Medicina

782 KiB

Open AccessReview

Molecular alterations in signal pathways of melanoma and new personalized treatment strategies: Targeting of Notch

by Julija Mozūraitienė, Kristina Bielskienė, Vydmantas Atkočius and Danutė Labeikytė

Medicina 2015, 51(3), 133-145; https://doi.org/10.1016/j.medici.2015.06.002 - 15 Jul 2015

Cited by 13 | Viewed by 833

Despite modern achievements in therapy of malignant melanomas new treatment strategies are welcomed in clinics for survival of patients. Now it is supposed that personalized molecular therapies for each patient are needed concerning a specificity of molecular alterations in patient's tumors. In human [...] Read more.

Despite modern achievements in therapy of malignant melanomas new treatment strategies are welcomed in clinics for survival of patients. Now it is supposed that personalized molecular therapies for each patient are needed concerning a specificity of molecular alterations in patient's tumors. In human melanoma, Notch signaling interacts with other pathways, including MAPK, PI3K-AKT, NF-kB, and p53. This article discusses mutated genes and leading aberrant signal pathways in human melanoma which are of interest concerning to their perspective for personalized treatment strategies in melanoma. We speculate that E3 ubiquitin ligases MDM2 and MDM4 can be attractive therapeutic target for p53 and Notch signaling pathways in malignant melanoma by using small molecule inhibitors. It is possible that restoration of p53-MDM2-NUMB complexes in melanoma can restore wild type p53 function and positively modulate Notch pathway. In this review we summarize recent data about novel US Food and Drug Administration approved target drugs for metastatic melanoma treatment, and suppose model for treatment strategy by targeting Notch. Full article

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Open AccessArticle

Comparison of body composition, nutritional status, functional status, and quality of life between osteoporotic and osteopenic postmenopausal women

by Beril Dogu, Hulya Sirzai, Ahmet Usen, Figen Yilmaz and Banu Kuran

Medicina 2015, 51(3), 173-179; https://doi.org/10.1016/j.medici.2015.05.003 - 5 Jul 2015

Cited by 6 | Viewed by 963

Abstract

Background and objective: Osteoporosis is a condition that affects body composition, physical activity, and psychological state. We aimed to examine the differences between osteoporotic and osteopenic postmenopausal women with respect to body composition, nutrition, functional status, and quality of life.
Materials and methods: [...] Read more.

Background and objective: Osteoporosis is a condition that affects body composition, physical activity, and psychological state. We aimed to examine the differences between osteoporotic and osteopenic postmenopausal women with respect to body composition, nutrition, functional status, and quality of life.
Materials and methods: A total of 102 osteopenic (Group 1) and 100 osteoporotic (Group 2) patients were enrolled in the study. Bone mineral density (BMD), fat tissue mass (FTM), lean tissue mass (LTM), and bone mineral content (BMC) were evaluated using dual-energy X-ray absorbtiometry. Nutritional status of the patients was assessed with the Mini Nutritional Assessment (MNA), functional status with the Nottingham Extended Activities of Daily Living (NEADL) scale, and quality of life with the assessment of health-related quality of life in osteoporosis (ECOS-16).
Results: Group 2 had significantly lower FTM, LTM, and MNA scores than Group 1 (P < 0.05). NEADL and ECOS-16 scores did not differ between the groups (P > 0.05). A significant correlation was found between MNA and FTM, LTM, BMC, and BMD (P < 0.05). Whereas the assessment of functional status showed a significant positive correlation with BMD and a significant negative correlation with age (P < 0.05), no significant correlation was found between functional status and body composition (P > 0.05).
Conclusions: We found lower FTM and LTM values and a poorer nutritional status in osteoporotic patients than in osteopenic ones. Nutritional status was correlated with body composition and BMD, and functional status was correlated with age and BMD. Full article

616 KiB

Open AccessArticle

Long-term follow-up of children with typical hemolytic uremic syndrome

by Birutė Pundzienė, Diana Dobilienė, Rimantė Čerkauskienė, Renata Mitkienė, Aina Medzevičienė, Elena Darškuvienė and Augustina Jankauskienė

Medicina 2015, 51(3), 146-151; https://doi.org/10.1016/j.medici.2015.06.004 - 5 Jul 2015

Cited by 9 | Viewed by 909

Abstract

Objective: The aim of the study was to determine the associations of the acute period course with late-emerging sequelae in children with typical hemolytic uremic syndrome (HUS).
Materials and methods: The data of 62 children with typical HUS during the acute phase were [...] Read more.

