Croatian Medical Journal最新文献

{"title":"Risk factors associated with adverse cardiovascular events during orthotopic liver transplantation and the early post-transplant period.","authors":"Nataša Višković Filipčić, Katarina Tomulić Brusich, Milan Milošević, Sonja Perkov, Miroslav Župčić, Tajana Filipec Kanižaj","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the incidence of severe adverse cardiovascular events during orthotopic liver transplantation and the early post-transplant period, and to determine the factors associated with these events.</p><p><strong>Methods: </strong>We retrospectively reviewed the medical records of 291 patients who underwent orthotopic liver transplantation at University Center Merkur, Zagreb, Croatia, from 2013 to 2015. Data on corresponding donor characteristics were sourced from the Eurotransplant database. Severe adverse cardiovascular events were defined as myocardial infarction, malignant arrhythmia, pulmonary embolism, cardiac failure, cardiac arrest, and death.</p><p><strong>Results: </strong>The incidence of severe adverse events was 8.9%. Univariate analysis demonstrated a positive predictive value linking severe adverse cardiovascular events with metabolic liver disease, an elevated model for end-stage liver disease, an international normalized ratio, and the preoperative administration of vasopressors. Multivariate analysis identified significant predictors of adverse events: liver metabolic diseases (odds ratio [OR] 4.88; 95% confidence interval [CI] 1.48-16.09; P=0.009), donor arterial hypertension (OR 2.68; 95% CI 1.01-7.18; P=0.049), prolonged cold ischemia duration (OR 1.22; 95% CI 1.01-1.49; P=0.044), and increased recipient age (OR 1.09; 95% CI 1.03-1.16; P=0.005).</p><p><strong>Conclusion: </strong>The occurrence of severe adverse cardiovascular events is markedly greater than previously documented. We propose the use of a scoring system including known risk variables to identify patients at risk of adverse cardiovascular events, hence improving surveillance for an early intervention.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 3","pages":"194-203"},"PeriodicalIF":1.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599563","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":"A case for a bigger role of transcutaneous vagus nerve stimulation in brain injury rehabilitation.","authors":"Martina Miklić Bublić, Dinko Tonković, Vilena Vrbanović Mijatović","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 3","pages":"241-242"},"PeriodicalIF":1.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599556","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":"Inadequate pain management in prehospital emergency care: a retrospective study from Krapina-Zagorje County.","authors":"Morena Milić, Ada Barić Grgurević, Josip Vrdoljak, Krunoslav Fučkar, Ana Brundula","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To assess the type of analgesics administered and their frequency of administration in pre-hospital pain management in Krapina-Zagorje County, Croatia.</p><p><strong>Methods: </strong>We retrospectively reviewed the data from 86 573 patients treated by the Emergency Department of Krapina-Zagorje County from October 1, 2017 to September 30, 2022. Data were obtained through the \"e-Hitna\" program. The inclusion criterion was a possible occurrence of pain based on the International Classification of Diseases diagnosis in patients who were treated by emergency team 1. We collected data on the type of analgesic and the frequency of administration according to age, the main diagnosis, emergency index, and the visual analog scale (VAS) score.</p><p><strong>Results: </strong>In 75% of the patients (64 938), analgesics were not administered. When analgesics were administered (21 635; 25%), physicians mostly opted for non-opioid analgesics (15480, 71.6%). Opioid analgesia was usually the treatment of choice in palliative care. Tramadol was administered significantly more often than morphine or pethidine (P<0.001, χ2 test).</p><p><strong>Conclusion: </strong>Despite wide accessibility of analgesics, pain is still not treated adequately in the Emergency Department of Krapina-Zagorje County.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 3","pages":"220-226"},"PeriodicalIF":1.5,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12246969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144599558","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":"Patients prefer human psychiatrists over chatbots: a letter to the editor.","authors":"Hinpetch Daungsupawong, Viroj Wiwanitkkit","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"179"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093122/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988881","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 diagnostic yield of molecular karyotyping: a retrospective single-center study.","authors":"Emine Göktaş, Ahmet Burak Arslan, Betül Turan, Betül Okur Altındaş, Ayşe Gül Zamani, Mahmut Selman Yıldırım","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To determine the diagnostic yield of chromosomal microarray analysis (CMA) in different patient groups: intellectual disability and developmental delay (ID/DD), multiple congenital anomalies (MCA), epilepsy, autism spectrum disorder (ASD), reproductive abnormalities, and dysmorphic features.