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Nikola Pavlović, Petar Todorović, Mirko Maglica, Marko Kumrić, Katarina Vukojević, Z. Pogorelić, J. Božić

The heart’s relentless contractile activity depends critically on mitochondrial function to meet its extraordinary bioenergetic demands. Mitochondria, through oxidative phosphorylation, not only supply ATP but also regulate metabolism, calcium homeostasis, and apoptotic signaling, ensuring cardiomyocyte viability and cardiac function. Mitochondrial dysfunction is a hallmark of cardiomyopathies and heart failure, characterized by impaired oxidative phosphorylation, excessive production of reactive oxygen species (ROS), dysregulated calcium handling, and disturbances in mitochondrial dynamics and mitophagy. These defects culminate in energetic insufficiency, cellular injury, and cardiomyocyte death, driving heart disease progression. Diverse cardiomyopathy phenotypes exhibit distinct mitochondrial pathologies, from acute ischemia-induced mitochondrial collapse to chronic remodeling seen in dilated, hypertrophic, restrictive, and primary mitochondrial cardiomyopathies. Mitochondria also orchestrate cell death and inflammatory pathways that worsen cardiac dysfunction. Therapeutic strategies targeting mitochondrial dysfunction, including antioxidants, modulators of mitochondrial biogenesis, metabolic therapies, and innovative approaches such as mitochondrial transplantation, show promise but face challenges in clinical translation. Advances in biomarker discovery and personalized medicine approaches hold promise for optimizing mitochondrial-targeted therapies. Unlike previous reviews that examined these pathways or interventions individually, this work summarizes insights into mechanisms with emerging therapeutic strategies, such as SGLT2 inhibition in HFpEF, NAD+ repletion, mitochondrial transplantation, and biomarker-driven precision medicine, into a unified synthesis. This framework underscores the novel contribution of linking basic mitochondrial biology to translational and clinical opportunities in cardiomyopathy and heart failure. This review synthesizes the current understanding of mitochondrial biology in cardiac health and disease, delineates the molecular mechanisms underpinning mitochondrial dysfunction in cardiomyopathy and heart failure, and explores emerging therapeutic avenues aimed at restoring mitochondrial integrity and improving clinical outcomes in cardiac patients.

Petar Todorović, Ivana Jurić, Nela Kelam, Matko Rošin, Davor Čarić, Danica Boban, Andrea Kopilaš, Katarina Vukojević

Background/Objectives: Hip osteoarthritis (HOA) is a progressive joint disease characterized by cartilage loss, subchondral bone changes, and synovial inflammation. While tumor necrosis factor receptor 1 (TNFR1), interleukin-6 (IL-6), and transforming growth factor-beta 1 (TGF-β1) are recognized as key mediators of joint pathology, their compartment-specific expression in the human hip synovium remains insufficiently characterized. Therefore, we aimed to investigate their localization and expression in the intimal and subintimal compartments of synovial tissue in patients with HOA compared to controls (CTRL). Methods: Synovial membrane samples were obtained from 19 patients with primary HOA undergoing total hip arthroplasty and 10 CTRL subjects undergoing arthroplasty for acute femoral neck fracture without HOA. Specimens were processed for hematoxylin and eosin (H&E) and immunofluorescence staining. Expression of TNFR1, IL-6, and TGF-β1 was quantified in the intima and subintima using ImageJ analysis. Group differences were assessed using two-way Analysis of variance (ANOVA) with Tukey’s test when assumptions were met; for heteroscedastic outcomes we applied Brown–Forsythe ANOVA with Dunnett’s T3 multiple comparisons. Results: Histological analysis confirmed synovitis in HOA samples, with intimal hyperplasia and mononuclear infiltration. IL-6 was significantly upregulated in the intima of HOA synovium compared with CTRLs, while subintimal expression remained unchanged. In contrast, TGF-β1 expression was reduced in the HOA intima, eliminating the normal intima–subintima gradient. For TNFR1, the within-HOA contrast (int > sub) was significant, whereas the intimal HOA vs. CTRL comparison showed a non-significant trend. Transcriptomic analysis supported IL-6 upregulation, while TNFR1 and TGF-β1 did not reach statistical significance at the mRNA level in an orthogonal, non-hip (knee-predominant) dataset. Conclusions: These findings demonstrate compartment-specific cytokine dysregulation in HOA, with increased intimal TNFR1 and IL-6 alongside reduced intimal TGF-β1. The synovial lining emerges as a dominant site of inflammatory signaling, underscoring its importance in disease progression.

