Advances in diagnostics and successful repair of proximal posttraumatic superior mesenteric arteriovenous fistula

Posttraumatic arteriovenous fistulas affecting the superior mesenteric artery and vein are extremely rare. Twenty-four cases of posttraumatic superior mesenteric arteriovenous fistulas (SMAVFs) have been reported. We presented two cases of SMAVFs occurring in a young woman and man secondary to a gunshot and a grenade shrapnel wound in the epigastrium, respectively. Nausea, heartburn, emesis, and cramping abdominal pain were the clinical signs of SMAVF. Abdominal pains, particularly after meals, tense and meteoristic abdomen, frequent liquid bowel movements, oliguria, subfebrility, abdominal thrill, and bruit were also present. Abdominal duplex ultrasonic scanning and computed tomograms with a contrast agent were especially useful screening tools. As our results demonstrated, those methods were not only suitable for clinical use, but were also as good as arteriography in defining both the exact location and the extent of the mesenteric vessel involvement. However, the superior mesenteric arteriogram remains mandatory for complete preoperative evaluation. Arteriovenous fistulas were successfully treated by suturing the arterial and venous sides of the fistula in one case, and resectioning the fistula and end-to-end anastomosis in the other case.

War injuries of the femoral artery and vein: a report on 67 cases

During the war in Croatia (from May 1991 to December 1995), 67 patients with war injuries of the femoral vein and/or artery were treated at the Surgical Clinic of Split Clinical Hospital. All the wounded were admitted directly from the battlefield or from front-line hospitals. There were five women and 62 men with a median age of 29 (range 15-54) years. There were 70 arterial (28 isolated) and 49 venous injuries (six isolated). Forty-six arterial injuries were repaired by reverse vein graft. Four proximal profound femoral arteries were reconstructed. Major venous injuries were repaired, 11 by compilation autogenous vein graft. No synthetic grafts were used. Repair of veins with large defects using compilation saphenous vein grafts gave good results. Six profound femoral veins and two superficial femoral veins were ligated. Vein ligation should be avoided unless another life-threatening injury demands priority. Twenty-one patients required open prophylactic fasciotomy. Two patients died (3%) and three ultimately underwent amputation (5%). Intermittent hyperbaric oxygen therapy was given to 18 heavily wounded patients with beneficial effect. The results support an immediate and coordinated approach to femoral vascular trauma with repair of arterial and venous injuries.

Benchmarking Attention-Based Interpretability of Deep Learning in Multivariate Time Series Predictions

The adaptation of deep learning models within safety-critical systems cannot rely only on good prediction performance but needs to provide interpretable and robust explanations for their decisions. When modeling complex sequences, attention mechanisms are regarded as the established approach to support deep neural networks with intrinsic interpretability. This paper focuses on the emerging trend of specifically designing diagnostic datasets for understanding the inner workings of attention mechanism based deep learning models for multivariate forecasting tasks. We design a novel benchmark of synthetically designed datasets with the transparent underlying generating process of multiple time series interactions with increasing complexity. The benchmark enables empirical evaluation of the performance of attention based deep neural networks in three different aspects: (i) prediction performance score, (ii) interpretability correctness, (iii) sensitivity analysis. Our analysis shows that although most models have satisfying and stable prediction performance results, they often fail to give correct interpretability. The only model with both a satisfying performance score and correct interpretability is IMV-LSTM, capturing both autocorrelations and crosscorrelations between multiple time series. Interestingly, while evaluating IMV-LSTM on simulated data from statistical and mechanistic models, the correctness of interpretability increases with more complex datasets.

From statistical inference to machine learning: A paradigm shift in contemporary cardiovascular pharmacotherapy

AIMS

Heart failure with reduced ejection fraction (HFrEF) poses significant challenges for clinicians and researchers, owing to its multifaceted aetiology and complex treatment regimens. In light of this, artificial intelligence methods offer an innovative approach to identifying relationships within complex clinical datasets. Our study aims to explore the potential for machine learning algorithms to provide deeper insights into datasets of HFrEF patients.

METHODS

To this end, we analysed a cohort of 386 HFrEF patients who had been initiated on sodium-glucose co-transporter-2 inhibitor treatment and had completed a minimum of a 6-month follow-up.

