MOBILITY PACKAGE IN LITHUANIAN LOGISTICS

Over the past few years, there have been significant changes in the logistics sector. New regulations of commercial road transport at the European Union level have been released. Hundreds of cargo transports are carried out by road transport every day. The study shows that these rules aim to ensure a balance between the social security of drivers and the freedom of operators to provide cross-border transport services. Although, the changes also caused a lot of conflicting thoughts. Therefore, this article attempts to reveal the benefits/harms and impact on businesses of introducing a Mobility package

THE IMPACT OF THE MOBILITY PACKAGE ON ROAD TRANSPORT COMPANIES IN LITHUANIA AND LATVIA

Throughout the years, there have been several changes made in logistics sphere and until this day it does not stop. One of the novelties was the Mobility package. It is known that many freights are being carried out by road transport as we are reading this, so it is very clear that new regulations hold a huge impact on transport companies. The research shows that introduction of Mobility package made drastic changes to European Union road transport rules and regulations. It aims to improve safety and working conditions for drivers and to ensure that the entire sector operates on a level playing field. However, emersion of Mobility package made some people questioning. Consequently, this article tries to introduce Mobility package as it is by analysing the impact of it on particular road transport companies of Lithuania and Latvia, operating in European Union

RESEARCH ON THE NEED FOR THE TIR TRANSIT SYSTEM IN LITHUANIAN COMPANIES

This scientific article will introduce the concept of the TIR Convention of 1975. Considering the favourable geographical position for transit cargo transportation in Lithuania, the development of logistics areas, potential obstacles and improvements have great importance. The article provides an overview of the basic provisions, the elements of the TIR system, the aims and benefits of this Convention for transport companies. Also, after analysing the results of interviews with various Lithuanian transport companies, there is an investigation of the need for a TIR transit system and the issue raised: whether a system of international freight transportation with TIR carnets is needed today

Endoskopinis ūminės storosios žarnos obstrukcijos gydymas

Kęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas TamelisKMU Gastroenterologijos klinika, KMU Chirurgijos klinika Šiuolaikis virškinimo trakto piktybinės obstrukcijos gydymas vis labiau tampa minimaliai invazinis. Ligoniai, sergantys storosios žarnos vėžiu, komplikuotu obstrukcija, į gydymo įstaigas patenka skubos tvarka, neretai sunkios būklės, ir nėra idealūs kandidatai chirurginei operacijai. Šiuolaikinėje medicinos literatūroje gausėja mokslinių straipsnių apie sėkmingą ir saugų endoskopiniu būdu įkišamų savaime išsiplečiančių metalinių stentų naudojimą proktologijoje. Nors stentai ir yra brangūs, tačiau proktologinis stentavimas yra rentabili procedūra, leidžianti ligoniams, sergantiems storosios žarnos vėžiu, komplikuotu ūminė storosios žarnos obstrukcija, išvengti neatidėliotinos operacijos, o esant nerezektabiliam vėžiui, – kolostomos. Straipsnyje aprašomas KMU Chirurgijos klinikoje atliktas pirmasis Lietuvoje sėkmingas endoskopinis ūminės žarnų obstrukcijos gydymas stentuojant žarnyną. Prasminiai žodžiai: žarnyno obstrukcija, kolorektinis vėžys, endoskopija, stentavimas. Acute colonic obstruction: endoscopical management Kęstutis Adamonis, Dainius Pavalkis, Žilvinas Saladžinskas, Algimantas Tamelis Management of malignant gastrointestinal obstruction presents a significant challenge. Most patients are in a profoundly decompensated state due to underlying malignancy and are not ideal candidates for invasive surgical procedures. In recent years, self-expandable metal stents have emerged as an effective and safe, less invasive alternative for the treatment of malignant intestinal obstruction. Although stents are expensive, the procedure appears to be cost-effective, since emergency surgery can be avoided in patients with acute bowel obstruction, and in those with advanced disease no resection of the colon is necessary. Here we report a retrospective analysis of a first self-expandable metal stent placed for colorectal obstruction at Kaunas Medical University Hospital, as well as review the literature published on self-expandable metal stent placement. Our first data confirm self-expandable metal stent efficacy in palliation of malignant intestinal obstruction. Keywords: intestinal obstruction, colorectal cancer, endoscopy, endoluminal stenting

Racionalaus antibakterinių vaistų vartojimo algoritmo įtaka Staphylocoscus aureus atsparumo antibiotikams kitimui

