Veterinary medicine - Repository of PHD, master's thesis
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A large-scale multicenter breast cancer DCE-MRI benchmark dataset with expert segmentations
No full textArtificial Intelligence (AI) research in breast cancer Magnetic Resonance Imaging (MRI) faces challenges due to limited expert-labeled segmentations. To address this, we present a multicenter dataset of 1506 pre-treatment T1-weighted dynamic contrast-enhanced MRI cases, including expert annotations of primary tumors and non-mass-enhanced regions. The dataset integrates imaging data from four collections in The Cancer Imaging Archive (TCIA), where only 163 cases with expert segmentations were initially available. To facilitate the annotation process, a deep learning model was trained to produce preliminary segmentations for the remaining cases. These were subsequently corrected and verified by 16 breast cancer experts (averaging 9 years of experience), creating a fully annotated dataset. Additionally, the dataset includes 49 harmonized clinical and demographic variables, as well as pre-trained weights for a baseline nnU-Net model trained on the annotated data. This resource addresses a critical gap in publicly available breast cancer datasets, enabling the development, validation, and benchmarking of advanced deep learning models, thus driving progress in breast cancer diagnostics, treatment response prediction, and personalized care
From clinical presentation to therapeutic approach in the treatment of the anterior cruciate ligament
No full textPrednji križni ligament (ACL) jedna je od ključnih struktura u održavanju stabilnosti koljena, čije ozljede predstavljaju ozbiljan klinički i funkcionalni problem, osobito među sportašima. Cilj ovog rada je prikazati sveobuhvatan pregled anatomsko-biomehaničkih značajki ACL-a, etioloških čimbenika njegova oštećenja, kliničke prezentacije, dijagnostičkih metoda te mogućnosti terapijskog pristupa - konzervativnog i kirurškog. Ozljeda ACL-a godišnje zahvaća oko 2 milijuna ljudi širom svijeta i čini ogroman financijski teret na zdravstveni sustav. Ključno je prepoznati rizične faktore za rupturu ACL-a i educirati ljude i sportaše o mogućim ozljedama. Klinička slika ozljede ACL-a nije karakteristična te je potrebno raznim testovima prilikom fizikalnog statusa i radiološkim metodama poput magnetske rezonance ili kompjuterizirane tomografije isključiti bilo kakve druge ozljede. Ruptura ACL-a, kompletna ili parcijalna, može se liječiti na konzervativan tj. neoperativan način i na operativan način. Ukoliko pacijent zadovoljava kriterije za konzervativno liječenje prolazi kod opsežnu fizikalnu rehabilitaciju u trajanju od 12 tjedana, ili po potrebi duže. Naglasak rehabilitacije je na povratku osjećaja stabilnosti u koljenu i snaženju mišića stabilizatora koljena. Ukoliko je pacijent kandidat za operacijsko liječenje, postoji više opcija presadaka pomoću kojih se rekonstruira ACL- od autograftova koji su u ovom radu u detalje opisani, do alograftova dobivenih od humanih kadavera koji se čuvaju u banci tkiva i sintetičkih presadaka sagrađenih od umjetnih materijala. Ishod liječenja je bolji kada se ACL kirurški rekonstruira. Unatoč brojnim kratkoročnim i dugoročnim istraživanjima koja pokazuju obećavajuće rezultate, ipak se dio pacijenta neće moći vratiti aktivnostima koje su radili prije ozljede te imaju veću šansu za razvitak degenerativnih promjena koljena.The anterior cruciate ligament (ACL) is one of the key structures in maintaining knee stability, and its injuries represent a serious clinical and functional problem, especially among athletes. The aim of this paper is to provide a comprehensive review of the anatomical-mechanical characteristics of the ACL, etiological factors of its damage, clinical presentation, diagnostic methods, and possible therapeutic approaches, both conservative and surgical. ACL injuries affect approximately 2 million people worldwide each year and impose a significant financial burden on healthcare systems. It is crucial to recognize the risk factors for ACL rupture and educate individuals and athletes about potential injuries. The clinical picture of ACL injury is not characteristic, so various tests during physical examination and radiological methods such as magnetic resonance imaging (MRI) or computed tomography (CT) are necessary to exclude other