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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 52, Issue 5 (October 2016) , Pages 263-324

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Open AccessArticle
Role of serum cytokines in acute appendicitis and acute mesenteric lymphadenitis among children
Medicina 2016, 52(5), 291-297; https://doi.org/10.1016/j.medici.2016.10.002
Received: 21 January 2015 / Revised: 10 October 2016 / Accepted: 10 October 2016 / Published: 24 October 2016
Cited by 3 | Viewed by 280 | PDF Full-text (507 KB)
Abstract
Background and objective: The diagnostic role of serum cytokines depends on the etiology and pathogenesis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). The aim of this study was to evaluate differences in cytokine levels between AA and AML.
Materials and [...] Read more.
Background and objective: The diagnostic role of serum cytokines depends on the etiology and pathogenesis of acute appendicitis (AA) and acute mesenteric lymphadenitis (AML). The aim of this study was to evaluate differences in cytokine levels between AA and AML.
Materials and methods: Data of 7- to 18-year-old children were collected prospectively from October 2010 to October 2013. There were 31 patients with AA (AA group), 26 with AML (AML group), and 17 with elective non-inflammatory surgical disease (control group). Serum levels of IL-10, IL-12(p70), IL-1b, IL-4, IL-6, IL-8, IL-17, MCP-1, EGF, TNF-α and white blood count (WBC) were measured three times consecutively in each group.
Results: The level of IL-6 and IL-10 was significantly higher in the AA group than the AML group at the first measurement (8 pg/mL vs. 3.2 pg/mL, P = 0.000; 6.1 pg/mL vs. 3.2 pg/mL, P = 0.005, respectively). There was a significant difference observed in time dynamics of concentration of IL-6 and MCP-1 for AA and AML. The area under the curve (AUC) was 0.77 (95% CI 0.64–0.89; P = 0.001) for IL-6 with a cut-off value of 4.3 pg/mL (67.7% sensitivity and 76.9% specificity) for AA 1 h before surgery. The AUC for WBC was 0.72 (95% CI 0.58.4–0.85; P = 0.005) with a cut-off value of 10.7 × 103/μL (sensitivity 71.0% and specificity 46.2%).
Conclusions: Serum IL-6 with a cut-off value of 4.3 pg/mL and WBC with a cut-off value of 10.7 × 103/μL assessed together will yield more sensitivity for AA. Full article
Open AccessArticle
Use of drugs against osteoporosis in the Baltic countries during 2010–2014
Medicina 2016, 52(5), 315-320; https://doi.org/10.1016/j.medici.2016.10.001
Received: 17 November 2015 / Revised: 20 September 2016 / Accepted: 2 October 2016 / Published: 13 October 2016
Cited by 4 | Viewed by 342 | PDF Full-text (478 KB)
Abstract
Background and objective: Osteoporosis is a major health threat nowadays. Aging of the population and changes in peoples' lifestyle result in a constant increase in the number of fractures all over the world. Our study aimed at describing the drug utilization pattern and [...] Read more.
Background and objective: Osteoporosis is a major health threat nowadays. Aging of the population and changes in peoples' lifestyle result in a constant increase in the number of fractures all over the world. Our study aimed at describing the drug utilization pattern and choice of active substances of antiosteoporotic medicines in the Baltic countries.
Materials and methods: Sales data of the antiosteoporotic medicines was obtained from the internet. These are available on the website of medicines regulatory agencies. The World Health Organization (WHO) methodology of Anatomical Therapeutic Chemical (ATC) classification and defined daily dose (DDD) was used to compare the data among countries.
Results: During the study period the consumption of antiosteoporotic medicines was rather stable in all the countries. The overall choice of active substances used to treat osteoporosis is similar in all the Baltic countries but the market shares of substances were different. Estonia stands out with high use of combination product of alendronic acid and colecalci- ferol. In Latvia the highest consumption was of risedronic acid. In Lithuania the most used active substance in 2014 was ibandronic acid and second was denosumab with 0.8 daily doses per 1000 inhabitants per day (DID) and 25% of the total share.
Conclusions: The differences in consumption of drugs against osteoporosis in the Baltic countries are not very big. The consumption of antiosteoporotic drugs is not to be regarded as sufficient though. The generally low consumption of osteoporotic medicines in the Baltic countries can be attributed to the overall less than EU average wealth of the countries and less than optimal expenditure on healthcare out of the GDP. Full article
Open AccessArticle
Relationship between malocclusion, soft tissue profile, and pharyngeal airways: A cephalometric study
Medicina 2016, 52(5), 307-314; https://doi.org/10.1016/j.medici.2016.09.005
Received: 27 April 2016 / Revised: 10 July 2016 / Accepted: 26 September 2016 / Published: 11 October 2016
Cited by 2 | Viewed by 278 | PDF Full-text (723 KB)
Abstract
Background and objective: The recent years have been marked by a search for new interrela- tions between the respiratory function and the risk of the development of malocclusions, and algorithms of early diagnostics and treatment have been developed. The aim of the study [...] Read more.
