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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they 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.

Medicina, Volume 51, Issue 5 (October 2015) – 9 articles

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419 KiB  
Article
Regional inequalities of hospital morbidity and associations with mortality in Lithuania
by Skirmantė Jurevičiūtė and Ramunė Kalėdienė
Medicina 2015, 51(5), 312-319; https://doi.org/10.1016/j.medici.2015.09.002 - 19 Nov 2015
Viewed by 612
Abstract
Background and objective: In Lithuania, hospitalization was planned to be reduced with the approval of the national healthcare restructuring program. The aim of this study was to describe regional inequalities of hospitalization and hospital morbidity in Lithuania and to associate them with mortality [...] Read more.
Background and objective: In Lithuania, hospitalization was planned to be reduced with the approval of the national healthcare restructuring program. The aim of this study was to describe regional inequalities of hospitalization and hospital morbidity in Lithuania and to associate them with mortality in the regions.
Materials and methods: Routine hospital discharge data of Lithuanian hospitals, reimbursed by the Compulsory Health Insurance Fund and registered in database SVEIDRA, was used. Age-adjusted general hospitalization and hospital morbidity rates (per 1000 population) due to cardiovascular diseases (CVD), malignant neoplasms and external causes were calculated. Contribution of diseases, causing major public health problems, to general hospitalization was evaluated by analysis of components. Association of general hospitalization or hospital morbidity and mortality of respective causes was evaluated using non-parametric Spearman correlation.
Results: General hospitalization and hospital morbidity of CVD, malignant neoplasms and external causes had increased from 2005 to 2011. Inequalities of hospitalization and hospital morbidity existed between regions of Lithuania. In Šiauliai, Klaipėda, Utena and Panevėžys regions, general hospitalization remained higher than national level. In Marijampolė, Alytus and Kaunas regions, general hospitalization became lower than Lithuanian average. There was no statistically significant correlation between variation in hospitalization and mortality rates in the regions.
Conclusions: Despite national efforts to decrease hospital care, our study detected the failure of hospitalization reduction and revealed an increase of hospitalization with the existing regional inequalities in Lithuania. Full article
638 KiB  
Article
Spinal posture in different DanceSport dance styles compared with track and field athletes
by Helena Kruusamäe, Katre Maasalu, Matthew Wyon, Toivo Jürimäe, Jarek Mäestu, Martin Mooses and Jaak Jürimäe
Medicina 2015, 51(5), 307-311; https://doi.org/10.1016/j.medici.2015.08.003 - 11 Nov 2015
Cited by 15 | Viewed by 1005
Abstract
Background and objective: In DanceSport, athletes train for many years to develop a very specific posture. Presently there are few data as to whether these adaptations are habitual or cause permanent anatomical changes to the spine. The aim of the current study was [...] Read more.
Background and objective: In DanceSport, athletes train for many years to develop a very specific posture. Presently there are few data as to whether these adaptations are habitual or cause permanent anatomical changes to the spine. The aim of the current study was to evaluate lumbar lordosis and thoracic kyphosis of the international level DanceSport dancers using track and field athletes as controls.
Materials and methods: Thirty competitive DanceSport couples (15 men aged 23.4 ± 6.6 years; 15 women aged 22.5 ± 6.4 years) and 29 track and field athletes (16 mean aged 27 ± 4.4 years and 13 women aged 22 ± 4.1 years) volunteered. Twelve couples were Standard, 7 Latin American and 11 were Ten Dance couples. Thoracic kyphosis and lumbar lordosis angle were assessed in lateral view using a Vertebral Fracture Assessment scan.
Results: DanceSport athletes had smaller S-shaped vertebral curvatures compared to track and field athletes. Male (5.7 ± 4.78) and female dancers (8.7 ± 5.98) had significantly smaller lumbar lordosis angle compared to their track and field counterparts (22.3 ± 9.98 for men; 20.3 ± 5.98 for women).Femaledancers(25.3 ± 8.08)alsodemonstratedsignificantly smallerthoracickyphosis angle than female track and field (32.1 ± 8.98) participants. It was further revealed that female Latin American dancers had significantly smaller lumbar lordosis values (3.7 ± 3.18) compared with female Standard (10.7 ± 6.18) and Ten Dance dancers (9.7 ± 5.58).