injuries. ACL ruptures, whether complete or partial, can be treated conservatively (non-operatively) or surgically. If a patient meets the criteria for conservative treatment, they undergo extensive physical rehabilitation lasting about 12 weeks or longer as needed. The emphasis of rehabilitation is on restoring a sense of stability in the knee and strengthening the muscles that stabilize the joint. If a patient is a candidate for surgical treatment, there are multiple graft options available for ACL reconstruction. These include autografts, described in detail in this work, such as those obtained from the patient's own tissues, allografts from human cadavers stored in tissue banks, and synthetic grafts made from artificial materials. The outcome of treatment is better when the ACL is surgically reconstructed. Despite numerous short-term and long-term studies showing promising results, some patients will not be able to return to activities they performed before the injury and are at a higher risk of developing degenerative changes in the knee
Analysis of Radiomic Features of Breast Cancer Using Machine Learning
No full textKarcinom dojke najčešća je maligna bolest u ženskoj populaciji, kao i vodeći uzrok smrtnosti od malignih bolesti u ženskoj populaciji. Etiologija i patofiziologija bolesti vrlo je kompleksna te podrazumijeva međudjelovanje većeg broja okolišnih i genetskih čimbenika. Incidencija bolesti raste iz godine u godinu, a pretpostavlja se da je uzrok tomu veće izlaganje predisponirajućim čimbenicima, kao i sve naprednije metode dijagnostike. Radiomika karcinoma dojke bavi se transformacijom radioloških slika u skupove kvantitativnih značajki, koji su pokazali značajnu dijagnostičku i prognostičku vrijednost. Umjetna inteligencija, odnosno strojno učenje dobili su značajnu ulogu u biomedicinskim istraživanjima prošlih godina, ponajprije u izradi prediktivnih modela za ključna klinička pitanja. Cilj ovog istraživanja bio je razviti prediktivni model koji će na temelju radiomskih značajki magnetske rezonance predvidjeti hoće li pacijentica s karcinomom dojke imati potpuni patološki odgovor na neoadjuvantnu kemoterapiju. Skup radiomskih podataka dobiven je iz snimki 158 pacijentica s luminalnim B karcinomom dojke prije početka kemoterapije, a za izradu modela primijenjeni su složeni algoritmi učenja temeljeni na stablima odlučivanja i logistička regresija. Modeli su validirani na izdvojenom dijelu skupa, a kao metrike kvalitete određeni su točnost, F1 vrijednost i ROC krivulja s površinom ispod krivulje. Najuspješnijim se pokazao model temeljen na algoritmu slučajne šume, s točnosti od 78% i površinom ispod ROC krivulje od 0.83. Ostali modeli temeljeni na stablima odlučivanja postigli su zadovoljavajuću preciznost, dok je preciznost modela logističke regresije bila niža. Potencijal kliničke primjene ovakvih modela leži u mogućnosti predviđanja odgovora na neoadjuvantnu kemoterapiju prije njezina početka. Bilo u vidu promjene intenziteta liječenja ili izbora protokola, ovakvi modeli mogu omogućiti individualniji pristup liječenju karcinoma dojke, a takav pristup u skladu je s pravcem moderne onkologije.Breast cancer is the leading malignant disease in the female population by incidence and mortality. The etiology and pathophysiology of the disease is complex and entails interactions between multiple environmental and genetic factors. The incidence of breast cancer is continuously on the rise, which is assumed to be a result of greater exposure to predisposing factors and advancements in diagnostic methods. Breast cancer radiomics deals with transformation of images into sets of quantitative features, which have demonstrated significant diagnostic and prognostic value. Artificial intelligence and machine learning have had a key role in biomedical research in recent years, primarily in solving clinically relevant predictive problems. The aim of this study was to develop a predictive model for neoadjuvant treatment response based on breast cancer radiomic features. The data was acquired from magnetic resonance images of 158 patients with luminal B breast cancer, taken before neoadjuvant treatment. For machine learning model development, ensemble decision tree-based algorithms and logistic regression were used. The models were validated on a segregated test set, using accuracy, F1 score and ROC curve with the area under curve value. The random forest model showed the best performance with an accuracy of 78% and ROC-AUC value of 0.83. Other decision tree-based models achieved sufficient precision, while the logistic regression model did not. The potential for clinical application of these models lies in the possibility of predicting neoadjuvant treatment response before its initiation. Either as adjustment of treatment intensity or choice of protocol, these models can facilitate a more individualised approach to breast cancer treatment, which is in line with the current trends in modern oncology
