Croatian Medical Journal最新文献_第4页

The effect of tumor necrosis factor-alpha on rheumatoid arthritis-related pain: overview of evidence and mechanistic pathways. 肿瘤坏死因子- α对类风湿关节炎相关疼痛的影响：证据和机制途径综述。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-04-30

Andrej Belančić, Seher Sener, Marija Rogoznica Pavlović, Mirjana Stanić Benić, Yusuf Ziya Sener, Almir Fajkić, Marijana Vučković, Josipa Radić, Mislav Radić

{"title":"The effect of tumor necrosis factor-alpha on rheumatoid arthritis-related pain: overview of evidence and mechanistic pathways.","authors":"Andrej Belančić, Seher Sener, Marija Rogoznica Pavlović, Mirjana Stanić Benić, Yusuf Ziya Sener, Almir Fajkić, Marijana Vučković, Josipa Radić, Mislav Radić","doi":"","DOIUrl":"","url":null,"abstract":"Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by debilitating pain and progressive joint destruction. Tumor necrosis factor-alpha (TNF-α), a key pro-inflammatory cytokine, has been implicated in modulating both peripheral and central pain pathways. TNF-α inhibitors, initially developed to halt structural damage in RA, have demonstrated substantial efficacy in pain relief, independent of their anti-inflammatory properties. This narrative review explores the mechanistic pathways through which TNF-α contributes to pain sensitization and highlights the role of TNF-α inhibitors in disrupting these pathways. Evidence suggests that these biologics not only reduce synovial inflammation but also modulate neuroinflammatory circuits, altering pain perception at the spinal and supraspinal levels. Despite their clinical success, variability in patient response and concerns regarding long-term safety necessitate further research into personalized therapeutic strategies. Identifying biomarkers predictive of pain relief could enhance treatment precision. Ultimately, the integration of TNF-α inhibitors into multidisciplinary pain management approaches holds promise for improving clinical outcomes and quality of life in RA.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 2","pages":"112-131"},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856114","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}

引用次数: 0

The association of burnout with occupational stressors among physicians and medical technicians/nurses in the Federation of Bosnia and Herzegovina: a cross-sectional study. 波斯尼亚和黑塞哥维那联邦医生和医疗技术人员/护士职业压力源与职业倦怠的关系：一项横断面研究。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-04-30

Ankica Mijić Marić, Marnela Palameta, Mirela Mabic, Amra Zalihić, Edita Černy Obrdalj, Anđela Pupić, Marina Berberović, Sandra Kostić

{"title":"The association of burnout with occupational stressors among physicians and medical technicians/nurses in the Federation of Bosnia and Herzegovina: a cross-sectional study.","authors":"Ankica Mijić Marić, Marnela Palameta, Mirela Mabic, Amra Zalihić, Edita Černy Obrdalj, Anđela Pupić, Marina Berberović, Sandra Kostić","doi":"","DOIUrl":"","url":null,"abstract":"Aim: To assess the prevalence of burnout syndrome and its association with occupational stressors among physicians and medical technicians/nurses in the Federation of Bosnia and Herzegovina (FBiH).Methods: This cross-sectional study was conducted between February 12 and April 12, 2025, using an anonymous online survey. Structured self-administered questionnaire scales were used to assess burnout (Copenhagen Burnout Inventory) and workplace stressors (Occupational Stress Questionnaire). The association of personal, work-related, and patient-related burnout with occupational stressors was assessed. The survey was sent to the members of the Union of Physicians and Dentists in the FBIH, who were asked to forward the link to their medical technicians and nurses.Results: Overall burnout symptoms were reported by more than half of the respondents (53.0%), with 75.7% experiencing at least one form of burnout. Personal burnout was the most prevalent (70.9%), followed by work-related burnout (54.2%) and patient-related burnout (40.1%). In multiple regression analysis, overall burnout was driven by the cumulative impact of multiple stressors rather than by any single factor. All stressors were positively correlated with burnout, but conflicts and communication at work (for personal and work burnout) and public criticism (for patient-related burnout) stood out as the strongest predictors.Conclusion: This study observed a high prevalence of burnout among physicians and medical technicians/nurses in the FBiH. All examined domains of professional stressors were correlated with all burnout dimensions. Given the importance of preventing and alleviating burnout among health care professionals, this research provides insight into key factors contributing to burnout.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 2","pages":"85-94"},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13176950/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856178","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}

