Acta Medico-Biotechnica

We cannot wish for success, and we cannot seek it. Success is not the goal. It is the result of our work.

Dušica Pahor — 2024-12-24

The Day of the University of Maribor, September 12, 2024 - Upon the presentation of this year's awards and acknowledgments on the Day of the University of Maribor, I was given the pleasant opportunity to show my gratitude on behalf of all award winners. Among this year's recipients was Sir Gregory Paul Winter, who won the Nobel Prize in chemistry in 2018, and who on that auspicious day was awarded an honorary doctorate by the university ...

A narrative review of ADME testing platforms

Tina Maver — 2024-12-24

Background: Significant progress has been made in absorption, distribution, metabolism, excretion (ADME) models, but the creation of platforms that reduce animal testing and research costs is still challenging. The increasing complexity of pharmacokinetic interactions underscores the need for reliable, reproducible ADME models, which are essential for drug development and safety to prevent serious clinical complications and hospitalizations.

Aims: This narrative review aimed to discuss multi-organ, function-based ADME platforms and evaluate recent developments in microphysiological systems (MPS) emphasizing functional accuracy.

Methods: We evaluated MPS models developed to improve the relevance of in vitro drug interaction studies by emphasizing critical tissue function over detailed anatomical mimicry. We also highlighted the strengths and limitations of these platforms in replicating the full complexity and functionality of native tissues.

Results: Despite making progress in structural replication, MPS models often lack the functional fidelity required for accurate drug testing. Models that emphasize functionality rather than complex structural details show promise in producing results relevant to humans, thus providing an alternative to animal testing.

Conclusions: A shift in focus from anatomical complexity to mimicking key tissue functions is required to fully realize the potential of MPS in ADME studies. Addressing the current limitations of biomedical engineering in this way may support the ethical, scientific, and regulatory goals of preclinical research. MPS can bridge the gap between traditional models and human-relevant systems by emphasizing functional accuracy, thus increasing the translational value of ADME studies and contributing to effective, ethical drug discovery.

Pancreas transplantation: indications, surgical technique, and clinical significance

Gaja Hladnik — 2024-12-24

Pancreas transplantation (PT) is a vital therapeutic option for patients with diabetes mellitus (DM)|, particularly those with end-stage renal disease (ESRD) or severe metabolic complications. Over the past several decades, advancements in surgical techniques, organ preservation and procurement methods, and immunosuppression therapies have significantly enhanced post-transplant patient survival, graft survival, and quality of life. The primary goals of PT are to achieve effective and stable glycemic control, often leading to insulin independence, improve the patient's quality of life, and reduce secondary complications associated with DM. PT encompasses a variety of procedures, including PT alone from a living donor, whole PT, pancreas with kidney transplantation, and pancreatic islet cell transplantation. PT is most commonly performed in conjunction with kidney transplantation for selected patients with DM and ESRD. Over the past decade, unadjusted patient survival rates have exceeded 96% at 1-year post-transplant and > 80% at 5 years.

Subtotal petrosectomy in cochlear implantation

Janez Rebol — 2024-12-24

The main indication for subtotal petrosectomy (SP) in cochlear implant surgery is chronic otitis media with or without cholesteatoma. In addition to chronic otitis, other indications for surgery include inner ear malformations with the possibility of cerebrospinal fluid leakage and anatomical abnormalities. The main goal of the surgical technique is to eliminate the inflammation in the mastoid cavity and insert an electrode into the inner ear. Over the past thirteen years, the procedure has been performed in 15 patients with an average follow-up of 61 months. In all patients, complete insertion of the electrode was achieved, and the cavity was filled with abdominal fat.

Revision surgery was required in three patients with preservation of the device. All patients are still using the cochlear implant.

Subtotal petrosectomy is a safe procedure. However, follow-up is required for at least ten years after surgery. Meticulous surgery with removal of all disease, middle ear mucosa, and epithelium, the complete sealing of the external ear canal, and covering of the implant to prevent extrusion are critical for a successful surgical result.

Perception of patient-centered care in three fertility clinics: influence of domestic or cross-border treatment and reimbursement policy

Veljko Vlaisavljević — 2024-12-24

Introduction: This study aimed to evaluate the experience of patients undergoing patient-centered care (PCC) at three fertility clinics in Southeastern Europe in terms of the treatment cost coverage and quality of care provided.

Methods: Couples who underwent assisted reproductive technology (ART) were divided into three groups: (i) Slovenian patients covered under the national insurance programme; (ii) self-pay patients receiving treatment in their country of origin/a clinic abroad; and (iii) cross-border self-pay patients receiving treatment in Maribor, Slovenia.

A standardized questionnaire, the “Patient Centeredness Questionnaire on Infertility Treatment (PCQ-Infertility)”, was translated into each patient’s native language and administered to 400 couples, of whom 78% completed it. For each of the three patient groups, the mean scores of the PCC domains and indicators were calculated. These data were then used for the score gap analysis.

Results: Overall, the domain assessing the competence level of medical staff produced the biggest score domain gap (SDG) in the group of cross-border, self-pay patients, while the smallest score was observed for the health organization domain in the group of domestic patients with reimbursed cycles. In our research, the indicator corresponding to information about any possible side-effects of the prescribed medication produced the smallest score indicator gap (SIG), while the biggest SIG was observed for staff members assigned to be contacted for questions at any time.

