Browsing by Author "Vojvodić, Danilo (6603787420)"

Background/Aim. Melanoma is the most aggresive malignant tumor of the skin. Contradictory data was published on vascular endothelial growth factor (VGEF) in tumor samples and its role in skin melanoma progression and prognosis. The aim of this study was to investigate the significance of VEGF expression as a prognostic parameter in melanoma. Methods. The experimental group included 81 patients with primary skin melanomas treated from 2009 to 2013 at the Military Medical Academy, Belgrade. The control group included 20 patients with dysplastic and 20 with benign naevi. Stratification was done according to gender, age, clinical and patological stage, localization, histologic type, Clark’s, Breslow, mitotic count, regression and ulceration, tumor infiltrating lymphocytes and metastatic spread. Immunohistochemical staining was performed on skin biopsies using DAKO anti-VEGF antibodies (Ab), LSAB™ +HRP, DAB and microvawe antigen (Ag) retrieval in DAKO pH 9.0 solution. For statistical data analysis was done with ANOVA, Bonferroni, Mann Whitney and Wilcoxon test. Results. The mean intensity of VEGF staining was statistically significantly higher in melanomas than in benign or dysplastic naevi. Furthermore, the highest re-corded values were in Ia and IV clinical stages. The majority of melanomas with high intensity of VEGF staining were in pT1a pathological stage. Melanomas with the highest mitotic count (> 6) had a significantly higher intensity of VEGF staining than those with < 2 mitoses. The higest intensity of staining was in melanomas without significant lymphocytic infiltrate and the lowest was in those with brisk lymphocytic infiltrate, thus a statistical difference was siginifant. The mean intensity of VEGF staining was highest in melanomas with lymphovascular invasion. There was no statistically significant difference between VEGF and any other parameter. Conclusion. VEGF in primary skin mela-omas plays an important role in tumor progression and is linked to the absence if tumor infiltrating lymphocytes and the presence of lymphovascular invasion. More detailed studies have to be done on VEGF prognostic value in melanoma on a larger number of patients. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Clara cell protein 16 (CC16) is a small protein mainly produced by non-ciliated Clara cells in the respiratory epithelium. It has an anti-inflammatory role in chronic upper and lower airway eosinophilic inflammations. Decreased levels of CC16 are found in the nasal secretions and plasma of patients with chronic eosinophilic inflammatory disorders, such as asthma, allergic rhinitis, and chronic rhinosinusitis with or without nasal polyps, as well as in people exposed to high levels of air pollutants. Intranasal corticosteroid administration suppresses chronic inflammation of the nasal mucosa driven by eosinophils and stimulates local CC16 production. CC16 can be a reliable biomarker of the beneficial effects of perennial allergic rhinitis and chronic rhinosinusitis therapy and of the functional recovery of the nasal mucosa after treatment with topical glucocorticoids. © E-flow Walter de Gruyter 2018. All rights reserved.

Clara cell protein 16 (CC16) is a small protein mainly produced by non-ciliated Clara cells in the respiratory epithelium. It has an anti-inflammatory role in chronic upper and lower airway eosinophilic inflammations. Decreased levels of CC16 are found in the nasal secretions and plasma of patients with chronic eosinophilic inflammatory disorders, such as asthma, allergic rhinitis, and chronic rhinosinusitis with or without nasal polyps, as well as in people exposed to high levels of air pollutants. Intranasal corticosteroid administration suppresses chronic inflammation of the nasal mucosa driven by eosinophils and stimulates local CC16 production. CC16 can be a reliable biomarker of the beneficial effects of perennial allergic rhinitis and chronic rhinosinusitis therapy and of the functional recovery of the nasal mucosa after treatment with topical glucocorticoids. © E-flow Walter de Gruyter 2018. All rights reserved.

