Croatian Medical Journal最新文献

{"title":"Surveillance of infectious-disease outbreaks on cruise ships: a fragmented system without a global registry.","authors":"Aristomenis Exadaktylos, Aebhric O Kelly, Isabella Demartini, Tyson Welzel","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"322-323"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Croatian Medical Journal - evidence for better health.","authors":"Mario Šekerija","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 4","pages":"253-254"},"PeriodicalIF":2.1,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative changes in IgG and plasma N-glycosylation in children with acute appendicitis and elective surgery: a prospective study.","authors":"Jasna Obuljen, Nikol Mraz, Tea Pribić, Irena Trbojević-Akmačić, Irena Linarić, Jasna Leniček Krleža, Stjepan Višnjić, Marko Mesić, Mislav Bastić, Anto Pajić, Neda Striber, Anđelo Beletić, Zoran Bahtijarević, Gordan Lauc, Dragan Primorac, Borna Rapčan","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To compare plasma protein and IgG N-glycosylation levels in pediatric patients undergoing acute appendicitis surgery and in those undergoing minor elective surgery. The secondary aim was to explore whether the plasma N-glycome profile may serve as a biomarker of systemic inflammatory burden in children.</p><p><strong>Methods: </strong>This prospective study enrolled children aged 4-16 years undergoing minor elective surgery (n = 38) or surgery for acute appendicitis (n = 19) at Children's Hospital Zagreb from 2017 to 2021. Blood samples were collected preoperatively and 24 hours postoperatively. IgG and total plasma N-glycans were assessed using high-throughput hydrophilic interaction ultra-high-performance liquid chromatography. Derived glycan traits were compared between the groups and across timepoints.</p><p><strong>Results: </strong>Compared with elective surgery controls, children with acute appendicitis exhibited extensive plasma glycomic remodeling. This was characterized by increased branching, sialylation, and antennary fucosylation, along with reduced abundance of less complex glycans, indicating a systemic inflammatory glycan phenotype. IgG glycosylation also differed between the groups but showed fewer and less pronounced changes. Minor elective surgery, despite increased C-reactive protein levels, did not significantly alter either plasma or IgG glycomes. Twenty-four hours after surgery, children with appendicitis exhibited significant postoperative changes only in the plasma N-glycome, while IgG glycosylation remained stable.</p><p><strong>Conclusion: </strong>Plasma N-glycosylation reflects inflammatory burden rather than surgical stress. These findings highlight plasma glycome profiling as a potential systems-level biomarker for assessing acute inflammation and disease severity in pediatric populations.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"164-174"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in medicine: from molecular data analysis to clinical decision-making.","authors":"Dragan Primorac, Thomas C Südhof","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"135-143"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263549/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic mesenchymal stem cell therapy for reduction of inflammatory burden in a patient with juvenile-onset rheumatoid arthritis and dialysis-dependent renal failure.","authors":"Dragan Primorac, Petar Brlek, Luka Bulić, Miomir Knežević, Gordana Kalan Živčec","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Chronic systemic inflammation is a key driver of disease progression in rheumatoid arthritis and chronic kidney disease (CKD), particularly in patients undergoing long-term hemodialysis. Persistent elevation of proinflammatory cytokines contributes to pain, anemia, endothelial dysfunction, and increased cardiovascular risk, while therapeutic options are often limited by comorbidities and drug intolerance. Mesenchymal stem cells (MSCs) possess immunomodulatory properties that may offer an alternative strategy for systemic inflammatory control. We report on the case of a 56-year-old woman with juvenile-onset rheumatoid arthritis and dialysis-dependent CKD who received three consecutive systemic administrations of MSCs. Baseline evaluation demonstrated elevated inflammatory markers, including C-reactive protein, interleukin-6, and tumor necrosis factor-α. Following treatment, inflammatory parameters were consistently reduced, which was accompanied by improvement in hemoglobin levels and favorable trends in renal function markers. Additionally, pain assessment scores (Western Ontario and McMaster Universities Arthritis Index, Knee Injury and Osteoarthritis Outcome Score, Visual Analogue Scale) showed clinically significant improvement. The patient also reported significant subjective pain relief and improved overall well-being. Although limited by its single-case design, this report supports the biological plausibility of systemic MSC therapy as a potential immunomodulatory approach in patients with overlapping autoimmune and uremia-associated chronic inflammation. Further controlled studies are warranted.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"238-246"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in pathology: a framework for preserving brain capital in the diagnostic apex.","authors":"Steven N Hart","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To present a five-criterion calibration framework for evaluating artificial intelligence (AI) tools in pathology centered on preserving \"brain capital\" - the finite cognitive resources available to clinicians - and stabilizing the \"diagnostic apex,\" the point where histological evidence meets clinical judgment.