Nonalcoholic fatty liver disease and obesity
No full textRastuća prevalencija sjedilačkog načina života u zapadnom dijelu svijeta usporedna je sa značajnim porastom nealkoholne masne bolesti jetre (NAFLD), koja je trenutno jedan od najčešćih uzroka bolesti jetre u svijetu. Središnji je čimbenik u patogenezi NAFLD-a visceralna pretilost, koja potiče ektopičnu akumulaciju masti, uključujući steatozu jetre. Ovo ektopično taloženje masti remeti homeostazu masnog tkiva i mijenja proizvodnju adipokina, što dovodi do neravnoteže koju karakteriziraju povišeni proupalni citokini. Ova kronična upala niskog stupnja povezana s pretilošću uspostavlja nepovoljno okruženje za jetru i njezinu funkciju. Cilj ovog rada jest uvodno prikazati osnovne koncepte iza brojnih čimbenika rizika i pratećih komorbiditeta NAFLD-a, složene patogeneze s naglaskom na povezanost NAFLD-a i debljine te same progresije bolesti od jednostavne steatoze prema nealkoholnom steatohepatitisu (NASH) i fibrozi jetre. Zatim je cilj podrobnije opisati trenutne, ali i suvremenije i obećavajuće pristupe u dijagnostici i liječenju ovih stanja s prvenstvenim naglaskom na promjene stila života, a potom i na brojne farmakološke opcije koje se danas nude.The increasing prevalence of a sedentary lifestyle in Western populations parallels a significant rise in non-alcoholic fatty liver disease (NAFLD), which is currently one of the most common causes of liver disease worldwide. A central factor in the pathogenesis of NAFLD is visceral obesity, which promotes ectopic fat accumulation, including hepatic steatosis. This ectopic fat deposition disrupts adipose tissue homeostasis and alters adipokine production, leading to an imbalance characterized by elevated pro-inflammatory cytokines. This chronic low-grade inflammation associated with obesity creates an unfavorable environment for liver function. The aim of this paper is to introduce the fundamental concepts underlying the numerous risk factors and associated comorbidities of NAFLD, as well as the complex pathogenesis, with a particular emphasis on the connection between NAFLD and obesity, and the progression of the disease from simple steatosis to non-alcoholic steatohepatitis (NASH) and liver fibrosis. Furthermore, the goal is to provide a more detailed overview of current, as well as modern and promising approaches to the diagnosis and treatment of these conditions, with a primary focus on lifestyle modifications, followed by the many pharmacological options currently available
Valve sparing aortic root surgery
No full textOperiranje korijena aorte s tendencijom očuvanja nativne valvule je relativno nov i tehnički intrigantan pristup rješavanju problema u slučaju sekundarne aortne regurgitacije uzrokovane patološkim proširenjem korijena aorte uz urednu anatomiju aortne valvule. S obzirom da je ovaj kirurški pristup posebice prikladan za mlađe pacijente te osobe s genetički uzrokovanim prijevremenim razvojem aneurizme korijena i/ili uzlazne aorte poput Marfanovog, Loeys-Dietzovog te Ehlers-Danlos sindroma, dugoročni cilj je zaobići kroničnu upotrebu antikoagulantne terapije i njezinih neizbježnih komplikacija koje inače prate pacijente nakon primjerice operacije po Bentallu. Začetak ovakvog kirurškog pristupa bio je 70-ih godina prošlog stoljeća kada je britanski kirurg egipatskog porijekla Sir Magdi Yacoub opisao tehniku remodelacije korijena aorte oblikovanjem Dacronskog grafta u svrhu formiranja neosinusa s očuvanjem zalistka. Krajem 80-ih godina kanadski kirurg Tirone David opisuje i kroz naredna desetljeća usavršava tehniku reimplantacije aortne valvule unutar ravnog (a kasnije i Valsalvinog) Dacronskog grafta, omogućavajući bolju strukturalnu stabilnost aortnog prstena. Davidova tehnika je doživjela mnoge nadogradnje poput Stanford V tehnike, a iskazala se