Assesment of clinical significance four dimensional computed tomography simulationa in planning optimal radiation therapy technique for locoregional advanced lung cancer

Cilj istraživanja je definisanje optimalne tehnike zračenja lokoregionalno uznapredovalog karcinoma pluća komparacijom dozno volumnih parametara za navedene tehnike zračenja : IMRT, VMAT RA (4DCT simulacija) i 3DCRT (CT simulacija). Urađena je klinička opservaciona kohortna studija, u kojoj je analizirano 70 pacijenata(studijska grupa A-VMAT RA, studijska grupa B-IMRT), te urađeni komparativni 3DCRT planovi za obe studijske grupe. Kriterijumi za uključenje: patohistološki potvrđen lokalno uznapredovali karcinom pluća, klinički stadijum: IIIA,IIIB,IIIC. Kriterijumi za isključivanje:Karcinom pluća druge histologije osim nemikrocelularni i mikrocelularni, metastatski karcinom, klinički stadijumi IA,IB,IIA,IIB,IV,IVA,IVB Analiza doznovolumnih parametara organa od rizika(srce,pluća,jednjak,kičmena moždina) IMRT, VMAT RA tehnike (4DCT simulacija) pokazuje dozimetrijsku prednost, vrednosti parametara su bile signifikantno veće kod planova urađenih 3DCRT tehnikom. Dalja evaluacija ukazuje na homogeniju distribuciju radioterapijske doze kod planova urađenih VMAT RA i IMRT u komparaciji sa 3DCRT tehnikom. Postoji statistički signifikantna redukcija planiranog ciljnog volumena kod tehnika IMRT i VMAT RA u odnosu na klasičnu CT simulaciju i 3DCRT tehniku. Statistički značajno veće vrednosti V20 i MLD –organa od rizika pluća kao i maksimalne doze na organ od rizika kičmena moždina u studijskoj grupi planiranoj IMRT tehnikom, ukazuju na potencijalni benefit VMAT RA tehnike. Komparacija akutnih i hroničnih neželjenih efekata na organ od rizika pluća i jednjak pokazuje da nema statistički značajne razlike između IMRT i VMAT RA tehnike Na osnovu rezultata naše studije možemo zaključiti da IMRT i VMAT RA, tehnike bazirane na 4DCT simulaciji predstavljaju optimalan izbor u radioterapiji lokalno uznapredovalog karcinoma pluća u odnosu na 3DCRT tehniku i klasičnu CT simulaciju.The aim of this study is to define optimal radiation technique of locoregionally advanced lung cancer by comparing dose-volume parameters for radiation techniques: IMRT, VMAT RA (4DCT simulation) and 3DCRT (CT simulation). This is cinical observational cohort study in which we analyzed 70 patients (study group A-VMAT RA technique, study group B-IMRT). Comparative 3DCRT plans for both study groups were also made.Inclusion criteria: Patients diagnosed and pathohistologically confirmed as locally advanced lung cancer, patients who belong to clinical groups: IIIA, IIIB, and IIIC. Exclusion criteria: Lung cancer of histology other than nonmicrocellular and microcellular, metastatic cancer, clinical stages IA, IB, IIA, IIB, IV, IVA, IVB. In this study, analysis dose volume parameters organs at risk (lungs, oesophagus, heart and spinal cord) IMRT, VMAT RA (4DCT) simulation present dosimetric advantage compared with 3DCRT technique, the values of parameters were significantly higher in 3DCRT technique plans. Further evaluation indicate a more homogeneous distribution of radiotherapy dose on 4D CT based VMAT RA, IMRT techniques plans compared to 3DCRT technique. There was statistically significant reduction of planning target volume in 4D CT based IMRT and VMAT RA plans compared to 3DCRT plans. Statistically significantly higher values of V20 and MLD, maximal dose to the organ of risk spinal cord in the study group planned by IMRT technique compared with VMAT RA, indicates the potential benefit of VMAT RA technique. There was no statistical significant difference between IMRT and VMAT RA study group when comparation of acute and late toxicity (lung and oesophagus) was done. Based on this results, IMRT and VMAT RA, techniques based on 4DCT simulation represent the optimal choice in radiotherapy of locally advanced lung cancer compared to 3DCRT technique and classical CT simulation