引用次数: 0

Repressive regulatory function of seryl-tRNA synthetase on VEGFA gene expression is impaired in renal cell carcinoma. seryl-tRNA合成酶对VEGFA基因表达的抑制调控功能在肾细胞癌中受损。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-04-30

Maja Barači, Petar Ozretić, Marijana Knezovic Florijan, Nika Foglar, Željko Kaštelan, Neda Slade, Jasmina Rokov-Plavec, Tvrtko Hudolin

{"title":"Repressive regulatory function of seryl-tRNA synthetase on VEGFA gene expression is impaired in renal cell carcinoma.","authors":"Maja Barači, Petar Ozretić, Marijana Knezovic Florijan, Nika Foglar, Željko Kaštelan, Neda Slade, Jasmina Rokov-Plavec, Tvrtko Hudolin","doi":"","DOIUrl":"","url":null,"abstract":"Aim: To assess the relationship of the mRNA and protein expression levels of seryl-tRNA synthetase (SerRS) and the expression of gene encoding vascular endothelial growth factor A (VEGFA) in patients with renal cell carcinoma (RCC).Methods: Expression levels of VEGFA and SerRS mRNA were quantified by quantitative real-time polymerase chain reaction in 31 paired RCC tumor and adjacent healthy kidney tissues, while SerRS protein levels were assessed by Western blot analysis in 19 paired samples. The association of SerRS and VEGFA with clinicopathological parameters was evaluated. In addition, bioinformatics analyses were performed using publicly available transcriptomic and proteomic data sets.Results: VEGFA expression was significantly higher in tumor tissues than in adjacent healthy tissues, while SerRS mRNA levels were similar in both. However, SerRS protein was significantly elevated in tumor tissues. Despite elevated levels of SerRS protein in RCC tumor tissues, SerRS repressive regulatory function on VEGFA was impaired. This dysregulation was associated with increased SerRS phosphorylation, upregulation of several transcriptional activators, and hypomethylation of the VEGFA promoter - factors likely contributing to VEGFA overexpression. Importantly, higher SerRS gene expression was significantly associated with improved overall survival in patients.Conclusion: The findings indicate that various factors diminish SerRS repressor function leading to the VEGFA upregulation in RCC. Survival analysis suggests that SerRS may serve as a valuable prognostic biomarker and represent a potential therapeutic target in RCC.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 2","pages":"72-84"},"PeriodicalIF":2.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13181588/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856130","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}

引用次数: 0

Correction to: Non-invasive prenatal testing of beta-hemoglobinopathies using next generation sequencing, in-silico sequence size selection, and haplotyping. 更正：使用下一代测序、计算机序列大小选择和单倍型对β -血红蛋白病进行无创产前检测。

IF 2.3 4区医学

Croatian Medical Journal Pub Date : 2026-03-20 DOI: 10.3325/cmj.2026.67.51

Henry A Erlich, Lily Ko, Jiyae Lee, Katrina Eaton, Cassandra D Calloway, Ashutosh Lal, Reena Das, Manu Jamwal, Christian Lopez-Pena, Steven J Mack

引用次数: 0

Before PAX1, DKK1, and D-loop variants are held responsible for the Chiari-I malformation, the pathogenicity of each variant must be proven. 在认为PAX1、DKK1和D-loop变异体是导致chari - i畸形的原因之前，必须证明每种变异体的致病性。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-03-20

Josef Finsterer

引用次数: 0

Artificial intelligence literacy and readiness in future health care professionals: a cross-sectional study. 未来卫生保健专业人员的人工智能素养和准备：一项横断面研究。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-03-20