Objective: The aim of the study was to determine the associations of the acute period course with late-emerging sequelae in children with typical hemolytic uremic syndrome (HUS).
Materials and methods: The data of 62 children with typical HUS during the acute phase were retrospectively analyzed by age, sex, duration of anuria/oliguria, method and duration of renal replacement therapy, proteinuria, hypertension, and renal function. The data of 33 children at 10-year follow-up after the onset of the disease were evaluated for changes in hypertension, proteinuria, and renal function.
Results: In the acute phase of the disease (n = 62), hypertension was documented in 75.8% of the children; proteinuria, in 85.5%; and renal dysfunction, in 100%. At 10 years after the onset of the disease (n = 33), hypertension was documented in 12.1%, 6.1%, and 24.2% at 1-, 5-, and ≥10-year follow-ups, respectively, and more often in children aged <1 year at the onset of the disease. Proteinuria was found in 15.2%, 9.1%, and 33.3% of the patients, respectively. After ≥10 years, hypertension developed for the first time in 6.1% of the patients. Renal injury of varying degrees was seen in 15.2% of the children at the 1-year follow-up, and after ≥10 years the proportion increased to 33.3%.
Conclusions: At 10 years after the acute phase of typical HUS in children, the prevalence of hypertension and proteinuria at 1- and 5-year follow-ups decreased, but after 10 years it started to increase. As much as 6.1% of the children developed hypertension or proteinuria for the first time at 10 years. Hypertension was documented more frequently in children who were younger than <1 year at the onset of the disease. Renal dysfunction after 5 and 10 years remained in more than one-third of cases, and it was observed more often if hypertension was documented at the acute period. Full article

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Open AccessArticle

Cardiovascular changes during the performance by nonathletes of Bosco repeated jumps anaerobic test

by Jonas Poderys, Albinas Grūnovas, Kristina Poderienė, Alfonsas Buliuolis, Viktoras Šilinskas and Eugenijus Trinkūnas

Medicina 2015, 51(3), 187-192; https://doi.org/10.1016/j.medici.2015.06.003 - 2 Jul 2015

Cited by 2 | Viewed by 967

Abstract

Objective: The aim of this study was to find out the characteristics of cardiovascular changes when performing Bosco repeated jumps anaerobic test depending on the duration of jumping in a nonathletes cohort.
Materials and methods: Changes in arterial blood pressure indices and changes [...] Read more.

Objective: The aim of this study was to find out the characteristics of cardiovascular changes when performing Bosco repeated jumps anaerobic test depending on the duration of jumping in a nonathletes cohort.
Materials and methods: Changes in arterial blood pressure indices and changes in 12-lead ECG indices were analyzed. The characteristics of recovery after workloads were assessed by evaluating the time of half period of recovery of registered indices and by the Lyapunov exponent.
Results: The results have shown that the ratio of JT and RR intervals of ECG (JT/RR) can be useful for outlining to what extent a cardiovascular function was mobilized. The mobilization of cardiovascular function when performing a 30-s jump test changed up to 0.454 ± 0.012 and when performing a Bosco test, up to the maximal values, i.e. 0.634 ± 0.004. When performing jumps of maximal intensity, a maximal change of JT/RR occurrence was between 50 and 60 s. The increasingly serious myocardial ischemic episodes were observed at the onset of the jumping task. The duration of 60-s of all-out jump test has made an influence on the stability of the recovery processes of cardiovascular indices, i.e. the nonexponential type of recovery was observed.
Conclusions: When performing Bosco 60-s repeated jumps in an anaerobic test, a maximal mobilization of the cardiovascular system occurs between 50 and 60 s. The 30-s all-out test duration in jumping is enough to outline at what extent cardiovascular function was mobilized as well as to assess other functional characteristics during high intensity intensive exercising. Full article

