Analiza hidrauličke veze potoka Plitvice i podzemnih voda varaždinskog aluvijalnog vodonosnika

A combination of different statistical methods and flow duration curves was used to examine hydraulic connection between the Plitvica stream and the surrounding piezometers that capture the groundwater of the Varaždin alluvial aquifer. Also, rainfall quantities over a wider study area were considered to examine the effect of precipitation on Plitvica water levels and groundwater levels. The following statistical methods were used in this paper: the correlation method, the auto- correlation method, and the cross-correlation method. Correlation analysis show that there is generally a significant correlation between the Plitvica water levels and groundwater levels, with positive direction of the correlation. The analysis of auto-correlograms for groundwater and surface water shows that the correlation coefficient value drops below 0.2 after a longer period, which indicates a long-term memory of the system that can be explained by the slow flow and thus slow pressure transfer. Cross-correlation analyses of the time series of the Plitvica water levels and groundwater levels showed a time lag of 1-2 days with a fairly significant cross-correlation coefficient. For precipitation and groundwater levels, the relationship is much weaker, with a lag time of 4-5 days with a weak cross- correlation coefficient. The least time lag, within a day, was established between precipitation and Plitvica water levels. Analyses of the flow duration curves revealed that Plitvica almost completely drains groundwater, except in the vicinity of the piezometer 2178 where Plitvica recharges the aquifer about a quarter of the time.Kombinacija različitih statističkih metoda i krivulja trajanja korištena je za ispitivanje hidrauličke veze potoka Plitvice i okolnih piezometra koji zahvaćaju podzemne vode varaždinskog aluvijalnog vodonosnika. Također, razmatrane su količine oborina sa šireg područja istraživanja kako bi se utvrdio utjecaj oborina na vodostaj Plitvice i razine podzemne vode. U radu su korištene sljedeće statističke metode: korelacija, auto-korelacija i kros-korelacija. Korelacijske analize pokazuju da generalno postoji značajna povezanost između vodostaja Plitvice i razina podzemnih voda, s pozitivnim smjerom korelacije. Analiza auto-korelograma za podzemne i površinske vode pokazuje da vrijednost koeficijenta korelacije pada ispod 0,2 nakon duljeg vremenskog razdoblja, što ukazuje na dugotrajnu memoriju sustava koja se može objasniti sporim tečenjem, odnosno sporim prijenosom tlaka. Kros-korelacijska analiza vremenskih nizova između vodostaja Plitvice i podzemnih voda pokazala je vremensko zaostajanje od 1–2 dana s prilično značajnim koeficijentom korelacije. Između oborina i podzemnih voda veza je mnogo slabija, s vremenskim zaostajanjem od 4–5 dana te slabim koeficijentom korelacije. Najmanje zaostajanje, unutar jednog dana, utvrđeno je između oborina i vodostaja Plitvice. Analizama krivulja trajanja utvrđeno je da Plitvica gotovo u potpunosti drenira podzemne vode, izuzev piezometra 2178 u blizini kojega oko četvrtinu vremena prihranjuje vodonosnik

Termografija skrotuma u procjeni ishoda operacije varikokele: prikaz slučaja

Scrotal thermography is a diagnostic method for varicocele. In short, there are five diagnostic thermographic criteria for varicocele, i.e., pattern of scrotal thermographic image indicative of varicocele, temperature at pampiniform plexus ≥34 C°, temperature difference between left and right pampiniform plexus ≥0.5 C°, enhancement of image during Valsalva maneuver, and temperature at pampiniform plexus ≥ temperature at ipsilateral thigh. Three or more positive signs are indicative of varicocele. The aim of this report is to present the use of digital thermography as a diagnostic method to evaluate the outcome of varicocele repair. We present a case of a student diagnosed with varicocele grade III, and assessed preoperatively and followed up postoperatively by scrotal thermography. According to thermographic indicators, our patient was positive for varicocele diagnosis before surgical treatment. Three months after varicocele repair, the patient did not show positive thermographic indicators of varicocele while physical examination and color Doppler ultrasound were equivocal. This case report suggests that infrared digital thermography of scrotum could be very valuable for monitoring patients in the period after surgery for varicocele, however, it should be confirmed in a larger number of patients.Termografija skrotuma je metoda dijagnostike varikokele. Postoji pet termografskih dijagnostičkih kriterija za dijagnozu varikokele: termografski prikaz karakterističan za varikokelu, temperatura pampiniformnog pleksusa ≥34 C°, razlika temperature između lijevog i desnog pampiniformnog pleksusa ≥0,5 C°, indikativna promjena slike prilikom Valsalvina manevra i temperatura pampiniformnog pleksusa koja je ≥ temperaturi ipsilateralne natkoljenice. Tri ili više pozitivnih znakova predstavlja pozitivan nalaz u slučaju dijagnostike varikokele. Cilj ovoga rada je prikazati primjenu termografije skrotuma kao dijagnostičke metode u procjeni ishoda operacije varikokele. Prikazat ćemo slučaj studenta koji je imao dijagnozu varikokele III. stupnja te je prijeoperacijski dijagnosticiran, a poslijeoperacijski praćen termografijom skrotuma. Prema termografskim kriterijima ovaj bolesnik je prijeoperacijski imao varikokelu. Tri mjeseca nakon operacije bolesnik nije imao pozitivne termografske znakove za varikokelu, međutim, klinički pregled i obojeni doppler nisu bilo tako uvjerljivi. Ovaj prikaz slučaja pokazuje mogućnost primjene termografije skrotuma u praćenju bolesnika nakon operacije varikokele, no ovo svakako treba potvrditi na većem broju ispitanika