B. Milovanović, Nikola Marković, Maša Petrović, Vasko Žugić, Milijana Ostojic, Milovan Bojic

Background/Objectives: Postural orthostatic tachycardia syndrome (POTS) is a form of dysautonomia characterized by excessive tachycardia during orthostatic stress. It is frequently observed in patients with syncope, Chronic Fatigue Syndrome (CFS), and post-COVID-19 syndrome (PCS), yet the underlying mechanisms may differ across these conditions. This study aimed to assess autonomic nervous system (ANS) function in patients with syncope, CFS of insidious onset, and CFS post-COVID-19 who presented with POTS, and to compare them with age- and sex-matched patients without POTS. Methods: In this retrospective cross-sectional study, 138 patients over 18 years of age were included following head-up tilt testing (HUTT). Patients were divided into six groups: syncope with and without POTS, CFS with insidious onset with and without POTS, and CFS post-COVID-19 with and without POTS. All participants underwent HUTT, cardiovascular reflex testing (CART) by Ewing, five-minute resting ECG with short-term Heart Rate Variability (HRV) analysis, and 24 h Holter ECG monitoring. Results: The prevalence of POTS across groups ranged from 5% to 7%. Female predominance was consistent across all subgroups. In syncope with POTS, hypertensive responses during HUTT, lower rates of normal Valsalva maneuver results, and reduced HF values in short-term HRV suggested baroreceptor dysfunction with sympathetic overdrive. In both CFS subgroups with POTS, CART revealed higher rates of definite parasympathetic dysfunction, along with more frequent extreme blood pressure variation during HUTT and reduced vagally mediated HRV parameters (rMSSD, pNN50). Across groups, no significant differences were observed with regard to long-term HRV across groups. Conclusions: Distinct autonomic profiles were identified in POTS patients depending on the underlying condition. Syncope-related POTS was associated with baroreceptor dysfunction and sympathetic predominance, whereas CFS-related POTS was characterized by parasympathetic impairment and impaired short-term baroreflex regulation. Evaluating dysautonomia patterns across disease contexts may inform tailored therapeutic strategies and improve management of patients with POTS.

P. Široký, B. Bilbija, Claudia Paetzold, C. Kehlmaier, U. Fritz

The African hinged terrapin genus Pelusios currently contains 17 recognized species. We describe an additional new species with two subspecies from the Democratic Republic of the Congo and Tanzania. According to phylogenetic analyses of mitochondrial DNA, the new species is closely related to P. subniger, whereas three nuclear loci (C-mos, RAG2, R35) suggest a closer relationship to P. bechuanicus and P. upembae. Morphologically, the new species resembles in plastral shape P. subniger, but differs in plastral coloration in having a diffuse dark plastral pattern instead of the blotched pattern of P. subniger. The two subspecies of the new species are characterized by distinct mitochondrial clades and private alleles in the nuclear RAG2 and R35 loci. According to an examination of museum specimens and photographic records, the new species occurs largely west of the Rift Valley, while P. subniger is distributed east of the Rift Valley. Museum specimens and iNaturalist records suggest that the two species could occur sympatrically in central Tanzania. Furthermore, we found no evidence for any genetic distinctness of P. subniger from the Seychelles, supporting that the subspecies from there is invalid.

Justinas Babinskas, Jokūbas Krutkevičius, Lada Lukić Bilela, Renata Bešta-Gajević, Inga Matijošytė

ABSTRACT Enzymes derived from extremophiles, or extremozymes, possess unique properties that enable them to function under extreme environmental conditions. Microbial communities in subterranean ecosystems have evolved specialized metabolic pathways to survive, leading to the discovery of bioactive molecules with diverse biotechnological and industrial applications as well as the development of sustainable methods for habitat restoration. This study aimed to identify cultivable microorganisms producing industrially relevant enzymes, such as laccases, proteases, and urethanases, from extremophiles in the Dinaric Karst subterranean ecosystems, which are known as biodiversity hotspot. A total of 40 samples were collected from six caves and an abandoned railway tunnel, now a key roost for a large Myotis myotis maternity colony. Cave samples were taken from the entrance, twilight, and dark zones, including soil, sediments, moonmilk, mineral deposits, bedrock deposits, insect remains, entomophagous fungi, wall biofilm, and guano from various bat species. Following microbial cultivation, 207 colonies were screened for enzymatic activity using substrate‐specific assays. Functional analysis identified one microorganism exhibiting strong laccase activity, seven capable of degrading polyurethane, and numerous protease‐producing colonies. Notably, this study constitutes the inaugural report on discovering polyurethane‐degrading microorganisms in karst caves. Molecular identification revealed microbial genera, including Bacillus, Pseudomonas, Serratia, Paenibacillus, and Priestia. These findings underscore the biotechnological potential of subterranean extremophiles and highlight the importance of conserving these ecosystems. Further characterization of these enzymes may drive advancements in environmental remediation, waste recycling, and sustainable industrial processes.