Conclusions: The results of the present study suggest that smaller S-shaped vertebral curvatures of DanceSport athletes compared with track and field athletes are permanent changes rather than habitual. Full article
637 KiB  
Article
Evaluation of low-dose proton beam radiation efficiency in MIA PaCa-2 pancreatic cancer cell line vitality and H2AX formation
by Aušra Liubavičiūtė, Jan Aleksander Kraśko, Agata Mlynska, Jelena Lagzdina, Kęstutis Sužiedėlis and Vita Pašukonienė
Medicina 2015, 51(5), 302-306; https://doi.org/10.1016/j.medici.2015.10.002 - 06 Nov 2015
Cited by 5 | Viewed by 780
Abstract
Background and objective: The aim of this study was to evaluate the efficiency of proton beam irradiation in pancreatic cancer cell line MIA PaCa-2 and its role in the cell cycle, apoptosis, and formation of histone gH2AX in different reparation times (72-h follow-up).
[...] Read more.
Background and objective: The aim of this study was to evaluate the efficiency of proton beam irradiation in pancreatic cancer cell line MIA PaCa-2 and its role in the cell cycle, apoptosis, and formation of histone gH2AX in different reparation times (72-h follow-up).
Material and methods: The MIA PaCa-2 pancreatic carcinoma cell line was irradiated with 1.6- Gy proton beam. After irradiation, cell viability was measured colorimetrically, and the cell cycle, apoptosis, and gH2AX expression were evaluated on a FACScan cytometer.
Results: Low-dose proton beam irradiation had an effect on the MIA PaCa-2 tumor cell line already 1 h after exposure, but maximal lethality was reached after 72 h postirradiation with a cell viability rate of 24%. The cell cycle went into partial G1/0 arrest, and was released after 72 h. The expression of gH2AX was strong and its levels were significantly elevated as late as 48 h post radiation. The apoptosis levels increased with post radiation incubation time to reach 79% after 72 h.
Conclusions: Our data demonstrate that low-doses proton beam irradiation had an effect on MIA PaCa-2 pancreatic carcinoma cell line. Full extent of irradiation had an impact only 24 h postirradiation, triggering DNA arrested cell cycle in G1/0 phase. Formed DNA DSBs were found to be repaired via the NHEJ pathway mechanism within 72 h. Unsuccessful repaired DSBs induced apoptotic cell death. After 72 h reparation processes were completed, and cell cycle was released from arrest in G1/0 phase. Full article
338 KiB  
Article
The influence of the extended indications for sentinel node biopsy on the identification of metastasis-free and metastatic sentinel nodes
by Linas Martinaitis, Žilvinas Dambrauskas and Algirdas Boguševičius
Medicina 2015, 51(5), 291-295; https://doi.org/10.1016/j.medici.2015.10.001 - 28 Oct 2015
Viewed by 694
Abstract
Background and objective: Rates of sentinel node (SN) identification and metastasis-positive SNs were compared between the group with highly selective indications for sentinel node biopsy (SNB) and the group with merely no contraindications for SNB (Groups A and B, respectively).
Materials and methods: [...] Read more.
Background and objective: Rates of sentinel node (SN) identification and metastasis-positive SNs were compared between the group with highly selective indications for sentinel node biopsy (SNB) and the group with merely no contraindications for SNB (Groups A and B, respectively).
Materials and methods: We performed a single-center retrospective data analysis of 471 breast cancer patients treated during 2004–2010. Data on clinical and pathologic staging, frozen section results, radiological measurements and pathologic examination results were obtained from patient records. Patients were analyzed in two groups. Group A (n = 143) had SNB performed only when the patients fulfilled to the following criteria: breast tumor no greater than 3 cm in diameter, unifocal disease, no pure ductal carcinoma in situ, no history of previous breast or lymph node surgery, and no neoadjuvant chemotherapy. Indications for SNB were extended in Group B (n = 328) so that inflammatory breast cancer and positive lymph nodes became the only exclusion criteria.
Results: The rate of SN identification was 97.9% in Group A vs. 99.09% in Group B (P = 0.29). SNs were metastasis positive and frozen sections false negative at comparable proportions in both groups.
Conclusions: The extension of indications for SNB did not reduce the rates of SN identification or did not create any impact on the rate of metastatic SNs. Full article
465 KiB  
Article
Treatment procedures and referral patterns of general dentists in Lithuania
by Vilija Berlin, Alina Pūrienė, Vytautė Pečiulienė and Jolanta Aleksejūnienė
Medicina 2015, 51(5), 296-301; https://doi.org/10.1016/j.medici.2015.09.004 - 24 Oct 2015
Cited by 3 | Viewed by 768
Abstract
Background and objective: The requirement for dental specialties and the number of specialists in each country depends on the content and execution of undergraduate dental education, the complex oral health care needs of the society and other factors. The aim of our study [...] Read more.
Background and objective: The requirement for dental specialties and the number of specialists in each country depends on the content and execution of undergraduate dental education, the complex oral health care needs of the society and other factors. The aim of our study was to assess specific treatment procedures of Lithuanian general dentists and their need to refer patients to specialists.
