Impact of malnutrition on postoperative delirium development after on pump coronary artery bypass grafting

Background & aims: Even though malnutrition is frequently observed in cardiac population outcome data after cardiac surgery in malnourished patients is very rare. No thorough research was done concerning the impact of malnutrition on neuropsychological outcomes after cardiac surgery. The aim of our study was to analyze the incidence of postoperative delirium development in malnourished patients undergoing on pump bypass grafting. Methods: We performed a cohort study of adults admitted to Vilnius University Hospital Santariskiu Clinics for elective coronary artery bypass grafting. The nutritional status of the patients was assessed by Nutritional Risk Screening 2002 (NRS-2002) questionnaire the day before surgery. Patients were considered as having no risk of malnutrition when NRS-2002 score was less than 3 and at risk of malnutrition when NRS-2002 score was ≥3. During ICU stay patients were screened for postoperative delirium development using the CAM-ICU method. and divided into two groups: delirium and non delirium. The statistical analysis was preformed to evaluate the differences between the two independent groups. The logistic regression model was used to evaluate the potential preoperative and intraoperative risk factors of postoperative delirium. Results: Ninety-nine patients were enrolled in the study. Preoperative risk of malnutrition was detected in 24 % (n = 24) of the patients. The incidence of early postoperative delirium in overall study population was 8.0 % (n = 8). The incidence of the patients at risk of malnutrition was significantly higher in the delirium group (5 (62.5 %) vs 19 (20.9 %), p <0.0191). In multivariate logistic regression analysis risk of malnutrition defined by NRS 2002 was an independent preoperative and intraoperative risk factor of postoperative delirium after coronary artery bypass grafting (OR: 6.316, 95 % CI: 1.384-28.819 p = 0.0173). Conclusions: Preoperative malnutrition is common in patients undergoing elective coronary artery bypass grafting. Nutrition deprivation is associated with early postoperative delirium after on pump coronary artery bypass grafting

Application of predictive and machine learning models for mechatronic systems parameters prediction and fault classification

Pastaruoju metu kuriant vis sudėtingesnes mechatronines sistemas susiduriama su įvairiomis šių sistemų eksploatavimo problemomis: priežiūra, palaikymu, gedimų identifikavimu bei šalinimu. Sudėtingų sistemų eksploatavimas reikalauja ieškoti naujų šiuolaikiškų šių problemų sprendimo būdų. Mokslinėje literatūroje ir prak- tikoje jau kuris laikas yra vystomi netiesioginiai mechatroninių sistemų priežiūros metodai tokie kaip virpesių analizė. Iš surinktų virpesių duomenų reikalingai informacijai išgauti taikomi dviejų tipų metodai: signalo apdorojimo ir duomenų struktūros požymių atpažinimo. Šie metodai remiasi automatizuotais duomenų apdorojimo algoritmais. Duomenų struktūros požymių atpažinimo metodai apima tris pagrindines dalis: duomenų rinkimą, požymių išskyrimą ir požymių atpažinimą. Šį darbą dabar jau gali atlikti dirbtinio intelekto sistemos su integruotais mašininio mokymosi modeliais gebančiais apdoroti itin kompleksiškus ir didelės dimensijos duomenų masyvus. Disertacijoje pateikiami vidaus degimo variklių ekologinių ir energinių parametrų statistiniai prognozavimo modeliai bei mašininio mokymosi modeliai skirti mechatroninių sistemų gedimams identifikuoti. Pateikti modeliai remiasi mechatroninių sistemų skleidžiamų virpesių bei garso slėgio signalų reikšmių analize. Mašininio mokymosi modeliai taikomi hipoidinės pavaros gedimams bei juostinio konvejerio apkrovos būsenoms identifikuoti. Disertacijos tema publikuoti 3 moksliniai darbai. Du darbai buvo publikuoti Clarivate Analytics Web of Science duomenų bazės leidiniuose, turinčiuose citavimo rodiklį, vienas – kituose leidiniuose. Disertacijoje atliktų tyrimų rezultatai buvo pristatyti 4 mokslinėse konferencijose Lietuvoje ir užsienyje: tarptautinėse konferencijose „Fizyka Uszkodzeń Eksploatacyjnych“, Demblinas (2022); „IEEE 8th Workshop on Advances in Information, Electronic and Electrical Engineering (AIEEE’20)“, Vilnius (2021); „ESMO 21st World Congress on Gastrointestinal Cancer, Barselona (2019) bei Lietuvoje vykusioje konferencijoje „10-asis Lietuvos jaunųjų matematikų susitikimas (LJMS’10)“, Vilnius (2021). Disertaciją sudaro įvadas, trys skyriai, bendrosios išvados ir literatūros šaltinių sąrašas.Daktaro disertacij

