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Kaunas, Lithuania

Lithuanian University of Health science ) is a medical school in Kaunas, Lithuania. The present-day Lithuanian University of Health science is a consolidation of two institutions of higher education, Kaunas University of Medicine and the Lithuanian Veterinary Academy. It uses the Hospital of Lithuanian University of Health science Kaunas Clinics and the Kaunas Red Cross Hospital as a teaching hospitals. Wikipedia.

Macijauskiene J.,Lithuanian University of Health Sciences
Medicina (Kaunas, Lithuania)

Dementia with Lewy bodies was first recognized as a separate entity about 30 years ago. The prevalence varies from 0% to 5% in the general population, and this disease accounts for 0% to 30.5% of all dementia cases. Dementia with Lewy bodies is considered the second most common cause of degenerative dementia after Alzheimer's disease. The disease is characterized by alpha-synuclein immunoreactive protein deposits in both neurons and glial cells. The protein deposits are especially prominent in dopaminergic neurons, where they can be detected using conventional histological stains, such as hematoxylin and eosin, and are commonly referred to as Lewy bodies. The diagnosis of dementia with Lewy bodies is based on the presence of dementia as well as 2 of the following 3 core diagnostic features: 1) fluctuating cognition, 2) visual hallucinations, and 3) movement disorder. Diagnostic tests include laboratory data, structural and functional imaging, and electroencephalography. Differential diagnosis of dementia with Lewy bodies focuses on other later life dementia syndromes, other parkinsonian diseases (Parkinson's disease, progressive supranuclear palsy, corticobasal degeneration), and primary psychiatric illnesses. There is type 1b evidence to support treatment with cholinesterase inhibitors. Glutamatergic and dopaminergic therapies are used as well. Standard neuroleptics are contraindicated, and atypical agents should be used cautiously. Nonpharmacologic measures - therapeutic environment, psychological and social support, physical activity, behavioral management strategies, caregivers' education and support, and different services - could be suggested. Source

Atrial fibrillation continues to be a challenging arrhythmia. There are some conventional, time-tested explanations of atrial fibrillation genesis, however some uncertainty of its complete understanding still exists. We focused on atrial ischemia which, hypothetically, could be responsible for manifestation of the arrhythmia, irrespective of the underlying heart disease. Evidences abounds that atrial fibrillation has an extremely strong association with nutritional/oxidative status of myocardium. This arrhythmia seemingly may stem from the electrophysiological differences taking place in the boundary areas. To validate such assumptions we have surveyed widely accepted theories based on clinical and experimental evidence. There was an attempt to integrate some well-known theoretical explanations (focal, multifocal, ectopic, reentrant activity, atrial remodeling, etc.) into a new conceptually systematized arrhythmogenesis. Confronting ischemic and non-ischemic atrial zones electrophysiologically on their borderlines presumably creates a substrate vulnerable to the development of atrial fibrillation. The behavior of these interrelated areas is likely ischemia-dependent; the separating borderline(s) may be treated as conflictogenic, releasing triggers/drivers to commence and to perpetuate the arrhythmia. Ischemically damaged and non-damaged myocardial areas likely participate in the relay-race carousel of arrhythmogenicity due to their mutual interactions, accompanied by the "fireworks" at the separating borderlines. It could be concluded that myocardial ischemia as a nonspecific proarrhythmic factor presumably plays a key role in the genesis and sustenance of atrial fibrillation. Theoretically the most important step in eradication of arrhythmogenic substrate might be an overall abolition of ischemia regardless of the characteristics of underlying heart disease. Innovative intellectual and explorative research is needed to render innocuous the ischemia that might help us win the century's cardioarrhythmological battle. Source

Kowalski P.M.,Lithuanian University of Health Sciences
Polish Annals of Medicine

Introduction Posttraumatic brain injury is one of the most common causes of disability and death among children. Every 2nd child in Poland requires medical intervention after suffering from cranial-cerebral trauma, and every 10th is being admitted to hospital for the same reason. In children, only a very small fraction of this type of traumas leads to temporal bone fracture with complete vestibular apparatus damage, followed by disturbances in balance and dizziness.Aim: The aim of this paper is to provide with easily accessible and unsophisticated therapy methods applied in children with total damage to vestibular system. Case study This paper presents a case of a 6-year-old boy who has suffered from cranial-cerebral trauma with a total damage to the vestibular system, with accompanying symptoms of dizziness, impaired balance, and unilateral hearing loss. Patient was implemented in rehabilitation based on vestibular physiotherapy, visual- and mobility-coordination exercises, balance exercises and adequate psychotherapy. Improvement relied on simple and child-friendly methods.Results and discussion Diminution of dizziness and balance deficit in vestibular apparatus damage depends upon alignment of bioelectrical activity between two vestibuli. Onset of such process begins few hours after the vestibular damage has occurred and is based on inhibition of excessive reactions from unaffected vestibulum, as well as stimulation of the one with defect. It is being regulated in CNS on the basis of positive and negative feedbacks.Conclusions Easily accessible and friendly methods of rehabilitation significantly shorten the time of almost full recovery in children with vestibular system damage; moreover continuous stimulation of CNS through repetition of mobility exercises shortens recovery time and has a significant value in development of correct image of spatial information. © 2014 Warminsko-Mazurska Izba Lekarska w Olsztynie. Published by Elsevier Urban and Partner Sp. z o.o. All rights reserved. © 2014 Warminsko-Mazurska Izba Lekarska w Olsztynie. Published by Elsevier Urban and Partner Sp. z o.o. All rights reserved. Source