superiornim izborom kod genetički urokovanih aneurizama korijena aorte. Sredinom 2000-ih opisuju se dodatne dvije kirurške tehnike. Francuski kirurg Emmanuel Lansac nadograđuje tehniku remodelacije dodatkom vanjskog prstena oko aortnog korijena u svrhu poboljšanja anularne stabilizacije, time eliminirajući tehnički nedostatak originalne remodelacije po Yacoubu. Florida sleeve tehniku osmislila je nekolicina američkih kirurga, među kojima se ističe dr. Thomas Beaver, nudeći pojednostavljenu verziju prethodnih tehnika, gdje se korijen aorte obavije unutar Dacronskog grafta poput rukava koji se osigura ispod polazišta koronarnih arterija time eliminirajući resekciju kompletnog aortnog korijena i reimplantaciju koronarnih ušća za graft. U svrhu ostvarivanja dugoročnih i uspješnih rezultata, za bilo koju od navedenih tehnika nužna je kvalitetna selekcija pacijenata i izvedba u visokospecijaliziranom centru.Valve-sparing aortic root replacement surgery is a relatively new and technically intriguing approach to solving the problem in the case of secondary aortic regurgitation caused by pathological aortic root dilation with normal aortic valve anatomy. Since this surgical approach is particularly suitable for younger patients and people with genetically caused premature development of aneurysms of the root and/or ascending aorta such as Marfan, Loeys-Dietz and Ehlers-Danlos syndromes, the long-term goal is to bypass the chronic use of anticoagulant therapy and its inevitable complications that usually accompany patients after, for example, the Bentall operation. The beginning of this surgical approach was in the 70s when the Egyptian-British surgeon Sir Magdi Yacoub described the technique of remodeling the aortic root by shaping a Dacron graft for the purpose of forming neosinuses with the preservation of the valve. 10 years later, the Canadian surgeon Tirone David described and during the next decades perfected the reimplantation technique of sewing the aortic valve within a straight (and later modified Valsalva) Dacron graft, enabling better structural stability of the aortic annulus. David's technique has undergone many modifications such as the Stanford V technique, and has proven to be a superior strategic choice for genetically-caused aortic root aneurysms. In the mid-2000s, two additional surgical techniques were described. French surgeon Emmanuel Lansac upgrades the remodeling technique by adding an external ring around the aortic root to improve annular stabilization, thereby eliminating the technical drawback of the original remodeling technique. The Florida sleeve technique was designed by several American surgeons, offering a simplified version of previous techniques, where the aortic root is sleeved inside a Dacron graft which is secured below the origin of the coronary arteries, thereby eliminating resection of the entire aortic root and reimplantation of the coronary ostia for the graft. Achieving the long-term and successful results, for any of the mentioned techniques, mindful patient selection and operation done in a highly specialized center is necessary
Effect of obstructive sleep apnea on the heart
No full textOpstrukcijska apneja tijekom spavanja (Obstructive sleep apnea, OSA) najčešći je poremećaj disanja povezan sa spavanjem. Obilježavaju ga epizode potpune ili djelomične opstrukcije gornjih dišnih puteva tijekom spavanja. Opstrukcije dišnih puteva dovode do potpunog prestanka disanja, pojam koji se zove apneja ili do djelomičnog prestanka disanja, što se zove hipopneja. U oba slučaja dolazi do pada saturacije krvi kisikom i/ili ometanja spavanja. Visoka učestalost epizoda apneje ili hipopneje tijekom spavanja dovodi do znatnog pogoršanja kvalitete sna što u kombinaciji s poremećajima krvne oksigenacije dovodi do
značajnog narušenja zdravlja osobe kroz godine. Većina osoba koja boluje od OSA nije svjesna toga, čak ni nakon iznenadnog
buđenja. Na ovaj poremećaj najčešće posumnjaju druge osobe koje dijele životni prostor s oboljelim. To zaključe na temelju epizoda glasnog hrkanja osobe popraćeno s epizodama prestanka disanja i borbe za zrak. Osoba koja boluje od neprepoznate OSA tijekom dana može imati pospanost, glavobolje i umor koji su povezani s lošom kvalitetom sna. Osim tih simptoma, nakon godina neliječene OSA dolazi do narušavanja zdravlja osobe u vidu kardiovaskularnih i neuroloških bolesti te dijabetesa.