Impact of Medical Treatment of Hemodynamically Significant Patent Ductus Arteriosus on Cerebral and Renal Tissue Oxygenation Measured by Near-Infrared Spectroscopy in Very Low-Birth-Weight Infants

Background and objective: Hemodynamically significant patent ductus arteriosus (hsPDA) can cause ductal steal and contribute to poor outcomes in preterm infants. Near-infrared spectroscopy (NIRS) allows us to continuously evaluate regional tissue oxygenation (rSpO2) and perfusion changes in underlying organs. The aim of this study was to evaluate the effect of medical treatment for hsPDA on cerebral and renal rSpO2 in infants less than 32 weeks of gestational age, and older than 72 h of life. Materials and methods: Infants with a gestational age of &lt;32 weeks with hsPDA were prospectively studied before and during medical treatment. Two-site (cerebral and renal) rSpO2 monitoring by NIRS was performed 1 h before treatment (T0) and 24 h (T1), 24&ndash;48 h (T2), 48&ndash;72 h (T3) after the infusion of the first drug dose. Results: A total of 21 infants were studied. The mean day of life at treatment initiation was 8.2 (SD, 2.75). The DA diameter, LA/Ao ratio, and resistive index in the anterior cerebral artery (RI ACA) were significantly lower after treatment (p &lt; 0.05). There were no significant differences in cerebral rSpO2, cerebral fractional tissue oxygen extraction (FTOE), and SpO2 comparing different time points. A significantly higher renal SpO2 value was recorded at T2 as compared with T0 (75.0%, SD 4.9%, vs. 69.4%, SD 7.6%; p &lt; 0.013), while for renal FTOE, a tendency to lower values at T2 was observed (0.18, SD 0.05, vs. 0.24, SD 0.09; p = 0.068). Conclusions: Late (later than 7 days postpartum) hsPDA medical treatment with paracetamol or ibuprofen completely closed the duct only in a small proportion of preterm infants, despite a statistically significant reduction in the DA diameter, LA/Ao ratio, and RI ACA. Continuous renal, not cerebral, NIRS measurements can help to anticipate the efficacy of medical treatment of hsPDA in preterm infants. Large-scale prospective studies are needed to ascertain that renal and cerebral NIRS can be used as a reliable tool for evaluating the effectiveness of medical treatment for hsPDA

Improving Diesel Engine Reliability Using an Optimal Prognostic Model to Predict Diesel Engine Emissions and Performance Using Pure Diesel and Hydrogenated Vegetable Oil

The reliability of internal combustion engines becomes an important aspect when traditional fuels with biofuels. Therefore, the development of prognostic models becomes very important for evaluating and predicting the replacement of traditional fuels with biofuels in internal combustion engines. The models have been made to model AVL 5402 engine emission, vibration, and sound pressure parameters using a three-stage statistical regression models. The fifteen parameters might be accurately predicted by a single statistic presented here. Both fuel type (diesel fuel and HVO) and engine parameters that can be adjusted were considered, since this analysis followed the symmetry of the methods. The data analysis process included three distinct steps and symmetric statistical regression testing was performed. The algorithm examined the effectiveness of various engine settings. Finally, the optimal fixed engine parameter and the optimal statistic were used to construct an ANCOVA model. The ANCOVA model improved the accuracy of prediction for all fifteen missing parameters

