Prostatos biopsija, kontroliuojama transrektaliniu ultragarsu

Deimantas Šukys1, Sergejus Gaižauskas1, Robert Jankovski1, Andrius Gaižauskas1, Edgaras Stankevičius21 Vilniaus greitosios pagalbosuniversitetinės ligoninėsBendrosios chirurgijos centras,Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Kauno medicinos universitetoFiziologijos katedra,A. Mickevičiaus g. 9, Kaunas Prostata yra viena dažniausių vėžio lokalizacijų vyrams. Prostatos biopsija, kontroliuojama transrektiniu ultragarsu, yra pagrindinis metodas diagnozuojant prostatos vėžį ir pasirenkant gydymo taktiką. Pagrindinės indikacijos atlikti biopsiją yra PSA > 4 ng/ml ir pirštu čiuopiami prostatos karcinomai būdingi pakitimai. Yra pasiūlyta daug prostatos biopsijos atlikimo metodikų. Įrodyta, jog vietoje klasikinės sekstantinės biopsijos taikant daugiau mėginių turinčias ir labiau į periferinę prostatos zoną orientuotas schemas, randama iki 30% daugiau prostatos vėžio atvejų. Atliekant daugiau mėginių, tampa aktuali nuskausminimo problema. Dar nėra visuotinai priimtų prostatos biopsijos indikacijų ir jos atlikimo schemos. Reikšminiai žodžiai: prostatos vėžys, prostatos biopsija Transrectal ultrasound-guided prostate biopsies Deimantas Šukys1, Sergejus Gaižauskas1, Robert Jankovski1, Andrius Gaižauskas1, Edgaras Stankevičius21 Center of General Surgery,Vilnius Emergency Hospital,Šiltnamių str. 29,LT-04130 Vilnius, LithuaniaE-mail: [email protected] Department of Physiology,Kaunas Medical University,A. Mickevičiaus str. 9,LT-44307 Kaunas, Lithuania Prostate cancer is one of the most frequent cancer localizations in men. Transrectal ultrasound-guided prostate biopsy is the main method in prostate cancer diagnostics and deciding tactics of treatment. The main indications for prostate biopsy are PSA over 4 ng/ml and characteristic palpable lesions. There are a lot of methods to perform prostate biopsy. It is proven that using multicore schemes directed closer to the peripheral zone of the prostate instead of the classic sextant prostate biopsy increases prostate cancer detection by up to 30%. Anesthesia becomes the problem when performing more extended biopsies. So far, there is no strict generally adopted indications and prostate biopsy performing schemes. Keywords: prostate cancer, prostate biops

Interactive Training of the Emergency Medical Services Improved Prehospital Stroke Recognition and Transport Time

Funding Information: This study received funding from Boehringer Ingelheim GmbH & Co KG Lithuania. The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit for publication. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Funding Information: We greatly acknowledge the EMS staff for taking part in the training. LS was supported by the Swiss National Science Foundation postdoctoral scholarship (P2GEP3_191584). This article/publication is based on work from the IRENE COST Action—Implementation Research Network in Stroke Care Quality (CA18118), supported by COST (European Cooperation in Science and Technology; www.cost.eu ). Publisher Copyright: Copyright © 2022 Sveikata, Melaika, Wiśniewski, Vilionskis, Petrikonis, Stankevičius, Jurjans, Ekkert, Jatužis and Masiliūnas.Background and Purpose: Acute stroke treatment outcomes are predicated on reperfusion timeliness which can be improved by better prehospital stroke identification. We aimed to assess the effect of interactive emergency medical services (EMS) training on stroke recognition and prehospital care performance in a very high-risk cardiovascular risk population in Lithuania. Methods: We conducted a single-center interrupted time-series study between March 1, 2019 and March 15, 2020. Two-hour small-group interactive stroke training sessions were organized for 166 paramedics serving our stroke network. We evaluated positive predictive value (PPV) and sensitivity for stroke including transient ischemic attack identification, onset-to-door time, and hospital-based outcomes during 6-months prior and 3.5 months after the training. The study outcomes were compared between EMS providers in urban and suburban areas. Results: In total, 677 suspected stroke cases and 239 stroke chameleons (median age 75 years, 54.8% women) were transported by EMS. After the training, we observed improved PPV for stroke recognition (79.8% vs. 71.8%, p = 0.017) and a trend of decreased in-hospital mortality (7.8% vs. 12.3, p = 0.070). Multivariable logistic regression models adjusted for age, gender, EMS location, and stroke subtype showed an association between EMS stroke training and improved odds of stroke identification (adjusted odds ratio [aOR] 1.6 [1.1–2.3]) and onset-to-door ≤ 90 min (aOR 1.6 [1.1–2.5]). The improvement of PPV was observed in urban EMS (84.9% vs. 71.2%, p = 0.003), but not in the suburban group (75.0% vs. 72.6%, p = 0.621). Conclusions: The interactive EMS training was associated with a robust improvement of stroke recognition, onset to hospital transport time, and a trend of decreased in-hospital mortality. Adapted training strategies may be needed for EMS providers in suburban areas. Future studies should evaluate the long-term effects of the EMS training and identify optimal retraining intervals.publishersversionPeer reviewe

