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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.

Table of Contents

Medicina, Volume 50, Issue 6 (December 2014) , Pages 313-365

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Open AccessArticle
Mechanical function of left atrium and pulmonary vein sleeves before and after their antrum isolation
Medicina 2014, 50(6), 353-359; https://doi.org/10.1016/j.medici.2014.11.008 - 28 Nov 2014
Cited by 2 | Viewed by 210
Abstract
Background and objective: Pulmonary vein (PV) sleeves are established as the main substrate taking part in the mechanisms of atrial fibrillation (AF) initiation. However, we have extremely few data concerning their physiological role in the heart contractility. The aim of the study was [...] Read more.
Background and objective: Pulmonary vein (PV) sleeves are established as the main substrate taking part in the mechanisms of atrial fibrillation (AF) initiation. However, we have extremely few data concerning their physiological role in the heart contractility. The aim of the study was to estimate the mechanical function of the left atrium (LA) and PV sleeves before and early after their isolation.
Materials and methods: A total of 17 patients with a mean age of 57.4 ± 8.3 years who underwent PVs isolation due to AF were enrolled in the study. A day before the procedure a computed tomography (CT) of the LA and PVs and dopplerography of transmitral flow were performed. During the procedure the mechanical function of the LA and PV sleeves were estimated by transesophageal echocardiography and manometry in the left heart chambers.
Results: During the invasive study the patterns of the heart chambers and PV sleeves pressure were identified. These patterns confirmed the active role of the PV sleeves in LA filling and active LA relaxation during left ventricular systole. After PV isolation an alteration of transmitral blood flow and increase of LA pressure were registered. However, diastolic dysfunction was ruled out by LV manometry, thereby testifying LA mechanical function disturbance. The change in PV hemodynamics also occurred as a result of the decrease in PV sleeves contractility, revealed by manometry and paired CT scans.
Conclusions: The PVs take an active part in left atrial filling by contraction of their sleeves. Antrum isolation of the PVs leads to the deterioration of their contractility and LA reservoir function. Full article
Open AccessArticle
Evaluation of left ventricular longitudinal function and synchrony after dual chamber pacemaker implantation
Medicina 2014, 50(6), 340-344; https://doi.org/10.1016/j.medici.2014.11.010 - 28 Nov 2014
Viewed by 237
Abstract
Background and objective: To evaluate left ventricular (LV) longitudinal function and dyssynchrony mechanisms after dual chamber pacemaker implantation.
Materials and methods: The speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and for dyssynchrony evaluation before [...] Read more.
Background and objective: To evaluate left ventricular (LV) longitudinal function and dyssynchrony mechanisms after dual chamber pacemaker implantation.
Materials and methods: The speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and for dyssynchrony evaluation before pacemaker implantation and after 3-month follow-up. The study group consisted of 98 patients with conventional indications for dual chamber pacemaker implantation.
Results: Speckle tracking echocardiographic methods and image postprocessing revealed impairment of global longitudinal strain and significant LV dyssynchrony derived from 12 basal and mid-septum segments usually untraceable with conventional echocardiographic methods. Despite good physical performance and ejection fraction, global longitudinal strain significantly decreased in all patients from −15.08 ± 0.46 to −13.56 ± 0.5 (P < 0.05) as well as mitral annulus movement decreased from 11.57 ± 2.41 to 8.46 ± 1.74 cm/s (P < 0.001) and from 12.55 ± 2.75 to 10.78 ± 2.82 mm (P < 0.001). It was expected that patients with dual chamber pacemaker will develop inter- and intraventricular dyssynchrony, but our study showed that pacing lead position did not prevent from LV dysynchronisation and only changed the mechanism.
Conclusions: Global longitudinal strain and LV dyssynchrony assessment enables us to detect early signs of LV dysfunction. Mechanisms of dyssynchrony development will be useful for pacemaker programing choices in order to prevent further dyssynchronisation. Full article
Open AccessArticle
Atherogenic index as a predictor of atherosclerosis in subjects with familial Mediterranean fever
Medicina 2014, 50(6), 329-333; https://doi.org/10.1016/j.medici.2014.11.009 - 28 Nov 2014
Cited by 20 | Viewed by 274
Abstract
Background and objective: Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis.
