Medicina, Volume 52, Issue 6 (December 2016) – 8 articles , Pages 325-388

Background and objective: Angiogenic factors such as soluble fms-like tyrosine kinase 1 (sFlt- 1) and placental growth factor (PlGF) play a key role in the pathogenesis of preeclampsia. Uterine artery (UA) blood flow is important for preeclamptic pregnancy outcome, but small amount of evidence suggests UA dopplerometry for preeclampsia diagnostics and management. The aim of our study was to compare the value of angiogenic factors and UA dopplerometry in preeclampsia diagnosis and determine cut-off values to obtain the highest sensitivity and specificity of the parameter.
Materials and methods: We performed a case controlled study of 72 pregnant women with preeclampsia and 72 healthy matched controls. SFlt-1 and PlGF were measured in serum samples, the sFlt-1/PlGF ratio was calculated and UA pulsatility (PI) and resistance (RI) indexes were registered.
Results: Significantly higher levels of sFlt-1, sFlt-1/PlGF ratio and mean UAPI and UARI and lower levels of PlGF were found in preeclampsia group when compared to controls. The highest sensitivity and specificity for preeclampsia had SFlt-1/PlGF and PlGF with the cut-off values of ≥35 (sensitivity of 95.8% and specificity of 96.2%, respectively) and ≤138.6 pg/mL (sensitivity of 95.8% and specificity of 93.7%, respectively). For diagnostics of early-onset preeclampsia, all factors sFlt-1, PlGF and sFlt-1/PlGF had equal significance with the cut-off values of ≥7572 pg/mL (specificity of 97.5%, sensitivity 92.3%), ≤100.5 pg/mL (specificity 96.2%, sensitivity of 100%) and ≥54.6 (specificity 97.5%, sensitivity 97.5%) respectively.
Conclusions: The sFlt-1/PlGF ratio and PlGF are superior to sFlt-1, UAPI and UARI for preeclampsia diagnosis. For early-onset preeclampsia diagnostics either sFlt-1 or PlGF is sufficient. Full article

Background and objectives: The sex differences and similarities in cognitive abilities is a continuing topic of major interest. Besides, the influences of trends over time and possible effects of sex steroid and assessment time on cognition have expanded the necessity to reevaluate differences between men and women. Therefore, the aim of this study was to compare cognitive performance between men and women in a strongly controlled experiment.
Materials and methods: In total, 28 men and 25 women were investigated. Variables of body temperature and heart rate were assessed. A cognitive test battery was used to assess attention (visual search, unpredictable task switching as well as complex visual search and predictable task switching tests) and memory (forced visual memory, forward digit span and free recall test).
Results: The differences in heart rate and body temperatures between men and women were not significant. There were no differences in the mean values of attention and memory abilities between men and women. Coefficients of variation of unpredictable task switching response and forward digit span were lower (P < 0.05) in men. Coefficients of variation positively correlated (P < 0.05) with attention task incorrect response and negatively correlated (P < 0.05) with correct answers in the memory task.
Conclusions: Current study showed no sex differences in the mean values of cognition, whereas higher intra-individual variability of short-term memory and attention switching was identified in women, indicating that their performance was lower on these cognitive abilities. Full article

Background and objective: A mini volume loading test (mVLT) evaluating hemodilution during step-wise crystalloid infusion has established that the arterio-capillary plasma dilution difference is inversely correlated to the body hydration level of subjects. This observational study aimed to test whether this can be replicated in a perioperative setting using a 2.5-mL kg⁻¹ boluses.
Materials and methods: The mVLT was performed before induction of regional anesthesia and 24 h later. Step-wise infusion implied six mini fluid challenges. These consisted of 2.5-mL kg⁻¹ boluses of Ringer's acetate infused during 2–3 min and followed by 5-min periods with no fluids. Invasive (arterial) and noninvasive (capillary) measurements of hemoglobin were performed before and after each mini fluid challenge, as well as after a 20-min period without fluid following the last bolus. Hemoglobins were used to calculate the arteriocapillary plasma dilution difference which is used as an indication of changes in body hydration level. The 24-h fluid balance was calculated.
Results: Subjects were 69.5 (6.0) years old, their height was 1.62 m (1.56–1.65), weight was 87.0 kg (75.5–97.5) and body mass index (BMI) was 33.5 kg/m² (31.0–35.1). Preoperative arterio-capillary plasma dilution difference was significantly higher than postoperative (0.085 [0.012–0.141] vs. 0.006 [−0.059 to 0.101], P = 0.000). The perioperative 24-h fluid balance was 1976 mL (870–2545).
Conclusions: The mVLT using 2.5-mL kg⁻¹ boluses of crystalloid was able to detect the higher postoperative body hydration level in total knee arthroplasty patients. Full article