The aviation industry operates as a complex, dynamic system generating vast volumes of data from aircraft sensors, flight schedules, and external sources. Managing this data is critical for mitigating disruptive and costly events such as mechanical failures and flight delays. This paper presents a comprehensive application of predictive analytics and machine learning to enhance aviation safety and operational efficiency. We address two core challenges: predictive maintenance of aircraft engines and forecasting flight delays. For maintenance, we utilise NASA’s C-MAPSS simulation dataset to develop and compare models, including one-dimensional convolutional neural networks (1D CNNs) and long short-term memory networks (LSTMs), for classifying engine health status and predicting the Remaining Useful Life (RUL), achieving classification accuracy up to 97%. For operational efficiency, we analyse historical flight data to build regression models for predicting departure delays, identifying key contributing factors such as airline, origin airport, and scheduled time. Our methodology highlights the critical role of Exploratory Data Analysis (EDA), feature selection, and data preprocessing in managing high-volume, heterogeneous data sources. The results demonstrate the significant potential of integrating these predictive models into aviation Business Intelligence (BI) systems to transition from reactive to proactive decision-making. The study concludes by discussing the integration challenges within existing data architectures and the future potential of these approaches for optimising complex, networked transportation systems.

Darko Boljević, Jovana Lakčević, Mihajlo Farkić, Vladimir Mihajlović, S. Veljković, A. Šljivo, Marina Lukić, Milovan Bojic et al.

Background and Clinical Significance: Concomitant severe aortic stenosis (AS) and abdominal aortic aneurysm (AAA) in elderly patients presents a significant therapeutic challenge. While transcatheter aortic valve replacement (TAVR) and endovascular aneurysm repair (EVAR) have become established minimally invasive treatments for high-risk patients, simultaneous management of both conditions remains rare. Case Presentation: We report the first documented case in Serbia of a simultaneous TAVR and EVAR in a 75-year-old male with severe symptomatic AS and AAA. The patient had a history of hypertension, diabetes mellitus, atrial fibrillation, prior radiofrequency pulmonary vein ablation, and pacemaker implantation. Echocardiography demonstrated severe AS with a transvalvular gradient of 116/61 mmHg, an aortic valve area of 0.6 cm2, and a left ventricular ejection fraction of 30–35%. Coronary angiography revealed 50–60% stenosis of the right coronary artery. Following evaluation by a multidisciplinary Heart and Vascular Team, a combined procedure was performed under general anesthesia via bilateral femoral access. TAVR with a Medtronic Evolut R valve was successfully deployed, followed by EVAR with satisfactory stent graft positioning and angiographic results. The patient’s postoperative course was uneventful, and he was discharged on the ninth day. At six-month follow-up, echocardiography showed optimal valve function, and CT identified a type II endoleak, which was managed conservatively. Conclusions: This case demonstrates the feasibility and safety of simultaneous TAVR and EVAR in a high-risk elderly patient, emphasizing the importance of careful preoperative planning and a coordinated multidisciplinary approach. Further studies are warranted to establish standardized guidelines for the management of patients with coexisting severe AS and AAA.

Petar Todorović, Nikola Pavlović, Mirko Maglica, Patricija Bajt, Nela Kelam, Fila Raguž, Katarina Vukojević

The kidney’s intricate physiology relies on finely tuned gene regulatory networks that coordinate cellular responses to metabolic, inflammatory, and fibrotic stress. Beyond protein-coding transcripts, non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), have emerged as pivotal regulators of renal biology. By modulating transcriptional, post-transcriptional, and epigenetic pathways, ncRNAs govern podocyte integrity, tubular adaptation, intercellular signaling, and immune activation. Dysregulation of these networks is now recognized as a hallmark of major kidney diseases, ranging from diabetic nephropathy and acute kidney injury to chronic kidney disease, glomerulopathies, and polycystic kidney disease. Mechanistic studies have revealed how pathogenic ncRNAs drive apoptosis, inflammation, fibrosis, and cystic remodeling, while protective ncRNAs mitigate these processes, highlighting their dual roles as both disease mediators and therapeutic targets. The exceptional stability of ncRNAs in urine, plasma, and exosomes further positions them as minimally invasive biomarkers with diagnostic and prognostic value. Translational advances include anti-miR and mimic-based therapies (e.g., lademirsen targeting miR-21, miR-29 mimics, anti-miR-17 oligonucleotides), alongside lncRNA silencing strategies, although challenges in delivery, safety, and redundancy remain significant. This review integrates molecular mechanisms with translational perspectives, providing a comprehensive synthesis of how ncRNAs shape renal pathophysiology. By bridging mechanistic insights with emerging diagnostic and therapeutic applications, we highlight the potential of ncRNAs to transform nephrology, paving the way for biomarker-driven precision medicine and novel interventions aimed at intercepting kidney injury at its regulatory roots. In clinical terms, ncRNA-based biomarkers and therapeutics promise earlier detection, more precise risk stratification, and individualized treatment selection within precision nephrology.

