University of Rijeka

Background: Balkan nephropathy (BEN) is an environmental form of aristolochic acid nephropathy (AAN) strongly associated with upper urinary tract urothelial carcinoma (UTUC). Clinical diagnosis remains challenging, and misclassification is frequent. The study reassessed BEN diagnoses in kidney transplant recipients from rural farming areas who did not undergo prophylactic bilateral nephroureterectomy and evaluated post-transplant outcomes. Methods: In this retrospective single-centre study, we analysed 12 kidney transplant recipients from rural Balkan farming regions. BEN diagnoses were reevaluated according to international consensus criteria. Key endpoints included patient and graft survival, post-transplant clinical course, and UTUC characteristics. Results: Upon reassessment, three of the six patients initially diagnosed with BEN were reclassified as having BEN. Among the remaining six patients, four were reclassified as having sporadic BEN. Overall, only 33% of patients had a diagnosis concordant with their admission records. During a median follow-up of 6.8 years (IQR 2.1-15.8), UTUC developed in seven out of 12 patients. The UTUC cases were predominantly high-grade and multifocal, and they were identified as the leading cause of death. Five-year patient and graft survival rates were 71% and 100%, respectively. Conclusions: BEN is frequently misdiagnosed or misclassified in kidney transplant candidates from rural farming areas. Despite excellent graft survival, the high incidence of post-transplant urothelial carcinoma underscores the necessity of accurate diagnosis and the consideration of prophylactic bilateral nephroureterectomy. Lifelong intensive surveillance is essential not only for patients from established BEN regions but also for individuals from other rural farming areas at risk for sporadic BEN.

It is unknown whether the failure of antihypertensive drug treatment to normalize sympathetic cardiovascular (CV) function reported in previous studies selectively affects regional sympathetic CV outflow or it also involves whole body neuroadrenergic drive. The present study examines the impact of antihypertensive drug treatment on regional and whole body sympathetic CV influences. Fifthyfour essential hypertensive patients were included in the study. In each patient measurements consisted of the microneurographic recording of muscle sympathetic nerve traffic (MSNA) and the assay of venous plasma norepinephrine (NE). They were performed before and during an antihypertensive drug treatment (monotherapy or two-drugs combination) prolonged for a 3 months period. Measurements were also carried out in 31 age-matched normotensive controls. In the study population antihypertensive drug treatment lowered clinic blood pressure to values <140/90 mmHg and significantly (P<0.001) reduced both MSNA and NE. However, during treatment the values of these two adrenergic markers remained significantly greater (+70.8 % and +64.4%, respectively) than those detected in the normotensive subjects. These data provide evidence that antihypertensive drug treatment reduces but not normalizes regional and whole body sympathetic CV drive, likely participating at determining the residual CV risk reported in different studies in treated hypertensives.

Heavy metals in agricultural systems pose a significant challenge to food security, especially in regions with long-term intensive land use. While the Pannonian Plain represents Croatia's primary breadbasket, accounting for a significant portion of the nation's cereal production, data on the soil-to-grain transfer of heavy metals and the associated human exposure risk are limited. The objective of this study was (i) to determine the concentrations of arsenic (As), cadmium (Cd), and lead (Pb) in agricultural soils and corresponding grains (wheat, barley, and maize) across four principal counties within the Pannonian region of Croatia; (ii) to evaluate the soil-to-grain transfer factors that varied regionally and among cereal types; and (iii) to assess the potential non-carcinogenic health risks for both adults and children highlighting differences in exposure due to body weight and consumption patterns. Soil and cereal grain samples were collected in 2019 and 2020, and metal concentrations were determined by ICP-MS after microwave acid digestion. The transfer of metals from soil to grain was estimated using the transfer factor (TF), while exposure assessment was conducted by calculating the estimated daily intake (EDI), hazard quotient (HQ), and hazard index (HI). Due to the nonlinear distribution of the data and the lack of strictly matched soil and grain samples, median metal concentrations pooled across all studied regions were used for exposure assessment. For As, a conservative approach was applied, assuming that 50% of the total As is in inorganic form. Additionally, a probabilistic risk assessment using Monte Carlo simulations was conducted to account for variability in body weight and cereal intake, providing a more comprehensive evaluation of potential exposure. The results showed differences in metal accumulation among cereal species, with wheat and barley tending to accumulate more Cd than maize, while As and Pb concentrations in grains were low for all crops studied. Although soil metal concentrations in Međimurje County were generally low, elevated TF values for As and Pb were observed, indicating enhanced soil-to-plant transfer under specific local soil conditions. In contrast, high soil metal concentrations in Slavonski Brod-Posavina County were associated with low TF values, suggesting limited bioavailability and restricted transfer to cereal grains. Both deterministic and probabilistic assessments indicated that the HQ and HI for adults and children were below 1, suggesting low non-carcinogenic risk from cereal consumption. These findings highlight pronounced regional and crop-specific differences in soil-to-plant metal transfer and confirm that low soil contamination does not necessarily imply low transfer potential, emphasizing the importance of integrated soil-plant-grain monitoring for food safety assessment.