Background and objective: The recent years have been marked by a search for new interrela- tions between the respiratory function and the risk of the development of malocclusions, and algorithms of early diagnostics and treatment have been developed. The aim of the study was to evaluate the relationships between hard and soft tissues and upper airway morphology in patients with normal sagittal occlusion and Angle Class II malocclusion according to gender.
Materials and methods: After the evaluation of clinical and radiological data, 114 pre-ortho- dontic patients with normal or increased ANB angle, were randomly selected for the study. The cephalometric analysis was done by using the Dolphin Imaging 11.8 computer software.
Results: Comparison of the cephalometric values of soft tissue and airway measurements performed statistically significant negative correlation between the width of the upper pharynx and the ANB angle was found: the ANB angle was decreasing with an increasing width of the upper pharynx. The airways showed a statistically significant negative correlation between the width of the lower pharynx and the distance from the upper and the lower lips to the E line. Logistic regression analysis was performed to evaluate significant factors that could predict airway constriction. The upper pharynx was influenced by the following risk factors: a decrease in the SNB angle, an increase in the nose tip angle, and younger age; while the lower pharynx was influenced by an increase in the distance between the upper lip and the E line and by an increase in the upper lip thickness.
Conclusions: During critical period of growth and development of the maxillofacial system, the patients with oral functional disturbances should be monitored and treated by a multidisciplinary team consisting of a dentist, an orthodontist, a pediatrician, an ENT specialist, and an allergologist. Cephalometric analysis applied in our study showed that Angle Class II patients with significantly decreased facial convexity angle, increased nasomental, upper lip-chin, and lower lip-chin angles, and upper and lower lips located more proximally to the E line more frequently had constricted airways. Full article
Open AccessArticle
Association of HFE gene C282Y and H63D mutations with liver cirrhosis in the Lithuanian population
Medicina 2016, 52(5), 269-275; https://doi.org/10.1016/j.medici.2016.09.004
Received: 20 March 2015 / Revised: 27 July 2016 / Accepted: 13 September 2016 / Published: 3 October 2016
Viewed by 247 | PDF Full-text (417 KB)
Abstract
Background and objective: Liver cirrhosis is the end-stage disease of chronic liver injury. Due to differences in the natural course of chronic liver diseases, identification of genetic factors that influence individual outcomes is warranted. HFE-linked hereditary hemochro- matosis (HH) predisposes disease progression to [...] Read more.
Background and objective: Liver cirrhosis is the end-stage disease of chronic liver injury. Due to differences in the natural course of chronic liver diseases, identification of genetic factors that influence individual outcomes is warranted. HFE-linked hereditary hemochro- matosis (HH) predisposes disease progression to cirrhosis; however, the role of heterozy- gous C282Y or H63D mutations in the development of cirrhosis in the presence of other etiological factors is still debated. The aim of this study was to determine the association between heterozygous C282Y and H63D mutations and non-HH liver cirrhosis in Lithua- nian population.
Materials and methods: The patient cohort consisted of 209 individuals. Diagnosis of cirrhosis was confirmed by clinical, laboratory parameters, liver biopsy, and radiological imaging. Control samples were obtained from 1005 randomly selected unrelated healthy individuals. HFE gene mutations were determined using the PCR-RFLP method.
Results: The most common causes of cirrhosis were hepatitis C (33.9%), hepatitis B (13.6%), and alcohol (25.8%). C282Y allele was associated with the presence of cirrhosis (OR = 2.07; P = 0.005); this was also observed under recessive model for C282Y (OR = 2.06, P = 0.008). The prevalence of C282Y allele was higher in cirrhotic men than in controls (7.0% vs. 2.8%, P = 0.002). The carriage of H63D risk allele (OR = 1.54; P = 0.02), heterozygous C282Y/wt and homozygous H63D/H63D genotypes were associated with liver cirrhosis in males (OR = 2.48, P = 0.008, and OR = 4.13, P = 0.005, respectively).
Conclusions: Heterozygous C282Y mutation of the HFE gene was associated with liver cirrhosis in the Lithuanian population. In gender-related analysis, heterozygous C282Y and homozygous H63D mutations were linked to liver cirrhosis in men, not in women. Full article
Open AccessArticle
Molecular features of doxorubicin-resistance development in colorectal cancer CX-1 cell line
Medicina 2016, 52(5), 298-306; https://doi.org/10.1016/j.medici.2016.09.003
Received: 5 May 2016 / Revised: 13 September 2016 / Accepted: 15 September 2016 / Published: 29 September 2016
Cited by 3 | Viewed by 334 | PDF Full-text (1335 KB)
Abstract
Background and aim: Resistance to chemotherapy is the key obstacle to the effective treat- ment of various cancers. Accumulating evidence suggests significant involvement of the epithelial-to-mesenchymal transition (EMT) in the chemoresistance of most cancer types. This study aimed at analyzing the gene expression [...] Read more.