RESULTS

In traditional frequentist statistical analyses, patients receiving the highest doses of beta-blockers (BBs) (chi-square test, P = .036) and those newly initiated on sacubitril-valsartan (chi-square test, P = .023) showed better outcomes. However, none of these pharmacological features stood out as independent predictors of improved outcomes in the Cox proportional hazards model. In contrast, when employing eXtreme Gradient Boosting (XGBoost) algorithms in conjunction with the data using Shapley additive explanations (SHAP), we identified several models with significant predictive power. The XGBoost algorithm inherently accommodates non-linear distribution, multicollinearity and confounding. Within this framework, pharmacological categories like 'newly initiated treatment with sacubitril/valsartan' and 'BB dose escalation' emerged as strong predictors of long-term outcomes.

CONCLUSIONS

In this manuscript, we not only emphasize the strengths of this machine learning approach but also discuss its potential limitations and the risk of identifying statistically significant yet clinically irrelevant predictors.

[The lungs in human immunodeficiency virus type 1 infection]

This report describes a case of two patients who were admitted to the Zadar hospital and according to clinical symptoms directed to the Department of Lung Diseases. Both patients were temporarily employed abroad. It has been established that they were infected with human immunodeficiency virus type 1 (HIV-1). One of the patients has been moved to the Department of Infectious Diseases and later to Zagreb, while the other has returned abroad. On admission to the hospital of the Zadar Medical Center none of them answered the question about being engaged in risky behavior. In 1990 there were 699 registered patients hospitalized and 745 registered in the protocol of the Outpatient Clinic of the Department of Lung Diseases. 0.069% of patients were HIV-1-infected. In 1991, there were 520 hospitalized and 453 outpatients, whereas 0.102% were HIV-1-infected and registered subjects. It must be pointed out that these are only numbers of registration and not subjects, because there were patients who were examined or hospitalized twice or more times during the corresponding calendar year. The aim of this study was to point to a new differentially-diagnostic problem present especially at the Department of Lung Diseases after AIDS has become part of our reality. There still remains a problem in regard to detection of HIV-1 seropositivity in patients at departments with opportunistic infections such as tuberculosis.

[Retrospective study of echinococcosis in the Zadar region from 1960 to 1990]

Seven hundred and thirty-six patients with human echinococcosis admitted to the Zadar General Hospital between 1960 and 1990 were studied. Seven hundred and seventeen patients were residents of Zadar region, while 19 were referred from other areas. There were more females (61%) than males (39%) in our study, with the majority of patients (208 individuals) being in the age group of 60 years and more. Among the examinees, the largest number were housewives (42%). 59.1 percent of echinococcus was found in the liver, 22.7% in the lungs and 3.4% in the spleen. There was a significant difference between surgically treated and untreated patients (p < 0.01) as well as between cured and uncured ones (p < 0.01). Over the studied period, there were approximately 24 new cases and 23.74, respectively. The incidence rate per 100,000 inhabitants for 1990 was 12.74. The decrease of incidence was 83.13%. The prognosis made in 1978 for specific morbidity in 1990 was 9.051 approximately 9, and 3.682 approximately 4 for realized specific morbidity. In 1990, the density of population in Zadar region was 68.2 inhabitants/km2. The number of inhabitants per 1 km2 on the mainland within the same year was 79.9, while on the islands it was 29.2 inhabitants/km2. In order to make a comparison, density of population in 1980 was calculated. The number of population amounted to 66.1 inhabitants/km2. In 1980, there were 75.8 inhabitants/km2 on the mainland, and 35.2 inhabitants per 1 km2 on the islands of the Zadar region. In 1990 the number of inhabitants on the islands decreased, although the overall number of inhabitants of that region increased.

[Q-fever in the Zadar region]

The occurrence of Q fever in a population of Zadar region (2787 km2) which has five microregions (Zadar, Benkovac, Biograd, Obrovac and Pag microregion) is presented. In 1986, nine cases of Q fever were reported. Five patients were detected in Zadar community, one in Pag microregion and 3 in Biograd community and microregion, respectively. In 1989, two cases in Zadar and, in 1988 and 1991, one case in each year from the territory of Zadar were found. A total of 13 cases of Q fever were treated and reported. The personnel of the Zadar Veterinary Stations were not able to provide information since blood samples from the suspected animals were not taken. The agent was therefore not isolated. It is known that there were more serologically proven cases of Q fever, but they were not registered by the Epidemiologic Service of the Zadar Department for Health Protection. Clinical manifestation in a form of pulmonary affection is a very significant data in this zoonosis and it is therefore most commonly detected at the hospital departments for lung diseases, what was one of the reasons for undertaking this study.