Simplified description and interpretation of pathological thermography signs in malignant breast lesions

Background and Purpose: Breast cancer is the leading cause of death among women aged 20–59 years in developed countries, with similar mortality trends, observed among women in Croatia. Breast cancer detection usually relies on mammography, ultrasound (US) and magnetic resonance imaging (MRI), however, thermography is a noninvasive, reliable and applicable diagnostic procedure for early detection of breast disease that has attracted interest in this field. The aim of this study was to establish the frequency and characteristics of pathological thermographic signs in female patients, who were operated on malignant breast lesions. In addition, the authors offered a simplified description and interpretation of pathological thermographic signs, based on published literature. Matherial and Methods: The seventy four female patients with histopathologically confirmed breast cancer were included in the study. In all patients breast cancer was diagnosed using standard protocol which have included clinical examination, mammography, ultrasound and for selected patients MRI and/or fine needle aspiration (FNA). Thermographic imaging has been conducted 1 to 14 days before scheduled surgical procedures. Results: Mean tumor size positively correlated with number of pathological thermographic signs (IR 3 vs. IR 5, p < 0.05). Mean number of pathological thermographic signs per patient was 3.5±1, 72 (range 1 to 8). The most frequently noted singular signs were heat in area of finding and vascular signs, as well. Conclusion: The simplified description could offer a suitable clinical tool for standardization of pathological thermography signs in malignant breast lesions, taking into account the learning curve of medical teams involved and ethical aspects, as well

Karcinom sabirnih kanalića i endemska nefropatija - prikazi slučaja i pregled literature

Although collecting duct carcinoma is a subtype of renal cell carcinoma, several studies implicate association with urothelial carcinoma. The coexistence of collecting duct carcinoma and another renal neoplasm is rare. Endemic nephropathy is a renal disease causing chronic renal failure. It is highly associated with urothelial neoplasm and occurs in endemic villages in Bosnia, Croatia, Bulgaria, Romania and Serbia. Recent studies have confirmed the important role of exposure to aristolochic acid as an etiologic factor. We present three cases of collecting duct carcinoma with literature overview. In one case, we describe collecting duct carcinoma with metachronous urothelial carcinoma of the pyelon and urinary bladder in an endemic nephropathy patient. To our knowledge, this is the first case report describing this coexistence. Certain similarities between collecting duct carcinoma and urothelial carcinoma were found, e.g., higher incidence in female compared to male, higher mean age, and multifocal and multicentric occurrence of the tumor. Our observations support the hypothesis that collecting duct carcinoma and urothelial carcinoma could be connected.Iako je karcinom sabirnih kanalića podvrsta karcinoma bubrežnih stanica, određena istraživanja ukazuju na povezanost ovog entiteta s karcinomom prijelaznog epitela. Istodobna pojava karcinoma sabirnih kanalića i drugih bubrežnih neoplazma je rijetka. Endemska nefropatija je bubrežna bolest koja dovodi do kroničnog bubrežnog zatajenja. Vrlo je povezana s urotelnim tumorima i javlja se u endemskim selima u Bosni, Hrvatskoj, Bugarskoj, Rumunjskoj i Srbiji. Nedavna istraživanja potvrdila su značajnu ulogu izloženosti aristolohičnoj kiselini kao etiološkom čimbeniku. Predstavljamo tri slučaja karcinoma sabirnih kanalića s pregledom literature. U jednom slučaju opisujemo karcinom sabirnih kanalića s metakronom pojavom urotelnog karcinoma pijelona te mokraćnog mjehura u bolesnika s potvrđenom endemskom nefropatijom. Prema našim saznanjima ovo je prvi slučaj koji opisuje ovakvu koegzistenciju. Pronađene su određene sličnosti između karcinoma sabirnih kanalića i karcinoma prijelaznog epitela, a to su veća učestalost u ženskoj populaciji, viša prosječna dob, multifokalna i multicentrična pojava tumora. Naša zapažanja podupiru hipotezu o mogućoj povezanosti karcinoma sabirnih kanalića i karcinoma prijelaznog epitela