Background and objective: Myocardial deformation indices are considered as sensitive markers of ischemia and may be useful in the quantification of hemodynamic significance of coronary artery disease (CAD). We sought to determine the diagnostic value of speckletracking echocardiography derived myocardial deformation parameters at rest and during stress to determine hemodynamically significance coronary artery stenosis in patients with moderate and high probability of CAD.
Materials and methods: In 81 patients (mean age, 64 ± 8.6 years) with stable CAD inducible myocardial ischemia was evaluated by dobutamine stress echocardiography (DSE) and adenosine magnetic resonance imaging (AMRI). Based on AMRI patients were divided into two groups: nonpathologic (n = 41) and pathologic (n = 40). Strain and strain rate (SR) parameters and their changes from the rest (BASE) to low stress (MIN), peak stress (MAX), and recovery (REC) were analyzed using 2D speckle-tracking imaging (STI).
Results: In the nonpathologic group, systolic longitudinal and circumferential strain increased significantly from BASE to MIN, as well as systolic SR from BASE to MIN and from MIN to MAX in longitudinal plane. In contrast, in the pathologic group, insignificant longitudinal systolic SR increase and radial and circumferential systolic SR decrease from MIN to MAX was observed. Discriminant function analysis revealed that select STI derived parameters best classify patients into predefined AMRI groups (pathologic and nonpathologic) with the accuracy respectively 90.9% and 83.3%. According to ROC analysis these myocardial deformation parameters had the greatest predictive value of significant coronary artery stenoses: longitudinal strain at high dose (AUC 0.811, sensitivity 89.4%, specificity 64.7%), longitudinal strain rate at high dose (AUC 0.855, sensitivity 88.1%, specificity 71.0% at high doses). The sensitivity and specificity of inducible wall motion abnormalities were 74.0% and 85.0% (AUC 0.798) and was lower compared with the diagnostic value of longitudinal myocardial deformation parameters.
Conclusions: Left ventricular strain and strain rate analyses during DSE can be used in the assessment of hemodynamic significance of coronary artery stenosis in patients with moderate and high risk for CAD. Full article

Background and objective: Recent GWAS and meta-analyses have revealed about 200 suscepti- bility genes/loci for inflammatory bowel diseases (IBD). However, only a small number of studies were performed in early-onset IBD. The aim of this study was to assess the association between NOD2, IL23R, ATG16L1, IRGM, IL10, NKX2-3 and ORMDL3 variants and early-onset IBD.
Materials and methods: A total of 76 affected individuals (30 with Crohn's disease [CD] and 46 with ulcerative colitis [UC]) at the age of ≤17 years and 158 matched controls recruited in Lithuania were genotyped for the known genetic susceptibility variants in NOD2 (Arg702Trp (rs2066844), Gly908Arg (rs2066845) and Leu1007insC (rs2066847)), IL23R (rs11209026), ATG16L1 (rs2241880), IRGM (rs4958847), IL10 (rs3024505), NKX2-3 (rs11190140) and ORMDL3 (rs2872507) genes.
Results: Variants in NOD2 (Leu1007insC) and IRGM genes increased risk for CD (OR = 6.56, 95% CI: 2.54–16.91, P = 1.21 × 10⁻⁵ and OR = 2.32, 95% CI: 1.05–5.14, P = 0.033; respectively); whereas a variant in ORMDL3 gene was strongly associated with UC (OR = 1.99, 95% CI: 1.23–3.20, P = 4.15 × 10⁻³).
Conclusions: The results confirmed that polymorphisms in NOD2 (Leu1007insC) and IRGM genes are associated with increased risk of CD; whereas the ORMDL3 variant is associated with susceptibility to UC in the Lithuanian early-onset IBD population. Full article