Funda Catan-Inan

{"title":"Artificial intelligence literacy and readiness in future health care professionals: a cross-sectional study.","authors":"Funda Catan-Inan","doi":"","DOIUrl":"","url":null,"abstract":"Aim: To examine the relationship between artificial intelligence (AI) literacy and readiness for medical AI among medical and nursing students, and to explore demographic and educational factors affecting AI literacy and readiness for AI.Methods: This cross-sectional study enrolled 443 students attending the Faculty of Medicine and the Department of Nursing at Bilecik Seyh Edebali University between May and June 2025. Data were collected using a general demographic questionnaire, Medical Artificial Intelligence Readiness Scale (MAIRS), and Artificial Intelligence Literacy Scale (AILS).Results: Medical students showed higher AI readiness (P<0.001) and literacy (P=0.032) scores than nursing students. AI literacy was moderately and positively correlated with readiness for medical AI (r=0.338, P<0.001), and the associations were strongest on the Awareness and Usage dimensions. In multivariable models, MAIRS scores were independently associated with the study year, department, and single-item readiness to use AI, while AILS scores were independently associated with the readiness to use AI and the belief that AI could partially replace health care workers. Internal consistency of the questionnaires was high (MAIRS ?=0.972; AILS ?=0.878).Conclusion: The findings support the integration of structured, practical, and ethically informed AI education into health science curricula, as this may be associated with greater student readiness for future AI-supported health care environments.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 1","pages":"4-13"},"PeriodicalIF":2.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014291/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497805","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}

引用次数: 0

Too complex, too busy, yet paid the same: why university tertiary hospitals need a new model. 太复杂，太忙，但报酬一样：为什么大学三级医院需要一种新模式。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-03-20

Mislav Puljević

{"title":"Too complex, too busy, yet paid the same: why university tertiary hospitals need a new model.","authors":"Mislav Puljević","doi":"","DOIUrl":"","url":null,"abstract":"University tertiary hospitals in Croatia carry a disproportionate share of complex care, teaching, and research responsibilities, yet they are reimbursed under the same Diagnosis-Related Group framework as smaller secondary hospitals. This structural misalignment contributes to workforce strain, physician migration, and inefficiencies in patient flow, while challenging long-term system sustainability. This narrative review and policy analysis synthesizes biomedical literature, international policy reports, and national documents published between 2000 and 2024 to examine workforce shortages, burnout, migration patterns, financing models, and the Croatian context. Croatia reports 3.4 physicians per 1000 inhabitants compared with the European Union average of 4.1, while maintaining a highly centralized referral structure. Burnout prevalence among physicians is estimated at 30-50%, and in 2021 approximately 7% of Croatian physicians applied for certificates enabling employment abroad. Germany, France, the United Kingdom, Scandinavian countries, and Canada have introduced differentiated financing mechanisms that compensate tertiary hospitals for case complexity, referral flows, and academic responsibilities. A pilot Workload Index model is proposed to align reimbursement with case mix, teaching load, referral inflow, and occupational risk exposure. Linking financing to measurable workload indicators may support fairer resource allocation, workforce protection, and improved access to complex care within Croatia's tertiary health services.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 1","pages":"22-29"},"PeriodicalIF":2.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497460","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}

引用次数: 0

Effects of craniectomy on cerebrospinal fluid pressure gradient in the craniospinal space in different body positions of cats. 开颅手术对猫不同体位颅脊髓间隙脑脊液压力梯度的影响。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-03-20

Marijan Klarica, Gorislav Erceg, Sergej Mihailovič Marasanov, Milan Radoš, Filip Njavro, Darko Orešković, Ivana Jurjević