Chronic fatigue syndrome

Chronic fatigue syndrome (CFS) is defined by a profound, debilitating fatigue, lasting for at least 6 months and resulting in a substantial reduction of occupational, personal, social and educational status. CFS is a relatively poorly recognized clinical entity, although everyday experience shows that there are many patients with CFS symptoms. The incidence and prevalence of CFS remain unknown in most countries; however, the working population is most affected with predominantly female patients in generative period. Although, CFS was first mentioned four centuries ago, mysterious aethiopathogensis of CFS still intrigues scientists as hundreds of studies are still published every year on the subject. About 80 different aetiological CFS factors are mentioned, which can be classified into five basic groups: genetics, immunology, infectious diseases, endocrinology and neuropsychiatry-psychology. Even today the condition is passed established based on the diagnosis by exclusion of organic and psychiatric disorders, which demands u multidisciplinary approach. As the syndrome is often misdiagnosed and mistreated, self-medication is not uncommon in CFS patients’. In addition, such patients usually suffer for years tolerating severe fatigue. Thus, at the moment there are three priorities regarding CFS; understanding pathogenesis, development of diagnostic tests and creating efficient treatment program

Goals of consumers in the context of slow tourism

The concept of slow tourism is gaining attention in terms of emphasized need for slowing down the pace of life. This concept is tied to sustainable tourism and linked to social movements such as: 'Slow Food' (authentic, local food), 'Slow Cities' (environmentally responsible and peaceful environment) and 'Slow Transportation' (local buses and trains). This study provides insights into the phenomenon of slow tourism from the perspective of a goal-directed consumption process. The research was based on a model consisting of six slow tourism motivations (relaxation, self-reflection, escape, novelty-seeking, engagement, and discovery), two goals of slow tourism (revitalization and self-enrichment), and travel outcomes (satisfaction, future return intention, and recommendations). The sample included 320 respondents from the territory of the Republic of Serbia who had visited some of the destinations in Vojvodina labeled as 'slow place' in the past two years

ALCOHOLIC AND POSTOPERATIVE DELIRIUM: A CASE-CONTROL STUDY

Background: Delirium is an urgent condition in psychiatry and it occurs after long-lasting alcohol abuse, in surgical procedures and other organic mental syndromes with deprivation of interpersonal and social stimulations. The aim was to evaluate of sociodemographical and psychopathological differences in delirium patients with alcoholand surgical genesis, studied in period from January 1st 2003 to December 31st 2012 in Bosnia and Herzegovina (B&H). Subjects and methods: Subjects were divided into two groups: alcoholics (N=75) and surgical patients (N=75) and multicentric, prospective study was performed in B&H. The following instruments have been used: list of general data (according to MCD-10 criteria), Eysenck Personality Questionnaire (EPQ), Becks test of anxiety (BAI), Hamilton Depressive Rating Scale (HDRS) and Mini Mental State Examination (MMSE). Descriptive and analytical statistical processing of patients has been performed (alpha level: 0.001). Results: Patients from alcohol group showed, with statistical significance p=0.001, the following: unemployment (OR=0.657, CI 0.540-670), ruined marriage (OR=0.570, CI 0.650-710), alcohol abuse (OR=0.179, CI 0.860-0.990), on represented expressed psychoticism, (OR=0.635, CI 0.550-0.715) in EPQ test, HDRS total was more frequent (OR=0.925, CI 0.870-1.120) and on MMSE test, total score was more frequent (OR=0.560, CI 0.570-810). Postoperative patients were older p=0.001 (OR= 1.120, CI 1.082- 1.159) with acutestress: (OR=0.735, CI 0.650-0.910) and showed neuroticism (OR=-0.660, CI 0.575-0.715). Discriminative function confirms the differences between alcohol and surgical groups of delirium patients: Canonical Fcn: r=0.771; Wilkin’s lambda

Consumers' propensity to complain towards tourist agencies' services: Evidence from Serbia and Croatia

