Prisutnost bakterije helicobacter pylori u želucu i sluznici grkljana kod bolesnika s karcinomom grkljana

Helicobacter (H.) pylori is the cause of one of the most common chronic bacterial infections in humans. Risk factors for the development of laryngeal cancer are cigarette smoke, alcohol, and human papillomavirus. Several papers report on H. pylori isolated in tooth plaque, saliva, middle ear and sinuses. Many articles describe the presence of H. pylori in laryngeal cancer cases, however, without noting the possible source of infection, i.e. stomach or oral cavity. The aim of this study was to determine which patients and to what extent simultaneously developed H. pylori colonization in the stomach and the larynx. Prospective examinations were performed in 51 patients with laryngeal squamous cell carcinoma. The study group included patients with laryngeal squamous cell carcinoma histopathologically confirmed by two independent pathologists. The patients underwent fiber esophagogastroduodenoscopy with tumor tissue biopsy. Laryngeal and gastric biopsies were examined by histologic staining technique for histopathologic detection of H. pylori and with DNA analyses using the standardized fluorescent ABI Helicobacter plus-minus PCR assay. Laryngeal carcinoma patients showed positive H. pylori test results simultaneously in the laryngeal and stomach areas, implying H. pylori transmission from the stomach to the laryngeal area. In addition, H. pylori positive test results along with negative H. pylori results in the stomach region were also recorded, suggesting a possible bacteria migration from the oral cavity. In conclusion, H. pylori was found in the area of laryngeal carcinoma, and its migration appeared likely to occur both upwards (from the stomach to the mouth) and downwards (from the oral cavity to the stomach).Helicobacter (H.) pylori uzročnik je jedne od najčešćih kroničnih bakterijskih infekcija u ljudskoj populaciji, prisutne u svim zemljama u svijetu. Incidencija infekcije bakterijom H. pylori teško se može izravno utvrditi, jer akutna infekcija ima vrlo malo karakterističnih simptoma ili ih uopće nema. Planocelularni karcinom je najčešći karcinom grkljana koji čini 95% svih karcinoma grkljana. U čimbenike rizika za razvoj karcinoma grkljana ubrajaju se cigaretni dim i alkohol te infekcija humanim papilomavirusima. H. pylori je dokazan kao jedan od uzročnika karcinoma grkljana, ali nigdje nije jasno opisan rezervoar te bakterije s obzirom na to da je u nekoliko članaka dokazano nepostojanje bakterije H. pylori u zdravoj sluznici grkljana. Svrha našega rada bila je ispitati istodobnu prisutnost bakterije H. pylori u karcinomu grkljana i želucu. Kod 51 bolesnika s karcinomom grkljana učinjena je ezofagogastroskopija s uzimanjem uzoraka sluznice iz antruma i korpusa želuca te iz područja karcinoma grkljana za analizu na H. pylori pomoću lančane reakcije polimeraze i patohistološkom metodom. U tkivu karcinoma grkljana dobiveni su pozitivni rezultati testova na H. pylori istodobno s pozitivnim testom na H. pylori u području želuca, što upućuje na migraciju bakterije iz želuca u područje grkljana. U određenom broju ispitanika dobiveni su pozitivni rezultati testova na H. pylori u području karcinoma grkljana s negativnim testom na H. pylori u sluznici želuca, što upućuje na moguću migraciju bakterije iz usne šupljine. Iz nalaza se može zaključiti da je H. pylori prisutan u području karcinoma grkljana te da je njegov prijenos moguć i uzlaznim i silaznim putem iz usne šupljine i želuca