{"title":"Effects of craniectomy on cerebrospinal fluid pressure gradient in the craniospinal space in different body positions of cats.","authors":"Marijan Klarica, Gorislav Erceg, Sergej Mihailovič Marasanov, Milan Radoš, Filip Njavro, Darko Orešković, Ivana Jurjević","doi":"","DOIUrl":"","url":null,"abstract":"Aim: To assess whether a cranial defect in anesthetized cats alters cerebrospinal fluid (CSF) pressure distribution across the craniospinal axis in different body positions in the setting of intracranial normotension.Methods: After standardized parietal craniectomy, intracranial and lumbar CSF pressures were simultaneously measured in eight adult anesthetized (?-chloralose, i.p. 100 mg/kg) cats in different body positions: horizontal (0°), head-up (45°; 90°), and head-down (225°; 270°). CSF pressure gradient represents the difference between CSF pressure values in the lateral ventricle (LV) and lumbar subarachnoid space (LSS) in each body position.Results: At 0°, CSF pressures in the LV and LSS were similar (16.2±0.9 vs 15.8±1.2 cm H2O, respectively). In the 90° head-up position, LV pressure was subatmospheric (?1.5±0.5 cm H2O), while LSS pressure simultaneously increased (31.4±1.0 cm H2O). Conversely, in the head-down 270° position, LSS pressure was negative (?1.7±1.5 cm H2O) and LV pressure increased (30.0?±?1.8 cm H2O). Difference between LV and LSS pressures is strongly correlated with hydrostatic difference between the two recording points in the head-up and the head-down position. LV pressure at 90° in the craniectomy group was significantly higher than previously published in cats with an intact cranium in the same position (P<0.001).Conclusion: Hydrostatic CSF pressure gradient across the craniospinal axis remained unaltered by craniectomy. The finding that craniectomy in the head-up position of animals without intracranial pathology resulted in an intracranial pressure increase may offer additional explanation for the trephined syndrome pathophysiology.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 1","pages":"14-21"},"PeriodicalIF":2.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497848","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}

引用次数: 0

Craniospinal cerebrospinal fluid volume changes after extreme bilateral frontotemporoparietal craniectomy and cranioplasty: a volumetric magnetic resonance imaging case report. 极端双侧额颞顶颅骨切除术和颅骨成形术后颅脊髓脑脊液体积变化：体积磁共振成像病例报告。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-03-20

Sergej Mihailovič Marasanov, Milan Radoš, Filip Njavro, Miroslav Vukić, Ivana Jurjević, Marijan Klarica

{"title":"Craniospinal cerebrospinal fluid volume changes after extreme bilateral frontotemporoparietal craniectomy and cranioplasty: a volumetric magnetic resonance imaging case report.","authors":"Sergej Mihailovič Marasanov, Milan Radoš, Filip Njavro, Miroslav Vukić, Ivana Jurjević, Marijan Klarica","doi":"","DOIUrl":"","url":null,"abstract":"We report on an 18-year-old woman who sustained severe traumatic brain injury in a traffic accident. The resulting refractory intracranial hypertension required emergency bilateral frontotemporoparietal decompressive craniectomies, which left a large bilateral skull defect. Postoperatively, she developed a bilateral sinking skin flap syndrome, consistent with atmospheric pressure-driven collapse of the cranial compartment. She underwent full neuraxis 3D craniospinal imaging before and three months after elective bilateral cranioplasty using custom implants. Pre-cranioplasty volumetric assessment showed cranial cerebrospinal fluid (CSF) volume of 100.8 mL and spinal CSF volume of 78.2 mL (179.0 mL total). After cranioplasty, cranial CSF volume increased to 152.7 mL and spinal CSF volume to 91.1 mL (243.7 mL total), with an overall CSF net gain of 64.7 mL without relevant change in brain parenchyma volume. Clinically, after neurosurgical and neurointensive rehabilitation, the patient remained neurologically stable, with no new focal deficits, able to continue everyday life, finish high school, and enter university. The volumetric findings suggested global redistribution and expansion of neurofluids within the craniospinal axis when cranial boundaries were restored. Such findings are difficult to explain with the traditional model of CSF production and unidirectional circulation, but align with the Bulat-Klarica-Orešković hypothesis, which views CSF, intravascular and interstitial fluid as a single, hydrostatic, and osmotic capillary-driven system. This case indicates that quantitative craniospinal volumetry after cranioplasty can provide in vivo support for contemporary concepts of CSF physiology and may help guide cranioplasty timing in decompressive craniectomy patients.","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"67 1","pages":"44-49"},"PeriodicalIF":2.1,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13014290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147497756","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}

引用次数: 0

The (in)visibility of women in science. 女性在科学领域的知名度。

IF 2.1 4区医学

Croatian Medical Journal Pub Date : 2026-03-20

Svjetlana Kalanj Bognar, Klementina Fon Tacer, Ivana Rosenzweig

引用次数: 0