Background and aim: Resistance to chemotherapy is the key obstacle to the effective treat- ment of various cancers. Accumulating evidence suggests significant involvement of the epithelial-to-mesenchymal transition (EMT) in the chemoresistance of most cancer types. This study aimed at analyzing the gene expression profile of doxorubicin (DOX)-resistant colorectal cancer cells CX-1.
Materials and methods: DOX-resistant CX-1 cell sublines were acquired by stepwise increment of DOX concentrations in cell growth media. Global gene expression profiling was performed using human gene expression microarrays. The expression levels of individual genes were assessed by means of quantitative PCR (qPCR), while the DNA methylation pattern of several selected genes was determined by methylation-specific PCR.
Results: Four DOX-resistant CX-1 sublines were established as a valuable tool for cell chemoresistance studies. Altered expression of the EMT, cell adhesion and motility, and chemoresistance-related genes was observed in DOX-resistant cells by genome-wide gene expression analysis. Besides, early and significant upregulation of the key EMT genes ZEB1 (5.8×; P < 0.001) and CDH2 (6.2×; P = 0.044) was identified by qPCR, with subsequent activation of drug transporter gene ABCC1 (3.3×; P = 0.007) and cell stemness gene NANOG (2.4×; P = 0.008). Downregulation of TET1 (2.1×; P = 0.041) and changes in the methylation status of the p16 gene were also involved in the acquisition of cell resistance to DOX. Full article
Open AccessArticle
Sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma: Analysis of recurrence-free survival
Medicina 2016, 52(5), 276-282; https://doi.org/10.1016/j.medici.2016.09.002
Received: 21 June 2015 / Revised: 21 June 2016 / Accepted: 8 September 2016 / Published: 28 September 2016
Cited by 5 | Viewed by 348 | PDF Full-text (707 KB)
Abstract
Background and aim: Cutaneous squamous cell carcinoma (CSCC) is a malignant epithelial cell tumor. CSCC has a tendency to spread via lymphogenic pathway. Metastases are found in 2%–6% of cases. Prognosis of patients with CSCC is directly related to the morphology and localization [...] Read more.
Background and aim: Cutaneous squamous cell carcinoma (CSCC) is a malignant epithelial cell tumor. CSCC has a tendency to spread via lymphogenic pathway. Metastases are found in 2%–6% of cases. Prognosis of patients with CSCC is directly related to the morphology and localization of primary tumor.
The aim of this study was to evaluate the recurrence-free survival of patients with CSCC after tumor excision and SLNB as well as to analyze morphologic CSCC features related to patient recurrence-free survival.
Materials and materials: A retrospective analysis of 51 patients with CSCC, who underwent surgical treatment between January 1, 2012, and December 31, 2014, in the Clinic of Plastic and Reconstructive Surgery, Hospital of the Lithuanian University of Health Sciences, was done. The diagnosis of CSCC was verified on a histological examination, and all patients had no clinical evidence of nodal or distant metastases on a physical examination or imaging studies. Sentinel lymph node biopsy (SLNB) was performed for low- and high-risk CSCC patients.
Results: A total of 51 patients were enrolled into the study (34 women and 17 men). Total of 68 lymph nodes were removed during sentinel lymph node biopsy. No micrometastases were identified. Until April 1, 2015, no relapse event was documented. The mean time after operation was 27.5 months. During the follow-up period, no distant metastases were identified.
Conclusions: No patient who had no micrometastases in sentinel lymph nodes developed local and distant CSCC metastases during the follow-up period. Our report supports the concept that SLNB can be applied for CSCC. It is obvious that larger prospective studies with longer follow-up period are needed to establish the efficacy of SLNB and define the optimal treatment of occult nodal metastasis for CSCC. Full article
Open AccessCase Report
Multiple gastrointestinal metastases of Merkel cell carcinoma
Medicina 2016, 52(5), 321-324; https://doi.org/10.1016/j.medici.2016.09.001
Received: 25 February 2015 / Revised: 25 June 2016 / Accepted: 12 September 2016 / Published: 20 September 2016
Cited by 1 | Viewed by 253 | PDF Full-text (1133 KB)
Abstract
Merkel cell carcinoma is an aggressive skin malignancy. Primary Merkel cell carcinomas are treated by wide radical excision with or without adjuvant radiotherapy, while benefits of adjuvant chemotherapy remain doubtful. There are only several cases of gastrointestinal metastases of Merkel cell carcinoma reported [...] Read more.