Logical Notations on Chess

Namjena je rada pokušati prikazati šahovska pravila kao logičke iskaze te ljudsko (ne računalno) šahovsko razmišljanje kao postupak koji se može rekonstruirati pomoću klasičnih logičkih shema kao što su istinitosno stablo i deduktivni postupak u Fitchevu stilu. Šahovska pravila mogu se prevoditi na jezik logike prvoga reda, iako je mjestimično potrebno primjenjivati i operatore deontičke logike. Ciljevi se u šahovskoj igri mogu prikazati pomoću logičkog kvadrata. Mogućnosti jakih poteza općenito se mogu logički promišljati. Nesavršenost ljudske procjene kvalitete određenih poteza otvara mogućnost primjene elemenata trovrijednosnih logika. Ipak, rad je u većini posvećen mogućnostima primjene elementarne logike na osnove šahovske igre.This paper aims to present the rules of chess as logical statements and human (non-computer) chess reasoning as a decision procedure that can be reconstructed using classical logic methods such as tableaux and Fitch-style natural deductions. Chess rules can be represented in first-order logic terms with the occasional application of deontic logic operators. A consideration of chess game objectives can be offered by the tableaux method. In general terms, possible strong moves can be assessed with logical reasoning. Human imperfection in the quality assessment of certain moves opens up the possibility of applying three-valued logic parameters. However, the main focus of this paper is to examine the possibilities of applying elementary logic to the basics of chess play

Connection between knowledge of oral hygiene and dental status of the elderly in Požeško-slavonska County

Timely visits to the dentist are extremely important for the preservation of dental health. Given the biological predisposition of teeth decay with age, it is important to act preventively in order to minimize the adverse effects of age on dental health. Aim: The aim of this study is to establish the correlation between the various factors related to oral health and dental status in older age and to examine the differences in dental status between retirement home residents and those living at home. Materials and methods: The data were collected through a survey consisting of 39 questions. The sample consisted of 110 participants located in the Požega HPP and the Home for the Elderly and Infirm in Požega, 42.7% of which were men and 57.3% women. The study used the selection criterion of persons over the age of 65. The average age in the sample was 77.35 years (SD = 7.18) ranging from 65 to 97 years of age. The data were collected in the period from January 2018 to July 2018. The participants were divided into two groups, those living in the Požega Nursing Home and those living in their own household but were hospitalized once in the Požega County Hospital. Results: The obtained results showed that participants have different dental problems that were partially related to their knowledge of oral hygiene. This paper emphasizes the importance of additional training and education for the elderly population in order to preserve and improve the quality of their dental health. Conclusion: The results of this study suggest that participants, in average, were less concerned about their dental health, which was confirmed by the small number of healthy teeth. There was a partial correlation between the knowledge about oral hygiene and the dental status of elderly people in Požega-Slavonia County, i.e. their knowledge was related only to some aspects of their dental status. According to the results obtained, it is important to organize training for the elderly about the importance of timely interventions when dental health is in question, as well as to further educate them about the harmful factors when it comes to the preservation of their dental health

Neuro-fuzzy inference systems approach to decision support system for economic order quantity

Supply chain management (SCM) has a dynamic structure involving the constant flow of information, product, and funds among different participants. SCM is a complex process and most often characterized by uncertainty. Many values are stochastic and cannot be precisely determined and described by classical mathematical methods. Therefore, in solving real and complex problems individual methods of artificial intelligence are increasingly used, or their combination in the form of hybrid methods. This paper has proposed the decision support system for determining economic order quantity and order implementation based on Adaptive neuro-fuzzy inference systems - ANFIS. A combination of two concepts of artificial intelligence in the form of hybrid neuro-fuzzy method has been applied into the decision support system in order to exploit the individual advantages of both methods. This method can deal with complexity and uncertainty in SCM better than classical methods because they it stems from experts’ opinions. The proposed decision support system showed good results for determining the amount of economic order and it is presented as a successful tool for planning in SCM. Sensitivity analysis has been applied, which indicates that the decision sup- port system gives valid results. The proposed system is flexible and can be applied to various types of goods in SC

New Analytic Solutions of Queueing System for Shared-Short Lanes at Unsignalized Intersections

Designing the crossroads capacity is a prerequisite for achieving a high level of service with the same sustainability in stochastic traffic flow. Also, modeling of crossroad capacity can influence on balancing (symmetry) of traffic flow. Loss of priority in a left turn and optimal dimensioning of shared-short line is one of the permanent problems at intersections. A shared-short lane for taking a left turn from a priority direction at unsignalized intersections with a homogenous traffic flow and heterogeneous demands is a two-phase queueing system requiring a first in-first out (FIFO) service discipline and single-server service facility. The first phase (short lane) of the system is the queueing system M(p lambda)/M(mu)/1/infinity, whereas the second phase (shared lane) is a system with a binomial distribution service. In this research, we explicitly derive the probability of the state of a queueing system with a short lane of a finite capacity for taking a left turn and shared lane of infinite capacity. The presented formulas are under the presumption that the system is Markovian, i.e., the vehicle arrivals in both the minor and major streams are distributed according to the Poisson law, and that the service of the vehicles is exponentially distributed. Complex recursive operations in the two-phase queueing system are explained and solved in manuscript