Background/Aim. Survivin is a multifunctional protein abundantly expressed in tumors of various types, including melanoma. There are still sparse data regarding relationship of melanoma cell survivin expression with accepted histopathological characteristics as well as serum concentration. The aim of this study was to investigate the association of local tumor survivin expression (primary tumor and metastatic lesions) and serum concentration with clinical and histopathological parameters in melanoma patients. Methods. The level of survivin expression was determined immunocy-tochemically in tumor tissue and with ELISA test in the serum of 84 melanoma patients diagnosed from 2009 to 2013 at the Institute for Pathology and Forensic Medicine and Institute for Medical Research at Military Medical Academy, Belgrade, Serbia. Results. The intensity of survivin expression was significantly higher in the patients whose tumor had ulceration, higher mitotic index, higher Clark and Breslow stage, that made vascular invasion or spread through lymphatic vessels in primary tumor, and was significantly higher in the patients with metastatic disease. Survivin expression and the number of survivin positive cells in metastatic lesions were significantly associated with the duration of disease free interval (DFI). The patients with high expression score had almost double shorter DFI comparing to those with weak local survivin expression and a small number of survivin+ cells (9 ± 7 vs 19 ± 13 months, respectively). The degree of tumor infiltrating lymphocytes presence in tumor tissue was significantly associated with serum survivin concentration, with lowest average level detected in samples of patients with the highest degree of infiltration. Serum survivin concentrations were highest in samples of melanoma patients with IA American Joint Commission on Cancer (AJCC) clinical stage, pT1a histological stage, patients whose tumors were still in horizontal growth phase, without signs of lympho-hematological disease spreading, with the highest number of mitoses and the smallest Clark index. Conclusion. Survivin expression in tumor tissue and its serum concetration significantly correlate with clinical and histopathological parameters. Serum levels could be important in initial followup as indicators of those patients that would have aggressive local tumor growth and spreading. Survivin determination in tumor tissue is of great significance in estimation of DFI. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Background: Previous investigations suggest the use of extract from the roots of Pelargonium sidoides (EPs 7630) for the therapy of uncomplicated rhinosinusitis. The aim of this prospective study was to compare the effects of herbal drug EPs 7630 and antibiotic roxithromycin on chemokine production in nasal mucosa and clinical parameters in patients with uncomplicated acute bacterial rhinosinusitis (ABRS). Methods: Seventy-eight ABRS patients were divided into 26 patients receiving EPs 7630 tablets, 3 × 20 mg/day per os (group 1), 26 patients receiving roxithromycin tablets, 2 × 150 mg/day per os (group 2), both for 10 days, and 26 patients who received no therapy (Control group). We measured chemokine levels in nasal secretions by flow cytometry and assessed clinical parameters on day 0 and day 10 of investigation. Results: EPs 7630 increased concentrations of MCP-1 (P =.001) and IP-10 (P =.049) and decreased levels of MIP-1α (P <.001), ENA-78 (P <.001), and IL-8 (P <.001). Roxithromycin increased levels of IP-10 (P =.049) and decreased levels of MCP-1 (P <.001), MIP-1α (P <.016), ENA-78 (P <.001), and IL-8 (P <.001). Comparison of the non-treated patients' group with groups 1 and 2 revealed significant improvement of all clinical parameters in treated patients (P <.001), but therapy with roxithromycin resulted in better improvement in nasal symptoms and endoscopic findings than therapy with EPs 7630. Conclusion: Our results suggest the presence of similar modulatory effects of both therapies on production of chemokines that regulate the function of neutrophils and monocytes in nasal mucosa. Roxithromycin shows better clinical efficacy than EPs 7630 in patients with uncomplicated ABRS. Level of Evidence: 1b. © 2020 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC. on behalf of The Triological Society.

Objective: Eotaxin-2 and regulated on activation normal T cell expressed and secreted (RANTES) are involved in the eosinophil trafficking in patients with persistent allergic rhinitis (PAR). Clara cell protein 16 (CC16) is an anti-inflammatory protein mainly produced by the epithelial non-ciliated Clara cells. The aim of this study was to investigate the production of CC16 and chemokines eotaxin-2 and RANTES in nasal mucosa of patients with PAR. Materials and Methods: Twenty-one PAR patients and 20 healthy participants were included. CC16, eotaxin- 2, and RANTES concentrations were measured in nasal secretions. PAR patients were administered fluticasone furoate nasal spray (220 µg daily for 14 days). We performed nasal cytology, symptom score assessment, and inflammatory mediator detection before and after the therapy. Results: The level of CC16 in patients with PAR was lower than in the healthy subjects (p=0.023). The eosinophil counts and local concentrations of eotaxin-2 and RANTES were higher in patients with PAR in comparison with controls (p=0.008, p=0.001, p=0.031, respectively). We also found a negative correlation between the CC16 and eotaxin-2 levels in nasal secretions of PAR patients (r=-0.492, p=0.023). After corticosteroid therapy, the patients with PAR had lower nasal symptoms, eosinophil counts, eotaxin-2, and RANTES levels and higher levels of CC16 (p<0.001 for all parameters). Conclusion: Our results suggest the presence of a negative correlation in production of CC16 and eotaxin-2 in nasal mucosa of patients with PAR. Intranasal corticosteroids have a suppressive effect on mucosal eosinophilic inflammation and a stimulating effect on local CC16 production. © 2017 by the Atatürk University School of Medicine.