359 KiB

Open AccessArticle

Impact of etiology on course and outcomes of severe acute pancreatitis

by Giedrius Barauskas, Povilas Ignatavičius, Astra Vitkauskienė, Juozas Pundzius and Žilvinas Dambrauskas

Medicina 2015, 51(3), 167-172; https://doi.org/10.1016/j.medici.2015.04.002 - 2 Jul 2015

Cited by 8 | Viewed by 907

Abstract

Background and objective: Since the influence of etiological factors on the course and outcomes of acute pancreatitis (AP) is not fully understood yet, the aim of the study was to compare the outcomes of alcoholic and biliary severe acute pancreatitis (SAP).
Materials and [...] Read more.

Background and objective: Since the influence of etiological factors on the course and outcomes of acute pancreatitis (AP) is not fully understood yet, the aim of the study was to compare the outcomes of alcoholic and biliary severe acute pancreatitis (SAP).
Materials and methods: We investigated 81 patients with alcoholic and biliary SAP. Demographic data, etiologic factors, severity scores, intra-abdominal pressure, imaging studies, interventions, and treatment outcomes were prospectively entered into specially maintained database and subsequently analyzed.
Results: No statistically significant difference was observed in the prevalence of SAP in biliary and alcoholic AP groups (P = 0.429). Although, in the biliary SAP group patients were predominantly elderly women (P = 0.003), the total in-hospital stay was longer in alcoholic SAP patients (P = 0.021). The abdominal compartment syndrome developed more frequently (P = 0.041) and necrosectomy was more frequently performed in alcoholic SAP group (not statistically significant). Although not statistically significant, a lower mortality rate among biliary SAP patients (25.0% vs. 13.5%) was observed.
Conclusions: We defined a trend toward decreased incidence of infected necrosis in larger volume (≥30%) pancreatic necrosis, absence of abdominal compartment syndrome, lower rate of necrosectomies, shorter in-hospital stay, and an insignificantly reduced mortality rate in biliary SAP patients, indicating more favorable course of biliary SAP. Full article

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Open AccessArticle

Increased innate and adaptive immune responses in induced sputum of young smokers

by Agnese Kislina, Liga Balode, Normunds Jurka, Zane Sinkevica, Sergejs Isajevs, Darja Isajeva, Valentina Gordjusina, Maris Bukovskis, Immanuels Taivans and Gunta Strazda

Medicina 2015, 51(3), 159-166; https://doi.org/10.1016/j.medici.2015.06.001 - 2 Jul 2015

Cited by 2 | Viewed by 982

Abstract

Background and objectives: It is known that chronic obstructive pulmonary disease (COPD) development process is imperceptible and can be asymptomatic for 20 or more years. It is of great importance to diagnose early inflammatory changes that can lead to COPD in young asymptomatic [...] Read more.