Materials and methods: Census sampling was employed and the data collected by means of a structured questionnaire asking dentists about the frequency of specific treatment proce- dures they perform and the frequency of referrals they make to different dental specialists. The results are of a self-reported nature.
Results: From general dental practice, 76.3% of cases needing orthodontic treatment were referred to orthodontists. About half of patients needing specialized care were referred to periodontists (50.2%), orthopedists (46.9%) and oral surgeons (45.0). More than one-third (39%) of the cases needing specialist care were referred to endodontists. Only one-third of patients were referred to pediatric dentists. In about 60% of cases needing respective care general dentists extracted teeth and roots, made incisions in acute jaw infections and treated young children; in about half of cases general dentists performed complex endodontic manipulations and treatment with fixed and removable prostheses.
Conclusions: There is a clear need for Lithuanian dental practitioners to refer patients to all types of dental specialists. Undergraduate dental education program and postgraduate training should be more directed toward the extraction of teeth and roots, treatment of young children and provision of dental prostheses to patients Full article
2173 KiB  
Article
Correlation between throat-related symptoms and histological examination in adults with chronic tonsillitis
by Rūta Pribuišienė, Valdas Šarauskas, Alina Kuzminienė and Virgilijus Uloza
Medicina 2015, 51(5), 286-290; https://doi.org/10.1016/j.medici.2015.09.003 - 23 Oct 2015
Cited by 5 | Viewed by 832
Abstract
Objective: The aim of the study was to evaluate correlations between throat-related symptoms and histological findings in adults with chronic tonsillitis.
Materials and methods: A prospective cohort study was carried out. Throat-related symptoms (complaints, tonsillitis rate, and pharyngeal findings) of 81 [...] Read more.
Objective: The aim of the study was to evaluate correlations between throat-related symptoms and histological findings in adults with chronic tonsillitis.
Materials and methods: A prospective cohort study was carried out. Throat-related symptoms (complaints, tonsillitis rate, and pharyngeal findings) of 81 adults with histologically proven chronic tonsillitis followed by tonsillectomy were analyzed. Four types of histological changes in removed tonsils were determined: (1) pure hyperplasia, (2) chronic inflammation, (3) chronic inflammation with hyperplasia, (4) chronic inflammation with scarring/fibrosis. The power of correlation was tested using the Pearson contingency coefficient (CC).
Results: Recurrent throat infections were the most common complaint (74.1%). The mean tonsillitis rate was 3.6 (SD 1.9) episodes per year. Tonsillar cryptic debris (61.7%) and hyperemia of the anterior pillars (59.3%) were the most common pharyngeal findings. Chronic inflammation with hyperplasia was predominant (38.3%) histological type of chronic tonsillitis. The statistically significant correlations between histological type and combination of tonsillitis rate ≥3 times per year with cryptic debris (CC = 0.346; P = 0.010) and cryptic debris alone (CC = 0.294; P = 0.051) were detected.
Conclusions: Assessment of throat-related symptoms is complementary to histological examination in adults with chronic tonsillitis. Full article
1365 KiB  
Article
Distribution of CD4+ and CD8+ T cells in tumor islets and stroma from patients with non-small cell lung cancer in association with COPD and smoking
by Jurgita Jackutė, Marius Žemaitis, Darius Pranys, Brigita Šitkauskienė, Skaidrius Miliauskas, Vytis Bajoriūnas and Raimundas Sakalauskas
Medicina 2015, 51(5), 263-271; https://doi.org/10.1016/j.medici.2015.08.002 - 21 Sep 2015
Cited by 19 | Viewed by 928
Abstract
Background and objective: The immune system plays an important role in non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the infiltration patterns of CD4+ and CD8+ T cells in NSCLC [...] Read more.
Background and objective: The immune system plays an important role in non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the infiltration patterns of CD4+ and CD8+ T cells in NSCLC and to analyze their relation to COPD, smoking status and other clinicopathologic variables.
Materials and methods: Lung tissue specimens from 50 patients who underwent surgery for NSCLC (stages I–III) and 10 control group subjects were analyzed immunohistochemically.
Results: NSCLC patients had a greater number of CD4+ and CD8+ T cells infiltrating the lung tissue than the control group (P = 0.001) with predominant infiltration in the tumor stroma. We found a significant association between the number of total and tumor stroma-infiltrating CD4+ and CD8+ T cells, and smoking status (P < 0.05). There were more CD8+ T cells in the tumor stroma and fewer in the tumor islets in NSCLC patients with COPD as compared to NSCLC patients without COPD (P < 0.05). However, there was no such association between CD4+ T cells and COPD status. A high level of CD8+ T cell infiltration in the tumor stroma was independently associated with the coexistence of COPD in multivariate analysis (P < 0.05).