Ovaj diplomski rad opisat će u prvom dijelu OSA s njenom epidemiologijom, rizičnim čimbenicima, patofiziologijom, kliničkom prezentacijom, dijagnostikom i liječenjem. Fokus će biti prvenstveno na kardiovaskularnoj patologiji i simptomima. U drugom dijelu diplomskog rada bit će opisana povezanost OSA s kardiovaskularnim bolestima. Neke od kardiovaskularnih bolesti koje se dovede u vezu s OSA su hipertenzija, zatajivanje srca, fibrilacija atrija, iznenadna srčana smrt i koronarna bolest.Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. It is characterized by episodes of complete or partial obstruction of the upper airway during sleep. Airway obstructions lead to complete cessation of
breathing, a term called apnea, or to partial cessation of breathing, which is called hypopnea. In both cases, there is a decrease in blood oxygen saturation and/or sleep disturbance. A high frequency of episodes of apnea or hypopnea
during sleep leads to a significant deterioration in sleep quality, which, combined with blood oxygenation disorders, leads to significant deterioration in a person's health over the years. Most people with OSA are unaware of it, even after waking up suddenly. The disorder is most often suspected by other people who share the living space with the sufferer. They conclude this based on episodes of loud snoring accompanied by episodes of stopping breathing and struggling for air. A person with an unrecognized OSA may experience daytime sleepiness, headaches, and fatigue associated with poor sleep quality. In addition to these symptoms, years of untreated OSA can lead to health problems such as cardiovascular and neurological diseases and diabetes. The first part of this thesis will describe OSA with its epidemiology, risk factors, pathophysiology, clinical presentation, diagnosis and treatment. The focus will be primarily on cardiovascular pathology and symptoms. The second part of the thesis will describe the association between OSA and cardiovascular diseases. Some of cardiovascular diseases associated with OSA are hypertension, heart failure, atrial fibrillation, sudden cardiac death, and coronary artery disease
Sports injuries and basic principles of rehabilitation
No full textSportske ozljede mogu se javljati kod profesionalnih sportaša, ali i onih koji se rekreativno bave sportom. Prema tipu sporta, javljaju se različite patoanatomske ozljede. Ozljede mogu biti akutne koje nastaju naglim opterećenjem ili kontaktnom traumom, ali i kronične koje su posljedica ponavljajućih pokreta i prenaprezanja mišićno – koštanog sustava. Sportske ozljede najčešće zahvaćaju gornje i donje ekstremitete. Ozljede gornjih ektremiteta najčešće se javljaju kod sportaša koji često rade pokrete rukom iznad glave npr. rukometaša i tenisača. Rame je najpokretljiviji zglob u našem tijelu i najpodložniji ozljedama te su česte ozljede rotatorne manšete, sindromi uklještenja, sindromi SLAP (engl. superior labral anterior posterior tears) i nestabilnost samog zgloba. U području lakta javljaju se ozljede ulnarnog kolateralnog ligamenta, epikondilitisi te sindromi prenaprezanja kao što je posteromedijalno uklještenje. U ručnom zglobu i šaci češće su akutne ozljede uzrokovane padom ili kontaktom poput prijeloma, ali postoje i kronične ozljede poput dorzalnog radiokarpalnog sindroma sraza. U sportskim ozljedama kuka najčešće se viđaju istegnuće aduktora, osteitis pubis, sportska hernija i femoroacetabularno uklještenje. Koljeno je složen zglob koji trpi velika opterećenja i vrlo često je zahvaćen ozljedama meniskusa, prednjeg križnog ligamenta, patelarnom nestablinošću, tendinitisom i patelofemoralnim bolnim sindromom. U sportovima u kojima su zastupljeni česti doskoci i promjene smjera javljaju se ozljede gležnja i stopala osobito prijelomi, uganuća, ali i kronične ozljede. Za očuvanje funkcije i povratak sportaša na teren potrebna je rana i pravilna rehabilitacija. Neposredno nakon ozljede glavni je cilj smanjiti bol i edem. U akutnim fazama ozljede, RICE (engl. rest, ice, compression, elelvation (odmor, led, kompresija i