Acta medica academica最新文献

Objective: This review examines the existing literature on the structural and functional changes in the anatomy of the prefrontal cortex (PFC) associated with autism spectrum disorder (ASD), focusing on the roles of molecular signaling disruptions and trace element imbalances.

Methods: A literature review was performed through a structured search of academic publications from 2010 to 2025.

Discussion: Anatomic variations and structural and functional abnormalities within the PFC, including disruptions in neural connectivity, synaptic plasticity, and neurochemical balance, significantly contribute to the cognitive, social, and emotional deficits observed in ASD. The interplay between brain-derived neurotrophic factor dysregulation, oxidative stress, and trace element imbalances further exacerbates these dysfunctions.

Conclusion: According to our findings, the anatomy of the PFC appears to play a crucial role in the pathophysiology of ASD, given its involvement in executive function, emotional processing, and social cognition, suggesting a multifactorial pathophysiology that demands a multidimensional research approach.

Objective: This study analyzed PhD theses defended in Croatia between 1992 and 2023, with the aim of examining national trends, institutional contributions, disciplinary patterns, and data-related challenges.

Methods: This retrospective time-trend study utilized the administrative data obtained from the Croatian Bureau of Statistics. Data on the number of defended PhD theses were collected by year, university, and school/department. Linear regression models were applied to assess temporal trends at both the national and institutional levels.

Results: A total of 17,578 PhD theses were defended in Croatia between 1992 and 2023. The national output increased substantially, reaching a peak of 1,338 theses in 2012, followed by a subsequent decline and a gradual recovery. The University of Zagreb accounted for 74.8% of all defended theses, followed by the Universities of Osijek, Rijeka, and Split. Across institutions, the medical, economic, and engineering faculties were the most productive. Linear regression analyses demonstrated statistically significant upward trends at both the national level and across all major public universities. Collectively, medical schools produced 18% of all theses, with newer institutions, particularly those in Split and Osijek, exhibiting later but consistent growth. However, notable data inconsistencies were observed, including non-standardized institutional nomenclature, variable data granularity, and discrepancies among official reports.

Conclusion: Croatia's PhD output expanded markedly after 2000, reflecting the maturation and expansion of its higher education system. Regional universities and medical schools substantially increased their contributions, indicating national academic growth. Sustained institutional support will be essential to sustain progress and foster disciplinary development.

Objective: To report two additional cases of glycogen-rich clear cell carcinoma (GRCC) of the breast - detailing their clinicopathologic features, immunophenotypes, and follow-up - and to provide an updated literature review since 2020.

Case reports: Two patients (66 and 52 years old) had GRCC confirmed morphologically and histochemically. Case 1 was ER-positive/HER2- positive (luminal B/HER2-positive) and was managed with surgery, followed by adjuvant chemotherapy, endocrine therapy, and anti-HER2 therapy (trastuzumab). Case 2 was triple-negative and received neoadjuvant chemoimmunotherapy (pembrolizumab- based) with marked pathologic tumor regression at resection. Both patients were disease-free at one and 12 months, respectively.

Conclusions: GRCC is heterogeneous and should not be regarded as a single clinicopathologic entity within invasive breast carcinoma of no special type or assumed to have a uniform prognosis. Management should be biomarker-guided, as illustrated by these cases. The role of targeted and immune therapies in GRCC warrants multi-institutional studies.

Objective: This article aims to emphasize the importance of considering invasive thymoma in the differential diagnosis of mediastinal masses and highlights the critical role of timely surgical and oncological management in improving patient outcomes.

Case report: We present the case of a 70-year-old woman who presented with signs of superior vena cava syndrome, including dyspnea, facial swelling, and fatigue. Advanced imaging and intraoperative findings revealed a large anterior mediastinal mass infiltrating the left brachiocephalic vein and superior vena cava, extending into both the right atrium and right ventricle. Surgical intervention was performed, and histopathological analysis confirmed B2 thymoma with a high Ki-67 proliferation index. Despite surgical intervention, the patient's condition deteriorated, and she ultimately succumbed to the disease.

Conclusion: To the best of our knowledge, this is the first reported Bosnian case of B2 thymoma invading the brachiocephalic vein and superior vena cava and infiltrating both the right atrium and ventricle, causing superior vena cava syndrome. Despite their rarity, thymomas should always be considered in patients presenting with an enlarged mediastinum.

Objective: Childhood obesity is a growing public health concern influenced by social and familial determinants. This study examines the associations between caregiver education, family structure, social risk factors, and familial obesity with childhood obesity in a Portuguese pediatric population to inform targeted interventions.

Materials and methods: A retrospective case-control study was conducted at a Portuguese secondary hospital, including 78 children with obesity and 326 controls. Controls were selected using a time-matched, hospital-based approach from the same ward and calendar years as the cases. Socioeconomic data were extracted from the hospital records. Social risk was defined based on documented indicators of socioeconomic vulnerability, such as financial hardship, suspicion of neglect, and housing instability, identified through multidisciplinary records. Logistic regression models were used to assess the risk of obesity while adjusting for age and sex.

Resulst: Caregiver education and familial obesity were the strongest predictors of childhood obesity. Children whose caregivers had not completed compulsory education had a significantly higher risk of obesity, whereas familial obesity showed an even stronger association. Social risk factors were linked to obesity in univariate analyses but lost significance in adjusted models. An exploratory interaction between caregiver education and social risk suggested higher odds when both disadvantages co-occurred. Family structure did not independently predict obesity.

Conclusion: This study highlights the need for targeted public health interventions addressing caregiver education, economic support for at-risk families, and family-wide lifestyle changes. A multi-sectoral approach integrating healthcare, education, and community programs is crucial for reducing childhood obesity and promoting long-term health equity.