Materials and methods: A total of 60 [...] Read more.
Background and objective: Numerous inflammatory and innate immune pathways are involved in atherogenesis. We aimed to investigate the atherogenic index and other lipid parameters in individuals with familial Mediterranean fever (FMF), as a predictor of atherosclerosis.
Materials and methods: A total of 60 patients with FMF and 60 healthy age- and sex- matched controls were included in this study. The patients with acute infection, chronic metabolic and rheumatic diseases, use of drugs other than colchicine and smoking history were excluded. CRP, ESR, total cholesterol, triglycerides, LDL-C, and HDL-C levels of patients and the control group were measured. Atherogenic index (TG/HDL-C) was calculated.
Results: We found that the atherogenic index values of the patients were significantly higher than those of the control group. HDL-C levels were lower and ESR and TG levels were higher in patients. Total cholesterol, LDL-C and CRP levels did not differ significantly between the two groups. There was no significant difference in the values of total cholesterol, LDL-C, triglycerides (TG), HDL-C, and atherogenic indexes between the groups of patients with and without M694V mutation.
Conclusions: Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. We believe that the atherogenic index also be used as a preliminary indication of accelerated atherosclerosis in FMF. However, large- scale prospective studies on this issue are needed. Full article
Open AccessArticle
Detection and evaluation of ventricular repolarization alternans: An approach to combined ECG, thoracic impedance, and beat-to-beat heart rate variability analysis
Medicina 2014, 50(6), 345-352; https://doi.org/10.1016/j.medici.2014.11.004 - 27 Nov 2014
Cited by 1 | Viewed by 283
Abstract
Background and objective: Beat-to-beat alteration in ventricles repolarization reflected by alternans of amplitude and/or shape of ECG S-T,T segment (TWA) is known as phenomena related with risk of severe arrhythmias leading to sudden cardiac death. Technical difficulties have caused limited its usage in [...] Read more.
Background and objective: Beat-to-beat alteration in ventricles repolarization reflected by alternans of amplitude and/or shape of ECG S-T,T segment (TWA) is known as phenomena related with risk of severe arrhythmias leading to sudden cardiac death. Technical difficulties have caused limited its usage in clinical diagnostics. Possibilities to register and analyze multimodal signals reflecting heart activity inspired search for new technical solutions. First objective of this study was to test whether thoracic impedance signal and beat-to-beat heart rate reflect repolarization alternans detected as TWA. The second objective was revelation of multimodal signal features more comprehensively representing the phenomena and increasing its prognostic usefulness.
Materials and methods: ECG, and thoracic impedance signal recordings made during 24 h follow-up of the patients hospitalized in acute phase of myocardial infarction were used for investigation. Signal morphology variations reflecting estimates were obtained by the principal component analysis-based method. Clinical outcomes of patients (survival and/ or rehospitalization in 6 and 12 months) were compared to repolarization alternans and heart rate variability estimates.
Results: Repolarization alternans detected as TWA was also reflected in estimates of thoracic impedance signal shape and variation in beat-to-beat heart rate. All these parameters showed correlation with clinical outcomes of patients. The strongest significant correlation showed magnitude of alternans in estimates of thoracic impedance signal shape.
Conclusions: The features of ECG, thoracic impedance signal and beat-to-beat variability of heart rate, give comprehensive estimates of repolarization alternans, which correlate, with clinical outcomes of the patients and we recommend using them to improve diagnostic reliability. Full article
Open AccessArticle
Impedance plethysmography as an alternative method for the diagnosis of peripheral arterial disease
Medicina 2014, 50(6), 334-339; https://doi.org/10.1016/j.medici.2014.11.007 - 27 Nov 2014
Cited by 3 | Viewed by 232
Abstract
Background and objective: In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index (ABI) is considered as the standard, and other noninvasive methods have received too little attention. Therefore, the aim of the study was to determine the diagnostic accuracy of impedance [...] Read more.
Background and objective: In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index (ABI) is considered as the standard, and other noninvasive methods have received too little attention. Therefore, the aim of the study was to determine the diagnostic accuracy of impedance plethysmography in diagnosing PAD and to compare this method with other methods.