elevacija)) protokol igra važnu ulogu, a može se primijenjivati i krioterapija. Termoterapija se koristi u kroničnim fazama cijeljenja ozljede, a nakon ozljede važno je što ranije moguće započeti s kineziterapijom. U to spadaju vježbe opsega pokreta, snaženja, koordinacije i ravnoteže te izdržljivosti, a pri poticanju kontrakcije mišića koristi se i električna stimulacija.Sports injuries can occur in both professional athletes and those who engage in sports recreationally. Depending on the type of sport, different pathoanatomical injuries may develop. Injuries can be acute, resulting from sudden strain or contact trauma, or chronic, caused by repetitive movements and overuse of the musculoskeletal system. Sports injuries most commonly affect the upper and lower extremities. Upper extremity injuries most often occur in athletes who frequently perform overhead movements, such as handball and tennis players. The shoulder is the most mobile joint in the human body and therefore particularly prone to injury. Common shoulder injuries include rotator cuff tears, impingement syndromes, SLAP (superior labral anterior posterior tears) syndromes and joint instability. Injuries of the elbow include ulnar collateral ligament injuries, epicondylitis and overuse syndromes such as posteromedial impingement. In the wrist and hand, acute injuries are more common, such as fractures, but chronic injuries can also occur, such as dorsal radiocarpal impingement syndrome. Common hip – related sports injuries include adductor strains, osteitis pubis, sports hernia and femoroacetabular impingement. The knee is a complex joint and is frequently affected by injuries such as meniscal tears, anterior cruciate ligament injuries, patellar instability, tendinitis and patellofemoral pain syndrome. In sports that involve frequent jumping and direction changes, there are prevalent injuries of the ankle and foot including strains and fractures, as well as chronic overuse injuries. Early and proper rehabilitation is essential for restoring function and returning to sport. Immediately after injury the primary goal is to reduce pain and swelling. In the acute phase, the RICE (rest, ice, compression, elevation) protocol plays a key role, but cryotherapy may also be used. Thermotherapy is more appropriate for the chronic healing phase. Kinesiotherapy should be initiated as early as possible. That includes a range of motion exercises, strengthening, coordination and balance training and endurance. Electrical stimulation can also be used to promote muscle contraction during rehabilitation
Technology and diabetes
No full textŠećerna bolest ili diabetes mellitus skupina je metaboličkih bolesti koje karakterizira hiperglikemija, a povezuje se s dugoročnim oštećenjem, disfunkcijom i zatajenjem različitih organa, osobito očiju, bubrega, živaca, srca i krvnih žila. Šećerna bolest predstavlja jedan od najsloženijih i najraširenijih javnozdravstvenih problema suvremenog društva. Tehnološki napredak u posljednjim desetljećima omogućio je značajna poboljšanja u dijagnostici, praćenju i liječenju ove bolesti. Praćenje šećerne bolesti temelji se na mjerenju koncentracija glukoze u krvi. Desetljećima se mjerenje koncentracije glukoze u krvi vršilo glukometrima koji omogućavaju jednostavno i precizno kućno praćenje glikemije. Samokontrola glikemije sve se manje upotrebljava zahvaljujući razvoju kontinuiranog monitoriranja glukoze koje omogućuje kontinuirano ili često periodično mjerenje koncentracije glukoze u krvi tijekom 24 sata i dokazano poboljšava glikemijske ishode kod osoba sa šećernom bolesti. U liječenju tipa 1 šećerne bolesti osnovu predstavlja inzulin te su razvijeni različiti oblici brzodjelujućih, ultrabrzodjelujućih i dugodjelujućih inzulinskih analoga koji olakšavaju liječenje. Potrebu za unosom inzulina putem štrcaljki i brizgalica zamjenjuje razvoj uređaja za kontinuiranu supkutanu infuziju inzulina poznatih kao inzulinske crpke. Inzulinske crpke dokazano poboljšavaju glikemijske ishode i smanjuju vjerojatnost od hipoglikemije u osoba oboljelih od tipa 