</p><p><strong>Methods: </strong>We retrospectively reviewed microarray data of 176 patients admitted to the Medical Genetics Outpatient Clinic of Necmettin Erbakan University Medical Faculty Hospital from 2016 to 2022. After the copy number variation (CNV) interpretation, we evaluated the diagnostic strength of CMA in each group.</p><p><strong>Results: </strong>Phenotype-associated CNVs were detected in 20.3% (22/108) of patients with ID/DD, 23.9% (17/71) of patients with MCA, 15.9% of patients (7/44) with epilepsy, 16.6% (4/24) of patients with ASD, and 11.7% (2/17) of those with reproductive abnormalities. Chromosomal gains or losses were found in 43% (35/80) of patients with dysmorphic findings.</p><p><strong>Conclusion: </strong>This study confirmed the remarkable diagnostic yield of CMA in ID/DD, MCA, and ASD patients, and expanded its value for cases with epilepsy and dysmorphism.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"92-99"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961856","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":"Disease characteristics and outcomes of Croatian pediatric patients with acute lymphoblastic leukemia: pretreatment immunophenotypic predictors of high bone marrow minimal residual disease on day 15 of treatment.","authors":"Klara Dubravčić, Ružica Lasan Trčić, Ernest Bilić, Josip Konja, Ljubica Rajić, Ranka Femenić, Maja Pavlović, Koraljka Gjadrov Kuveždić, Sunčica Ries, Mirna Sučić, Ivana Franić Šimić, Renata Zadro, Margareta Radić Antolic, Ivana Horvat, Gordana Jakovljević, Jelena Roganović, Srđana Čulić, Dubravka Kuljiš, Višnja Armanda, Karolina Malić Tudor, Senada Šerifi, Bernarda Lozić, Drago Batinić","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To assess the clinical-biological characteristics and outcomes of Croatian pediatric patients with acute lymphoblastic leukemia (ALL). A secondary aim was to evaluate the predictive value of pretreatment leukemia-associated immunophenotypes (LAIPs) for poor early response to induction therapy defined as ≥10% day 15 bone marrow flow cytometry minimal residual disease (FCM-MRD).</p><p><strong>Methods: </strong>This retrospective cohort study reviewed the medical data of 393 consecutive pediatric ALL patients diagnosed and treated from February 2003 to April 2017 at four Croatian pediatric hemato-oncology centers. FCM data of 379 non-infant patients enrolled in two consecutive intercontinental trials, ALL IC-BFM 2002 (NCT00764907) and ALL IC-BFM 2009 (EudraCT 2010-019722-13), were analyzed to evaluate the association between LAIPs at diagnosis and day 15 FCM-MRD≥10% using univariate and multivariate logistic regression.</p><p><strong>Results: </strong>The median age at diagnosis was 5.2 years, with a predominance (83%) of B-cell precursor (BCP) ALL, and high hyperdiploidy (25.1%) and ETV6::RUNX1 (18.7%) as the most common genetic abnormalities. The protocols did not significantly differ in 5-year event-free survival (82.1% vs 81.7%), overall survival (88% vs 85%), and cumulative incidence of relapse (12.3% vs 10%). FCM-MRD≥10% on day 15 was identified in 22.1% of patients and was predicted by white blood cell (WBC) count ≥20×109/L (P=0.011) and strong expression of CD34 (P=0.032) and CD13 (P=0.001) at diagnosis.</p><p><strong>Conclusion: </strong>The characteristics and survival rates of Croatian pediatric ALL patients aligned with ALL IC-BFM data. WBC≥20×109/L, CD34strong, and CD13strong independently predicted poor early response in BCP-ALL, suggesting a potential prognostic value of LAIPs at diagnosis.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"100-114"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995972","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":"Applying the complex patient model to the care of persons with disabilities.","authors":"Aleksandar Džakula, Karmen Lončarek, Tomislav Benjak, Darijo Jurišić, Dorja Vočanec","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"180-181"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093117/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988880","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":"Bibliometric and clinical trial registry analysis of the University of Split medical research from 1997 to 2022.","authors":"Ana Marušić, Igor Jerković, Petra Jelić, Dragan Ljutić","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To analyze the most influential publications from researchers in medicine at the University of Split in Croatia, as well as their participation in publicly registered clinical trials, to gain insight into medical research excellence in the second largest university in Croatia.</p><p><strong>Methods: </strong>For articles published in the top 5% of journals in 47 medical categories in the Web of Science Core Collection (WoSCC) from 1997, when the School of Medicine became an independent University constituent, to 2022, we analyzed the number of articles in different discipline categories, citations to these articles, and geographical and institutional collaborations. From the public registry ClinicalTrials.gov, we collected the information on the number of clinical trials at the University of Split School of Medicine and/or the University Hospital of Split.