Materials and methods: A total of 66 patients with a mean age of 76.1 ± 9.6 years who had been treated for various cardiovascular diseases at Kaunas Clinical Hospital during 2011–2012 were enrolled into the study. All the patients were screened for PAD. Impedance plethysmography was performed with a new-generation NiccomoTM device. The receiver operating characteristic analysis was employed to determine the diagnostic accuracy of 4 parameters of impedance plethysmography: crest time (CT), crest width (CW), pulse amplitude (Pampl), and alternating blood flow (ABF).
Results: There were a significant correlation between the ABI and the CT (r = 0.699, P < 0.001), between the ABI and the ABF (r = 0.552; P < 0.001), and between the ABI and the Pampl only among men (r = 0.652; P < 0001). No correlation was found between the ABI and the CW. Among all the parameters, the CT had the highest sensitivity and specificity (73.2% and 96.0%, respectively). Other parameters had the following sensitivities and specificities: ABF, 61.0% and 96.0%; and Pampl, 90.0% and 20.0%, respectively.
Conclusions: Impedance plethysmography, especially its parameter CT, is an alternative non- invasive method in diagnosing PAD and could be used for the screening of patients with PAD. Full article
Open AccessArticle
The family needs of parents of preschool children with cerebral palsy: The impact of child's gross motor and communications functions
Medicina 2014, 50(6), 323-328; https://doi.org/10.1016/j.medici.2014.11.005 - 27 Nov 2014
Cited by 4 | Viewed by 256
Abstract
Background and objective: An understanding of the needs of families of preschool children with cerebral palsy (CP) is of essential importance if efficient and cost-effective services are to be provided to them. The aims of this study were to identify the most frequently [...] Read more.
Background and objective: An understanding of the needs of families of preschool children with cerebral palsy (CP) is of essential importance if efficient and cost-effective services are to be provided to them. The aims of this study were to identify the most frequently expressed needs of families with preschool children with CP; differences in the amount and types of family needs based on the child's gross motor function and communication function level; and the impact of the child's gross motor function and communication function level on the type and amount of family needs.
Materials and methods: A total of 227 parents of preschool children with CP completed a modified version of the Family Needs Survey and a demographic questionnaire. Children's gross motor function level and communication function level was classified using the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS), respectively.
Results: The total number of family needs differed based on GMFCS and CFCS levels. Children's GMFCS and CFCS level were not significant predictors of overall family needs (adjusted R2 = 0.163). In this model the GMFCS level of children did not account for the total number of family needs, while the CFCS level did.
Conclusions: Child's limitations in terms of communication and gross motor functions must be taken into consideration when planning services for families with preschool children with CP. Full article
Open AccessArticle
How useful is antireflux surgery in lung transplant patients with gastroesophageal reflux?
Medicina 2014, 50(6), 318-322; https://doi.org/10.1016/j.medici.2014.11.006 - 27 Nov 2014
Cited by 4 | Viewed by 251
Abstract
Background and objective: Respiratory function deteriorates over time after lung transplant. Reflux disease with pulmonary complications is a possible cause of this decline. This case series we aim to assess whether respiratory function improves after Nissen fundoplication in lung transplant patients and if [...] Read more.
Background and objective: Respiratory function deteriorates over time after lung transplant. Reflux disease with pulmonary complications is a possible cause of this decline. This case series we aim to assess whether respiratory function improves after Nissen fundoplication in lung transplant patients and if surgery reduces gastroesophageal reflux disease (GERD) symptoms and use of proton pump inhibitors (PPIs).
Materials and methods: A retrospective case series of lung transplant patients with reflux disease and Nissen fundoplication. Clinical symptoms, pH-metry data, use of PPIs were recorded before the procedure and up to 18 months postoperatively. The FEV1 values before and after Nissen fundoplication were recorded at 3 monthly intervals. Patients' satisfaction scores were recorded before operation and postoperatively.
Results: A total of 64 lung transplant patients were selected. After Nissen fundoplication, the pH studies were done on 26 patients. The mean overall acid exposure fraction was 1.03% (P < 0.05). FEV1 declined for 6 months postoperatively and then gradually improved. The comparison of FEV1 at 3 months preoperatively to 3 months postoperatively showed no significant difference (P = 0.067) as well as at 6 months. A significant improvement in clinical GERD symptoms was achieved after antireflux surgery; however, the patients remained receiving PPIs.