Outcomes and Risk Factors of Critically Ill Patients with Hematological Malignancy. Prospective Single-Centre Observational Study

Background and Objectives: Oncohematological patients have a high risk of mortality when they need treatment in an intensive care unit (ICU). The aim of our study is to analyze the outcomes of oncohemathological patients admitted to the ICU and their risk factors. Materials and Methods: A prospective single-center observational study was performed with 114 patients from July 2017 to December 2019. Inclusion criteria were transfer to an ICU, hematological malignancy, age &gt;18 years, a central line or arterial line inserted or planned to be inserted, and a signed informed consent form. Univariate and multivariable logistic regression models were used to evaluate the potential risk factors for ICU mortality. Results: ICU mortality was 44.74%. Invasive mechanical ventilation in ICU was used for 55.26% of the patients, and vasoactive drugs were used for 77.19% of patients. Factors independently associated with it were qSOFA score &ge;2, increase of SOFA score over the first 48 h, mechanical ventilation on the first day in ICU, need for colistin therapy, lower arterial pH on arrival to ICU. Cut-off value of the noradrenaline dose associated with ICU mortality was 0.21 &mu;g/kg/min with a ROC of 0.9686 (95% CI 0.93&ndash;1.00, p &lt; 0.0001). Conclusions: Mortality of oncohematological patients in the ICU is high and it is associated with progression of organ dysfunction over the first 48 h in ICU, invasive mechanical ventilation and need for relatively low dose of noradrenaline. Despite our findings, we do not recommend making decisions regarding treatment limitations for patients who have reached cut-off dose of noradrenaline

Cure rates of childhood acute lymphoblastic leukemia in Lithuania and the benefit of joining international treatment protocol

Background: Childhood acute lymphoblastic leukemia (ALL) represents the largest group of pediatric malignancies with long-term survival rates of more than 80% achieved in developed countries. Epidemiological data and survival rates of childhood ALL in Lithuania were lacking. Therefore, the aim of this study was to analyze the population-based long-term treatment results of childhood ALL in Lithuania during 1992–2012. Materials and methods: Data of all 459 children with T-lineage and B-cell precursor ALL treated in Lithuania from 1992 to 2012 were collected and analyzed. Results were compared among four time-periods: 1992–1996 (N = 132), 1997–2002 (N = 136), 2003–2008 (N = 109) and 2009–2012 (N = 82). Results: The incidence of childhood ALL in Lithuania was 3.2–3.6 cases per 100 000 children per year during the study period. Five-year probability of event-free survival increased from 50% ± 4% in 1992–1996 to 71% ± 4% in 2003–2008 (P < 0.001). Five-year cumulative incidence of relapses reduced from 27% ± 4.5% in 1992–1996 to 14% ± 3.6% in 2003–2008 (P = 0.042). After introduction of high-dose methotrexate of 5 g/m2, cumulative incidence of CNS-involving relapses reduced from 17% ± 3.9% in 1992–1996 to 1% ± 1.0% in 2003–2008 (P < 0.001). Trend for further improvement in survival was seen in 2009–2012 when Lithuania joined international the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL-2008 treatment protocol. Conclusions: Cure rates of childhood ALL in Lithuania are improving steadily and are now approaching those reported by the largest international study groups. The reasons for such a positive effect are both better financial support for treatment of children with cancer in Lithuania and international collaboration with joining international treatment protocol for childhood ALL

Preoperative long-course chemoradiotherapy plus adjuvant chemotherapy versus short-course radiotherapy without adjuvant chemotherapy both with delayed surgery for stage II–III resectable rectal cancer: 5-Year survival data of a randomized controlled trial