Objective: To highlight the diagnostic and therapeutic challenges of Spitzoid melanoma in childhood, with a focus on its potential genetic predisposition.

Case report: A 7-year-old female patient presented with a growing nodular lesion on her upper leg. Excision was performed, and histopathological analysis confirmed a diagnosis of Spitzoid melanoma, classified as pT2a. Following a multidisciplinary review, wide local re-excision and sentinel lymph node biopsy (SLNB) were recommended. No residual tumor was found, and the SLNB was negative. A comprehensive diagnostic evaluation ruled out systemic disease, and no additional treatment was required. Germline genetic testing identified a pathogenic CHEK2 variant (c.444+1G>A), prompting recommendations for genetic counseling and close follow-up.

Conclusion: This case report contributes to the limited body of knowledge on pediatric Spitzoid melanomas and underscores the importance of genetic insights in guiding both diagnostic and treatment decisions. The detection of a CHEK2 mutation underscores the importance of genetic profiling in family counseling.

Immunoglobulin A (IgA) vasculitis (IgAV) is the most prevalent systemic vasculitis in children. Although the condition is typically self-limiting with spontaneous recovery within a few weeks, both acute and long-term complications can arise, with renal involvement being the most significant. In recent years, considerable attention has been directed toward unraveling the genetic basis of IgAV. Studies have identified associations between disease susceptibility and specific human leukocyte antigen (HLA) polymorphisms. In addition, variants in genes encoding cytokines, chemokines, and other biologically important proteins - particularly those involved in the abnormal glycosylation of IgA1 - have been linked to both increased risk of developing IgAV and more severe disease manifestations. Notably, polymorphisms in the interleukin-1 receptor antagonist (IL1RN) and IL8 genes have been correlated with an increased risk of glomerular injury. Other gene polymorphisms have also been associated with specific clinical phenotypes, such as HMGB1 and RAGE, whereas polymorphisms in genes involved in mucosal immune defense have not demonstrated any significant correlations to date. Ongoing research is essential to clarify these findings further and determine their implications for clinical practice.

Objective: This study aimed to identify the factors affecting the quality of life (QoL) of children with transfusion-dependent thalassemia.

Materials and methods: A cross-sectional study was conducted on 38 hospitalized pediatric patients with thalassemia at two regional hospitals in Indonesia. We used demographic and anthropometric data, as well as the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL), to collect the data.

Results: The median age of the participants was 11 years (range, 2-18), with a median age at diagnosis of 12.5 months (2 - 84). The average hemoglobin (Hb) level was 8.47 g/dl, and 34% of the patients had blood type O. The interval between blood transfusions was 23.74 days, with a median number of transfusions of 200.5 (range, 22 - 405). The median current weight was 25 kg (range, 9.5 - 50 kg). More than half of the fathers (52.6%) and mothers (50%) of the children with thalassemia had completed only elementary school. The mean total QoL score reported by children was 82.69±13.38, and by parents, 82.6±11.27. Among the PedsQL domains, the children reported the highest scores in social functioning (89.86±15.48) and the lowest in school functioning (74.21±18.06). Similarly, parents reported the highest score in social functioning (91.05±12.95) and the lowest in school functioning (78.42±13.9). Multivariable analysis showed that Hb level and current weight were significantly associated with QoL in children with thalassemia.

Conclusions: The QoL of children with thalassemia is generally good and is influenced by their current body weight and Hb levels.

Objective: This study aimed to precisely identify the location of the adductor canal to assist knee surgeons during procedures.

Materials and methods: We utilized twenty formalin-fixed cadavers to measure the length of the lower limb from the midinguinal point (MIP) to the base of the patella and divided the measured length into three parts: the proximal, middle, and distal. After dissecting the adductor canal, we measured the distance between the MIP and the proximal foramen and the distal foramen (adductor hiatus), the distance between the distal foramen and the base of the patella, and the length of the adductor canal. We also measured the location of the proximal and distal foramina concerning the upper and lower limits of the middle third of the thigh.

Results: The mean lengths of the thigh and adductor canal were 39.59±3.6 cm and 15.24±2.26 cm, respectively. The average distances between the MIP and the proximal and distal foramina and between the distal foramen and the base of the patella were 14.39±1.98 cm, 29.56±2.22 cm, and 10.28±1.87 cm, respectively. In 75% of lower limbs, the proximal foramen was below the upper limit of the mid-third of the thigh, with an average distance of 1.74 cm, whereas in 85% of cases, the distal foramen was below the lower limit of the mid-third of the thigh, with an average distance of 3.3 cm.

Conclusion: This study suggests that the ideal adductor canal block approach is within the middle third of the thigh.

This review explores how virtual and augmented reality technologies are transforming medical education and clinical practice, particularly in anatomy instruction. Virtual and augmented reality technologies are reshaping our perception and interaction with anatomical structures. Their integration into medical practice has introduced opportunities in diagnostics, surgical training, rehabilitation, and patient education. With the increasing number of U.S. Food and Drug Administration approvals, these technologies offer a transformative shift in the teaching and practice of medicine. Virtual environments facilitate detailed anatomical visualization, offering students and trainees immersive and interactive experiences. This paper highlights the role of these technologies in enhancing educational methods, improving knowledge retention, and overcoming traditional limitations, such as the scarcity of cadavers. CONCLUSION: Virtual and augmented reality offer novel educational tools in the health sciences, providing cost-effective, accessible, and innovative approaches to anatomy education and clinical application. Further research is required to elucidate the benefits of these technologies in the education and training of medical students.