Efficient genome monomer higher-order structure annotation and identification using the GRMhor algorithm

Motivation

Tandem monomeric units, integral components of eukaryotic genomes, form higher-order repeat (HOR) structures that play crucial roles in maintaining chromosome integrity and regulating gene expression and protein abundance. Given their significant influence on processes such as evolution, chromosome segregation, and disease, developing a sensitive and automated tool for identifying HORs across diverse genomic sequences is essential.

Results

In this study, we applied the GRMhor (Global Repeat Map hor) algorithm to analyse the centromeric region of chromosome 20 in three individual human genomes, as well as in the centromeric regions of three higher primates. In all three human genomes, we identified six distinct HOR arrays, which revealed significantly greater differences in the number of canonical and variant copies, as well as in their overall structure, than would be expected given the 99.9% genetic similarity among humans. Furthermore, our analysis of higher primate genomes, which revealed entirely different HOR sequences, indicates a much larger genomic divergence between humans and higher primates than previously recognized. These results underscore the suitability of the GRMhor algorithm for studying specificities in individual genomes, particularly those involving repetitive monomers in centromere structure, which is essential for proper chromosome segregation during cell division, while also highlighting its utility in exploring centromere evolution and other repetitive genomic regions.

Availability and implementation

Source code and example binaries freely available for download at github.com/gluncic/GRM2023.

Military injuries to the popliteal vessels in Croatia

OBJECTIVE

The paper reviews military popliteal vascular injuries in Croatia.

SUMMARY BACKGROUND DATA

Popliteal vascular injuries still pose difficult problems for vascular surgeons despite improvements in resuscitation, surgical techniques and wound coverage. Popliteal vascular injuries, both arterial and venous, with a high incidence of associated musculoskeletal injuries are presented in patients with military injuries in South Croatia.

METHODS

26 wounded with popliteal vascular injuries are presented. Explosive injuries are found in 21 and associated fractures in 9 cases. In immediate repair group the time interval between trauma and surgery was 2 to 30 hours (average 9.8 hours). In the delayed repair group the interval between trauma and surgery was 11 days to 24 days.

RESULTS

21 out of 26 patients with popliteal vascular injuries had combined arterial and venous injuries; 4 patients had isolated popliteal arterial injuries, while 8 patients had other vascular injuries along with the popliteal ones; 8 amputations resulted (30.8%).

CONCLUSION

Popliteal vascular injuries caused by typical military mechanism during the war in Croatia present large and extensive defects of tissues and bones, are often associated with other injuries and require more extensive surgical therapy. Evacuation of the wounded under very difficult conditions as well as considerable organization and transportation problems are characteristic for this war and greatly affect the success of vascular reconstruction. Hyperbaric oxygen therapy offers a safe noninvasive method of improving wound healing and decreasing edema formation in popliteal vascular injuries.

Mechanistic investigation of charge-remote and charge-driven fragmentation processes in 2,5-diphenyl-3,4-ethylenedioxythiophene diamidines

RATIONALE

Diphenylfuran diamidines represent an important class of DNA minor groove binders of high therapeutic interest as antitumor and antibacterial agents. This study aimed to investigate fragmentation patterns in mass spectra of four diamidine derivatives with significant antitumor activity, in order to gain more insight into the structures and stability of their putative biological metabolites.

METHODS

Compounds were investigated by electrospray ionization tandem mass spectrometry (ESI-MS/MS) using low-energy collision-induced dissociation (CID). Density functional theory calculations were performed to confirm the main fragmentation paths.

RESULTS

The most abundant ion present in mass spectra is the doubly protonated molecule, whereas singly protonated molecules are present to a lesser extent. In the simplest compound, 2,5-bis(4-amidinophenyl)-3,4-ethylenedioxythiophene, the main fragmentation path was loss of ammonia, followed by loss of HCN where possible. The fragmentation of the N-alkyl derivatives (N-isopropyl-, N-isobutyl-, N-cyclopentyl-) includes competition between loss of alkene and the corresponding amine, followed by loss of another alkene and formation of fragment ions present in the pathway of the parent compound.

CONCLUSIONS

The primary sites of fragmentations of investigated compounds are amidine groups, while breaking the core 3,4-ethylenedioxythiophene ring system does not take place. Fragmentation of the singly protonated molecule [M + H](+) occurs primarily on the charged side of the molecule, but a charge-remote process is energetically viable. The fragmentation mechanism of the alkyl derivatives revealed that singly and doubly protonated molecules cleave to the singly and doubly protonated molecules of the parent compound. Once formed, they are gradually transformed into nitrile. Copyright © 2016 John Wiley & Sons, Ltd.