</p><p><strong>Results: </strong>Authors with a UNIST affiliation published 106 articles in the top 5% journals in 29 out of 59 WoSCC journal categories. The annual publication output significantly increased over the years. Over 80% of the articles were the result of collaboration with the global research community, involving 82 different countries. The total number of citations across these articles was 21 171, with a median of 187.4 citations per article. The first registered clinical trial in the ClinicalTrials.gov registry with a location in Split School of Medicine or the University Hospital of Split was in 1993, with a statistically significant increasing trend over the years. These trials represented 20.6% of all registered trials from Croatia.</p><p><strong>Conclusion: </strong>The University of Split has been continually increasing its impact in medical research. Bibliometric analysis should be regularly performed to follow the development of medical research at the University, identify new strategic areas for research excellence, support researchers, and attract new researchers and research teams.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"153-163"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093127/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978460","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":"Metformin induces mitochondria-mediated and endoplasmic reticulum stress-mediated apoptosis and inhibits angiogenesis-related gene expression in breast cancer cells via targeting VEGF-A/VEGFR2/NRP1.","authors":"Ares Alizade, Gulsah Evyapan, Ibrahim Seyfettin Celik, Berna Ozdem","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Aim: </strong>To investigate the apoptotic and anti-angiogenic effects of metformin in human MCF7 breast cancer cells.</p><p><strong>Methods: </strong>The effect of metformin on cell viability was assessed by MTS and crystal violet assays, and its effect on cell migration was evaluated by the wound healing assay. The gene expression and protein levels of angiogenesis- and apoptosis-related genes were determined by real-time polymerase chain reaction, Western blot, and flow cytometry.</p><p><strong>Results: </strong>Metformin reduced the viability and migration of breast cancer cells compared with the control group. Furthermore, metformin (10 μM) increased the apoptosis-related gene and protein expression of caspase-3, Bax, AIF, CHOP and GRP78 48 hours after treatment compared with the control group. In contrast, it significantly decreased Bcl-2 and Wee1 gene and protein expression and suppressed angiogenesis-related genes VEGFA, VEGFR2, and NRP1.</p><p><strong>Conclusions: </strong>Our results suggest that metformin treatment activates apoptosis pathways and inactivates the angiogenesis pathway. Although this study was conducted in vitro and did not directly evaluate blood vessel formation, the observed downregulation of angiogenesis-related genes suggests potential anti-angiogenic activity of metformin at the gene expression level.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"115-124"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983508","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 painless ST-elevation myocardial infarction equivalent: a case report.","authors":"Martin Medvid, Salome Glauser, Fabian Zürcher","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This report presents the case of a 61-year-old patient who experienced sporadically occurring episodes of chest pain lasting approximately 15 minutes. The initial electrocardiogram (ECG) showed unspecific repolarization disturbances but no ST-elevation indicative of ST-elevation myocardial infarction (STEMI). However, upon closer examination, biphasic T waves were detected, suggestive of specific repolarization abnormalities. The conventional Wellens criteria were met, possibly indicating an etiopathogenetic correlation with the patient's complaints. Subsequent coronary angiography revealed a functional occlusion of the middle segment of the left anterior descending artery, which was treated by percutaneous transluminal coronary angioplasty/drug eluting stent. It also revealed a severely stenosed distal circumflex artery, indicating a two-vessel coronary disease. If we had used only conventional STEMI criteria, this patient would have certainly been missed. Therefore, when evaluating patients presenting with chest pain, it is imperative to consider non-occlusion infarction ECG abnormalities, known as STEMI equivalents. This case, moreover, highlights the importance of the non-officially proposed occlusion myocardial infarction (OMI)/non-OMI paradigm instead of the old STEMI/non-STEMI dichotomy.</p>","PeriodicalId":10796,"journal":{"name":"Croatian Medical Journal","volume":"66 2","pages":"173-178"},"PeriodicalIF":1.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12093120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978461","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}