Association between oxidative stress biomarkers and concentrations of some metal ions in the blood of patients with brain tumors and hydrocephalus

Introduction Any substance that induces production of free radicals can be a potential cause of brain damage. The aim of our study was to investigate the relationship between some metal ions and oxidative stress biomarkers in the blood of patients with brain tumor and hydrocephalus. Material and methods Our study included 27 control subjects, 24 patients with brain tumor and 21 patients with hydrocephalus. The activities of superoxide dismutase (CuZn SOD), catalase (CAT), glutathione peroxidase (GSH-Px), glutathione reductase (GR), glutathione S-transferase (GST) and acetyl cholinesterase (AChE), as well as concentrations of reduced glutathione (GSH), lipid peroxides (TBARS) and sulfhydryl groups (SH) were analyzed in the plasma and red blood cells (RBCs) of patients. We also determined the concentrations of Mn, Ni, Co, Cu, Zn, As, Se, Cd, Hg and Fe. Results The higher activity of SOD and concentration of GSH in both investigated groups could indicate higher oxidative stress. We also observed decreased levels of SH groups in both groups of patients. In both groups of patients we detected decreased concentrations of Ni, Co, Zn and Fe (and Mn in brain tumor patients) and increased concentrations of As, Se and Cd in the blood. Interestingly, we observed a higher concentration of Cd in both plasma and RBCs of hydrocephalus patients compared to the patients with brain tumor. Conclusions There are strong correlations between some metal ion concentrations and certain oxidative stress biomarkers in the blood of patients, which supports our hypothesis, but the observed trend needs to be further investigated

Divovska kavernozna malformacija s neuobičajeno agresivnim kliničkim tijekom: prikaz slučaja

Giant cavernomas (GC) are rare lesions, with less than 50 cases reported so far. Clinical presentation usually involves epileptic seizures and less typically focal neurological deficit, due to repeated hemorrhages and GC mass effect and consequentially increased intracranial pressure. Although individual cases have been reported, due to the rarity and variable imaging appearance, GCs are usually not considered in the differential diagnosis of large hemorrhagic lesions, especially when significant mass effect is present. A 17-year-old boy presented due to severe headache, right-sided weakness, and slurred speech. Symptoms started three days before with occasional headaches, which intensified gradually. Emergency computed tomography revealed a left frontal massive heterogeneous lesion. Soon after, right-sided hemiparesis and speech impairment progressed, and the patient became drowsy with the slightly dilated left pupil. Emergency surgery was performed, and the lobed grayish lesion was entirely removed. Based on the macroscopic appearance, the surgeon assumed it was a metastasis of melanoma. Histopathologic analysis result was cavernoma. GC should be considered as an option in hemorrhagic lesions, especially in the young age population. Emergency surgery for mass lesions is not uncommon in neurosurgery; however, bleeding cavernomas are usually planned for elective surgery due to the specific approach and complications.Divovski kavernomi (DK) su rijetke lezije s manje od 50 dosad opisanih slučajeva. Uobičajena simptomatologija su epileptični napadaji, a rjeđe se manifestiraju žarišnim neurološkim deficitom koji je uzrokovan ponavljanim hemoragijama i posljedičnim povećanjem intrakranijskog tlaka. Iako su objavljeni pojedini slučajevi, zbog rijetke pojavnosti i raznovrsne radiološke prezentacije DK se obično ne razmatraju u diferencijalnoj dijagnostici velikih hemoragičnih ekspanzivnih lezija, pogotovo kada je prisutan značajan kompresivni učinak. Sedamnaestogodišnji dječak se javio liječniku zbog jake glavobolje, blaže desnostrane slabosti i nerazgovijetnog govora. Simtpomi su se javili 3 dana ranije u vidu blagih glavobolja koje su se postupno pojačavale. Hitna kompjutorizirana tomografija je pokazala masivnu hemoragičnu leziju frontalno lijevo. Nedugo zatim desnostrana slabost i nerazgovijetan govor su se pogoršali i bolesnik je postao pospan s blago proširenom lijevom zjenicom. Učinjena je hitna operacija, kružna sivkasta lezija je u cijelosti uklonjena. Na osnovi makroskopskog izgleda kirurg je pomislio da se radi o metastazi melanoma. Histopatološka analiza je pokazala da se radi o kavernomu. DK bi trebalo razmatrati kao mogućnost kod hemoragičnih lezija, pogotovo kod mlađih bolesnika. Hitna operacija kod kompresivnih lezija nije rijetkost u neurokirurgiji, međutim, krvareći kavernomi se obično planiraju za elektivnu operaciju zbog specifičnog pristupa i mogućih komplikacija

