Vojnosanitetski pregled

Vojnosanitetski pregled in 2026 – new challenges, same dreams

2026-01-30T09:39:12+01:00

Stem cell transplantation – an overview of clinic-based data and practice in the era of new drugs

2026-01-30T09:39:12+01:00

Hematopoietic stem cell transplantation (HSCT) has been the therapy of choice for treating some hematologic malignancies and selected non-malignant disorders for decades. With the introduction of novel immunotherapeutic and cell-mediated approaches, the role of autologous HSCT (auto-HSCT) and allogeneic HSCT (allo-HSCT) should be redefined. Auto-HSCT remains the standard of treatment for multiple myeloma, Hodgkin’s lymphoma, and non-Hodgkin’s lymphoma. The use of novel agents, including proteasome inhibitors, immunomodulatory drugs, monoclonal and bispecific antibodies, enhances the intensity and efficacy of the therapeutic response and opens debate on an optimized timing for HSCT. Allo-HSCT represents the most effective type of adoptive immunotherapy, ensuring complete and long-term hematopoietic reconstitution, often accompanied by the graft-versus-leukemia effect. It remains the main curative treatment for acute leukemias, high-risk myelodysplastic and myeloproliferative syndromes, and severe aplastic anemia. Improvements in stem cell (SC) donor selection, ex vivo manipulations of harvested cells, and graft engineering with superior immune monitoring have broadened and expanded their applicability, while improving safety and clinical outcome. Despite rapid progress in cellular and other immunotherapies, HSCT continues to play an essential role in the treatment of numerous hematologic disorders. A combination of HSCT with novel drugs and other immunotherapies offers the potential for personalized and safer treatment with long-term positive clinical outcomes, ensuring that HSCT remains a highly relevant method in modern medicine. The aim of this review was to summarize current biological concepts of SCs, as well as important advances in the rapidly developing fields of SC research, and to determine the place and efficacy of HSCT nowadays, in the era of new therapeutic approaches and agents.

Multiparametric structural imaging biomarkers of early white matter microstructural changes during and after glioblastoma chemoradiotherapy: diffusion tensor imaging and diffusion kurtosis imaging

2026-01-30T09:39:13+01:00

Background/Aim. Recognizing early irradiation-induced changes in the white matter is of great importance. The aim of this study was to investigate the potential use of diffusion tensor imaging (DTI) and diffusion kurtosis imaging (DKI) parameters as biomarkers of early brain tissue microstructural changes during chemoradiotherapy (CRT) treatment of newly diagnosed glioblastoma. Methods. A total of 42 glioblastoma patients who underwent CRT after surgical resection/biopsy were scanned three times using magnetic resonance imaging (MRI): before treatment, after 16 fractions, and after 33 fractions. Regions of interest (ROI) with total irradiation doses of 59.4 Gy (ROI 1), 39.6 Gy (ROI 2), and 19.8 Gy (ROI 3) were identified using co-registered axial dose distribution plans/dose-volume histograms and MRI scans. For each ROI, the following DTI parameters were calculated, measured, and analyzed: fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD), and mean diffusivity (MD). The corresponding DKI parameters included: radial kurtosis (RK), axial kurtosis (AK), and mean kurtosis (MK). Results. A significant decrease in FA value was observed in ROI 1 (total delivered dose 59.4 Gy) after both 16 and 33 delivered fractions, while the other DTI parameters and MK showed a significant increase. In ROI 1, a decreasing trend in RK and AK was identified, which was statistically confirmed after both 16 and 33 delivered fractions. In ROI 2 (total delivered dose of 39.6 Gy), FA values were significantly reduced after both 16 and 33 fractions, whereas RD, AD, MD, and MK were increased after 16 fractions, followed by a decrease after 33 fractions. The RK value in ROI 2 showed a significant decrease after both 16 and 33 fractions, and no changes were observed in AK values. In ROI 3 (total delivered dose of 19.8 Gy), no significant changes in any of the measured DTI or DKI parameters were noticed. Conclusion. DTI and DKI metric parameters may serve as biomarkers of early changes during and after CRT, providing information that may offer a better understanding of the complex dynamics of early white matter microstructural changes in response to glioblastoma CRT.