Background and objectives: It is known that chronic obstructive pulmonary disease (COPD) development process is imperceptible and can be asymptomatic for 20 or more years. It is of great importance to diagnose early inflammatory changes that can lead to COPD in young asymptomatic cigarette smokers. The aim of our study was to analyze the cell spectrum of induced sputum (IS) of young cigarette smokers, with emphasis on T-regulatory cells.
Materials and methods: A total of 20 healthy nonallergic smokers, 20 nonsmokers and 20 COPD patients were enrolled in the study. After lung function measurements were taken, we performed sputum induction and analyzed sputum cells. We evaluated the cell count of FOXP3-positive, CD4⁺ and CD8⁺ T lymphocytes by immunocytochemistry staining, and the cell count of macrophages and neutrophils by May-Grünwald Giemsa staining.
Results: Induced sputum of smokers contained a higher absolute amount of macrophages and neutrophils when compared to nonsmokers. FOXP3-positive cells in the sputum of young smokers showed a statistically significant increase when compared to nonsmokers. Induced sputum of COPD patients contained an increased absolute amount of neutrophils and FOXP3-positive Treg cells when compared to nonsmokers. Regression analysis showed that the amount of FOXP-3 positive cells, neutrophils and macrophages in the induced sputum was increasing with the number of pack years.
Conclusions: This study demonstrates that young smokers have early inflammatory changes in their airways that not only initiate nonspecific mechanisms recruiting neutrophils, but also involve specific immune mechanisms with recruitment of T regulatory lymphocytes. The lymphocyte response is probably adaptive. Full article

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Open AccessArticle

Healthcare-associated infections in Northern Russia: Results of ten point-prevalence surveys in 2006–2010

by Ekaterina A. Krieger, Andrej M. Grjibovski, Olga V. Samodova and Hanne M. Eriksen

Medicina 2015, 51(3), 193-199; https://doi.org/10.1016/j.medici.2015.05.002 - 16 Jun 2015

Cited by 3 | Viewed by 955

Abstract

Background and objective: Statistics on healthcare-associated infections (HAIs) in Russia is scarce and has been considered to suffer from underreporting. We assessed the prevalence and changes in the prevalence of HAIs over 5 years and identified factors associated with acquiring HAIs in the [...] Read more.

Background and objective: Statistics on healthcare-associated infections (HAIs) in Russia is scarce and has been considered to suffer from underreporting. We assessed the prevalence and changes in the prevalence of HAIs over 5 years and identified factors associated with acquiring HAIs in the pediatric hospital in Arkhangelsk, Northern Russia.
Materials and methods: Ten cross-sectional studies were conducted in the Arkhangelsk regional pediatric hospital biannually during 2006–2010. We used a standardized protocol, including the criteria of HAI proposed by the Centers for Disease Control and Prevention. Binary logistic regression was applied to study factors associated with HAI.
Results: Altogether, 3264 inpatients were enrolled in the study and 347 of them had HAI (11.2%). The prevalence of HAI per survey ranged from 7.1% (95% CI: 4.8%–10.4%) to 16.7% (95% CI: 13.1%–21.2%). The most prevalent HAIs were upper respiratory tract infections 5.1% (95% CI: 4.4%–5.9%), followed by urinary tract infections, 1.5% (95% CI: 1.2%–2.0%), and acute gastroenteritis, 1.4% (95% CI: 1.1%–1.9%). Compared to infants, children aged 5–9 years (OR = 0.7, 95% CI: 0.4–1.0), 10–14 years (OR = 0.4, 95% CI: 0.3–0.7), and ≥15 years (OR = 0.3, 95% CI: 0.2–0.5) were less likely to have HAI. Neutropenia (OR = 1.5, 95% CI: 1.0–2.3) and use of intravascular catheter(s) (OR = 1.8, 95% CI: 1.1–3.0) were positively associated with HAI.
Conclusions: The observed prevalence of HAIs is within the range reported in several other European countries. We do not recommend generalizing our findings to other Russian settings given considerable variations between regions in both socio-economic situation and conditions of medical facilities. Full article

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Open AccessArticle

Association of cardio-ankle vascular index with cardiovascular risk factors and cardiovascular events in metabolic syndrome patients

by Aleksandras Laucevičius, Ligita Ryliškytė, Jūratė Balsytė, Jolita Badarienė, Roma Puronaitė, Rokas Navickas and Svetlana Solovjova

Medicina 2015, 51(3), 152-158; https://doi.org/10.1016/j.medici.2015.05.001 - 16 Jun 2015

Cited by 40 | Viewed by 879

Abstract

Objectives: We aimed to investigate the association between arterial stiffness assessed as cardio-ankle vascular index (CAVI) and cardiovascular (CV) risk factors and CV events in the middle-aged metabolic syndrome (MS) patients.
Materials and methods: A follow-up study was carried out in 2106 middle-aged [...] Read more.