Synthesis and Spectroscopic Evidences of N-Arylmaleimides and N-Aryl-2,3-dimethylmaleimides

A series of N-arylmaleimides (N-aryl-MI) and N-aryl-2,3-dimethylmaleimides (N-aryl-DiMeMI) were prepared by condensation of primary amines with maleic anhydride (MAn) and 2,3-dimethylmaleic anhydride (DiMeMAn), respectively. Preparation of N-aryl-MI proceeded through the formation of N-arylmaleamic acid, which subsequently cyclized to N-aryl-MI. In the reaction of N-arylamines with DiMeMAn, cyclic condensation products were formed in one step. By means of one- and two-dimensional 1H and 13C NMR spectroscopy it was proven that Naryl- DiMeMI and not isomaleimides were formed by a one step reaction

Molecular profiles and urinary biomarkers of upper tract urothelial carcinomas associated with aristolochic acid exposure

Recurrent upper tract urothelial carcinomas (UTUCs) arise in the context of nephropathy linked to exposure to the herbal carcinogen aristolochic acid (AA). Here we delineated the molecular programs underlying UTUC tumorigenesis in patients from endemic aristolochic acid nephropathy (AAN) regions in Southern Europe. We applied an integrative multiomics analysis of UTUCs, corresponding unaffected tissues and of patient urines. Quantitative microRNA (miRNA) and messenger ribonucleic acid (mRNA) expression profiling, immunohistochemical analysis by tissue microarrays and exome and transcriptome sequencing were performed in UTUC and nontumor tissues. Urinary miRNAs of cases undergoing surgery were profiled before and after tumor resection. Ribonucleic acid (RNA) and protein levels were analyzed using appropriate statistical tests and trend assessment. Dedicated bioinformatic tools were used for analysis of pathways, mutational signatures and result visualization. The results delineate UTUC-specific miRNA:mRNA networks comprising 89 miRNAs associated with 1,862 target mRNAs, involving deregulation of cell cycle, deoxyribonucleic acid (DNA) damage response, DNA repair, bladder cancer, oncogenes, tumor suppressors, chromatin structure regulators and developmental signaling pathways. Key UTUC-specific transcripts were confirmed at the protein level. Exome and transcriptome sequencing of UTUCs revealed AA-specific mutational signature SBS22, with 68% to 76% AA-specific, deleterious mutations propagated at the transcript level, a possible basis for neoantigen formation and immunotherapy targeting. We next identified a signature of UTUC-specific miRNAs consistently more abundant in the patients' urine prior to tumor resection, thereby defining biomarkers of tumor presence. The complex gene regulation programs of AAN-associated UTUC tumors involve regulatory miRNAs prospectively applicable to noninvasive urine-based screening of AAN patients for cancer presence and recurrence

Smjernice za dijagnostiku i liječenje bolesnika s vratoboljom – 1. dio

Vratobolja je jedna od najčešćih mišićnokoštanih bolesti koja rezultira značajnom boli i nesposobnosti te ima velik utjecaj na individualnoj razini, kao i na zdravstveni sustav i društvo u cjelini. Uzroci vratobolje su različiti, a etiološki prevladavaju oni mehanički povezani s degenerativnim promjenama vratne kralješnice. Svjedočimo raznim dijagnostičkim i terapijskim pristupima za ove bolesnike. Hrvatsko vertebrološko društvo Hrvatskoga liječničkog zbora predstavlja sveobuhvatni narativni pregled i smjernice za dijagnozu i liječenje bolesnika s vratoboljom, s naglaskom na najčešće uzroke. Smjernice su rezultat konsenzusa stručnjaka različitih specijalnosti, a temelje se na najboljim dokazima. Ovaj prvi dio odnosi se na dijagnostiku, a drugi njemu komplementarni dio odnosi se na terapiju. Dijagnostički dio smjernica (1. dio) obuhvaća: klinička obilježja i evaluaciju (uključivo strukturirane upitnike), laboratorijsku dijagnostiku, slikovne metode, neurofiziološko testiranje i minimalno invazivne dijagnostičke postupke. Dio smjernica o liječenju (2. dio) uključuje: farmakološko liječenje, tjelesne medicinske vježbe, trakciju, manualnu terapiju, metode fizikalne terapije, primjenu ortoza, minimalno invazivne terapijske intervencije, kirurško liječenje, rehabilitaciju nakon kirurških zahvata i psihijatrijski pristup. Ovo su prve hrvatske smjernice za vratobolju primarno namijenjene liječničkoj profesionalnoj zajednici