</p><p><strong>Methods: </strong>Using cognitive load theory (CLT) and implementation science, we developed the Pathology AI Diagnostic Balance - a conceptual model mapping the physician-specimen interaction within working memory and IT infrastructure constraints - and examined it in the context of peer-reviewed case studies of implemented pathology AI tools.</p><p><strong>Results: </strong>The framework identifies five criteria: Contextual Literacy (integration of clinical history), Responsibility (preservation of signing authority), Evidence Gap Analysis (closure of diagnostic uncertainty), Verification (feasibility of quality control), and Opportunity Cost (return on cognitive investment). Successful tools, such as Ki-67 quantification and breast cancer screening, reduce cognitive burden by automating routine tasks or enabling rapid verification. Conversely, tools requiring an exhaustive re-review or producing opaque recommendations deplete cognitive bandwidth, causing decision fatigue and diagnostic errors.</p><p><strong>Conclusion: </strong>Pathologists are positioned to exercise evaluative authority over tools that increase extraneous cognitive load. Clinical expertise represents pathologists' most distinctive contribution to AI development: defining which failure modes matter clinically, what context an AI must integrate, and whether a tool serves patient care. By prioritizing cognitive sustainability over purely technical metrics, the profession can ensure AI functions as a genuine enhancement of diagnostic capability rather than an additional burden on diagnostic workflows.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"219-225"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity and IgG N-glycosylation in medical students: a cross-sectional study.","authors":"Stipe Vidović, Ivanka Maduna, Matko Fančović, Nina Šimunić-Briški, Maja Hanić, Petar Šušnjara, Gordan Lauc, Marija Heffer, Lada Zibar","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To examine differences in IgG N-glycan composition between physical activity (PA) categories and to assess associations between PA domains and IgG N-glycan traits in medical students.</p><p><strong>Methods: </strong>This cross-sectional study enrolled first-year and second-year medical students at the University Josip Juraj Strossmayer, Osijek. PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF), capturing walking, moderate, and vigorous PA, total PA, and sitting time. Participants were classified as health-enhancing physical activity (HEPA)-active or non-HEPA-active. IgG was isolated from plasma, and N-glycan composition was assessed using capillary gel electrophoresis with laser-induced fluorescence detection. Twenty-seven glycan peaks and eight derived glycan traits (G0, G1, G2, S0, S1, S2, B, and CF) were quantified.</p><p><strong>Results: </strong>Seventy-nine students (56 women; median age, 20 [range, 18-25] years) were enrolled: 23 were HEPA-active and 56 non-HEPA-active. The groups did not significantly differ in individual IgG N-glycan peaks or derived glycan traits. In unadjusted analyses, vigorous PA was weakly positively correlated with G1 (ρ=0.24, P=0.034) and total PA with G1 (ρ=0.27, P=0.017), while total PA was negatively correlated with G2 (ρ=-0.34, P=0.002). However, none of these associations remained significant after adjustment for multiple testing.</p><p><strong>Conclusion: </strong>Self-reported PA was not associated with IgG N-glycosylation after correction, and no differences were observed between PA categories. These findings indicate no robust association between PA and the IgG glycome.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"156-163"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early PCR-based DNA identification in a wartime mass-fatality event: archival reconstruction of the 1994 Duboki Jarak explosion.","authors":"Dragan Primorac, Šimun Anđelinović, Ante Gugić, Ivan Mario Staničić, Marija Definis, Ivana Kružić, Ivan Jerković, Željana Bašić","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To reconstruct the forensic identification process following the 1994 explosion at the Duboki Jarak military ammunition and explosive ordnance storage facility in Croatia and to evaluate the role of early PCR-based DNA typing in the identification of severely fragmented human remains under wartime conditions.</p><p><strong>Methods: </strong>A retrospective archival analysis was conducted using original forensic, judicial, and laboratory documentation generated after the explosion. We reviewed crime scene records, medico-legal documentation, forensic body diagrams, situational plans, judicial orders authorizing DNA testing, laboratory reports, and genotype summary tables. Archived laboratory records indicate that recovered tissue samples underwent PCR-based DNA typing using the GeneAmp PCR System 9600 with reverse hybridization assays targeting six loci (HLA-DQA1, LDLR, GYPA, HBGG, D7S8, and GC). The obtained profiles were compared with reference samples from the missing persons' relatives.