This paper presents a multi-modal perception system tailored for autonomous driving and safety monitoring in public parking environments, utilizing a dual-stage decision-level fusion of YOLOv8-seg and PointPillars. The architecture ensures precise occupancy monitoring and safety by integrating 2D instance segmentation with 3D LiDAR point clouds. A specialized decision fusion rngine features a distance-based matching phase and a rescue phase to maintain detections during sensor occlusions. By implementing a 2.5m Euclidean threshold and a high-confidence YOLO override mechanism, the system effectively compensates for LiDAR sparsity. Experimental results on the KITTI dataset demonstrate significant reliability gains, notably increasing the F1-score for pedestrians by 10.11% and cars by 6.99%. These findings prove that the synergy of visual masks and geometric data provides a robust solution for real-time monitoring of vehicles and vulnerable road users (pedestrians and cyclists) in automated parking environments.

HighlightsWhat are the main findings?CGM revealed markedly different glucose responses in elite athletes without diabetes depending on exercise modality, intensity, and fueling strategy, with both hypoglycemic and hyperglycemic excursions occurring well outside conventional euglycemic ranges.Extreme and discipline-specific physiological stressors, including intermittent ultra-endurance cycling, uninterrupted prolonged climbing, and hypoxic breath-hold diving, produced distinct and reproducible CGM patterns despite preserving metabolic health.What are the implications of the main findings?CGM metrics and clinical glycemic thresholds require context-specific interpretation in elite sport, as transient deviations from euglycemia may reflect adaptive physiological responses rather than metabolic dysfunction.These findings support the development of sport- and task-specific CGM benchmarks and highlight the need to integrate CGM data with exercise context, fueling practices, and performance demands when applied in high-performance settings.Glucose data regarding extreme elite performances in athletes without diabetes remains limited. The purpose is to characterize continuous glucose monitoring (CGM) responses in elite athletes across distinct high-performance contexts. This descriptive case series includes three separate elite athletes who used a CGM during their respective sporting events. The first is an ultra-endurance relay cycling world-record performance (Race Across the West, RAW), the second is a continuous high-intensity Everesting Challenge cycling record attempt, and the third is a maximal constant-weight no-fins breath-hold depth dive performed in international competition. Glycemic outcomes, as measured by CGM, included mean, maximum, and minimum glucose, glucose standard deviation (SD), and the percentage of time in tight glucose range (TITR: 70–140 mg/dL; 3.9–7.8 mmol/L), time below range (TBR: <70 mg/dL; <3.9 mmol/L), and time above range (TAR140: >140 mg/dL; >7.8 mmol/L). Other performance data, including peak power, heart rate, and lactate, are also provided where available. During the RAW challenge lasting 44 h and 20 min, mean glucose was 91 ± 23.2 mg/dL (mean ± SD) with 9.15% TBR and 35.58% TITR during cycling and 115 ± 24.7 mg/dL with 9.11% TBR and 43.16% TITR during resting periods. In contrast, the Everesting Challenge cycling record attempt demonstrated a persistently elevated glucose profile (160 ± 5.7 mg/dL), minimal variability (CV 3.5%), and 100% TAR140. Following the maximal breath-hold depth dive, interstitial glucose was 100% TAR140 during recovery (187 ± 18.5 mg/dL), alongside marked elevations in blood lactate concentrations (peak 13.4 mmol/L). The series of case studies demonstrate that substantial deviations from traditional euglycemic ranges are common during elite performance in athletes without diabetes. Interpretation of CGM data in athletic settings should therefore be performance- and context-specific rather than based on clinical glycemic thresholds.

