кај пациентките со ендометриоза во однос на контролната група пациентки. Меѓутоа, ниту еден од овие биомаркери не покажа висока сензитивност за дијагноза на ендометриозата. Потребно е да се најде панел комбинација на биомаркери со висока сензитивност од околу 100% кои ќе овозможат&nbsp; рана дијагноза на ендометриозата

Бактериемија предизвикана од Rhizobium radiobacter кај двегодишен пациент со акутна лимфобластна леукемија: приказ на случај

Rhizobium radiobacter is a Gram-negative rod-shaped bacterium usually associated with diseases in plants. Infections due to R. radiobacter in humans are strongly related to the presence of foreign plastic materials, immunocompromised and chronically debilitated hosts with underlying conditions such as malignancies, human immunodeficiency virus as well as bone marrow transplant recipients. The aim of this paper was to present a rare blood infection with Rhizobium radiobacter in North Macedonia in a pediatric patient with underlying conditions. The treatment was successful with appropriate cephalosporin and aminoglycoside therapy without removing the central venous catheterRhizobium radiobacter е Грам-негативна стапчеста бактерија најчесто поврзана со болести кај растенијата. Кај луѓето, инфекциите предизвикани од R. radiobacter се строго поврзани со присуство на материјали од пластика, имунокомпромитирачки и хронични состојби кај пациенти со основни заболувања како малигнитети, СИДА (или присуство на вирус на хумана имунодефициенција), како и кај пациенти со трансплантирана коскена срцевина. Целта на овој труд беше да се прикаже редок случај на инфекција на крвта предизвикана од Rhizobium radiobacter кај педијатриски пациент со акутна лимфобластна леукемија како основно заболување. Терапијата беше успешно спроведена со соодветна цефалоспоринска и аминогликозидна терапија, без отстранување на централниот венски катетер

Clinical Significance of Minimal Residual Disease at the End of Remission Induction Therapy in Childhood Acute Lymphoblastic Leukemia

BACKGROUND: Detection of minimal residual disease (MRD) in the early phase of therapy is the most powerful predictor of relapse risk in children with acute lymphoblastic leukaemia (ALL). AIM: We aimed to determine the significance of MRD at the end of remission induction therapy in the prediction of treatment outcome in children with ALL. METHODS: Sixty-four consecutive patients aged 1-14 years with newly diagnosed ALL were enrolled in this study from January 2010 to October 2017. All patients were treated according to the ALL IC BFM 2002 protocol. MRD was detected at the end of remission induction therapy (day 33) by multiparameter 6-colour flow cytometry performed on bone marrow specimens with a sensitivity of 0.01%. RESULTS: Overall, 42.2% of patients had detectable MRD on day 33 of therapy. MRD measurements were not significantly related to presenting characteristics but were associated with a poorer blast clearance on day 8 and 15 of remission induction therapy. Patients with negative MRD status on day 33 had a 5-year event-free survival of 94.6% compared with 76.1% for those with positive MRD status (P = 0.044). CONCLUSION: MRD levels at the end of remission induction therapy measured by multiparameter flow cytometry have clinical significance in childhood ALL. High levels of MRD are strongly related to poor treatment outcome

Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

BACKGROUND: A variety of recent evidence exists about the clinical implication of low level of Pregnancy-associated plasma protein A (PAPP-A) in pregnancy. This glycoprotein is a protease, which releases the Insulin-like growth factor from IGFBP 4. Its role is a trophoblastic invasion of decidua, stimulation of cell mitosis and differentiation. It has an immunosuppressive effect in the placenta, inhibition of coagulation and complex role for integration of all these processes in the placenta. Level of PAPP-A (under 0.4 MoM-Multiple of Medians) in first-trimester screening in chromosomally and morphologically normal fetuses, could influence fetal weight, preeclampsia, premature birth and stillbirth. As a result of the complications mentioned above, there is implication on timing, mode of delivery and condition of the newborn. AIM: The study aims to evaluate the influence of low PAPP-A, measured in the first trimester on the outcome of pregnancy, with accent disorders which are the result of placental insufficiency. Also, gestational week, mode of delivery and condition of newborn secondary underlying conditions will be evaluated. MATERIAL AND METHODS: After given information and consultation about the expectation from the screening, pregnant women with a singleton pregnancy were tested for First Trimester Screening to estimate the risk for Trisomy 21, 13, 18- the most frequent chromosomopathies. After exclusion of chromosomopathies and congenital malformations, one hundred and fourteen patients enrolled in the study. The target group (n = 64) with PAPP-A below 0.4 MoM and control group (n = 50) with PAPP-A equal and above 0.4 MoM. An assessment of mode and time of delivery and presence of small for gestational age newborns, preeclampsia, premature birth and newborn condition at delivery was made. RESULTS: The percentage of the patients delivered in term was similar between the target group (n = 64) and the control group (n = 50), 82.81% vs 82.0% respectively. The rate of cesarean section was 29.7 % in the target group vs 32% in the control group. A significant difference was found about elective vs urgent cesarean section in favour of the target group. The difference was present about the complication in pregnancy before delivery, 56% vs 22%, p = 0.023, which were the main indication for cesarean section. The difference in newborn outcome was not significant. CONCLUSION: There is a difference in frequency of complications, in the cases with PAPP-A under 0.4 MoM, such as premature birth, preeclampsia compound with SGA fetuses versus the control group. The difference for SGA newborn and premature birth among the groups has statistical significance. The patients delivered with cesarean section were with the main indications SGA or elevated blood pressure, often occurred combined with prematurity. Apgar score and birth weight were similar in target and control group, but the newborns with a birth weight under 2500 g. were more frequent in the target group. Because these results did not show another significance among two groups, probably lower cut-off is needed, combining with another test (Doppler of uterine arteries in the first trimester, biochemical test). Presence of other diseases which could hurt placental function should be emphasised