Comparison of antimicrobial and thrombolytic central venous catheter lock solutions in preventing catheter-related complications in hemodialysis: a randomized controlled trial

2026-01-30T09:39:15+01:00

Background/Aim. Central venous catheters (CVC) in hemodialysis (HD) patients are associated with serious complications, particularly catheter-related bloodstream infection (CRBSI) and thrombosis, leading to increased morbidity and mortality. The aim of this study was to evaluate the effectiveness of three different catheter lock solutions in preventing major catheter-related complications. Methods. This prospective, randomized, controlled, single-center study, conducted between June 2018 and June 2023, included 96 adult HD patients. Depending on the solutions they received, the patients were equally divided into three groups: gentamicin-citrate twice weekly plus taurolidine/urokinase after the third weekly session (TAURO); gentamicin-citrate three times weekly (GENTAM); unfractionated heparin 5,000 international units/mL three times weekly (HEPARIN). Lock solutions were administered for a minimum of three months post-CVC insertion and continued until catheter removal. Measured outcomes included CRBSI incidence, catheter thrombosis, and adverse events. Results. Over the course of 10,770 catheter-days, eight CRBSI episodes were recorded, with Staphylococcus aureus as the most common pathogen (50%). The incidence of CRBSI (per 1,000 catheter-days) was 0.27 in the TAURO group, 0.83 in the GENTAM group, and 1.15 in the HEPARIN group, without statistical significance (p = 0.526). Thrombosis incidence was similar across groups (1.09–1.15; p = 0.990). Cox proportional hazards analysis revealed no significant differences, although the TAURO group demonstrated a trend toward lower CRBSI risk compared to the HEPARIN group (hazard ratio = 0.236; 95% confidence interval 0.026–2.116). Conclusion. None of the evaluated lock regimens significantly reduced the risk of CRBSI or thrombosis. Nonetheless, the lowest CRBSI incidence was observed in the TAURO group, suggesting a potential benefit that warrants confirmation in larger, multicenter studies.

Possible relationship between blood groups and impacted lower third molars categorized according to Pell and Gregory and Winter classifications

2026-01-30T09:39:16+01:00

Background/Aim. Teeth that fail to reach their normal position within the jaws are considered to be impacted, and the etiology of impacted teeth is multifactorial. The aim of this study was to examine the possible relationship between blood groups and classifications of impacted lower third molars (LTMs) according to the Pell and Gregory’s and Winter’s classifications. Methods. This retrospective, cross-sectional study included 534 patients (274 males and 260 females) with at least one impacted LTM. A total of 890 LTMs were assessed using panoramic radiographs. Teeth were classified based on Pell and Gregory’s and Winter’s classifications., and blood groups were documented for each patient. Statistical analysis was performed using Fisher-Freeman-Halton test and Fisher’s exact test, with the Bonferroni correction Z test for multiple comparisons. Results. Significant relationships were identified between blood groups and the Pell and Gregory classification (p = 0.008), but not with the Winter classification. Notably, women with A Rh-negative (Rh-), AB Rh-, and B Rh- blood groups exhibited higher prevalence rates for the I/B, I/C, and III/C positions, respectively. Additionally, women with A Rh-positive (Rh+) and O Rh+ blood groups demonstrated higher prevalence rates for the II/A position, while men with A Rh+ showed higher rates for the II/C position. Gender-specific differences in impaction patterns were observed for A Rh+ and O Rh+ blood groups (p = 0.006, p = 0.038, respectively). Conclusion. Blood group antigens might influence LTM impaction patterns, particularly in relation to Pell and Gregory classification.

Fracture resistance of five intra-orifice barriers in endodontically treated mandibular premolars: an in vitro study

2026-01-30T09:39:16+01:00

Background/Aim. Endodontically treated teeth (ETT) are more prone to fractures than vital teeth, and insertion of an intra-orifice barrier (IOB) can increase their fracture resistance (FR). The aim of this study was to compare and evaluate the FR of ETT using smart dentin replacement (SDR), everX Flow (EXF), resin-modified glass-ionomer cements (RMGIC), calcium-enriched mixture (CEM), and universal flowable composite (UFC) as IOBs. Methods. After performing root canal treatment on 70 human mandibular premolars with a single root canal, the coronal 3 mm of root fillings were removed with heated instruments, except for the control specimens. Based on the IOB above the root canal obturation, the filled specimens were divided into six groups: RMGIC (n = 13), UFC (n = 13), SDR (n = 13), CEM (n = 13), EXF (n = 13), and a control group (CG; n = 5). A spherical steel insert with a diameter of 2 mm was used in the strength test with a universal testing machine. Data were analyzed using the Shapiro-Wilk test, analysis of variance, and least significant difference tests. The value of p < 0.05 is considered statistically significant. Results. The EXF group showed the highest mean FR of 759.9 ± 177.9 Newtons. The groups RMGIC, UFC, and EXF demonstrated a statistically significant difference compared to CG. CEM had a lower FR value than all groups except the SDR and CG. However, the FR of SDR was lower than that of the UFC and EXF groups. There were no significant differences between EXF, UFC, and RMGIC groups. Conclusion. Except for SDR and CEM, all other groups showed an increase in FR compared to CG. The results indicate that using EXF, UFC, or RMGIC as IOB can significantly enhance the FR of ETT compared to untreated controls. Clinically, selecting these IOBs may help prevent root fractures and improve the long-term prognosis of ETT.

Pharmacokinetics and pharmacogenetics – principles, applications, and challenges

2026-01-30T09:39:17+01:00