Merkel cell carcinoma is an aggressive skin malignancy. Primary Merkel cell carcinomas are treated by wide radical excision with or without adjuvant radiotherapy, while benefits of adjuvant chemotherapy remain doubtful. There are only several cases of gastrointestinal metastases of Merkel cell carcinoma reported so far. We report a case of recurrent Merkel cell carcinoma with metastases to the stomach and the small intestines after wide excision of primary Merkel cell carcinoma. Full article
Open AccessArticle
Gastric greater curvature plication combined with Nissen fundoplication in the treatment of gastroesophageal reflux disease and obesity
Medicina 2016, 52(5), 283-290; https://doi.org/10.1016/j.medici.2016.08.001
Received: 23 March 2016 / Revised: 8 August 2016 / Accepted: 26 August 2016 / Published: 20 September 2016
Cited by 2 | Viewed by 253 | PDF Full-text (640 KB)
Abstract
Background and aim: Established anti-reflux procedures such as fundoplications are less efficient in obese patients. The aim of this study was to investigate clinical effectiveness of the fundoplication combined with gastric greater curvature plication in the treatment of gastroesophageal reflux disease (GERD) in [...] Read more.
Background and aim: Established anti-reflux procedures such as fundoplications are less efficient in obese patients. The aim of this study was to investigate clinical effectiveness of the fundoplication combined with gastric greater curvature plication in the treatment of gastroesophageal reflux disease (GERD) in obese patients.
Materials and methods:
During the period from June 2010 to September 2014, patients operated for GERD with BMI from 30 to 39.9 kg/m2 were included into the prospective study. Laparoscopic Nissen fundoplication (LNF, n = 58) was performed until February 2013 and later laparoscopic Nissen fundoplication was combined with gastric greater curvature plication (LNFGP, n = 56). The groups were compared according to the control of GERD and weight loss.
Results:
In LNF group there were significantly more males, patients had lower BMI and longer duration of GERD symptoms. Duration of surgery was significantly longer in LNFGP group, 96.5 (17.3) min vs. 59.8 (16.1) min (P < 0.0001). Postoperative morbidity was similar, 3.6% and 3.4% in LNFGP and LNF groups, respectively (P = 0.9539). The average percentage of excess BMI loss after 12 months was 45.3 (5.8) in LNFGP group as compared to 18.4 (4.6) in LNF group (P < 0.0001). Significantly more patients experienced remission or improvement of type 2 diabetes mellitus (P = 0.03) and hypercholesterolemia (P = 0.0001) in LNFGP group. No significant differences between the groups in postoperative DeMeester score, GERD-HRQL mean score, overall satisfaction and healing of esophagitis were observed.
Conclusions: LNFGP took significantly longer time to perform, but resulted in significantly higher weight reduction and remission/improvement of comorbidities. Both procedures produced similar anti-reflux effect. Full article
Open AccessReview
Management of recurrent aphthous ulcers using low-level lasers: A systematic review
Medicina 2016, 52(5), 263-268; https://doi.org/10.1016/j.medici.2016.07.006
Received: 30 November 2015 / Revised: 5 July 2016 / Accepted: 21 July 2016 / Published: 15 September 2016
Cited by 5 | Viewed by 373 | PDF Full-text (588 KB)
Abstract
Background and objective: The exact etiology of recurrent aphthous ulcers (RAS) is unknown. The management of RAS is not always straightforward. The aim of this review is to critically analyze and summarize the clinical literature focusing on the management of aphthous ulcers using [...] Read more.
Background and objective: The exact etiology of recurrent aphthous ulcers (RAS) is unknown. The management of RAS is not always straightforward. The aim of this review is to critically analyze and summarize the clinical literature focusing on the management of aphthous ulcers using low-level lasers.
Materials and methods: The Medline (PubMed), Web of Knowledge (ISI), Cochrane Central Register of Controlled Trials (CENTRAL) and Embase databases were searched electronically for studies published in last 20 years (1995–2015) using the keywords ‘‘recurrent aphthous stomatitis,’’ ‘‘aphthous ulcers,’’ and ‘‘laser.’’
Results: A total of 85 articles were found during the initial search; 76 studies were excluded for not fulfilling the criteria whereas nine studies were deemed suitable for this review. Among the included studies, two articles were case reports and seven were randomized clinical trials. Study design, sample size, type of intervention and control of each study were critically analyzed and summarized according to the CONSORT protocol. In majority of the patients, immediate pain relief and accelerated ulcer healing was observed following irradiation with lasers.
Conclusions: Although various types of lasers have succeeded in providing immediate pain relief to patients, carbon dioxide (CO2) lasers have the unique advantage of requiring a short exposure time (5–10 s). In order to ascertain the efficacy of laser for treating ulcers in the clinical setting, more clinical trials are required. Full article
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