Functional dizziness in the light of the newly-established entity – Persistent postural-perceptual dizziness

Funkcionalne vrtoglavice ističu se svojom učestalošću i drugi su najčešći uzrok vrtoglavica u općoj populaciji, dok su u dobnoj skupini od 30 do 50 godina i najčešći. Klasični dijagnostički proces usmjeren je na pronalaženje medicinske ili kirurške dijagnoze, a ako se ona ne pronađe, obično kažemo da je uzrok bolesti „psihogen“. Posljednjih desetljeća, napuštanjem uvriježenoga dihotomnoga dijagnostičkog pristupa i primjenom novog, integrativnog načina dijagnostičkog razmišljanja došlo se do spoznaje o postojanju funkcionalnih vestibularnih poremećaja. Oni su uvijek posljedica loše readaptacije posturalnog sustava na neku vestibularnu, neurološku, strukturnu ili psihijatrijsku bolest. Uzrok tomu leži u uskoj povezanosti živčanih projekcija u mozgu odgovornih za kontrolu pokreta i položaja tijela u prostoru s onima odgovornima za opasnost i strah. Odbor za klasifikaciju vestibularnih poremećaja Bárányjeva društva nedavno je utemeljio dijagnostičke kriterije za perzistentnu posturalno-percepcijsku vrtoglavicu (PPPD). Riječ je o najčešćem funkcionalnom vestibularnom poremećaju, koji obuhvaća prije uspostavljene entitete: fobičnu posturalnu vrtoglavicu, vizualnu i kroničnu subjektivnu vrtoglavicu. Dominantni simptomi PPPD-a jesu: vrtoglavica koja kontinuirano traje najmanje 3 mjeseca i uvijek je povezana s držanjem tijela, a nije kružnog tipa. Javljaju se preosjetljivost na pokretne podražaje, uključujući i vlastite pokrete, ali i kretanje velikih vizualnih objekata ili kompleksnih vizualnih podražaja u širokome vidnom polju, kao i teškoće pri izvođenju preciznih vizualnih radnja. Kod blažih i umjerenih smetnja poželjno je provesti vestibularnu rehabilitaciju, jer većina pacijenata ima provokativne čimbenike vezane uz vid i kretanje. Indicirano je i farmakoterapijsko liječenje selektivnim inhibitorima ponovne pohrane serotonina i noradrenalina. Dobri rezultati postižu se i primjenom kognitivno-bihevioralne psihoterapije, mijenjanjem negativnih automatskih misli, refokusiranjem pažnje, reatribucijom, sustavnim i postupnim izlaganjem ili, pak, izlaganjem odjedanput i dr. Prognoza bolesti znatno je bolja kod pacijenata bez komorbiditeta u odnosu prema onima s njime.Functional dizziness is noted for its frequency and is the second most common cause of dizziness in the general population, most prevalent in the age group of 30–50 years. The classic diagnostic process is aimed at finding a medical or surgical diagnosis, and in case it is not found, it is said to be caused by a “psychogenic” disease. In recent decades, using a new, integrative way of thinking, there has been a discovery of functional vestibular disorders. They have always been overcome by acute or back vestibular disease due to poor readout of the postural system. The reason for this lies in a close connection to the brain of nerve projections responsible for controlling motion and position of the body in space with those responsible for danger and fear. The Nomenclature and Classification Committee of Barany’s Vestibular Disorders recently established diagnostic criteria for persistent postural-perceptive dizziness (PPPD). This is the most common functional vestibular disorder, which includes the previously established: persistent postural dizziness, visual and chronic subjective dizziness. The dominant symptom of PPPD is non-rotatory dizziness that lasts for at least three months continuously and is always associated with the condition of the body. The hypersensitivity to moving stimuli occurs, including the movements of large visual objects or complex visual stimuli in a wide field of vision and the difficulty of performing precision visual actions. For mild and moderate interferences it is advisable to conduct vestibular rehabilitation, as most patients have provocative factors related to vision and movement. Individually tailored exercises are used to reduce susceptibility to provocative movements, and conditioning exercises are very useful for repairing disturbed body posture. Pharmacotherapeutic treatment with selective serotonin or serotonin and norepinephrine reuptake inhibitors is also indicated. Good results are achieved by the use of cognitive-behavioural psychotherapy, changing of negative automatic thoughts, refocusing attention, re allocation, systematic and gradual exposure or exposure at once, biofeedback etc. The prognosis of the disease is better in patients without comorbidity, while in those with comorbidity it is significantly worse