Conclusions: NF has been established as a safe operation for lung transplant patients. Late Nissen fundoplication did not improve lung function significantly amongst lung transplanted patients; however, patients with symptomatic GERD may have benefited from Nissen fundo- plication in terms of symptom relief. A multicenter randomized control trial is needed to assess the effect of early unselected reflux control on respiratory function and graft survival. Full article
Open AccessArticle
Health profile of the urban community members in Lithuania: Do socio-demographic factors matter?
Medicina 2014, 50(6), 360-365; https://doi.org/10.1016/j.medici.2014.11.003 - 26 Nov 2014
Cited by 2 | Viewed by 210
Abstract
Background and objective: Objective of the study was to explore self-perceived health status, health determinants and its associations with socio-demographic factors among urban community members in Lithuania.
Materials and methods: Data were obtained from a European survey on urban health, conducted as part [...] Read more.
Background and objective: Objective of the study was to explore self-perceived health status, health determinants and its associations with socio-demographic factors among urban community members in Lithuania.
Materials and methods: Data were obtained from a European survey on urban health, conducted as part of the EURO-URHIS 2 project. The postal questionnaire survey of 3200 adults from Kaunas and Šiauliai (Lithuania) was conducted in 2010. A total of 1407 valid questionnaires were analyzed. Statistical analysis was carried out by using SPSS 17.0 inside Complex Sample module that takes design effects into account.
Results: Younger respondents (aged 19–64 years) perceived most of the health status indicators better than the older ones (65+ years), while they were less likely to report healthy lifestyle and less often perceived their neighborhood as being socially cohesive than the older ones. Men less frequently experienced psychological problems, indicated regular contacts with friends and/or family and had a greater tendency to be overweighed and obese, daily smokers and drinkers compared to women. Those having secondary or lower educational level perceived most of the health status indicators worse than those with university educational level. Respondents living with a partner less often experienced psychological problems than those living alone. Respondents who indicated having enough money for daily expenses more often perceived their health and health determinants better.
Conclusions: The results of this study demonstrate associations between socio-demographic factors and self-perceived health status, lifestyle and factors of living environment among urban community members in Lithuania. Full article
Open AccessArticle
Prostate cancer trends in Latvia during 1990–2012: Incidence, prevalence, mortality, and survival rates
Medicina 2014, 50(6), 313-317; https://doi.org/10.1016/j.medici.2014.11.002 - 26 Nov 2014
Cited by 3 | Viewed by 224
Abstract
Background and objective: Prostate cancer (PCa) is one of the most common form of cancer in males worldwide. One of the highest PCa-related mortality rates in the world is observed in Latvia.
Materials and methods: Our study included male patients diagnosed with PCa [...] Read more.
Background and objective: Prostate cancer (PCa) is one of the most common form of cancer in males worldwide. One of the highest PCa-related mortality rates in the world is observed in Latvia.
Materials and methods: Our study included male patients diagnosed with PCa between 1990 and 2012. We analyzed incidence, prevalence and mortality trends using joinpoint analysis. Kaplan–Meier analysis was performed for 5-, 10-, 15- and 20-year overall survival and cancer-specific survival rates.
Results: A total of 14,083 PCa patients with a mean age of initial PCa diagnosis being 70.1 (SD 8.6) was registered. The standardized incidence rates (per 100,000) increased from 18.9 in 1990 to 74.7 in 2012, while the standardized prevalence rates (per 100,000) increased from 69.9 in 1990 to 437.6 in 2012. Standardized PCa mortality rates (per 100,000) also rose from 13.2 in 1990 to 27.2 in 2006 followed by statistically insignificant decrease continuing up to 2012. The mean 5-year cancer-specific survival rates increased from 43.6% in 1990 to 70.7% in 2007, and the mean 10-year cancer-specific survival rates from 32.9% in 1990 to 40.5% in 2001.
Conclusions: This study revealed that the incidence, prevalence and mortality rates increased between 1990 and 2012, and although the 5- and 10-year overall and cancer-specific survival rates improved over the reviewed period they still needed to get better. Full article
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