INFRARED DIGITAL THERMOGRAPHY OF THE SCROTUM IN EVALUATION SURGICAL OUTCOME AFTER VARICOCELE OPERATIONS

Cilj: Utvrditi kako je infracrvena termografija skrotuma dijagnostička metoda koja može dijagnosticirati recidiv nakon operacije varikokele. Ispitanici i metode: Studija je ustrojena na temelju prospektivnog istraživanja. Ispitanici su pregledani i liječeni kroz urološku ambulantu Odjela za urologiju Opće bolnice „Dr. Josip Benčević“ Slavonski Brod. Istraživanje je provedeno na 38 ispitanika liječenih u razdoblju od 2010. do 2017.godine. Protokol istraživanja obuhvaća: 1. Dijagnostika primjenom moderne termografske kamere uz analizu slika u odgovarajućem računalnom programskom paketu. 2. Klinički pregled. 3. Dijagnostika ultrazvukom s color Dopplerom. 4. Ponovna dijagnostika primjenom termografije, kliničkog pregleda i ultrazvuka s color Dopplerom dva ili više mjeseci nakon operativnog zahvata. Rezultati: Pozitivan klinički nalaz imaju svi ispitanici prije operacije, dok je on pozitivan poslije operacije kod 33 (87 %) ispitanika. Prije zahvata kliničkim pregledom 31 (82 %) ispitanik imao je III. stupanj varikokele, a 7 (23 %) ispitanika imalo je II. ili II/III. stupanj varikokele. Nakon zahvata došlo je do značajnog poboljšanja, odnosno III. stupanj i II/III. stupanj varikokele ima sedam (19 %) ispitanika, dok ih je najviše, njih 16 imalo (42 %) I. stupnja, a kod pet (13 %) ispitanika bilježi se uredan nalaz (Test marginalne homogenosti, P < 0,001). Pozitivan termografski nalaz prije operacije nalazimo kod 37 (97 %) ispitanika, a poslije operacije pozitivan termografski nalaz ima 7 (18 %) ispitanika (McNemarov test, P < 0,001). Pozitivan ultrazvučni nalaz imaju svi ispitanici prije operacije, dok je on pozitivan poslije operacije kod 13 (34 %) ispitanika. Konglomerat vena lijeve strane uočava se prije operacije kod 25 (66 %) ispitanika, obostrano kod tri (8 %) ispitanika. Poslije operacije konglomerat vena lijeve strane bilježi se kod devet (24 %) ispitanika, po jedan (3 %) ispitanik bilježi konglomerat vena obostrano. 57 Uspoređujući nalaz infracrvene termografije s kliničkim nalazom nakon operacije, uočava se da je prema kliničkom nalazu nakon operacije još uvijek 33 (87 %) ispitanika s pozitivnim nalazom, dok je prema termografskom nalazu pozitivno njih sedam (18 %), što je značajna razlika (McNemarov test, P < 0,001). Uspoređujući te dvije metode s obzirom na nalaz nakon operacije, ne možemo reći da postoji slaganje u metodama (Cohenov Kappa k = 0,07 uz 95 % CI od -0,01 do 0,14). Nakon operacije uspoređujući UZV nalaz s nalazom infracrvene termografije, uočava se da je prema UZV nalazu nakon operacije još uvijek 13 (34 %) ispitanika s pozitivnim nalazom, dok je prema termografskom nalazu pozitivno njih 7 (18 %) (McNemarov test, P = 0,03) (mjereno prema termografiji uz osjetljivost od 100 %, specifičnost od 80,6 %). Uspoređujući te dvije metode s obzirom na nalaz nakon operacije, možemo reći da postoji značajno umjereno slaganje između UZV i termografskog nalaza (Cohenov Kappa k = 0,606 uz 95% CI od 0,339 do 0,872; P < 0,001) . Uspoređujući klinički nalaz s nalazom UZV-a, uočavamo da je značajno više ispitanika nakon operacije prema kliničkom nalazu pozitivno u odnosu na UZV nalaz. U usporedbi prema UZV nalazu osjetljivost kliničkog nalaza nakon operacije je 92,3 %, a specifičnost 16 %. Uočavamo da nakon operacije nema značajnog slaganja između kliničkog i UZV nalaza (Cohenov Kappa test k = 0,061, P = 0,64) Na osnovi ispunjenih kriterija značajno je smanjenje u broju ispitanika s konačnom dijagnozom varikokele nakon operacije, odnosno smanjenje je od 37 (97 %) ispitanika s pozitivnim termografskim nalazom prije operacije na sedam (18 %) ispitanika poslije operacije (McNemarov test, P < 0,001). Zaključak: Istraživanje je potvrdilo termografske kriterije kao dobro odabrane za adekvatno postavljanje dijagnoze varikokele te da se navedeni kriteriji mogu i trebaju koristiti u tumačenju snimaka skrotalne infracrvene termografije kako prije tako i poslije operativnog zahvata. Infracrvena termografija u usporedbi s kliničkim pregledom pokazala se kao statistički signifikantno bolje dijagnostička metoda za dijagnostiku recidiva varikokele. Pokazala je znatnu korist u dijagnostici recidiva nakon operacije varikokele, dok je klinički pregled imao veliku stopu lažno pozitivnih nalaza. Infracrvena termografija u usporedbi s UZV color Dopplerom pokazala se kao metoda koja ima 58 statistički signifikantno bolji rezultat, ali možemo reći i da imaju značajno umjereno slaganje. Infracrvena termografija je ovim istraživanjem pokazala dijangostičku vrijednost u dijagnostici recidiva varikokele. Pokazalo se kako u usporedbi s kliničkim pregledom i/ili UZV-om termografija ima bolju osjetljivost i specifičnost.Objective: To determine that infrared scrotal thermography is a diagnostic method that can diagnose recurrence after varicocele surgery. Subjects and methods: The study was structured based on a prospective research. Subjects were examined and treated through the urology clinic of the Department of Urology of the General Hospital "Dr. Josip Benčević" Slavonski Brod. The research was conducted on 38 subjects treated in the period from 2010 to 2017. .Research protocol includes: 1. Diagnostics using a modern thermographic camera with image analysis in the appropriate software package 2. Clinical examination 3. Ultrasound diagnosis with color Doppler 4. Two or more months after surgery, re-diagnosis using thermography, clinical examination and ultrasound with color Doppler. The results: All subjects had a positive clinical finding before surgery, while it was positive after surgery in 33 (87%) subjects. Before the procedure, 31 (82%) subjects had III. degree of varicocele, and 7 (23%) subjects had II. or II / III. degree of varicocele. After the procedure, there was a significant improvement, i.e. III. degree and II / III. the degree of varicocele has 7 (19%) subjects, while most of them, 16 (42%) I. degree, and 5 (13%) subjects recorded a regular finding (Marginal homogeneity test, P <0.001). Positive thermographic findings before surgery were found in 37 (97%) subjects, and after surgery negative thermographic findings were found in 7 (18%) subjects (McNemar test, P <0.001). All subjects had a positive ultrasound finding before surgery, while it was positive after surgery in 13 (34%) subjects. Left vein conglomerate is noticed before surgery in 25 (66%) subjects, bilaterally in 3 (8%) subjects. After the operation, left vein conglomerate was noticed in 9 (24%) subjects, and one (3%) subject recorded venous conglomerate on both sides. 60 Comparing the finding of infrared thermography with the clinical finding after surgery, it is noticed that according to the clinical finding after surgery there are still 33 (87%) subjects with a positive finding, while according to the thermographic finding positive 7 (18%), which is a significant difference test, P <0.001). Comparing these two methods with respect to the finding after surgery, one cannot say that there is agreement in the methods (Cohen's Kappa k = 0.07 with 95% CI from -0.01 to 0.14). After the operation, comparing the ultrasound finding with the infrared thermography finding, it is noticed that according to the ultrasound finding after the operation, there are still 13 (34%) subjects with a positive finding, while according to the thermographic finding, 7 (18%) are positive (McNemar test, P = 0 , 03) (measured by thermography with a sensitivity of 100%, a specificity of 80.6%). Comparing these two methods with respect to the postoperative finding, one can say that there is a significant moderate agreement between ultrasound and thermographic findings (Cohen's Kappa k = 0.606 with 95% CI from 0.339 to 0.872; P <0.001). Comparing the clinical finding with the ultrasound finding, we notice that significantly more subjects after surgery according to the clinical finding are positive compared to the ultrasound finding. Compared to ultrasound findings, the sensitivity of the clinical finding after surgery is 92.3% and the specificity is 16%. We note that, after surgery, there is no significant agreement between clinical and ultrasound findings (Cohen's Kappa test k= 0.061, P = 0.64) Based on the fulfilled criteria, there is a significant decrease in the number of subjects with a final diagnosis of varicocele after surgery, ie a decrease from 37 (97%) subjects with a positive thermographic finding before surgery to 7 (18%) subjects after surgery (McNemar test, P <0.001). Conclusion: The study confirmed the thermographic criteria as well selected for adequate diagnosis of varicocele and that these criteria can and should be used in the interpretation of scrotal infrared thermography images both before and after surgery. Infrared thermography compared to clinical examination proved to be a statistically significantly better diagnostic method for the diagnosis of varicocele recurrence. It showed significant benefit in the diagnosis of recurrence after varicocele surgery, while the clinical examination had a high rate of false-positive findings. Infrared thermography 61 compared to color Doppler proved to be a method that has a statistically significantly better result, but we can also say that they have a significantly moderate agreement. With this research, infrared thermography showed a diagnostic value in the diagnosis of varicocele recurrence. Thermography has been shown to have better sensitivity and specificity compared to clinical examination and / or ultrasound