1 šećerne bolesti. Potpuno izlječenje tipa 1 šećerne bolesti jedino je moguće uz transplantaciju gušterače, a inovativnost je pokazana u razvoju transplantacije Langerhansovih otočića gušterače i drugim metodama presađivanja β-stanica. Perspektivu u praćenju, dijagnostici i liječenju šećerne bolesti predstavljaju i moderna tehnološka rješenja poput umjetne inteligencije, baza podataka i računalstva u oblaku.Diabetes mellitus is a group of metabolic disorders characterized by hyperglycemia which is associated with long-term damage, dysfunction, and failure of various organs, particularly the eyes, kidneys, nerves, heart, and blood vessels. It represents one of the most complex and widespread public health challenges of modern society. Technological advancements in recent decades have enabled significant improvements in the diagnosis, monitoring, and treatment of this disease. Monitoring of diabetes is based on measuring blood glucose levels. For decades, this has been done using glucometers, which allow for simple and accurate home-based glycemic monitoring. Self-monitoring of blood glucose is increasingly being replaced by continuous glucose monitoring, which enables continuous or frequent periodic measurement of glucose levels throughout a 24-hour period and has been proven to improve glycemic outcomes in people with diabetes. In the treatment of type 1 diabetes, insulin remains the cornerstone. Various forms of rapid-acting, ultra-rapid-acting, and long-acting insulin analogues have been developed to facilitate more effective therapy. The need for insulin administration by syringes and pens is increasingly being replaced by devices for continuous subcutaneous insulin infusion, known as insulin pumps. These pumps have been shown to improve glycemic outcomes and reduce the risk of hypoglycemia in individuals with type 1 diabetes. Complete cure of type 1 diabetes is only possible through pancreas transplantation, with innovation evident in the development of pancreatic islet transplantation and other methods of β-cell replacement. Promising prospects in the monitoring, diagnosis, and treatment of diabetes are also found in modern technological solutions such as artificial intelligence, databases, and cloud computing
Significance of universal ovarian reserve testing
No full textOvarijska rezerva predstavlja broj i kvalitetu preostalih oocita te ima veliku važnost u procjeni
plodnosti. Zbog sve češćeg odgađanja roditeljstva raste zainteresiranost za ranim testiranjem
rezerve jajnika, a danas se to najčešće radi pomoću anti-Müllerovog hormona (AMH) i broja
antralnih folikula (AFC). Cilj ovog rada je analizirati potencijalne prednosti i nedostatke
univerzalnog testiranja ovarijske rezerve u općoj populaciji. Pozitivne strane probira uključuju
ranu procjenu plodnosti, informirano odlučivanje o planiranju obitelji i mogućnost
personaliziranog pristupa kontracepciji i potpomognutoj oplodnji. Također, probir je posebno
koristan kod žena s povećanim rizikom kao na primjer kod onih s autoimunim bolestima,
endometriozom ili pozitivnom obiteljskom anamnezom. S druge strane, negativni rezultati testa
mogu izazvati psihološki stres, tjeskobu, osjećaj manje vrijednosti i socijalnu izolaciju. Žene
bez partnera mogu osjećati dodatan pritisak da same osnuju obitelj, a mnoge bi zbog negativnog
rezultata odbacile ili pauzirale školovanje te profesionalni razvoj. Pozitivni rezultati testiranja
mogli bi ženama dati lažnu sigurnost i potaknuti ih na daljnje odgađanje roditeljstva, što bi u
budućnosti zasigurno smanjilo šansu za majčinstvom jer se zna da ovarijska rezerva opada s
godinama neovisno o trenutnom nalazu. Postoje i razne etičke i financijske dileme. Dok jedni
zagovaraju rani probir i ističu da trošak kasne dijagnoze uvelike premašuje troškove probira,
drugi vjeruju da su jednostavnije metode poput javnozdravstvenih edukacija puno korisniji i
jeftiniji način prevencije. Iako trenutno ne postoje stručne smjernice koje podržavaju
univerzalno testiranje, probir u populaciji koja nije neplodna mogao bi imati klinički značaj.