Conclusion: The results did not show that the financing method of ART treatment affected patient experiences of PCC. Although the competence of the medical staff is rated highly, domestic patients with reimbursed ART cycles continue to experience a lack of PCC in the health organization domain.

Molecular tissue markers integrated: A mathematical model approach to evaluating and predicting prostate cancer using molecular tissue markers

Mihael Munda — 2024-12-24

Purpose: The standard criteria available for the diagnosis of prostate cancer often do not sufficiently predict the course or outcome of this common disease. Evaluating molecular tissue markers, especially those that mark apoptosis and proliferation, in an integrated mathematical model, could contribute to a better understanding of the development and pathogenesis of this disease, aid in the selection of adequate therapies, and open new avenues of therapeutic research.

Materials and methods: Paraffin-embedded prostatectomy specimens were stained according to an immunohistochemical protocol for p53, bcl-2, and CD105. A mathematical model was developed, which incorporated values of tissue markers according to their apoptotic/proliferative characteristics.

Results: The results of tissue marker expression and mathematical modeling were correlated with patient clinical data. We showed that tissue marker values correlated better with clinical data when tissue markers values were incorporated in a mathematical model than when applied alone.

Chitosan nanoparticles as potential antimicrobial coating

Zdenka Peršin Fratnik — 2024-12-24

Purpose: To evaluate the antimicrobial efficacy of chitosan nanoparticles in comparison to a chitosan solution, as well as to assess their practical application on medical textile materials.

Methods: Dispersions of nanoparticles with different weight fractions of chitosan were prepared. An optimal chitosan nanoparticle system for textile material application was identified based on analyses of charge, particle size, changes in surface charge (zeta potential), concentration of free amine groups (polyelectrolyte titration), morphology, and antimicrobial properties. The effect of the nanoparticles dispersion application compared to the chitosan solution was determined using the ASTM E2149-01 antimicrobial test with Gram-positive (Staphylococcus aureus) and Gram-negative (Escherichia coli) bacteria and a fungus (Candida albicans).

Results: More effective application of chitosan was noted with the incorporation of chitosan nanoparticles. Applying chitosan on the inside and outside of the functional material enhanced the specific surface area and improved the accessibility of the chitosan coatings. Applying chitosan nanoparticles provided effective antimicrobial protection against all three microorganisms tested.

Conclusions: Chitosan deposition in the form of nanoparticles compared in form of solution, offered better antimicrobial protection. Such functionalised material presents a promising application in medical textile materials.

Patient Blood Management: Where Are We Now and What Should We Do?

Miodrag Žunić — 2024-12-24

Patient blood management (PBM) is an interdisciplinary, patient-centred approach based on three pillars: 1) comprehensive anaemia management; 2) minimization of blood loss and optimization of coagulation perioperatively; and 3) leverage and optimization of patient-specific physiological tolerance of anaemia. The effectiveness and safety of PBM, together with the fact that >30% of the world population is anaemic with detrimental health and economic consequences, led the World Health Organisation to issue a policy brief in 2021 on the urgent need to implement PBM. Implementation of the PBM programme, differs among European countries. On the basis of the current guidelines, the Central Eastern European Patient Blood Management Steering Committee reached a consensus in 2024 to ensure minimal hospital standards of PBM implementation in Central and Eastern European countries. This article describes the PBM programme, its current status, and the possibilities for its perioperative implementation, according to the three pillars of PBM, at the University Medical Centre Maribor, as the second largest hospital in the Republic of Slovenia, from the point of view of an anaesthesiologist and a clinical pharmacologist. Its purpose is to inform readers about the importance of PBM implementation and raise awareness of the need for urgent action by healthcare providers and authorities to ensure optimal patient care.

Systemic food embolism in a case of atrio-esophageal fistula after alcohol ablation of the Marshall vein: A case report

Živa Ledinek — 2024-12-24

Purpose: Ablation procedures are common and standard therapeutic interventions for symptomatic patients with persistent atrial fibrillation (AF). Various complications have been observed after the procedure, with one of the most fatal being atrio-esophageal fistula (AEF). Although rare, AEF has very high morality. Diagnosis of AEF is challenging, especially in emergency settings, because of its unspecific clinical signs, such as atypical neurological signs after food or air embolism.

Case Presentation: A 46-year-old woman with a 10-year history of AF underwent ethanol infusion of the Marshall vein. Almost a month after the procedure, the patient collapsed and was brought to the emergency department with signs of right side hemiparesis. Occlusion of the left middle cerebral artery was identified with no ischemic change in brain parenchyma. During thrombectomy the patient had a sudden episode of hematemesis. After esophagogastroscopy, she was immediately transferred to the operating room for emergency surgery, but died on the operating table. Autopsy confirmed a clinical suspicion of AEF with massive gastrointestinal bleeding and systemic food embolism. We present this case to improve clinical recognition of the signs of AEF after alcohol ablation for AF. We also recommend active surveillance for patients who undergo similar procedures, including regular check-ups.