INFRARED DIGITAL THERMOGRAPHY OF THE SCROTUM IN EVALUATION SURGICAL OUTCOME AFTER VARICOCELE OPERATIONS

Cilj: Utvrditi kako je infracrvena termografija skrotuma dijagnostička metoda koja može dijagnosticirati recidiv nakon operacije varikokele. Ispitanici i metode: Studija je ustrojena na temelju prospektivnog istraživanja. Ispitanici su pregledani i liječeni kroz urološku ambulantu Odjela za urologiju Opće bolnice „Dr. Josip Benčević“ Slavonski Brod. Istraživanje je provedeno na 38 ispitanika liječenih u razdoblju od 2010. do 2017.godine. Protokol istraživanja obuhvaća: 1. Dijagnostika primjenom moderne termografske kamere uz analizu slika u odgovarajućem računalnom programskom paketu. 2. Klinički pregled. 3. Dijagnostika ultrazvukom s color Dopplerom. 4. Ponovna dijagnostika primjenom termografije, kliničkog pregleda i ultrazvuka s color Dopplerom dva ili više mjeseci nakon operativnog zahvata. Rezultati: Pozitivan klinički nalaz imaju svi ispitanici prije operacije, dok je on pozitivan poslije operacije kod 33 (87 %) ispitanika. Prije zahvata kliničkim pregledom 31 (82 %) ispitanik imao je III. stupanj varikokele, a 7 (23 %) ispitanika imalo je II. ili II/III. stupanj varikokele. Nakon zahvata došlo je do značajnog poboljšanja, odnosno III. stupanj i II/III. stupanj varikokele ima sedam (19 %) ispitanika, dok ih je najviše, njih 16 imalo (42 %) I. stupnja, a kod pet (13 %) ispitanika bilježi se uredan nalaz (Test marginalne homogenosti, P < 0,001). Pozitivan termografski nalaz prije operacije nalazimo kod 37 (97 %) ispitanika, a poslije operacije pozitivan termografski nalaz ima 7 (18 %) ispitanika (McNemarov test, P < 0,001). Pozitivan ultrazvučni nalaz imaju svi ispitanici prije operacije, dok je on pozitivan poslije operacije kod 13 (34 %) ispitanika. Konglomerat vena lijeve strane uočava se prije operacije kod 25 (66 %) ispitanika, obostrano kod tri (8 %) ispitanika. Poslije operacije konglomerat vena lijeve strane bilježi se kod devet (24 %) ispitanika, po jedan (3 %) ispitanik bilježi konglomerat vena obostrano. 57 Uspoređujući nalaz infracrvene termografije s kliničkim nalazom nakon operacije, uočava se da je prema kliničkom nalazu nakon operacije još uvijek 33 (87 %) ispitanika s pozitivnim nalazom, dok je prema termografskom nalazu pozitivno njih sedam (18 %), što je značajna razlika (McNemarov test, P < 0,001). Uspoređujući te dvije metode s obzirom na nalaz nakon operacije, ne možemo reći da postoji slaganje u metodama (Cohenov Kappa k = 0,07 uz 95 % CI od -0,01 do 0,14). Nakon operacije uspoređujući UZV nalaz s nalazom infracrvene termografije, uočava se da je prema UZV nalazu nakon operacije još uvijek 13 (34 %) ispitanika s pozitivnim nalazom, dok je prema termografskom nalazu pozitivno njih 7 (18 %) (McNemarov test, P = 0,03) (mjereno prema termografiji uz osjetljivost od 100 %, specifičnost od 80,6 %). Uspoređujući te dvije metode s obzirom na nalaz nakon operacije, možemo reći da postoji značajno umjereno slaganje između UZV i termografskog nalaza (Cohenov Kappa k = 0,606 uz 95% CI od 0,339 do 0,872; P < 0,001) . Uspoređujući klinički nalaz s nalazom UZV-a, uočavamo da je značajno više ispitanika nakon operacije prema kliničkom nalazu pozitivno u odnosu na UZV nalaz. U usporedbi prema UZV nalazu osjetljivost kliničkog nalaza nakon operacije je 92,3 %, a specifičnost 16 %. Uočavamo da nakon operacije nema značajnog slaganja između kliničkog i UZV nalaza (Cohenov Kappa test k = 0,061, P = 0,64) Na osnovi ispunjenih kriterija značajno je smanjenje u broju ispitanika s konačnom dijagnozom varikokele nakon operacije, odnosno smanjenje je od 37 (97 %) ispitanika s pozitivnim termografskim nalazom prije operacije na sedam (18 %) ispitanika poslije operacije (McNemarov test, P < 0,001). Zaključak: Istraživanje je potvrdilo termografske kriterije kao dobro odabrane za adekvatno postavljanje dijagnoze varikokele te da se navedeni kriteriji mogu i trebaju koristiti u tumačenju snimaka skrotalne infracrvene termografije kako prije tako i poslije operativnog zahvata. Infracrvena termografija u usporedbi s kliničkim pregledom pokazala se kao statistički signifikantno bolje dijagnostička metoda za dijagnostiku recidiva varikokele. Pokazala je znatnu korist u dijagnostici recidiva nakon operacije varikokele, dok je klinički pregled imao veliku stopu lažno pozitivnih nalaza. Infracrvena termografija u usporedbi s UZV color Dopplerom pokazala se kao metoda koja ima 58 statistički signifikantno bolji rezultat, ali možemo reći i da imaju značajno umjereno slaganje. Infracrvena termografija je ovim istraživanjem pokazala dijangostičku vrijednost u dijagnostici recidiva varikokele. Pokazalo se kako u usporedbi s kliničkim pregledom i/ili UZV-om termografija ima bolju osjetljivost i specifičnost.Objective: To determine that infrared scrotal thermography is a diagnostic method that can diagnose recurrence after varicocele surgery. Subjects and methods: The study was structured based on a prospective research. Subjects were examined and treated through the urology clinic of the Department of Urology of the General Hospital "Dr. Josip Benčević" Slavonski Brod. The research was conducted on 38 subjects treated in the period from 2010 to 2017. .Research protocol includes: 1. Diagnostics using a modern thermographic camera with image analysis in the appropriate software package 2. Clinical examination 3. Ultrasound diagnosis with color Doppler 4. Two or more months after surgery, re-diagnosis using thermography, clinical examination and ultrasound with color Doppler. The results: All subjects had a positive clinical finding before surgery, while it was positive after surgery in 33 (87%) subjects. Before the procedure, 31 (82%) subjects had III. degree of varicocele, and 7 (23%) subjects had II. or II / III. degree of varicocele. After the procedure, there was a significant improvement, i.e. III. degree and II / III. the degree of varicocele has 7 (19%) subjects, while most of them, 16 (42%) I. degree, and 5 (13%) subjects recorded a regular finding (Marginal homogeneity test, P <0.001). Positive thermographic findings before surgery were found in 37 (97%) subjects, and after surgery negative thermographic findings were found in 7 (18%) subjects (McNemar test, P <0.001). All subjects had a positive ultrasound finding before surgery, while it was positive after surgery in 13 (34%) subjects. Left vein conglomerate is noticed before surgery in 25 (66%) subjects, bilaterally in 3 (8%) subjects. After the operation, left vein conglomerate was noticed in 9 (24%) subjects, and one (3%) subject recorded venous conglomerate on both sides. 60 Comparing the finding of infrared thermography with the clinical finding after surgery, it is noticed that according to the clinical finding after surgery there are still 33 (87%) subjects with a positive finding, while according to the thermographic finding positive 7 (18%), which is a significant difference test, P <0.001). Comparing these two methods with respect to the finding after surgery, one cannot say that there is agreement in the methods (Cohen's Kappa k = 0.07 with 95% CI from -0.01 to 0.14). After the operation, comparing the ultrasound finding with the infrared thermography finding, it is noticed that according to the ultrasound finding after the operation, there are still 13 (34%) subjects with a positive finding, while according to the thermographic finding, 7 (18%) are positive (McNemar test, P = 0 , 03) (measured by thermography with a sensitivity of 100%, a specificity of 80.6%). Comparing these two methods with respect to the postoperative finding, one can say that there is a significant moderate agreement between ultrasound and thermographic findings (Cohen's Kappa k = 0.606 with 95% CI from 0.339 to 0.872; P <0.001). Comparing the clinical finding with the ultrasound finding, we notice that significantly more subjects after surgery according to the clinical finding are positive compared to the ultrasound finding. Compared to ultrasound findings, the sensitivity of the clinical finding after surgery is 92.3% and the specificity is 16%. We note that, after surgery, there is no significant agreement between clinical and ultrasound findings (Cohen's Kappa test k= 0.061, P = 0.64) Based on the fulfilled criteria, there is a significant decrease in the number of subjects with a final diagnosis of varicocele after surgery, ie a decrease from 37 (97%) subjects with a positive thermographic finding before surgery to 7 (18%) subjects after surgery (McNemar test, P <0.001). Conclusion: The study confirmed the thermographic criteria as well selected for adequate diagnosis of varicocele and that these criteria can and should be used in the interpretation of scrotal infrared thermography images both before and after surgery. Infrared thermography compared to clinical examination proved to be a statistically significantly better diagnostic method for the diagnosis of varicocele recurrence. It showed significant benefit in the diagnosis of recurrence after varicocele surgery, while the clinical examination had a high rate of false-positive findings. Infrared thermography 61 compared to color Doppler proved to be a method that has a statistically significantly better result, but we can also say that they have a significantly moderate agreement. With this research, infrared thermography showed a diagnostic value in the diagnosis of varicocele recurrence. Thermography has been shown to have better sensitivity and specificity compared to clinical examination and / or ultrasound