Aspects of LKF branding strategy formation

The object of investigation – based on theoretical aspects of formulation branding strategy, to prepare the LKF guidelines of branding strategy. The aim - the Lithuanian Basketball Federation branding strategy formation. This master work is to identify the key of branding process and elements and assess their impact to marketing strategy of Lithuanian Basketball Federation. The Master thesis can be useful for employment in both public and private sector sports, as well as marketing, information and communication and public relations professionals. Conclusions In the second study concluded that the active promotion of Eurobasket 2011 brand communication in the event Eurobasket 2011 championship attracted the greatest interest in the context of the last four years, and the popularity of the event browser Google has grown to three months before the tournament begins. This suggests that the branding strategy integrated with an organization's marketing strategy to achieve optimal results. Uniform and specific definition of the concept of characterizing the brand does not exist. Many researchers treat the brand as a marker, a combination of words and symbols that distinguishes one organization from its competitors. The most widely described and analyzed the components of brand structure and functio

Rapid voluntary clench induces bite force reflex in human

Objective: The purpose of this study was to test the occlusal analysis system T-Scan II for the detection of a bite force reflex and to determine the net jaw reflex modulation during a rapid voluntary clench.Materials and Methods: Eleven subjects were asked to bite as fast as possible on the pressure-sensitive sheet using occlusal scanning system T-Scan II . The bite force reflex parameters were determined from the occlusal force curve.Results:The inhibitory bite force reflex occurred in nine subjects with a latency of 34.0 ± 7.8 ms, duration of 17.0 ± 2.8 ms and strength of 1.6% ± 0.3%. A strong correlation was detected between the latency of the reflex and the time to reach 80% of the maximal relative bite force (r = 0.833; p < 0.01). A moderate correlation was found between the relative bite force at the moment of the first turning point of the reflex and the change of this force during the reflex (r = 0.677; p < 0.05).Conclusion: The reflex modulation confirms the protective role of the jaw reflex: during faster bites the latency of the bite force reflex was shorter and with a higher bite force the strength of the reflex was greater.Keywords: Bite force reflex, Human, Occlusal scanning, Rapid voluntary clench, Relative bite forc

Impedance plethysmography as an alternative method for the diagnosis of peripheral arterial disease

Background and objective: In the diagnosis of peripheral artery disease (PAD), the ankle-brachial index (ABI) is considered as the standard, and other noninvasive methods have received too little attention. Therefore, the aim of the study was to determine the diagnostic accuracy of impedance plethysmography in diagnosing PAD and to compare this method with other methods. Materials and methods: A total of 66 patients with a mean age of 76.1 ± 9.6 years who had been treated for various cardiovascular diseases at Kaunas Clinical Hospital during 2011–2012 were enrolled into the study. All the patients were screened for PAD. Impedance plethysmography was performed with a new-generation Niccomo™ device. The receiver operating characteristic analysis was employed to determine the diagnostic accuracy of 4 parameters of impedance plethysmography: crest time (CT), crest width (CW), pulse amplitude (Pampl), and alternating blood flow (ABF). Results: There were a significant correlation between the ABI and the CT (r = −0.699, P < 0.001), between the ABI and the ABF (r = 0.552; P < 0.001), and between the ABI and the Pampl only among men (r = 0.652; P < 0001). No correlation was found between the ABI and the CW. Among all the parameters, the CT had the highest sensitivity and specificity (73.2% and 96.0%, respectively). Other parameters had the following sensitivities and specificities: ABF, 61.0% and 96.0%; and Pampl, 90.0% and 20.0%, respectively. Conclusions: Impedance plethysmography, especially its parameter CT, is an alternative noninvasive method in diagnosing PAD and could be used for the screening of patients with PAD