Racionalaus antibakterinių vaistų vartojimo algoritmo įtaka Staphylococcus aureus atsparumo antibiotikams kitimui Rokas Bagdonas1, Algimantas Tamelis2, Rytis Rimdeika2, Mindaugas Kiudelis2, Vytautas Jankūnas21 Klaipėdos universitetas,H. Manto g. 84, LT-92294 Klaipėda2 Kauno medicinos universiteto klinikųChirurgijos klinika,Mickevičiaus g. 9, LT-44307 KaunasEl paštas: [email protected] Įvadas / tikslas Didžiausia nudegimų chirurgijos problema yra infekcija, nuo kurios miršta daugiau kaip 50% visų nudegusių pacientų. Nudegimų žaizda greitai infekuojasi, kadangi žaizdos aplinka yra ideali mikroorganizmams tarpti. Darbo tikslas – įvertinti racionalaus antibakterinių vaistų vartojimo algoritmo įtaką S. aureus mikroorganizmų atsparumo antibiotikams kitimui. Ligoniai ir metodai 2001 m. įdiegtas racionalaus antibakterinių vaistų vartojimo algoritmas Plastinės chirurgijos ir nudegimų skyriuje. Remdamiesi KMUK Mikrobiologijos laboratorijos kompiuterine duomenų baze atlikę perspektyviąją analizę, ištyrėme Staphylococcus aureus atsparumo antibakteriniams vaistams dažnį 2001–2002 metais. Analizuodami retrospektyviąją 2000 m. ir perspektyviąją 2001–2002 m. grupes lyginome, kaip šiose grupėse pakito Staphylococcus aureus atsparumo ciprofloksacinui, gentamicinui, eritromicinui, fucidinui, klindamicinui, oksacilinui, penicilinui, rifampicinui, tetraciklinui ir vankomicinui dažnis. Rezultatai Įdiegus racionalaus antibakterinių vaistų vartojimo algoritmą į klinikinę praktiką, S. aureus bendras atsparumas antibiotikams nereikšmingai sumažėjo. Statistiškai reikšmingai sumažėjo S. aureus atsparumas eritromicinui ir penicilinui. Išvados Racionalaus antimikrobinių vaistų vartojimo algoritmas leidžia kontroliuoti ir sumažinti S. aureus atsparumą antimikrobiniams vaistams. Įdiegus algoritmą į klinikinę praktiką, statistiškai reikšmingai sumažėjo S. aureus atsparumas penicilinui ir eritromicinui. Reikšminiai žodžiai: Stapylococcus aureus atsparumas antibiotikams, racionali antibiotikoterapija Rational application algorithm of antibacterial drugs to staphylococcus aureus resistance Rokas Bagdonas1, Algimantas Tamelis2, Rytis Rimdeika2, Mindaugas Kiudelis2, Vytautas Jankūnas21 Klaipėda Universitety,H. Manto str. 84, LT-92294 Klaipėda, Lithuania2 Kaunas University of Medicine, Clinic of Surgery,Mickevičiaus str. 9, LT-44307 Kaunas, LithuaniaE-mail: [email protected] Background / objective The major challenge for burn team is infection which is known to cause over 50% of burn deaths. Burns become infected because the environment at the site of the wound is ideal for the propagation of the infecting organism. The aim of the study was to evaluate the rational application algorithm of antibacterial drugs to influence the S. aureus resistance changes to antibiotics. Patients and methods In 2001, the Rational Application Algorithm of antibacterial drugs was introduced into the Plastic Surgery and Burns Department. Performing the perspective analysis, we investigated Staphylococcus aureus resistance and its dynamics to antibacterial drugs using the computerized database of the Microbiology Laboratory in KMUH in 2001–2002. Analyzing a retrospective group (2000) and a perspective one (2001–2002) we compared changes of Staphylococcus aureus resistance to ciprofloxacin, gentamicin, erythromycin, fucidin, clindamycin, oxacillin, penicillin, rifampicin, tetracycline and vancomycin. Results S. aureus resistance to antibiotics decreased after introducing the Rational Application Algorithm of antibacterial drugs. The difference is statistically insignificant. The resistance of this microorganism decreased slightly to erythromycin and statistically significantly to penicillin. Conclusions The Rational Application Algorithm of antibacterial drugs allows to reduce and control S. aureus resistance to antibacterial drugs. S. aureus resistance to erythromycin and penicillin decreased statistically significant after introducing the Rational Application Algorithm of antibacterial drugs into clinical practice. Key words: Staphilococcus aureus resistance to antibiotics, racional antibioticotherap