Objective: The role of neurogenic inflammation in pathogenesis of chronic rhinitis is well known. However, very little is known about its importance in pathogenesis of nasal polyposis (NP), especially in form of NP which appears as a part of aspirin-exacerbated respiratory disease (AERD). The aim of this study was to examine the concentrations of neuropeptides substance P (SP) and bradykinin (BK) in nasal secretions of patients with NP. Methods: Fourteen patients with NP as a part of AERD with mild persistent asthma, 14 patients with NP without aspirin sensitivity, and 14 control subjects without nasal inflammation (C) entered this cross-sectional study. Clinical parameters (symptoms, endoscopic, and radiological findings) were assessed. The concentrations of SP and BK were measured in the nasal secretion samples using commercial human enzyme immunoassay kits. Results: The concentration of SP in nasal secretions was significantly higher in NP patients without aspirin sensitivity and AERD patients compared to controls (p =.022; p <.0001, respectively), but higher in AERD than in non-AERD patients (p =.018). The level of BK in nasal fluid was higher in non-AERD and AERD NP patients than in controls (p <.0001; p <.0001, respectively), but also higher in AERD than in non-AERD patients (p <.0001). We found high positive correlations between BK in nasal fluid and Lund–Mackay computed tomography (CT) score in both non-AERD and AERD groups of NP patients. Conclusion: Our results suggest more intense release of SP and BK from the nasal mucosa in patients with AERD than in patients with NP who do not have aspirin sensitivity. The strong correlation between concentration of BK in nasal secretions and CT score suggests that BK in nasal fluid could be used as a marker for disease severity as measured by the Lund–Mackay score. © 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.

Objective: To explore glucose metabolism in rheumatoid arthritis (RA) and its association with insulin resistance (IR) risk factors and disease activity indicators, including matrix metalloproteinase-3 (MMP3). Methods: This single-center study included 127 non-diabetic subjects: 90 RA patients and 37 matched controls. IR-related risk factors, disease activity (DAS28-ESR/CRP), concentrations of inflammation markers, MMP3, glucose, specific insulin, and C-peptide (a marker of β-cell secretion) were determined. Homeostasis Model Assessment was used to establish insulin resistance (HOMA2-IR) and sensitivity (HOMA2-%S). Associations of HOMA2 indices with IR-related risk factors, inflammation markers, and RA activity were tested using multiple regression analyses. Results: RA patients had significantly increased HOMA2-IR index than controls. In the RA group, multivariate analysis revealed DAS28-ESR, DAS28-CRP, tender joint counts, patient’s global assessment, and MMP3 level as significant positive predictors for HOMA2-IR (β = 0.206, P = 0.014; β = 0.192, P = 0.009; β = 0.121, P = 0.005; β = 0.148, P = 0.007; β = 0.075, P = 0.025, respectively), and reciprocal negative for HOMA2-%S index. According to the value of the coefficient of determination (R2), DAS28-ESR ≥ 5.1 has the largest proportion of variation in both HOMA2-IR indices. DAS28-ESR ≥ 5.1 and ESR were independent predictors for increased C-peptide concentration (β = 0.090, P = 0.022; β = 0.133, P = 0.022). Despite comparability regarding all IR-related risk factors, patients with DAS28-ESR ≥ 5.1 had higher HOMA2-IR than controls [1.7 (1.2–2.5) vs. 1.2 (0.8–1.4), P = 0.000]. There was no difference between patients with DAS28-ESR < 5.1 and controls [1.3 (0.9–1.9) vs. 1.2 (0.8–1.4), P = 0.375]. Conclusions: RA activity is an independent risk factor for impaired glucose metabolism. DAS28-ESR ≥ 5.1 was the main contributor to this metabolic disturbance, followed by MMP3 concentration, outweighing the impact of classic IR-related risk factors. © 2021, The Author(s).

