Data Analysis Methods for Software Systems

Using statistics, econometrics, machine learning, and functional data analysis methods, we evaluate the consequences of the lockdown during the COVID-19 pandemics for wage inequality and unemployment. We deduce that these two indicators mostly reacted to the first lockdown from March till June 2020. Also, analysing wage inequality, we conduct analysis separately for males and females and different age groups.We noticed that young females were affected mostly by the lockdown.Nevertheless, all the groups reacted to the lockdown at some level

Trimatės kompiuterinės vizualizacijos taikymas kepenų chirurgijoje

Jonas Jurgaitis1, Marius Paškonis1, Artūras Samuilis2, Ivo Volf3, Maks Shöbinger3, Gintautas Brimas1, Kęstutis Strupas11 Vilniaus universiteto Santariškių klinikų Gastroenterologijos, urologijos ir abdominalinės chirurgijos klinika, Santariškių g. 2, LT-08661 Vilnius;2 Vilniaus universiteto Santariškių klinikų Pulmonologijos ir radiologijos klinika,Santariškių g. 2, LT-08661 Vilnius;3 Vokietijos vėžio tyrimo centro Medicininės informatikos skyrius, Im Neuenheimer Feld 280,D-69120, Heidelbergas, VokietijaEl paštas: [email protected] Įvadas / tikslas Trimatė kompiuterinė kepenų vizualizacija – tai nauja priemonė, leidžianti planuoti kepenų chirurgines operacijas. Radiologinių tyrimų vaizdai daugeliu atvejų yra sunkiau suprantami ar interpretuojami gydytojų klinicistų. Kompiuterio sukurtas trimatis vaizdas leidžia lengviau analizuoti ir interpretuoti radiologinius duomenis. Trimatė kepenų vizualizacija yra atliekama planuojant gyvo donoro kepenų transplantaciją ir kepenų rezekcines operacijas. Straipsnyje aptarsime galimybes taikyti trimatę vizualizaciją kepenų chirurgijoje. Metodas Apžvelgiame trimačio kepenų vaizdo sukūrimą naudojant Vokietijos vėžio tyrimo centro Medicininės informatikos skyriaus sukurtą programą ir supažindiname su Vilniaus universiteto ligoninės Santariškių klinikose taikytu klinikiniu trimatės kepenų vizualizacijos atveju. Rezultatai Trimatės kompiuterinės kepenų vizualizacijos pranašumai: trimatis kepenų vaizdas padeda suvokti sudėtingą anatomiją, įvertinti anatominius įvairavimus, tiksliai nustatyti rezekcijos ribas ir operacijos matmenis. Tiksliai apskaičiuojamas liekamasis kepenų tūris, o tai padidina operacijos saugumą. Trimatės kompiuterinės kepenų vizualizacijos trūkumai: reikalingas geros kokybės kompiuterinis tomografijas. Ganėtinai ilgas (nuo 40 min. iki 240 min.) trimačio vaizdo sukūrimo laikas, įdiegti į klinikinę praktiką reikia įvairių sričių specialistų (radiologo, chirurgo, informatiko) bendrų pastangų; nėra tikslių trimatės vizualizacijos taikymo indikacijų. Išvados Nauja operacijos planavimo priemonė verčia svarstyti plačias jos taikymo galimybes, tačiau kūrimo proceso sudėtingumo, integracijos problemos ir indikacijų neapibrėžtumas riboja diegimą į klinikinę praktiką. Kad trimatė kepenų vizualizacija būtų taikoma, dažniau reikėtų nustatyti jos indikacijas, atkreipti dėmesį į mažos apimties kepenų operacijas ir jų įtaką gyvenimo kokybei. Reikšminiai žodžiai: trimatė kepenų vizualizacija, operacijos planavimas, kepenų rezekcija Three-dimensional visualization: applications in liver surgery Jonas Jurgaitis1, Marius Paškonis1, Artūras Samuilis2, Ivo Volf3, Maks Shöbinger3, Gintautas Brimas1, Kęstutis Strupas1.1 Clinic of Gastroenterology, Urology and Abdominal Surgery,Vilnius University Hospital Santariškių Klinikos, Santariškių 2, LT-08661 Vilnius, Lithuania;2 Clinic of Pulmonology and Radiology, Vilnius University Hospital Santariškių Klinikos,Santariškių 2, LT-08661 Vilnius, Lithuania;3 Division of Medical and Biological Informatics, German Cancer Research Center,Im Neuenheimer Feld 280,D-69120, Heidelberg, GermanyE-mail: [email protected] Background / objective Three-dimensional (3D) liver visualization is a new tool in liver surgery planning. In most cases, plain or two-dimensional radiological images are hardly perceptible and understandable by the clinician. 3D visualization helps in the perception and interpretation of radiological images. 3D liver visualization are is mostly used before living related liver transplantation and in extended liver resections. In this article, we discuss the usefulness and employment of 3D visualization in clinical practice. Method We observed the whole 3D liver image formation process using OrgaNicer program and present a case report on 3D liver visualization employment in the clinical practice of Vilnius University Santariškių Cinics Hospital. Results Benefits of 3D liver visualization: helps in easy perception of difficult liver anatomy and anatomical liver variations; helps to define the surgical plan of liver resection and the extent of operation; precise liver volume calculation increases the safety of the operation.Disadvantages of 3D liver visualization: it is necessary to obtain good quality computer tomography images; long duration (40 to 240 min); a wide range of different specialists and their close cooperation are needed; the lack of defined clinical indications for visualization. Conclusions The new tool for liver surgery planning opens new perspectives in liver surgery, but the difficult course of the process, problems with integration into practice and the lack of clinical indications restrict its use. To increase its employment, indications for three-dimensional liver visualization must be defined and attention must be paid to increasing the quality of small volume liver resection using the new tool. Key words: three-dimensional visualization, surgery planning, liver resectio