Background and objective: At present, there are common recommendations for treatment for stage II–III resectable rectal cancer patients: preoperative conventional chemoradiotherapy (CRT) with delayed surgery in 6–8 weeks or preoperative short-course radiotherapy (SCRT) followed by immediate surgery. The aim of this study was to compare overall survival (OS) and disease-free survival (DFS) in two treatment groups: preoperative SCRT and CRT both with delayed surgery plus adjuvant chemotherapy in CRT arm. Materials and methods: A total of 150 patients were randomly assigned to two groups: 75 to CRT (preoperative conventional CRT, 50 Gy/25 fr with fluorouracil and leucovorin on the 1st and the 5th week of RT followed by TME surgery in 6–8 weeks and 4 cycles of adjuvant fluorouracil/leucovorin every 4 weeks; then follow-up) and 75 to SCRT (preoperative short-course RT, 25 Gy/5 fr followed by TME surgery in 6–8 weeks; then follow-up). The data of 140 patients (72 in CRT and 68 in SCRT group) were included in statistical analysis. Primary end points were OS and DFS. Results: Median follow-up was 60.5 (range, 5–108) months. The 5-year DFS was 67% in the CRT group (n = 72) and 45% in the SCRT group (n = 68) (P = 0.013; HR = 1.88; 95% CI, 1.13–3.12; P = 0.015). The 5-year OS was 79% and 62% in the CRT and SCRT groups, respectively (P = 0.015; HR = 2.05; 95% CI, 1.13–3.70; P = 0.017). The 5-year OS for intent-to-treat (ITT) population (n = 150) was 78% in the CRT and 58% in the SCRT group (P = 0.003; HR = 2.28; 95% CI, 1.30–4.00; P = 0.004). Conclusions: The 5-year DFS and OS were significantly better in the CRT than the SCRT group. For ITT population, OS was also significantly better after CRT versus SCRT

Impact of Simulated Biogas Compositions (CH4 and CO2) on Vibration, Sound Pressure and Performance of a Spark Ignition Engine

Biogas has increasingly been used as an alternative to fossil fuels in the world due to a number of factors, including the availability of raw materials, extensive resources, relatively cheap production and sufficient energy efficiency in internal combustion engines. Tightening environmental and renewable energy requirements create excellent prospects for biogas (BG) as a fuel. A study was conducted on a 1.6-L spark ignition (SI) engine (HR16DE), testing simulated biogas with different methane and carbon dioxide contents (100CH4, 80CH4_20CO2, 60CH4_40CO2, and 50CH4_50CO2) as fuel. The rate of heat release (ROHR) was calculated for each fuel. Vibration acceleration time, sound pressure and spectrum characteristics were also analyzed. The results of the study revealed which vibration of the engine correlates with combustion intensity, which is directly related to the main measure of engine energy efficiency—break thermal efficiency (BTE). Increasing vibrations have a negative correlation with carbon monoxide (CO) and hydrocarbon (HC) emissions, but a positive correlation with nitrogen oxide (NOx) emissions. Sound pressure also relates to the combustion process, but, in contrast to vibration, had a negative correlation with BTE and NOx, and a positive correlation with emissions of incomplete combustion products (CO, HC)

The effects of treatment on peripheral blood immune cell profile in pancreatic ductal adenocarcinoma (PDAC)

BACKGROUND/AIM: This study evaluated whether circulating lymphocytes, assessed by flow cytometry, is a prognostic biomarker in pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS: We studied T cell subsets in blood samples from a cohort of 41 patients diagnosed with PDAC. Patients underwent surgery of the primary site and adjuvant chemotherapy or were treated with 1st line chemotherapy (mFOLFIRINOX regimen or gemcitabine alone). The changes in T cell subpopulations during treatment were evaluated at the initial diagnosis before surgery, and after 2 and 4 months. Friedman test was used for statistical analysis. RESULTS: A decline in CD19+ B lymphocytes, natural killer (NK) cells CD3-CD56+CD16+, and T regulatory cells CD4+FOXP3+ during treatment was observed. NKT-like cells CD3+CD56+ and cytotoxic T cells CD3+CD8+ tended to increase after two months and decrease after that. CONCLUSION: Statistically significant changes in lymphocyte counts in peripheral blood were detected in patients with PDAC during treatment