Conclusions: According to our data, COPD but not smoking seems to be associated with higher infiltration of CD8+ T cells in the tumor stroma of patients with NSCLC. It allows us to hypothesize that NSCLC patients with coexisting COPD may have a more favorable outcome due to anticancer properties of stromal CD8+ T cells. Full article
694 KiB  
Article
Cesarean section rates in Lithuania using Robson Ten Group Classification System
by Eglė Barčaitė, Gintarė Kemeklienė, Dalia Regina Railaitė, Arnoldas Bartusevičius, Laima Maleckienė and Rūta Nadišauskienė
Medicina 2015, 51(5), 280-285; https://doi.org/10.1016/j.medici.2015.09.001 - 14 Sep 2015
Cited by 23 | Viewed by 949
Abstract
Background and objective: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania.
Materials and methods: A prospective cross-sectional [...] Read more.
Background and objective: The aim of this study was to analyze cesarean section (CS) rates using Robson Ten Group Classification System (TGCS) and to identify the main contributors to the overall CS rate in Lithuania.
Materials and methods: A prospective cross-sectional study was carried out. All women who delivered between January 1 and December 31, 2012, in Lithuania were classified using the TGCS. The CS rates overall and in each Robson group were calculated, as was the contribution of each group to the overall CS rate.
Results: The CS rate was 26.4% (6697 among 25,373 deliveries) in 2012. Nulliparous women with single cephalic full-term pregnancy in spontaneous labor (Group 1) or who underwent induction of labor or prelabor CS (Group 2) and multiparous women with a previous CS (Group 5) were the greatest contributors (67.7%) to the overall CS rate. In addition, significant variation of CS rates between different institutions was observed, especially in women with single cephalic full-term pregnancy without previous CS (Groups 1–4), showing big differences in obstetric care across country.
Conclusions: Women in Groups 1, 2 and 5 were the largest contributions to the overall CS rate in Lithuania. It seems that efforts to reduce the overall CS rate should be directed on increasing vaginal birth after CS and reducing CS rates in nulliparous women with single cephalic full-term pregnancy (Groups 1 and 2). Full article
473 KiB  
Article
Factors associated with bone mineral density loss in patients with spondyloarthropathies: A 4-year follow-up study
by Lina Vencevičienė, Irena Butrimienė, Rimantas Vencevičius, Eglė Sadauskienė, Vytautas Kasiulevičius and Virginijus Šapoka
Medicina 2015, 51(5), 272-279; https://doi.org/10.1016/j.medici.2015.08.001 - 09 Sep 2015
Cited by 5 | Viewed by 808
Abstract
Objective: To explore the relationship between laboratory, functional, disease activity markers and bone mineral density (BMD) loss in patients with spondyloarthropathies (SpAs).
Methods: A cohort of 41 SpA patients were followed up for 4 years. Disease activity indices, spinal mobility and laboratory tests, [...] Read more.
Objective: To explore the relationship between laboratory, functional, disease activity markers and bone mineral density (BMD) loss in patients with spondyloarthropathies (SpAs).
Methods: A cohort of 41 SpA patients were followed up for 4 years. Disease activity indices, spinal mobility and laboratory tests, BMD using were monitored at the baseline and 4-year follow-up. The 4% BMD loss at either of the proximal femurs was defined as significant.
Results: Over the 4-year study period, 27% of SpA patients experienced femoral BMD loss. Baseline BMD > 0.85 g/cm2 (p = 0.011) was the baseline factor associated with BMD loss at 4- year follow-up. Several clinical and functional tests were helpful in identifying the BMD loss at follow-up: CRP > 15.6 mg/L (sens. 91%, spec. 70%), ESR > 29 mm/h (sens. 82%, spec. 73%), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) > 4.75 (sens. 91%, spec. 62%). At follow-up anti-TNFa treatment history, stable or improved lateral flexion and intermalleolar distance (NPV, accordingly, 95%, 88% and 87%), made BMD loss unlikely. Deterioration of the physician assessment of global disease activity (PAGDA) score from baseline to follow-up was a remarkable predictor of BMD loss (PPV = 0.83), while stable or improved score excluded the BMD loss (NPV = 0.83). According to multiple logistic regression analysis, baseline BMD value and follow-up CRP levels, when considered together, identify BMD status correctly in 85% of SpA patients (Nagelkerke R2 = 0.676).
Conclusion: Baseline BMD, anti-TNFa treatment, PAGDA score, spinal mobility tests and disease activity markers are useful factors in predicting the BMD loss in SpA patients and can provide surrogate information on BMD status. Full article
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