Dakle, pitanje univerzalnog testiranja na ovarijsku rezervu zahtijeva dodatnu znanstvenu
raspravu, etičku prosudbu i daljnja istraživanja kako bi se procijenila njegova korist naspram
štete.Ovarian reserve refers to the number and quality of remaining oocytes and plays a crucial role
in fertility assessment. Due to the increasing trend of delaying parenthood, interest in early
ovarian reserve testing is growing. Today, this is most commonly done by measuring anti
Müllerian hormone (AMH) levels and antral follicle count (AFC). The aim of this paper is to
analyze the potential advantages and disadvantages of universal ovarian reserve testing in the
general population. The positive aspects of screening include early fertility assessment,
informed decision-making regarding family planning and the possibility of a personalized
approach to contraception and assisted reproduction. Screening is also particularly useful for
women at increased risk, such as those with autoimmune diseases, endometriosis or a positive
family history. On the other hand, negative test results may cause psychological stress, anxiety,
feelings of inadequacy, and social isolation. Women without a partner may feel additional
pressure to start a family on their own and many might postpone or abandon their education
and professional development due to a negative result. Positive test results could give women
a false sense of security and encourage them to further delay parenthood which could ultimately
reduce their chances of becoming mothers, as ovarian reserve declines with age regardless of
the current test result. There are also various ethical and financial dilemmas. While some
advocate for early screening and point out that the cost of late diagnosis far exceeds the cost of
screening, others believe that simpler methods such as public health education are a more useful
and cost-effective form of prevention. Although there are currently no professional guidelines
supporting universal testing, screening in a non-infertile population could have clinical
significance. Therefore, the issue of universal ovarian reserve testing requires further scientific discussion, ethical evaluation, and continued research in order to assess its benefits versus
potential harms
Three-dimensional printing of tissue with applications in surgery
No full textTrodimenzionalni ispis tkiva predstavlja inovativnu tehnologiju koja omogućuje izradu složenih bioloških struktura korištenjem biotinti koje sadrže stanice i biomaterijale. Tehnologija kombinira inženjerstvo, računalne znanosti i medicinu kako bi omogućila izrada pacijentu prilagođenih tkiva temeljenih na digitalnim modelima dobivenim iz radioloških snimki. Tehnologija 3D biotiska već nalazi primjenu u različitim područjima kirurgije, uključujući plastičnu, maksilofacijalnu, vaskularnu, urološku, ortopedsku i kardiokirurgiju, pa su tako već opisani zahvati koji uključuju regeneraciju kože, oblikovanje nosne hrskavice, rekonstrukciju mokraćnog mjehura te izradu funkcionalnih srčanih zalistaka. Glavni smjer daljnjeg razvoja ove tehnologije uključuje individualni pristup pacijentu u kojemu se nakon pojave potrebe za zamjenom patološki promijenjenog tkiva, izrađuje pacijentu-specifični digitalni predložak nadomjestnog tkiva ili cjelovitoog organa pomoću radioloških snimki. Zatim se priprema za pacijenta specifična biokompatibilna tinta, tkivo ili organ se izrađuje na uređaju za trodimenzionalni biotisak, te se na posljetku zamjensko tkivo ili organ ugrađuje u pacijenta. Ukupno gledajući, 3D ispis i biotisak imaju potencijal postati jedno od revolucionarnih područja u pružanju zdravstvene skrbi u ovom stoljeću. Iako tehnologija još nije u potpunosti zrela za široku kliničku primjenu, njezin brzi napredak ukazuje na budućnost u kojoj će personalizirana terapija i regeneracija oštećenih tkiva postati standardni dio liječenja.Three-dimensional (3D) tissue printing represents an innovative technology that enables the fabrication of complex biological structures using bioinks containing cells and biomaterials. This technology combines engineering, computer science, and medicine to produce patient-specific tissues based on digital models obtained from radiological imaging. 3D bioprinting is already being applied in various surgical fields, including plastic, maxillofacial, vascular, urological, orthopedic, and cardiac surgery. Documented procedures include skin regeneration, nasal cartilage shaping, urinary bladder reconstruction, and the creation of functional heart valves. The main direction of further development in this field involves a personalized approach to the patient. When the need arises to replace pathologically altered tissue, a patient-specific digital template of the replacement tissue or entire organ is created using radiological scans. A biocompatible, patient-specific bioink is then prepared, and the tissue or organ is fabricated using a 3D bioprinting device. Finally, the replacement tissue or organ is implanted into the patient. Overall, 3D printing and bioprinting have the potential to become one of the most revolutionary areas in healthcare delivery in this century. Although the technology is not yet fully mature for widespread clinical application, its rapid advancement points toward a future where personalized therapy and the regeneration of damaged tissues will become a standard part of medical treatment