The goal of the research is to determine a statistically significant difference in the tendency to appeal in relation to socio-demographic characteristics of the users of tourist services. The study has been conducted on a group sample of 116 respondents from Serbia and 106 respondents from Croatia. The empirical part of the research was carried out by a survey technique. The results of the conducted empirical research confirmed the findings and claims of foreign authors on the impact of tourist service users' age, monthly income and the number of family members, on their inclination to complain. The main findings of this research indicate that maintaining a long-term loyalty relationships with existing users is becoming increasingly difficult. The paper seeks to contribute to the existing literature by indicating the importance of knowing the effects of influence factors upon a tendency to file a complaint. The obtained results help employees in the first service line to identify aspects of influence on the users' reaction to service failure and thus give a starting point for creating measures for effective resolution of user dissatisfaction. Future researchers are advised to collect additional information on the factors influencing the user's complaint behaviour

Evaluation of therapeutic dose linear accelerator out-of-field using different techniques radiation

Prilikom puštanja u rad terapijskog linearnog akceleratora dozimetrijska mjerenja se rade samo u zračnom polju i ti podaci se unose u TPS (sistem za planiranje), dok dozimetrijski podaci izvan zračnog polja nisu dobro dokumentovani. Neminovno je da dijelovi tijela izvan zračnog polja budu izloženi određenoj dozi zračenja rasijanog u tijelu pacijenta, akceleratorskoj glavi, kao i u samoj prostoriji. Razvojem tehnika isporuke doze pomoću kojih imamo mnogo bolju konformalnost, ali isto tako imamo više monitorskih jedinica čime se produžava vrijeme tretmana, a samim time izloženost tijela nižim dozama zračenja. Takođe, koristimo više polja pod različitim uglovima (IMRT) ili puni luk (VMAT). Sve ovo utiče da veća zapremina normalnog tkiva bude izložena nižim dozama zračenja. Cilj ovog rada je da se procijeni vrijednost doze izvan zračnog polja za tretmanske planove (3DCRT, IMRT i VMAT) napravljenih u Eclipse 13.6 TPS (Varian Medical Systems) koja je isporučena pomoću Clinac DHX (Varian Medical Systems) linearnog akceleratora. Mjerenje je rađeno u Thorax Phantom-u (CIRS) pomoću jonizacione komore na udaljenosti od ivice polja u rasponu od 1,75–15,75 cm.When commissioning therapeutic linear accelerator dosimetric measurements are made only in the air field and these data are entered in TPS (treatment planning system), and dosimetry data out-of-field are not well documented. It is inevitable that parts of the body out-of-field to be exposed to a certain dose of the scatter radiation in the patient's body, accelerator head, as well as in the room. The development of technique delivery doses with which we have a much better conformity, but also we have more of monitor units that serve to prolong the treatment time, and thus the exposure of the body lower doses of radiation. Also, use more fields at different angles (IMRT) or full arch (VMAT). All this affects the larger volume of normal tissue is exposed to lower doses of radiation. The aim of this study is to assess the value out-of-field dose for treatment plans (3DCRT, IMRT and VMAT) made in Eclipse 13.6 TPS (Varian Medical Systems) that is delivered using CLINAC DHX (Varian Medical Systems) linear accelerator. Measurement was conducted in Thorax Phantom-in (CIRS) using ionization chamber at the distance from the edge of the field in the range of (1.75 - 15.75) cm

Evaluation of therapeutic dose linear accelerator out-of-field using different techniques radiation