Echinokokozė. Lietuvos echinokokozės registro pirmieji duomenys

Kęstutis Strupas1, Vitalijus Sokolovas1, Gintautas Brimas1, Marius Paškonis1, Jonas Jurgaitis1, Jonas Valantinas1, Arida Buivydienė1, Jūratė Dementavičienė2, Artūras Samuilis2, Dimitrijus Nepomniaščis2, Audronė Marcinkutė3, Aušrinė Barakauskienė41 Vilniaus universiteto ligoninės Santariškių klinikų Gastroenterologijos,urologijos ir abdominalinės chirurgijos klinika, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikų Radiologijos klinika,Santariškių g. 2, LT-08661 Vilnius3 Respublikinė tuberkuliozės ir infekcinių ligų universitetinė ligoninė,Birutės g.1/20, LT-08117 Vilnius4 Valstybinis patologijos centras, P. Baublio 5, LT-08406 VilniusEl paštas: [email protected] Echinokokozės – tai parazitinės ligos, sukeliamos kaspinuočio, Echinococcus genties biohelmintų lervų. Europoje yra paplitę E. granulosus, sukeliantis cistinę echinokokozę (CE), ir E. multilocularis, sukeliantis alveokokinę echinokokozę (AE). Sergamumas CE svyruoja nuo 1 iki 220 atvejų iš 100 000 gyventojų. Sergamumas AE yra mažesnis – apie 0,3–1,2 atvejų iš 100 000 gyventojų. Tačiau mirštamumas yra didelis ir siekia > 90%. Echinokokozė specifinių simptomų neturi, o klinika priklauso nuo ligos sukėlėjo, stadijos, darinių dydžio ir lokalizacijos. Liga dažniausiai nustatoma atsitiktinai arba atsiradus komplikacijų. Sergant CE komplikacijas sukelia spaudimo reiškiniai, o sergant AE jas sukelia echinokokas, peraugdamas svarbias organų struktūras. Echinokokozės diagnostikai naudojami serologiniai (ELISA), radiologiniai (sonoskopija, KT, MRT) tyrimai. Nustačius echinokokozę taikomi įvairūs gydymo būdai. Jie priklauso nuo ligos sukėlėjo ir išplitimo. Bendrai abiem sukėlėjams gydyti vartojami benzimidazolo karbamatai (mebendazolis ir albendazolis). Be medikamentinio gydymo, CE atveju galima taikyti PAIR metodą, radiodažninę destrukciją, radikalų chirurginį gydymą. Nustačius AE, atsižvelgiant į išplitimą, taikomas radikalus chirurginis arba paliatyvus gydymas. Kadangi liga Europoje yra paplitus, 1998 metais buvo įkurtas Europos echinokokozės registras. Sergantys echinokokoze ligoniai Lietuvoje stebimi ir gydomi VU Infekcinėje ligoninėje nuo 1997 metų. 2003 m. birželio 6 d. VUL Santariškių klinikose įkurtas Lietuvos echinokokozės registras. 2004 m. rugpjūčio 14 d. Lietuvos echinokokozės registras įtrauktas į Europos echinokokozės registrą. Šiuo metu registre yra 76 ligoniai, iš jų 18 serga CE, 58 – AE. Radikaliai gydyti 25 pacientai. Paliatyvus gydymas buvo taikytas 39 ligoniams. Septyni ligoniai mirė. Echinokokozė yra reta pavojinga liga. Jos diagnostikos ir gydymo kokybė bei rezultatai priklauso nuo tarpdalykinės gydytojų koordinacijos efektyvumo. Echinokokozės registras garantuoja optimalią ligonių stebėjimo ir gydytojų veiksmų koordinacijos sistemą. Pateikti pirmieji Lietuvos echinokokozės registro duomenys rodo, kad gydymo rezultatai panašūs į pateikiamus Europos echinokozės registro suvestinėje. Pagrindiniai žodžiai: echinokokozė, diagnostika, gydymas, registras Echinococcosis. First results of Lithuania Echinococcosis Registry Kęstutis Strupas1, Vitalijus Sokolovas1, Gintautas Brimas1, Marius Paškonis1, Jonas Jurgaitis1, Jonas Valantinas1, Arida Buivydienė1, Jūratė Dementavičienė2, Artūras