Kybartaite A.,Lithuanian University of Health Sciences
International Journal for Numerical Methods in Biomedical Engineering

Computational head and brain volume conductor modeling is a practical and non-invasive method to investigate neuroelectrical activity in the brain. Anatomical structures included in a model affect the flow of volume currents and the resulting scalp surface potentials. The influence of different tissues within the head on scalp surface potentials was investigated by constructing five highly detailed, realistic head models from segmented and processed Visible Human Man digital images. The models were: (1) model with 20 different tissues, that is, skin, dense connective tissue (fat), aponeurosis (muscle), outer, middle and inner tables of the scalp, dura matter, arachnoid layer (including cerebrospinal fluid), pia matter, six cortical layers, eye tissue, muscle around the eye, optic nerve, temporal muscle, white matter and internal air, (2) model with three main inhomogeneities, that is, scalp, skull, brain, (3) model with homogeneous scalp and remaining inhomogeneities, (4) model with homogeneous skull and remaining inhomogeneities, and (5) model with homogeneous brain matter and remaining inhomogeneities. Scalp potentials because of three different dipolar sources in the parietal-occipital lobe were computed for all five models. Results of a forward solution revealed that tissues included in the model and the dipole source location directly affect the simulated scalp surface potentials. The major finding indicates that significant change in the scalp surface potentials is observed when the brain's distinctions are removed. The other modifications, for example, layers of the scalp and skull are important too, but they have less effect on the overall results. © 2012 John Wiley & Sons, Ltd. Source

Ciuleanu T.,Institute of Oncology Ion Chiricuta | Stelmakh L.,St. Petersburg State Medical University | Cicenas S.,Vilnius University | Miliauskas S.,Lithuanian University of Health Sciences | And 5 more authors.
The Lancet Oncology

Background: Erlotinib, docetaxel, and pemetrexed are approved for the second-line treatment of non-small-cell lung cancer (NSCLC), but no head-to-head data from large clinical trials are available. We undertook the Tarceva In Treatment of Advanced NSCLC (TITAN) study to assess the efficacy and tolerability of second-line erlotinib versus chemotherapy in patients with refractory NSCLC. Methods: TITAN was an international, randomised multicentre, open-label, phase 3 study that was done at 77 sites in 24 countries. Chemotherapy-naive patients with locally advanced, recurrent, or metastatic NSCLC received up to four cycles of first-line platinum doublet chemotherapy, after which patients with disease progression during or immediately after chemotherapy were offered enrolment into TITAN. Enrolled patients were randomly assigned (1:1) by a minimisation method to ensure balanced stratification, to receive erlotinib 150 mg/day or chemotherapy (standard docetaxel or pemetrexed regimens, at the treating investigators' discretion), until unacceptable toxicity, disease progression, or death. Patients were stratified by disease stage, Eastern Cooperative Oncology Group performance status, smoking history, and region of residence. The primary endpoint was overall survival in the intention-to-treat population. TITAN was halted prematurely because of slow recruitment. This study is registered with ClinicalTrials.gov, number NCT00556322. Findings: Between April 10, 2006, and Feb 24, 2010, 2590 chemotherapy-naive patients were treated with first-line platinum doublet chemotherapy, of whom 424 had disease progression and were enrolled into TITAN. 203 patients were randomly assigned to receive erlotinib and 221 were assigned to receive chemotherapy. Median follow-up was 27·9 months (IQR 11·0-36·0) in the erlotinib group and 24·8 months (12·1-41·6) in the chemotherapy group. Median overall survival was 5·3 months (95% CI 4·0-6·0) with erlotinib and 5·5 months (4·4-7·1) with chemotherapy (hazard ratio [HR] 0·96, 95% CI 0·78-1·19; log-rank p=0·73). The adverse-event profile of each group was in line with previous studies. Rash (98/196 [50%] in the erlotinib group vs 10/213 [5%] in the chemotherapy group for all grades; nine [5%] vs none for grade 3 or 4) and diarrhoea (36 [18%] vs four [2%] for all grades; five [3%] vs none for grade 3 or 4) were the most common treatment-related adverse events with erlotinib, whereas alopecia (none vs 23 [11%] for all grades; none vs one [<1%] for grade 3/4) was the most common treatment-related adverse event with chemotherapy. Interpretation: No significant differences in efficacy were noted between patients treated with erlotinib and those treated with docetaxel or pemetrexed. Since the toxicity profiles of erlotinib and chemotherapy differ, second-line treatment decisions should take into account patient preference and specific toxicity risk profiles. Funding: F Hoffmann-La Roche. © 2012 Elsevier Ltd. Source

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