Cyclosporine therapeutic window evaluation by Chebyshev\u27s inequality method in kidney recipients

Objective: The aim of this study was to identify a cyclosporine therapeutic range for kidney recipients.Materials and methods: The cyclosporine exposure level was based on the calculation of the mean area under the concentration-time curve AUC(0–12). The AUC(0–12) was estimated using a Bayesian estimator and a 3-point limited sampling strategy. Cyclosporine exposure levels were obtained from 3 blood samples: 0, 1, and 3 h postdose; and analyses were performed using a liquid chromatography–tandem mass spectrometry method. The therapeutic window of cyclosporine was calculated by the Chebyshev\u27s inequality method with a 99% guarantee (a = 0.01) using the IBM SPSS Statistics 20 software.Results: It was found that the therapeutic window of cyclosporine estimated by the Cheby- shev\u27s inequality method and put on the AUC(0–12) exposure lies in the ranges from 2.84– 3.13 mg h/L with the 99% confidence for the patients with the target AUC(0–12) exposure of 3.8 mg h/L (posttransplantation time &gt;1 year). The therapeutic window of cyclosporine differs in different posttransplantation time groups: the estimated AUC exposure range in the group of patients who have a graft longer than 5 years is 2.70–2.98 mg h/L, and the estimated AUC exposure range in the group of patients who have a graft for 1–5 years is 3.05–3.75 mg h/L.Conclusions: Chebyshev\u27s inequality could be an appropriate and more precise method to determine the therapeutic window for cyclosporine in kidney recipients than the target AUC(0–12) value and further studies should be conducted to evaluate patients with postoperative time &lt;1 year

The effects of sevoflurane and propofol on cerebral hemodynamics during intracranial tumors surgery under monitoring the depth of anesthesia

Hemodynamic effects during cerebral tumor resection surgery under monitoring the depth of anesthesia and during recovery in sevoflurane- or propofol-anesthetized patients have not been previously compared. Objective. To compare cerebral hemodynamic changes using transcranial Doppler sonography during sevoflurane or propofol anesthesia under state entropy (SE) monitoring, and during recovery period. Material and methods. In a randomized manner, 130 patients received sevoflurane (group T-S) or propofol (group T-P) to maintain SE at 40–50. Cerebral blood flow velocity (Vmean) in the middle cerebral artery was evaluated at baseline, after tracheal intubation, opening of the dura mater, tumor resection, skin closure, extubation, and two hours after extubation. Cerebrovascular resistance index (RAP), estimated cerebral perfusion pressure (eCPP), and cerebral blood flow index (CBFI) were calculated off-line. Results. During surgery SE was 40.6 (SD, 8.1) in the group T-S and 44.0 (SD, 7.4) in the group T-P. Blood pressure was significantly higher in the group T-P. Compared to the baseline, Vmean decreased by 16.6% and 23.5% in the groups T-S and T-P, respectively (P&lt;0.05). RAP and eCPP were higher in the group T-P versus the group T-S: 28.9% and 5.2%, respectively, above the baseline for RAP (P&lt;0.005) and 3.2% and 16.9% below the baseline for eCPP (P&lt;0.005). CBFI was below the baseline by 20.1% and 24.0% in the groups T-S and T-P, respectively (P&gt;0.05). After the extubation and 2 hours later, Vmean recovered comparably with no differences in RAP, eCPP, or CBFI between the two groups. Conclusions. At the comparable depth of anesthesia for intracranial tumors surgery and during recovery, sevoflurane had no major effect on cerebral circulation measured by transcranial Doppler sonography as compared with propofol. Our results add to current knowledge on the safety of sevoflurane in neuroanesthesia