Samuilis2, Dimitrijus Nepomniaščis2, Audronė Marcinkutė3, Aušrinė Barakauskienė41 Vilnius University Hospital "Santariškių klinkos", Department of Gastroenterology,Urology and Abdominal Surgery, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital "Santariškių klinkos", Department of Radiology,Santariškių str. 2, LT-08661 Vilnius, Lithuania3 National Tuberculosis and Infectious Diseases University Hospital,Birutės str. 1/20, LT-08117 Vilnius, Lithuania4 National Pathology Center, P. Baublio str. 5, LT-08406 Vilnius, LithuaniaE-mail: [email protected] Echinococcosis is a zoonotic infection caused by larval stages of cestodes belonging to the genus Echinococcus. Cystic echinococcosis (CE), caused by Echinococcus granulosus, and alveolar echinococcosis (AE), caused by E. multilocularis, are mostly spread in Europe. The annual incidence rates of CE vary between 1 to 220 per 100,000 population. The incidence of AE cases is lower and varies between 0.3–1.2 per 100 000 population, but morbidity reaches up to 90%. Echinococcosis has no specific symptoms, and its clinical presentation depends on many factors such as the type of parasite, stage of disease, localisation in the organ and its extent. Symptom-free echinococcosis is diagnosed occasionally or with appearance of complications. In case of CE, complications appear due to organ compression and in case of AE due to overgrowth of important organ structures. The diagnostic repertoire includes imaging techniques (US, CT, MBR) and immunodiagnostic tests. Chemotherapy with benzimidazoles (mebendazol or albendazol) is common in the treatment of bouth types of the disease. Treatment options for CE include surgery, PAIR and RFA. For AE, the first choice of treatment is radical surgical resection of the entire parasitic lesion or palliative treatment for inoperable cases. Because of the wide distribution of echinococcosis in Europe, the European Echinococcosis Registry was established in 1998. Lithuanian patients with echinococcosis were started to treat in 1997 at the Vilnius University Hospital of Infectious Diseases. On 6 June 2003, the Lithuanian Echinococcosis Registry was established at Vilnius University Hospital Santariškių Klinikos, and on 14 August 2004 it joined the European Echinococcosis Registry. Until 2007, 76 cases of echinococcosis were registered in the Lithuanian Echinococcosis Registry, including 18 cases of CE and 58 of AE. Radical surgical treatment was applied to 25 patients and palliative treatment to 39 patients. Seven patients died during the period of 4 years due to extention of the disease. Echinococcosis is a rare and dangerous disease. To enhance its treatment and diagnostic abilities, coordination among various specialists is necessary, and it is ensured by the Echinococcosis Registry. The first results of treatment presented in the Lithuanian Echinococcosis Registry are similar to the results presented in the European Echinococcosis Registry. Key words: echinococcosis, diagnosis, treatment, registr

Anatomical variants of the hepatic arteries and their influence on superior mesenteric artery hemodynamics

Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set forward

Kepenų arterijų anatominiai variantai ir jų įtaka viršutinės pasaito arterijos hemodinamikai