Krešimir Mustapić, Petar Đolonga, Tomislav Ivanović, Ana Paparella Karaman, Lukáš Minař́ık, Katarina Vukojević, Merica Glavina Durdov

Simple Summary Advanced gastric cancer is generally associated with a poor prognosis. Stroma AReactive Invasive Front Area (SARIFA) is a recently recognized aggressive histological feature, defined as five tumor cells in direct contact with adipocytes within perigastric, submucosal, or perivascular adipose tissue. The aim of our retrospective study was to evaluate the correlation of SARIFA with pathohistological variables and its impact on overall survival. A cohort of 102 Croatian patients with locally advanced gastric cancer was analyzed, and a significant association between SARIFA and nodal metastases as well as perineural invasion was observed. Patients with both lymphovascular invasion and SARIFA had a significantly higher proportion of affected lymph nodes. They also exhibited a shorter, though not statistically significant, overall survival compared with patients with one or neither of these factors (median 9.2 vs. 16.1 months). A positive SARIFA status may serve as a biomarker of invasiveness and an additional prognostic risk factor. Abstract Background/Objectives: Advanced gastric cancer usually has an unfavorable prognosis. Stroma AReactive Invasion Front Area (SARIFA) is a newly recognized biomarker of aggressiveness, easily recognized as five tumor cells in direct contact with adipocytes in perigastric, submucosal, and perivascular adipose tissue. We investigated this phenomenon and correlated it with other pathohistological variables. Material and Methods: The sample includes 102 Croatian patients with locally advanced gastric cancer, who underwent total gastrectomy/lymphadenectomy between 2012–2018 and in 2023 at University Hospital Split, Croatia, and had pathological stage pT3 or pT4. Representative histological specimens were analyzed for SARIFA, and results were compared with other variables and overall survival. External validation and gene expression analysis of CD36 and FABP4 were performed using the TCGA-STAD cohort. Results: SARIFA was significantly associated with positive pN status (p = 0.009) and perineural invasion (p = 0.043). Patients with SARIFA had a more than fivefold increased risk of nodal involvement (OR = 6.35; 95% CI: 1.35–29.84; p = 0.019). Lymphovascular invasion (LVI) was associated with nodal disease (OR = 4.39; 95% CI: 1.194–16.143; p = 0.026), and SARIFA was marginally associated (OR = 4.886; 95% CI: 0.985–24.241; p = 0.052). Patients who had both LVI and SARIFA had a higher proportion of affected lymph nodes (p = 0.009). SARIFA status did not significantly affect overall survival. Gene expression analysis showed a significant increase in CD36 expression, while FABP4 expression was elevated but not statistically significant, in SARIFA-positive cases. Conclusions: SARIFA could be used as a marker for invasiveness and further investigated due to its predictive potential.

D. Vejzović, Christina Karner, K. Fechter, Gerald Ritter, Viktoria Holzer, Lisa Barones, N. Schweintzger, Karin Wagner et al.

Julijana Pelivan, Ivana Sović, Bojan Miletić, Lejla Jelovica, G. Starčević-Klasan, Davor Horvat

Background The aim of this study was to examine the prevalence of malnutrition and its association with the frequency of falls and respiratory infections among older adults residing in Croatian nursing homes. Materials and methods The study included 148 participants, 112 (75.7%) women and 36 (24.3%) men, aged 65 years and older, living in the nursing homes in Rijeka and Opatija. The Mini Nutritional Assessment-Short Form (MNA-SF) and data from the medical records were used for data collection. Results The study showed that seven (4.7%) of the older adults living in nursing homes were malnourished, while 53 (35.8%) were at risk of malnutrition. It was found that participants with malnutrition and nutritional risk were more likely to develop respiratory infections (r=-0.37). No correlation was found between malnutrition and the frequency of falls in older adults (r=0.01). Conclusion Malnutrition and the risk of malnutrition are common problems in older adults in nursing homes, requiring regular monitoring and timely intervention. The results confirmed the association between malnutrition and respiratory tract infections, while also highlighting the possibility of co-occurrence of obesity and malnutrition, which is often overlooked.

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