Patogeninių mikroorganizmų identifikavimas elektronine nosimi

Rokas Bagdonas1, Rytis Rimdeika1, Algimantas Tamelis1, Mindaugas Kiudelis1, Andrius Olekas2, Daiva Senulienė2, Arūnas Šetkus21 Kauno medicinos universiteto klinikų Chirurgijos klinika,Eivenių g. 2, LT-50009, Kaunas2 Puslaidininkių fizikos institutas,Goštauto g. 11, LT-01108 Vilnius*El paštas: [email protected] Įvadas / tikslas Atlikdami įprastinius mikrobiologinius tyrimus, atsakymą apie infekcijos sukėlėją paprastai gauname per 48–72 val. Tačiau neretai toks laiko tarpas yra per ilgas, todėl visi nauji infekcijos diagnostikos metodai, leidžiantys anksčiau nustatyti žaizdos infekciją, kelia itin didelį susidomėjimą ir yra labai perspektyvūs. Mūsų eksperimentuose elektronine nosimi buvo tiriami kvapai, susiję su patogeninių mikroorganizmų augimu maitinamojoje terpėje. Mikroorganizmai buvo paimti nuo žaizdas dengiančių tvarsčių. Eksperimentams buvo išskirti Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus patogeniniai mikroorganizmai. Metodai Atlikta 313 matavimų su skirtingais mikroorganizmais, išsėtais skirtingose terpėse, sauso ir 100% oro drėgnio sąlygomis. Palyginti elektroninės nosies varžos kitimo parametrai tiriant Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus patogeninius mikroorganizmus sauso (n-119) ir 100% santykinio oro drėgnio sąlygomis (n-194). Rezultatai Bendras ištirtų mėginių skaičius buvo 194, jį sudarė skirtingų mikroorganizmų testavimas elektronine nosimi, naudojant 100% santykinio drėgnio nešančiojo sintetinio oro srautą. Iš visų testų mėginiams naudojant Acinetobacter spp. atlikti 48 matavimai, Staphylococcus aureus – 20, Pseudomonas aeruginosa – 65 ir Escherichia coli – 61 matavimas. Bakterijų kvapų 2, 4, 6 ir 7-ojo jutiklių atsakas statistiškai reikšmingai skyrėsi. Kiekvienam atvaizdui, įskaitant ir signalų matavimą bei jų matematinį apdorojimą, suformuoti buvo sugaišta maždaug 30–40 minučių. Išvados Elektroninės nosies varžos kitimo parametrai, diagnozuojant Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus patogeninius mikroorganizmus, reikšmingai skiriasi ir leidžia identifikuoti skirtingus mikroorganizmus. Elektroninė nosis gali būti tinkamas ankstyvesnio infekcijos diagnozės nustatymo metodas. Reikšminiai žodžiai: elektroninė nosis, dujų jutikliai, žaizdų patogeniniai mikroorganizmai, ankstyvoji diagnostika, neinvazinė diagnostika Identification of pathogenic microorganisms by electronic nose Rokas Bagdonas1, Rytis Rimdeika1, Algimantas Tamelis1, Mindaugas Kiudelis1, Andrius Olekas2, Daiva Senulienė2, Arūnas Šetkus21 Kaunas Medical University Hospital, Department of Surgery,Eivenių str. 2, LT-50009, Kaunas, Lithuania2 Semiconductor Physics Institute,Goštauto str. 11, LT-01108 Vilnius, Lithuania*E-mail: [email protected] Background / Objective Performing the routine microbiological assays the answer about infectious agent usually comes out in 48–72 hours. However, such a long time interval generally is too long and therefore all new diagnostic methods enabling earlier identification of wound infection generate great interest and are thought to be very promising. In our experiments with electronic nose we analysed odours related to growth of pathogenic microorganisms in nutrient medium. Microorganisms were taken from the wound dressing. For the experiments there were isolated Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus pathogenic microorganisms. Methods There were 313 measurements performed with different microorganisms from different mediums under the conditions of dry air and 100% air humidity. A comparison of changing parameters in electronic nose resistance was made in studying Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus pathogenic microorganisms under the conditions of dry air (n-119) and 100% air humidity (n-194). Results Overall there were 194 specimens analysed in which different microorganisms were tested with electronic nose using 100% relative humidity carrying the flow of synthetic air. From all the specimens 48 measurements were performed using Acinetobacter spp., 20 – Staphylococus aureus, 65 – Pseudomonas aeruginosa, and 61 measurement with Escherichia coli. The response of gas sensors 2, 4, 6 and 7 evoked by bacteria odours varied statistically significant. Composing each image took about 30–40 minutes including measuring and mathematical processing of signals. Conclusions The changing parameters of electronic nose resistance vary significantly in diagnosing Acinetobacter, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus pathogenic microorganisms and it enables to identify different microorganisms. Electronic nose may be an appropriate method for the earlier diagnostics of the infection. Keywords: electronic nose, gas sensors, pathogenic microorganisms of the wound, early diagnostics, noninvasive diagnostic

Replication study of ulcerative colitis risk loci in a Lithuanian-Latvian case control sample