Background and aim: Immunoglobulin A nephropathy (IgAN) is the most frequent glomerular disease worldwide and one of the main causes of chronic kidney disease. We aimed to investigate clinicopathological correlations in IgAN patients by gender.
Materials and methods: The study was based on a retrospective analysis of renal biopsy data and clinical manifestations of the disease. Consecutive 73 biopsy-proven IgAN cases of male (62%) and female (38%) patients were investigated. Renal biopsies were reviewed using the new Oxford classification assessing the MEST (mesangial hypercellularity, endocapillary hypercellularity, segmental sclerosis/adhesion, tubular atrophy/interstitial fibrosis) score. The most powerful IgAN prognostic risk factors, morphological (segmental glomerulosclerosis and tubular atrophy/interstitial fibrosis) as well as clinical (proteinuria and hypertension) were taken into account in the correlation analysis. The mean rate of renal function decline was expressed as a slope of eGFR during the follow-up (FU) dividing delta GFR with the FU years.
Results: The mean age of the patients was 33.7 years (range, 16–76). Follow-up data were available for 64 patients with the mean follow-up of 4.1 years. The mean proteinuria at biopsy was 0.79 g/24 h. The mean arterial pressure (MAP) was 94.5 ± 16.7 mmHg and 7% of the patients were hypertensive. The initial mean estimated glomerular filtration rate (eGFR) was 94.9 ± 30.7 mL/min, at the end of the follow-up it was 86.2 ± 27.1 mL/min. The mean rate of renal function decline was −3.4 ± 11.9 mL/min/1.73 m² per year in males (P < 0.05) and −0.7 ± 5.3 mL/min/1.73 m² per year in females. The Spearman correlation analysis confirmed a higher MEST score in the whole cohort and in males correlated with disease progression. In patients with proteinuria below 1.0 g/24 h, disease progression was faster in males.
Conclusions: According to the correlation analysis of the main prognostic risk factors, affecting the progression of IgAN, we can conclude that IgA nephropathy in males progresses more rapidly compared to females. Full article

Background and aim: Research shows that regular engagement in physical activity in childhood is associated with multiple physical and psychosocial health benefits. The data on associations between children physical activity level and built environment in Lithuania are limited. The built environment is one of many variables thought to affect children physical activity level. But consequently there is growing interest in how physical environment influences physical activity of school age children. The aim of this paper is to evaluate associations between physical activity of primary school age children and built environment (road safety, travel distance, playgrounds, etc.) in Lithuania.
Materials and methods: Data were obtained participating in the WHO European Childhood Obesity Surveillance Initiative (COSI). The study protocol was granted ethical approval from Lithuanian Bioethics Committee (No. 6B-10-02). Parents/guardians provided written informed consent. A cross-sectional study was carried out in 2013. A multilevel sampling method was employed for composing a national representative sample. The representing data were collected by means of standardized questionnaires, which were filled out by 3802 parents of the selected first-formers.
Results: The mean age of the first-formers was 7.3 years (SD 0.5). More than half (62.2%) of parents stated that roads to schools were safe; most (78.7%) of adults notified that children had where to play and exercise in their living area. Place of residence of family and recreation areas in living environment were significant predictors of children's daily physical activity and possibility to attend sport or dancing clubs.
Conclusions: Results from the national survey of 7–8-year-old children of Lithuania reveal that urban living area of families, availability of playgrounds and recreational facilities were associated with higher possibilities of children to be sufficiently physically active. Full article

Aortic dissection is a life-threatening rare condition that may virtually present by any organ system dysfunction, the nervous system included. Acute cerebral infarction among multiple other neurological and non-neurological presentations is part of this acute aortic syndrome. Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Department within a 4.5-h window after symptom onset. Systemic intravenous thrombolysis in the case of an acute brain infarction due to aortic dissection may lead to fatal outcomes. In this neurological emergency it is important to rule out underlying aortic dissection by choosing appropriately quick and accurate diagnostic tool. We aimed to present a prospective follow-up case, where carotid ultrasound examination was the primary key method that led to a correct diagnosis in hyperacute (<24 h) Stanford type A aortic dissection presenting as an acute ischemic stroke, and thereafter with a repeated contrast-enhanced computed tomog- raphy and transthoracic echocardiography, helped to monitor topography of intravascular processes and hemodynamic properties during the clinical course of a disease, which influenced treatment decisions. Thus, we reviewed the literature mainly focusing on the various neurological aspects associated with aortic dissection. Full article