</p><p><strong>Results: </strong>Archival documentation recorded 59 biological specimens recovered at the scene. Of the 48 samples submitted for laboratory examination, 33 were subjected to PCR-based DNA typing, and 20 yielded interpretable DNA profiles. Among the recovered remains, multilocus comparison documented five distinct genetic profiles. Comparison with 16 reference samples from 16 relatives representing six families enabled kinship-based attribution of remains to five victims. No compatible genotype was identified in one family, and one specimen was excluded from attribution due to mixed PCR signals consistent with contamination.</p><p><strong>Conclusion: </strong>The Duboki Jarak case represents one of the earliest documented applications of PCR-based DNA typing for victim identification in a mass-fatality event during active wartime conditions. DNA-supported identification was operationally implemented in Croatia in 1994, several years before molecular genetics was formally integrated into international disaster victim identification protocols.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"175-187"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13263550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Updated analysis of the Bronze Age population genetics from Bezdanjača Cave - the case of I2a1a male individuals.","authors":"Damir Marjanović, Jelena Šarac, Dubravka Havaš Auguštin, Ivor Janković, Siniša Radović, Dragan Primorac, Mario Novak","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This case report presents an updated interpretation of genetic and chronological data from human remains discovered in Bezdanjača Cave, a Bronze Age burial site located in the Lika region of Croatia. The cave contains a complex necropolis with at least 57 graves and up to 200 individuals, which indicates its use as a collective burial site during the Middle and Late Bronze Age. Based on ancient DNA analysis, 13 males were identified among 38 analyzed individuals, with the majority belonging to the Y-chromosome haplogroup R1b, commonly associated with Bronze Age populations. However, two individuals were assigned to haplogroup I2a1a (I-Y3120). The I2a lineage has deep roots in Europe, and its presence has been confirmed in prehistoric contexts in Croatia and the region. However, newly obtained radiocarbon dates from occipital bones reveal that at least one of the two I2a1a individuals from Bezdanjača Cave dates to the Early Modern period (1645-1950 calibrated CE), which indicates that the remains were deposited in the cave much later than previously assumed. At the same time, these new data do not contradict the possible presence of the I2a1a lineage in Bronze Age populations in this area, as Bronze Age I2a1a samples have been reported from other archaeological sites in Croatia and the wider region. These findings, presented here for the first time, highlight the risks of assuming chronological homogeneity based solely on archaeological context and demonstrate the necessity of direct radiocarbon dating when integrating archaeological and genetic data. An interdisciplinary approach and careful chronological verification in ancient DNA research are essential to avoid misinterpretations in broader population genetic studies.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"247-252"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic metabolic, hormonal, and glycomic remodeling during a 72-hour fast in healthy adults: a pilot study.","authors":"Gordan Lauc, Petar Brlek, Luka Bulić, Nina Šimunić Briški, Jelena Šimunović, Ivana Duvnjak Orešković, Lara Butumović, Damir Marjanović, Danijela Klarić, Ana Petrović, Jan Tesla Frcko, Dragan Primorac","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To investigate integrated biochemical and glycomic signatures in humans related to coordinated metabolic and endocrine adaptations during prolonged fasting, which are essential for maintaining systemic homeostasis.</p><p><strong>Methods: </strong>This single-arm longitudinal interventional study enrolled five healthy adults who underwent a 72-hour water-only fast. Blood samples were collected at baseline (T0), immediately after fasting (T1), and after 11 days of refeeding (T2). A broad panel of biochemical, hormonal, inflammatory, and glycomic parameters was determined. Time-dependent differences were evaluated using the Friedman test.</p><p><strong>Results: </strong>Fasting induced a distinct biphasic response across multiple circulating markers, with significant alterations in total cholesterol, C-reactive protein, thyroid-stimulating hormone, and free triiodothyronine at T1 followed by recovery toward baseline at T2. Insulin and glucose concentrations declined during fasting and increased after refeeding, although these changes did not reach statistical significance. Plasma, immunoglobulin G (IgG), and IgA N-glycosylation profiles were extensively remodeled, which indicated dynamic metabolic and immune system adaptation. Liver enzymes, electrolytes, and most lipid fractions exhibited only minor and reversible fluctuations.</p><p><strong>Conclusion: </strong>A 72-hour fast was associated with metabolic and hormonal changes consistent with an environment conducive to autophagy, although autophagy was not measured directly. The protocol appeared feasible and well tolerated in a small cohort of healthy adults. Given the limited sample size, these findings should be considered preliminary and require confirmation in larger studies incorporating direct autophagy markers and additional time points.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 3","pages":"226-237"},"PeriodicalIF":2.1,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148238988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}