Prilikom puštanja u rad terapijskog linearnog akceleratora dozimetrijska mjerenja se rade samo u zračnom polju i ti podaci se unose u TPS (sistem za planiranje), dok dozimetrijski podaci izvan zračnog polja nisu dobro dokumentovani. Neminovno je da dijelovi tijela izvan zračnog polja budu izloženi određenoj dozi zračenja rasijanog u tijelu pacijenta, akceleratorskoj glavi, kao i u samoj prostoriji. Razvojem tehnika isporuke doze pomoću kojih imamo mnogo bolju konformalnost, ali isto tako imamo više monitorskih jedinica čime se produžava vrijeme tretmana, a samim time izloženost tijela nižim dozama zračenja. Takođe, koristimo više polja pod različitim uglovima (IMRT) ili puni luk (VMAT). Sve ovo utiče da veća zapremina normalnog tkiva bude izložena nižim dozama zračenja. Cilj ovog rada je da se procijeni vrijednost doze izvan zračnog polja za tretmanske planove (3DCRT, IMRT i VMAT) napravljenih u Eclipse 13.6 TPS (Varian Medical Systems) koja je isporučena pomoću Clinac DHX (Varian Medical Systems) linearnog akceleratora. Mjerenje je rađeno u Thorax Phantom-u (CIRS) pomoću jonizacione komore na udaljenosti od ivice polja u rasponu od 1,75–15,75 cm.When commissioning therapeutic linear accelerator dosimetric measurements are made only in the air field and these data are entered in TPS (treatment planning system), and dosimetry data out-of-field are not well documented. It is inevitable that parts of the body out-of-field to be exposed to a certain dose of the scatter radiation in the patient's body, accelerator head, as well as in the room. The development of technique delivery doses with which we have a much better conformity, but also we have more of monitor units that serve to prolong the treatment time, and thus the exposure of the body lower doses of radiation. Also, use more fields at different angles (IMRT) or full arch (VMAT). All this affects the larger volume of normal tissue is exposed to lower doses of radiation. The aim of this study is to assess the value out-of-field dose for treatment plans (3DCRT, IMRT and VMAT) made in Eclipse 13.6 TPS (Varian Medical Systems) that is delivered using CLINAC DHX (Varian Medical Systems) linear accelerator. Measurement was conducted in Thorax Phantom-in (CIRS) using ionization chamber at the distance from the edge of the field in the range of (1.75 - 15.75) cm

Raznolikost mitohondrijske DnK jelena lopatara (Dama dama) iz nacionalnog parka Brijuni, republika Hrvatska - kratko priopćenje

Fallow deer (Dama dama) are one of the most important game species in Europe and approximately 5 million animals are raised on farms globally. These deer are considered to be indigenous in Europe, but during the last ice age became extinct from most of their range except Sicily, the Balkan Peninsula and Anatolia. Research suggests that after the Middle Ages the indigenous population only survived in Anatolia (today’s Turkey and Iran), so all present worldwide fallow deer populations were reintroduced from there. In Croatia, the species is mostly kept in fenced areas, while breeding in open hunting grounds or farms is rare. The goal of our research was to analyze the genetic diversity of fallow deer that live in the open grasslands of the Croatian island Veliki Brijun on an area of 5.72 km2. DNA was isolated from the muscle tissue of 22 animals and 405 base pairs of mitochondrial DNA control region were sequenced. One polymorphic site and two haplotypes were detected, both matching sequences from Germany, while one of the haplotypes was also previously detected in fallow deer in Hungary and Italy. The mtDNA diversity of Dama dama from Brijuni National park was rather low but, considering the island’s isolation, the obtained results were in accordance with the diversity of previously researched European continental populations of fallow deer.Jelen lopatar (Dama dama) jedna je od najvažnijih vrsta divljači u Europi, a na farmama diljem svijeta uzgaja se oko 5 milijuna ovih životinja. Smatra se da je vrsta autohtona u Europi, no tijekom posljednjeg ledenog doba izumrla je iz svih staništa osim Sicilije, Balkanskog poluotoka i Anatolije. Istraživanja pokazuju da je nakon srednjega vijeka autohtona populacija lopatara opstala samo u Anatoliji (današnja Turska i Iran) te da su sve današnje populacije reintroducirane iz tog područja. U Hrvatskoj je lopatar prisutan prije svega u gaterskim uzgojima, dok je slabije zastupljen u otvorenim lovištima i farmskom uzgoju. Cilj ovoga istraživanja bio je analizirati genetsku raznolikost slobodnoživuće populacije jelena lopatara na hrvatskom otoku Veliki Brijun, površine 5,72 km2. DNK je izolirana iz uzoraka mišićnog tkiva 22 različite životinje. Analizirani su sljedovi kontrolne regije mitohondrijske DNK ukupne dužine 405 parova baza te je utvrđeno jedno polimorfno mjesto koje definira dva haplotipa. Dobiveni sljedovi kontrolne regije mtDNK uspoređeni su s ostalim sljedovima pohranjenima u GenBank te su pronađene podudarnosti s uzorcima iz Njemačke kod oba haplotipa, a jedan se pojavljuje i u lopatara u Mađarskoj i Italiji. Raznolikost mtDNK jelena lopatara iz NP Brijuni prilično je niska, no s obzirom na otočnu izoliranost populacije takvi su rezultati u skladu s dosadašnjim istraživanjima europskih populacija jelena lopatara