Objective: To explore glucose metabolism in rheumatoid arthritis (RA) and its association with insulin resistance (IR) risk factors and disease activity indicators, including matrix metalloproteinase-3 (MMP3). Methods: This single-center study included 127 non-diabetic subjects: 90 RA patients and 37 matched controls. IR-related risk factors, disease activity (DAS28-ESR/CRP), concentrations of inflammation markers, MMP3, glucose, specific insulin, and C-peptide (a marker of β-cell secretion) were determined. Homeostasis Model Assessment was used to establish insulin resistance (HOMA2-IR) and sensitivity (HOMA2-%S). Associations of HOMA2 indices with IR-related risk factors, inflammation markers, and RA activity were tested using multiple regression analyses. Results: RA patients had significantly increased HOMA2-IR index than controls. In the RA group, multivariate analysis revealed DAS28-ESR, DAS28-CRP, tender joint counts, patient’s global assessment, and MMP3 level as significant positive predictors for HOMA2-IR (β = 0.206, P = 0.014; β = 0.192, P = 0.009; β = 0.121, P = 0.005; β = 0.148, P = 0.007; β = 0.075, P = 0.025, respectively), and reciprocal negative for HOMA2-%S index. According to the value of the coefficient of determination (R2), DAS28-ESR ≥ 5.1 has the largest proportion of variation in both HOMA2-IR indices. DAS28-ESR ≥ 5.1 and ESR were independent predictors for increased C-peptide concentration (β = 0.090, P = 0.022; β = 0.133, P = 0.022). Despite comparability regarding all IR-related risk factors, patients with DAS28-ESR ≥ 5.1 had higher HOMA2-IR than controls [1.7 (1.2–2.5) vs. 1.2 (0.8–1.4), P = 0.000]. There was no difference between patients with DAS28-ESR < 5.1 and controls [1.3 (0.9–1.9) vs. 1.2 (0.8–1.4), P = 0.375]. Conclusions: RA activity is an independent risk factor for impaired glucose metabolism. DAS28-ESR ≥ 5.1 was the main contributor to this metabolic disturbance, followed by MMP3 concentration, outweighing the impact of classic IR-related risk factors. © 2021, The Author(s).

Background: Premature ovarian failure (POF) can be found in 1% of women at the age of 35-40, mos‌tly due to un-known causes. PI3K-Akt signaling is associated with both ovarian function and growth of primordial follicles. In this s‌tudy, we examined the effects of autologous in vitro ovarian activation with s‌tem cells and autologous growth factors on reproductive and endocrine function in patients with ovarian impairment. Materials and Methods: The longitudinal prospective observational s‌tudy included 50 patients (between 30 and 50 years) with a diagnosis of POF and infertility. This multicenter s‌tudy was performed at Jevremova Special Hospital in Belgrade, Saint James Hospital (Malta), and Remedica Skoplje Hospital, between 2015 and 2018. All patients went through numerous laboratory tes‌tings, including hormonal s‌tatus. The autologous bone marrow mesenchymal s‌tem cells (BMSCs) and growth factors were used in combination for activation of ovarian tissue before its re-transplanta-tion. The software package SPSS 20.0 was used for s‌tatis‌tical analysis of the results. Results: Differences in follicle s‌timulating hormone (FSH), luteinizing hormone (LH), es‌tradiol (E2), and proges‌ter-one (PG) hormone concentrations before and after 3, 6, and 12 months pos‌t-transplantation were tes‌ted in correlation with the volume of transplanted ovarian tissue. A significant correlation (P=0.029) was found between the change in E2 level after 3 months and the volume of re-transplanted tissues. Also after re-transplantation, 64% of the patients had follicles resulting in aspiration of oocytes in 25% of positive women with follicles. Conclusion: The SEGOVA method could potentially solve many human reproductive problems in the future due to the large number of patients diagnosed with POF, as well as the possibility of delaying menopause, thus improving the quality of life and general health (Regis‌tration number: NCT04009473). © 2021, Royan Institute (ACECR). All rights reserved.