Analysis of the hydraulic connection of the Plitvica stream and the groundwater of the Varaždin alluvia aquifer

A combination of different statistical methods and flow duration curves was used to examine hydraulic connection between the Plitvica stream and the surrounding piezometers that capture the groundwater of the Varaždin alluvial aquifer. Also, rainfall quantities over a wider study area were considered to examine the effect of precipitation on Plitvica water levels and groundwater levels. The following statistical methods were used in this paper: the correlation method, the auto-correlation method, and the cross-correlation method. Correlation analysis show that there is generally a significant correlation between the Plitvica water levels and groundwater levels, with positive direction of the correlation. The analysis of auto-correlograms for groundwater and surface water shows that the correlation coefficient value drops below 0.2 after a longer period, which indicates a long-term memory of the system that can be explained by the slow flow and thus slow pressure transfer. Cross-correlation analyses of the time series of the Plitvica water levels and groundwater levels showed a time lag of 1–2 days with a fairly significant cross-correlation coefficient. For precipitation and groundwater levels, the relationship is much weaker, with a lag time of 4–5 days with a weak cross-correlation coefficient. The least time lag, within a day, was established between precipitation and Plitvica water levels. Analyses of the flow duration curves revealed that Plitvica almost completely drains groundwater, except in the vicinity of the piezometer 2178 where Plitvica recharges the aquifer about a quarter of the time.Kombinacija različitih statističkih metoda i krivulja trajanja korištena je za ispitivanje hidrauličke veze potoka Plitvice i okolnih piezometra koji zahvaćaju podzemne vode varaždinskog aluvijalnog vodonosnika. Također, razmatrane su količine oborina sa šireg područja istraživanja kako bi se utvrdio utjecaj oborina na vodostaj Plitvice i razine podzemne vode. U radu su korištene sljedeće statističke metode: korelacija, auto-korelacija i kros-korelacija. Korelacijske analize pokazuju da generalno postoji značajna povezanost između vodostaja Plitvice i razina podzemnih voda, s pozitivnim smjerom korelacije. Analiza auto-korelograma za podzemne i površinske vode pokazuje da vrijednost koeficijenta korelacije pada ispod 0,2 nakon duljeg vremenskog razdoblja, što ukazuje na dugotrajnu memoriju sustava koja se može objasniti sporim tečenjem, odnosno sporim prijenosom tlaka. Kros-korelacijska analiza vremenskih nizova između vodostaja Plitvice i podzemnih voda pokazala je vremensko zaostajanje od 1–2 dana s prilično značajnim koeficijentom korelacije. Između oborina i podzemnih voda veza je mnogo slabija, s vremenskim zaostajanjem od 4–5 dana te slabim koeficijentom korelacije. Najmanje zaostajanje, unutar jednog dana, utvrđeno je između oborina i vodostaja Plitvice. Analizama krivulja trajanja utvrđeno je da Plitvica gotovo u potpunosti drenira podzemne vode, izuzev piezometra 2178 u blizini kojega oko četvrtinu vremena prihranjuje vodonosnik