In vitro/in silico ispitivanje lekovite supstance i tableta telmisartana

Telmisartan acts as antagonist of angiotensin II type-1 (AT1) receptor and is indicated in the treatment of essential hypertension. In order to rationalize the pharmacokinetic characteristics, pharmacological activity, as well as the optimal method of administration of this drug, knowledge of its physico-chemical properties is needed. The assessment of the drug physico-chemical parameters on the basis of its chemical structure at different pH values, which are characteristic for physiological conditions, enables the prediction of its behaviour in the body before the drug is synthesized. Such assessment of its physico-chemical parameters during the preformulation phase is important for the development of a safe, efficient and stable dosage form. Based on the calculated pKa values, this paper is focused on the prediction of distribution of the ionized and nonionized drug species in the pH gradient of 1 to 8 and the calculation of physico-chemical parameters such as telmisartan lipophilicity (log P) and intrinsic solubility (log S0). On the basis of the calculated physicochemical parameters, the pH-dependent solubility and lipophilicity curves of this medicinal substance have been constructed. The assessment of intrinsic dissolution rate and dissolution rate of telmisartan from tablets was used to investigate the influence of medium pH values applied on the model substance behavior. The results obtained from predicting the physico-chemical properties and from experimental evaluation of the model substance intrinsic dissolution rate and telmisartan dissolution rate from tablets, indicate the importance of physico-chemical characterization of the active substance during the preformulation investigation for predicting the drug behaviour in the body (absorption, bioavailability, tissue penetration, elimination). .Telmisartan deluje kao antagonista angiotenzinskog II tipa-1 (AT1) receptora i indikovan je u terapiji esencijalne hipertenzije. Da bi se razjasnile farmakokinetičke osobine, farmakološka aktivnost, kao i optimalni način primene ove lekovite supstance, potrebno je poznavanje njenih fizičko-hemijskih osobina. Određivanje fizičko-hemijskih parametara lekovite supstance na osnovu hemijske strukture pri različitim pH vrednostima koje su karakteristične za fiziološke uslove omogućava predviđanje njenog ponašanja u organizmu pre nego što se lekovita supstanca sintetiše. Određivanje fizičko-hemijskih parametara u toku preformulacionih ispitivanja značajno je za razvijanje bezbednog, efikasnog i stabilnog farmaceutskog oblika. U ovom radu je, na osnovu izračunatih pKa vrednosti, izvršeno predviđanje raspodele jonizovanih i nejonizivanog oblika lekovite supstance u pH gradijentu od 1 do 8 i izračunavanje fizičko-hemijskih parametara telmisartana kao što su lipofilnost (log P) i osnovna rastvorljivost (log S0). Na osnovu izračunatih fizičko-hemijskih parametara konstruisane su krive pH-zavisne rastvorljivosti i lipofilnosti ove lekovite supstance. Određivanjem osnovnih brzina rastvaranja i brzina rastvaranja telmisartana iz tableta ispitan je uticaj pH vrednosti primenjenog medijuma na ponašanje model supstance. Rezultati dobijeni predviđanjem fizičko-hemijskih osobina, kao i eksperimentalnim određivanjem osnovne brzine rastvaranja model supstance i brzine rastvaranja telmisartana iz tableta ukazuju na značaj fizičko-hemijske karakterizacije aktivne supstance tokom preformulacionih ispitivanja za predviđanje njenog ponašanja u organizmu (resorpcije, biološke raspoloživosti, penetracije u tkiva, eliminacije)