Purpose: Otitis media with effusion (OME) associated with Samter’s triad (ST) is a difficult entity to treat. The aim of study was an investigation of the middle ear and nasal production of inflammatory mediators (IM) in patients with ST and analysing differences between them and controls. Methods: Prospective case–control study. Nineteen patients with OME (five had allergic rhinitis, four had nasopharyngeal lymphoid hyperplasia, five had no evident sino-nasopharyngeal disease and five had confirmed ST) and 15 healthy participants were included. The concentrations of IM interleukin–1 beta (IL-1β), interferon-alpha 2 (IFN-α2), interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), IL-6, IL-8, IL-10, IL-12p70, IL-17A, IL-18, IL-23 and IL-33 were measured in nasal and middle ear secretions. Results: There was a difference that was close to a level of statistical significance only for IL-1β levels in middle ear fluid (p = 0.052) between the ST subgroup and the other patients with OME. Also, we found a significant difference for IL-23 in nasal secretions between these subgroups (p = 0.040), whereas the difference in nasal fluid IL-33 was close to a level of statistical significance (p = 0.052). There was a significant difference in nasal concentrations of IL-1β, IFN-α2, MCP-1, IL-8, IL-18 and IL-33 (p < 0.001, p = 0.005, p = 0.008, p = 0.011, p = 0.011 and p = 0.011, respectively) between the OME group and the healthy subjects. There were significant positive correlations between concentrations of IL-1β, IFN-α2, IFN-γ, TNF-α, MCP-1, IL-17A, IL-18 and IL-33 (p < 0.001, p < 0.001, p = 0.002, p = 0.028, p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively) in nasal and middle ear secretions. Conclusion: This preliminary report showed some differences in IM production between the patients with OME associated with ST and those without it. Our results suggest a uniformity of the production of nasal and middle ear IM and supported the concept of a united airway respiratory disease. © 2020, Springer-Verlag GmbH Germany, part of Springer Nature.

Background/Aim. Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2) 2019 infection represents a global problem. At this moment, in October 2020, there is no vaccine or efficient treatment for infected patients. Treatment with blood plasma rich with anti-SARS-CoV-2 specific antibodies might be a safe, and effective therapy for COVID-19 patients. Methods. A total of 768 patients were analyzed in this study, whose samples were collected in a time interval from May 1, 2020, till August 15, 2020. Patients were enrolled in the study from COVID-19 hospitals and out-clinics. In-house ELISA tests were developed to measure the concentration of anti-S1S2 spike and anti-nucleoprotein (np) (IgG, IgA, IgM) SARS-CoV-2 antibodies. Blood convalescent plasma was selectively collected from recovered patients according to specific antibodies concentration. Results. The highest concentrations of anti-S1S2 spike or anti-np specific IgG antibodies were detected in patients with the moderate/heavy clinical form of the infection. An extremely high concentration of anti-S1S2 spike IgG and anti-np IgG was demonstrated in 3% and 6% of patients who recovered from severe COVID-19, respectively. Of tested hospitalized patients, 63% and 51% had modest levels of anti-S1S2 spike and anti-np, respectively. After 60 days, in our selected donors, concentrations of antiS1S2 spike IgG and anti-np IgG antibodies increased in 67% and 58% of donors, respectively. Conclusion. In-house developed ELISA tests enable a novel protocol for selecting convalescent blood plasma donors recovered from SARS-CoV-2 infection. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Background/Aim. Stem cells (SCs) guarantee complete/ long-term bone marrow (BM) repopulation after SCtransplants. The aim of the study was to evaluate absolute count of total SCs (determined by ISHAGE-sequential-gating protocol – SCish) and relative frequency of immature CD34+/CD90+ (CD90+SCish) subset in peripheral blood (PB) as predictive factors of mobilization and apheresis product (AP) quality. Methods. Mobilization included chemotherapy and granulocyte-growth-factor (G-CSF). Harvesting was performed by Spectra-Optia-IDL-system. The SCsish were determined as a constitutional part of CD34+ cells in the “stemcell- region” using FC-500 flow-cytometer. In this study, the original ISHAGE-sequential-gating protocol was modified by introduction of anti-CD90-PE monoclonal-antibody into the analysis of CD90 expression on SCish (CD90+SCish). The results were presented as a percentage of SCish per nucleatedcell count, absolute SCish count in μL of the PB or the AP, percentage of the CD90+SCish expressed to SCish and absolute CD90+SCish count in μL of the PB or the AP. Results. The absolute count of total SCish and CD90+SCish was significantly higher (p = 0.0007 and p = 0.0266, respectively) in the AP than in the PB samples. The CD90+SCish/total SCish indexes from PB were higher than indexes from the AP (p = 0.039). The relative frequency of CD90+SCish showed a highly significant inverse correlation with the absolute count of total SCish in both, the PB and AP (p = 0.0003 and p = 0.0013 respectively). The relative frequency of CD90+SCish from the PB also showed a significant (p = 0.0002) inverse relationship with total SCish count in the AP. Patients with less than 10% CD90+SCish in the PB had evidently higher (p = 0.0025) total SCish count in the AP. Conclusion. We speculate that lower CD90+SCish yield in the AP is not a consequence of an inferior collection efficacy, but most likely a result of several still not fully resolved immature SC cytomorphological/ biophysical features. Therefore, following the mobilization by chemotherapy G-CSF, some logical questions appear – whether we should follow the absolute count of total SCish, or, whether we should test for relative frequency of CD90+SCish prior to harvesting. To reach the final conclusions, it is essential to conduct further controlled and larger investigations concerning the correlation of circulating and harvested SCs with patients' hematopoietic recovery. © 2017, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Objectives: To evaluate the extent of subclinical atherosclerosis in patients with RA and low cardiovascular risk by measuring intima-media thickness (IMT) of the carotid arteries and to determine factors associated with increased IMT. Methods: IMT was measured by ultrasonography in 42 non-diabetic, normotensive, female RA patients and 32 matched healthy controls [age 45.3 (10.0) vs 45.2 (9.8) years] at common carotid arteries (CCAs), carotid bifurcation (BF) and internal carotid arteries (ICAs), bilaterally. Mean and maximal (max) IMTs were calculated from three measurements at each site. Clinical work-up included laboratory analyses, determination of the disease activity and evaluation of treatment. Results: RA patients had increased IMT (mm) in comparison with controls [CCAmax: 0.764 (0.148) vs 0.703 (0.100); CCAmean: 0.671 (0.119) vs 0.621 (0.085); BFmax: 1.055 (0.184) vs 0.941 (0.161); BFmean: 0.889 (0.168) vs 0.804 (0.124); ICAmax: 0.683 (0.108) vs 0.613 (0.093); ICAmean: 0.577 (0.101) vs 0.535 (0.076)]. Parameters associated with IMT in RA patients were (correlation at x/6 measurement sites): age (6/6), BMI (2/6), smoking (2/6), RF concentration (2/6), sedimentation rate (1/6) and duration of MTX+ chloroquine therapy (4/6; inverse correlation). Multivariate regression analysis revealed that RA is an independent risk factor for increased IMT. Factors correlating with IMT in the controls were: age (6/6), BMI (3/6), total cholesterol (5/6), low-density lipoprotein cholesterol (3/6), total/high-density lipoprotein cholesterol (2/6), triglycerides (1/6) and glycaemia (4/6). Conclusion: Despite a favourable risk profile, our female RA patients had significantly enlarged carotid IMT than controls. RA itself was an independent risk factor for increased IMT. Impact of chronic inflammation on atherosclerosis was confirmed by negative correlation of IMT and duration of anti-inflammatory treatment. © The Author 2010. Published by Oxford University Press.