The integration of artificial intelligence (AI) into online education has transformed the digital learning space, offering new ways to enhance learner satisfaction and engagement. This systematic literature review, covering a five-year span from 2020 to 2025, explores how AI technologies, such as chatbots, intelligent tutoring systems (ITS), sentiment analysis, gaze tracking and predictive analytics, support learner engagement across cognitive, emotional, behavioral, and social dimensions. Drawing from 30 peer-reviewed studies, the current review addresses three central research questions: (1) What aspects of AI positively influence learner satisfaction and engagement in online courses within higher education institutions; (2) What potential challenges from using these technologies may arise; and (3) What research approaches are most commonly used to assess AI’s impact in such learning contexts? The findings highlight that adaptive learning, real-time feedback, and emotion-aware systems contribute positively to personalized learning and motivation. However, concerns persist around data privacy, algorithmic bias, over-reliance on automation, and system usability. Experimental and quasi-experimental designs, as well as machine learning, mixed methods, and survey-based approaches are found to dominate in reviewed studies. Based on these insights, this work offers a foundation for future AI-enhanced learning management systems designed primarily to enhance learner engagement across cognitive, emotional, behavioral, and social domains.

Given Croatia's high and rising prevalence of arterial hypertension, we aimed to investigate the population-level determinants of hypertension. Out of 2049 individuals recruited in the EHUH 2 study (random sample), in this analysis, we included 864 individuals (men 34.5%) who provided valid 24-h urine samples. Data on demographics, lifestyle, clinical and laboratory parameters were collected. Hypertension was defined as blood pressure at least 140/90 mm Hg or antihypertensive use. Key determinants of hypertension included male sex [odds ratio (OR) 2.27], salt intake more than 5 g/day (OR 2.46), presence of diabetes (OR 1.95), residence in rural areas (OR 1.63) and a high sodium-to-potassium ratio (OR 1.24). Current smokers had fewer odds than nonsmokers (OR 0.55). When estimated pulse wave velocity (ePWV) was added, model 2 became stronger ( R2 = 0.455), and each increase of 1 m/s of ePWV increased odd for hypertension by 3.73. The higher prevalence of hypertension observed in rural areas was linked to low socioeconomic status, obesity and high sodium/potassium ratio. Ex-smokers had a higher risk obviously because they replaced one poor habit with another one. Based on our results, we can recommend in low-medium-income countries like Croatia tailor screening programs for hypertension not only for individuals with chronic kidney disease, diabetes, or obesity but also for those with low socioeconomic status and rural residents. We can suggest that two low-cost methods, sodium-to-potassium ratio and ePWV, become a regular routine part of these screening programs. In smoking cessation programs, smokers should be educated how to quit smoking, but also how to live healthier.

Abstractsurinary sediment, and cylindruria was observed exclusively in this group (p=0.007).In proliferative LN, the median NIH activity index was 7 (IQR 4-8), whereas the chronicity index was low at 1 (IQR 0-2).Interstitial fibrosis and tubular atrophy were absent in most cases and, when present, were uniformly mild.At the end of follow-up, 12 of 13 patients with proliferative LN maintained preserved renal function (eGFR >60 mL/min/1.73m 2 ).Conclusions Proliferative lupus nephritis is common in patients with SLE and proteinuria <500 mg/day and, in this cohort, occurred exclusively at proteinuria >300 mg/day.Integration of proteinuria with clinical and serological activity,particularly SLEDAI, anti-double-stranded DNA antibodies and complement levels,improves identification of patients at risk.Early kidney biopsy allows detection of active proliferative LN before irreversible renal damage and is associated with favourable renal outcomes.

Introduction: Intensive Care Units (ICUs) provide advanced, evidence-based care for critically ill patients. Physiotherapy is a vital component of ICU care but is often unavailable or insufficiently standardized. This study examined physicians’ and nurses’ satisfaction with physiotherapy care in Croatian ICUs and identified potential areas for improvement. Methods: A 26-item digital questionnaire was disseminated throughout Croatian ICUs to physicians and nurses. The items addressed included physiotherapy availability, equipment accessibility, satisfaction with the quality and effectiveness of care, and their perspectives on improvement. Responses were rated on a 5-point Likert scale or by selecting predefined options. Data analysis was performed using descriptive statistics in R Studio. Results: In total, 120 participants from 12 Croatian counties were included. The majority of responses (105) were from nurses/technicians, and only 15 from physicians. Physiotherapists were available in all ICUs, mainly on a consultative basis and mostly during morning shifts. Participants reported that physiotherapy interventions were effective in reducing pain, improving joint mobility, and enhancing respiratory function. Despite high overall satisfaction, participants emphasized the need for extended physiotherapist availability, improved ICU-specific training, and greater professional autonomy. Conclusion: Physicians and nurses expressed general satisfaction with ICU physiotherapy care but suggested improvements in physiotherapy availability and staff competence. Implementing standardized physiotherapy practices across ICUs could improve treatment outcomes and contribute to earlier patient discharge.