Obstetric Outcome in Pregnant Patients with Low Level of Pregnancy-Associated Plasma Protein A in First Trimester

BACKGROUND: Pregnancy-associated plasma protein A (PAPP-A), is a protease which releases Insulin-like growth factor. The role of this factor is stimulation of cell mitosis, differentiation and trophoblastic invasion of deciduas. Identification of patients with low PAPP-A (under 0.4 MoM in the first trimester has an influence on birth weight, attenuation of fetal growth, preeclampsia, birth and fetal demise.AIM: The main issue in the study is evaluating an influence of PAPP-A, calculated in the first trimester on the unfavourable outcome of pregnancy.MATERIAL AND METHODS: Seventy pregnant women with singleton pregnancy underwent first-trimester biochemical screening. The target group were women with PAPP-A below 0.4 MoM, and in control group, PAPP-A were оver 0.4 MoM. There was an assessment of the influence on the mode of delivery, gestational week, the presence of intrauterine growth restriction, preeclampsia, temporary birth, intrauterine fetal demise and newborn condition.RESULTS: In target group, consisted of 35 patients, 16 were delivered at term. From 28 to 37 g.w.- were 7 patient, 22-28 g.w.- 4 and 8 patients were under the 22 g.w (all with fetal demise) there were 19 pretemporary deliveries - 9 with Cesarean Section (SC). In the target group: 5 newborn wеre with IUGR, 6 women had preeclampsia, 1 had placental abruption. In control group were 35 patients: 28 delivered at term, 9 with SC, 26 vaginal deliveries; with IUGR were 4 newborns. Two newborns were hypertrophic.CONCLUSION: There is a significant difference in unfavourable outcome in the cases with PAPP-A under 0.4 Mom, particular in the group, with a PAPP-A value under 0.2 MoM. The patients delivered with SC with the main indications in utero hypoxia, growth restriction and elevated blood pressure had PAPP-A between 0.3-0.4 MoM. The patients with intrauterine fetal death and placental abruption in the most of the cases have PAPP-A value under 0.2 MoM. There is a need to be aware in these pregnancies to achieve the preventions of adverse outcome, to decrease perinatal morbidity and mortality

Drivers of phytoplankton community structure change with ecosystem ontogeny during the Quaternary

Freshwater species are particularly sensitive to climate fluctuations, but little is known of their response to the large-scale environmental change that took place during the Quaternary. This is partly due to the scarcity of continuously preserved freshwater sedimentary records with orbital chronology. We use a 1.363 Ma high-resolution fossil record of planktonic diatoms from ancient Lake Ohrid to evaluate the role of global and regional versus local-scale environmental change in driving temporal community dynamics. By using a Bayesian joint species distribution model, we found that communities were mostly driven by the local-scale environment. Its effects decreased over time, becoming less important than global and regional environment at the onset of the penultimate glacial, 0.183 Ma. Global and regional control over the environment became important with successive deepening of the lake at around 1.0 Ma, and its influence remained persistent until the present. Our high-resolution data demonstrate the critical role of lake depth and its thermal dynamics in determining phytoplankton response to environmental change by influencing lake mixing, nutrient and light availability. With this study we demonstrate the relative impact of various environmental factors and their scale dependant effect on the phytoplankton communities during the Quaternary, emphasizing the importance of not only considering climate fluctuations in driving their structure and temporal dynamics but also the local environment. (c) 2021 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

Environmental filtering drives assembly of diatom communities over evolutionary time‐scales

Aim Ecological communities are structured through the interplay of deterministic assembly processes such as competition and environmental filtering. Whereas the drivers of spatial community structure are frequently studied in extant communities, little is known about the relative importance of assembly processes in response to environmental factors over evolutionary time-scales. Here, we use an integrative framework to unravel community assembly processes since the inception of a long-lived lake ecosystem. Location Lake Ohrid. Time period From lake formation 1.36 million years ago to the present. Major taxa studied Planktonic diatoms. Methods We constructed a dated phylogeny of extant and extinct diatoms and collected trait data for 380 fossil communities to quantify phylogenetic community structure and functional richness and to determine the relative importance of deterministic assembly processes over time. We then used regression analysis to correlate the phylogenetic community structure with palaeoenvironmental and intrinsic biological predictors and to identify primary drivers of assembly processes. Results Our results suggest a dense packing of niche space with higher species richness and co-occurrence of closely related species. There are only two short episodes in the very recent past dominated by distantly related taxa. We found distinct changes in phylogenetic community structure upon speciation or extinction events and an increase in mean community relatedness over time. Main conclusions Our finding of closely related co-occurring species implies environmental filtering as the primary assembly mechanism, with a minor but increasingly important role of competition towards the present, driven by evolutionary dynamics. Such an increase in the relative contribution of competition to the assembly of communities in relation to the aging of an insular ecosystem, together with a denser packing of morphospace in the early phase of system ontogeny is compatible with ecological predictions according to the theory of island biogeography