Background/Aim. Soft tissue defects in the distal third of the lower leg are persistent and constitute a major problem in the reconstructive surgery. This study presents an analysis of the anatomical vascularization filed of ascending branch of the peroneal artery ramus perforans (PARS). The aim of this study was to assess reliability of the distal flap on the antero-lateral aspect of a lower leg distal third. Methods. Direct gentiana violet injection into the interosseal perforator of ten fresh cadaveric lower legs with subsequent corrosion acrylic preparation was performed to reveal vascularization filed of the ascending branch of the PARP. Height, length, diameter and communication of perforating branch and its subsequent smaller ascending and descending branches were determined. The CAMIA software was used. Results. Our results show that the PARP is always present. Its origin from the peroneal artery is at the medial height of 66 mm when measured from the inferior border of the lateral malleolus. Medium length of ramus perforans is 51.7mm. After transition through the interos-seous membrane, ramus perforans divides into ascending and descending branches. The diameter proximal to the level of bifurcation is 1.37 mm (variation 1.0-1.8 mm), and the diameter of the ascending branch distal to the level of bifurcation is 1 mm. Using CAMIA software, the medium length, width and area of the vascularization filed labeled with gentian violet were calculated to be 164 mm (variation 125-210 mm), 66 mm (57-77 mm), and 10,305 mm2 (6,385 mm2-14,341 mm2), respectively. Conclusion. Our results support the use of fas-ciocutaneous distal flap, vascularized by the ascending branch of the PARP for reconstruction of soft tissue defects in the distal third of the lower limb, malleolar regions and dorsum.