Rare Diseases of the Vestibular System

Vrtoglavica je jedna od najčešćih tegoba na koju se pacijenti žale liječniku. Može se reći da poremećaj ravnoteže tijekom života doživi oko trećina cjelokupne ljudske populacije pa otuda njegov veliki javnozdravstveni značaj. Ne radi se o jednoj bolesti, već se u slučaju vrtoglavice radi o sindromu koji uključuje stotine različitih uzroka. Liječniku kliničaru to može na prvi pogled djelovati zastrašujuće, ali nakon dublje analize shvaćamo da ogromnu većinu vrtoglavica čini deset najčešćih uzroka, dok se svi ostali mogu svrstati u rijetke bolesti prema važećoj definiciji koja kaže da se svaka bolest koja zahvaća < 5 : 10 000 ljudi smatra rijetkom. Ovo nas upućuje na zaključak da ovakve bolesti nikako ne bi trebalo zanemariti u procesu diferencijalno-dijagnostičkog promišljanja. Može se reći da su rijetke bolesti rijetke, ali da su oboljeli od njih vrlo brojni. Otprilike 5000 - 8000 različitih rijetkih bolesti pogađa 6-8 % stanovništva Europske unije, odnosno između 27 i 36 milijuna ljudi. U ovom tekstu pozornost smo posvetili onim rijetkim vestibularnim poremećajima koji su važni za svakodnevno dijagnostičko, posebice diferencijalno-dijagnostičko promišljanje. Neki od ovih poremećaja, iako po našem mišljenju imaju veliku diferencijalno-dijagnostičku važnost, još uvijek nisu uvršteni na listu rijetkih entiteta ORPHA, dok su s druge strane uvršteni dobro nam poznati i etablirani poremećaji ili pak oni potpuno beznačajni za svakodnevnu liječničku praksu zbog svoje enormno niske učestalosti.Dizziness is one of the most common symptoms that patients complain about to their doctors. It can be said that around one third of the entire human population experiences dizziness during their lifetime, and hence its great public health significance. It is not a single disease, however: in the case of dizziness, it is rather a syndrome, which involves hundreds of different causes. It may seem scary to a clinician, but we might realize subsequent to an in-depth analysis that ten dizziness causes are most common, while the remaining ones might be classified as rare diseases, according to the current definition. Consequently, they should not be ignored in a differential-diagnostic process. Actually, any disease that affects < 5:10.000 people is considered rare. It can be said that rare diseases are infrequent, but the patients suffering from them are numerous. Five to eight thousand different rare diseases affect 6-8% of the European Union (EU) population--that is, between 27 and 36 million people. In this article, we have paid attention to those rare vestibular disorders that are significant for quotidian diagnostics, especially with regard to a differential-diagnostic excogitation method. In spite of their major differential-diagnostic importance, some of these disorders are still not included in the ORPHA list of rare entities. On the other hand, the well-known and established disorders, or those that are completely insignificant for everyday medical practice, are enlisted due to their enormously low frequency