Background: Differences between populations might be reflected in their different genetic risk maps to complex diseases, for example, inflammatory bowel disease. We here investigated the role of known inflammatory bowel disease associated single nucleotide polymorphisms (SNPs) in a subset of patients with ulcerative colitis (UC) from the Northeastern European countries Lithuania and Latvia and evaluated possible epistatic interactions between these genetic variants. Methods: We investigated 77 SNPs derived from 5 previously published genome-wide association studies for Crohn's disease and UC. Our study panel comprised 444 Lithuanian and Latvian patients with UC and 1154 healthy controls. Single marker case control association and SNP-SNP epistasis analyses were performed. Results: We found 14 SNPs tagging 9 loci, including 21q21.1, NKX2-3, MST1, the HLA region, 1p36.13, IL10, JAK2, ORMDL3, and IL23R, to be associated with UC. Interestingly, the association of UC with previously identified variants in the HLA region was not the strongest association in our study (P = 4.34 × 1023, odds ratio [OR] = 1.25), which is in contrast to all previously published studies. No association with any disease subphenotype was found. SNP-SNP interaction analysis showed significant epistasis between SNPs in the PTPN22 (rs2476601) and C13orf31 (rs3764147) genes and increased risk for UC (P = 1.64 × 1026, OR = 2.44). The association has been confirmed in the Danish study group (P = 0.04, OR = 3.25). Conclusions: We confirmed the association of the 9 loci (21q21.1, 1p36.13, NKX2-3, MST1, the HLA region, IL10, JAK2, ORMDL3, and IL23R) with UC in the Lithuanian Latvian population. SNP-SNP interaction analyses showed that the combination of SNPs in the PTPN22 (rs2476601) and C13orf31 (rs3764147) genes increase the risk for UC.publishersversionPeer reviewe

The impact of age on post-operative outcomes of colorectal cancer patients undergoing surgical treatment

BACKGROUND: the purpose of study was to evaluate the impact of age on outcomes in colorectal cancer surgery. METHODS: patients on hospital database treated for colorectal cancer during the period 1995 – 2002 were divided into two groups: Group 1 – patients of 75 years or older (n = 154), and Group 2 – those younger than 75 years (n = 532). RESULTS: In Group 1, for colon cancers, proximal tumors were significantly more common (23% vs. 13.5%, p < 0.05), complicated cases were more frequent (46 % vs. 33%, p = 0.002), bowel obstruction more common at presentation (40% vs. 26.5%, p = 0.001), and more frequent emergency surgery required (24% vs. 14%, p = 0.003). Postoperative overall morbidity was higher in the elderly group, but with no differences in surgical complications rate. Overall 5 year survival was 39% vs. 55% (p = 0.0006) and cancer related 5 year survival was 44% vs. 62% (p = 0.0006). Multivariate Cox analysis showed that age was not an independent risk factor for postoperative mortality. CONCLUSION: Preoperative complications and co-morbidities, more advanced disease, and higher postoperative nonsurgical complication rates adversely affect postoperative outcomes after surgery for colorectal cancer in the elderly

Microvessel density as new prognostic marker after radiotherapy in rectal cancer

<p>Abstract</p> <p>Background</p> <p>The extent of angiogenesis is an important prognostic factor for colorectal carcinoma, however, there are few studies concerning changes in angiogenesis with radiotherapy (RTX). Our aim was to investigate changes in tumor angiogenesis influenced by radiotherapy to assess the prognostic value of angiogenesis the microvessel density (MVD) in overall survival after radiotherapy.</p> <p>Methods</p> <p>Tumor specimens were taken from 101 patients resected for rectal cancer. The patients were divided into three groups according to the treatment they received before surgery (not treated, a short course, or long course of RTX). Tumor specimens were paraffin-embedded and immunohistochemistry was performed with primary antibody against CD-34 to count MVD.</p> <p>Results</p> <p>MVD was significantly lower in the group of patients treated with a long course of RTX (p <0.025). The mean MVD for the long RTX group was 134.8; for the short RTX group – 192.5; and for those not treated with RTX – 193.0. There were no significant statistical correlations between MVD and age, sex, grade of tumor differentiation (G) and tumor size (T) in those untreated with RTX. In long RTX group we found a significant prognostic rate for MVD when the density cut off was near 130 with 92.3% sensitivity and 64.7% specificity. When the MVD was lower than a cut off of 130, the survival period significantly increased (p = 0.001), the mortality rate is significantly higher if the MVD is higher than 130 (microvessel/mm²) (1953.047; p = 0.002), if the histological grade is moderate/poor (127.407; p = 0.013), if the tumor is T3/T4 (111.618; p = 0.014), and if the patient is male (17.92; p = 0.034) adjusted by other variable in model.</p> <p>Conclusion</p> <p>Our results show that a long course of radiotherapy significantly decreased angiogenesis in rectal cancer tissue. MVD was found to be a favourable marker for tumor behaviour during RTX and a predictor of overall survival after long course of RTX. Further investigations are now needed to determine the changes in angiogenesis during a shorter course of RTX.</p