Objectives: We aimed to investigate the association between arterial stiffness assessed as cardio-ankle vascular index (CAVI) and cardiovascular (CV) risk factors and CV events in the middle-aged metabolic syndrome (MS) patients.
Materials and methods: A follow-up study was carried out in 2106 middle-aged (53.83 6.17 years old, 62% women) MS subjects without overt atherosclerotic disease. Patients were initially recruited in 2009–2011 as participants of the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program and followed up for 3.8 ± 1.7 years for CV events. Thorough cardiometabolic risk assessment was carried out at inclusion.
Results: Subjects with higher CAVI had worse lipid and glucose metabolism profile: elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), decreased highdensity lipoprotein cholesterol (HDL-C), higher fasting and oral glucose tolerance test (OGTT) glucose levels (all P < 0.001), and lower fasting insulin (P = 0.021). Greater age (P < 0.001), heart rate (P = 0.016), and mean arterial pressure (P < 0.001) were also associated with higher CAVI. Over the follow-up period, 93 (4.4%) patients developed a cardiovascular event: 55 (2.6%) patients had myocardial infarction and 38 (1.8%) suffered a cerebrovascular event. Fatal CV events comprised 6.5% (n = 6) of all CV events. CAVI was statistically significantly associated with occurrence of myocardial infarction (P = 0.027) and total cardiovascular events (P = 0.045), but not cerebrovascular events (P = 0.65). However, this association was dependent on age and gender.
Conclusions: In the middle-aged MS patients, higher CAVI was associated with altered lipid and glucose metabolism, older age, greater heart rate and mean arterial pressure, and worse cardiovascular outcome. Full article

354 KiB

Open AccessArticle

An evaluation of the effectiveness and safety of midazolam in children undergoing dental surgery

by Lina Kalibatienė, Vytenis Kalibatas, Andrius Macas and Darius Trepenaitis

Medicina 2015, 51(3), 180-186; https://doi.org/10.1016/j.medici.2015.04.001 - 12 May 2015

Cited by 3 | Viewed by 1000

Abstract

Objective: The aim of this study was to evaluate the effectiveness and safety of oral midazolam in children undergoing dental surgery.
Materials and methods: A prospective, randomized, controlled trial was conducted to assess the effectiveness and safety of midazolam in children. Patients aged [...] Read more.

Objective: The aim of this study was to evaluate the effectiveness and safety of oral midazolam in children undergoing dental surgery.
Materials and methods: A prospective, randomized, controlled trial was conducted to assess the effectiveness and safety of midazolam in children. Patients aged 2–9 years who underwent dental surgery under general anesthesia were randomly allocated into one of the four groups: midazolam 0.2 mg/kg dose group (n = 30); midazolam 0.21–0.4 mg/kg dose group (n = 15); midazolam more than 0.41 mg/kg dose group (n = 15) or the placebo group (n = 31). The effectiveness of midazolam on sedation was assessed by the evaluation of vital signs, such as the respiratory and heart rate, oxygen saturation and the patients' reactive behaviors, in comparison with the placebo.
Results: The scores of the ratings for sleep, movement and crying, as well as patients' reactions at the moment of separation from their parents and their collaboration with the staff were statistically significantly better among patients who received oral midazolam compared with the placebo. There were statistically significant direct correlations between the doses of midazolam and higher sleep, movement, crying and reaction scores 30 min after premedication as well as higher scores of patients upon separation from their parents. There were only a few clinically insignificant side effects.
Conclusions: Oral midazolam, at a single dose from 0.2 to 0.6 mg/kg, is effective and safe, and provides the expected sedative effects in children required by premedication for dental surgery. Full article

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Medicina, Volume 51, Issue 3 (June 2015) – 9 articles , Pages 133-199

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