Anatomical variants of hepatic arteries are frequent. One of the most common origins of aberrant (atypically branching) hepatic arteries is superior mesenteric artery. Many physiologic and pathologic features influence hemodynamics of the latter artery. There were some sporadic cases in literature about the influence of aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics of the latter artery, but no evidence based large extent studies were performed. Therefore the aim of this study was to evaluate how significant the aberrant hepatic artery branching from the superior mesenteric artery influences the hemodynamics of superior mesenteric artery. Anatomical variants of the hepatic arteries were evaluated by computed tomography angiography also the candidates for Doppler ultrasound were selected. Doppler ultrasound was used to evaluate the hemodynamics of the superior mesenteric artery in patients with aberrant hepatic artery arising from the superior mesenteric artery and in those with typical hepatic artery anatomy. The influence of the aberrant hepatic artery arising from superior mesenteric artery to the hemodynamics (resistance) of the superior mesenteric artery was assessed. The results of the investigation show that anatomical variants of the hepatic arteries are frequent. The aberrant hepatic artery arising from superior mesenteric artery significantly lowers resistance of the superior mesenteric artery. Practical recommendations were set forward

Diagnostic imaging of solid pseudopapillary tumor of the pancreas in children: report of two cases

Solid-pseudopapillary tumor of the pancreas (SPT) is an exceptionally rare neoplasm in children. lt is of low malignant potential and occurs most frequently in young females. Patients and methods: A cumulative review of the tumor's radiological characteristics from the English language scientific literature is presented. The clinical course, radiological investigations and outcome of surgery of two children treated at Vilnius University Hospital Santariskiu Klinikos Children 's hospital are analyzed. Results: Total number of 33 SPT was reported in litera/ure in 2000- 2011.4 articles about radiological features of SPT in children were found in reviewed literature. Between 2011 and 2012, two children with SPT were diagnosed at our institution. Both patients underwent abdominal ultrasound and computed tomography (CT) examinations. Preoperative biopsy was performed for both patients. After surgery SPTwas confirmed for both patients. Conclusions: SPT is a rare differential diagnosis of a pancreatic mass in children. SPT might be one of the radiological differential diagnoses in children with big pancreatic tumor within intratumoral hemorrhage, calcifications and pseudocapsule. CT examination is used to evaluate tumor invasion and resectability. Magnetic resonance tomography could be used to avoid radiation exposure

The concept of AI-based algorithm: analysis of CEUS images and HSPs for identification of early parenchymal changes in severe acute pancreatitis

(1) Background: Identifying early pancreas parenchymal changes remains a challenging radiologic diagnostic task. In this study, we hypothesized that applying artificial intelligence (AI) to contrast-enhanced ultrasound (CEUS) along with measurement of Heat Shock Protein (HSP)-70 levels could improve detection of early pancreatic necrosis in acute pancreatitis. (2) Methods: Acute pancreatitis (n = 146) and age- and sex matched healthy controls (n = 50) were enrolled in the study. The severity of acute pancreatitis was determined according to the revised Atlanta classification. The selected severe acute pancreatitis (AP) patient and an age/sex-matched healthy control were analysed for the algorithm initiation. Peripheral blood samples from the pancreatitis patient were collected on admission and HSP-70 levels were measured using ELISA. A CEUS device acquired multiple mechanical index contrast-specific mode images. Manual contour selection of the two-dimensional (2D) spatial region of interest (ROI) followed by calculations of the set of quantitative parameters. Image processing calculations and extraction of quantitative parameters from the CEUS diagnostic images were performed using algorithms implemented in the MATLAB software. (3) Results: Serum HSP-70 levels were 100.246 ng/ml (mean 76.4 ng/ml) at the time of the acute pancreatitis diagnosis. The CEUS Peek value was higher (155.5) and the mean transit time was longer (40.1 s) for healthy pancreas than in parenchyma affected by necrosis (46.5 and 34.6 s, respectively). (4) Conclusions: The extracted quantitative parameters and HSP-70 biochemical changes are suitable to be used further for AI-based classification of pancreas pathology cases and automatic estimation of pancreatic necrosis in AP

Assessment of liver stiffness regression and hepatocellular carcinoma risk in chronic hepatitis C patients after treatment with direct-acting antiviral drugs

Background and Objectives: Chronic hepatitis C virus infection affects about 71 million people worldwide. It is one of the most common chronic liver conditions associated with an increased risk of developing liver cirrhosis and cancer. The aim of this study was to evaluate changes in liver fibrosis and the risk of developing hepatocellular carcinoma after direct-acting antiviral drug therapy, and to assess factors, linked with these outcomes. Materials and Methods: 70 chronic hepatitis C patients were evaluated for factors linked to increased risk of de novo liver cancer and > 20% decrease of ultrasound transient elastography values 12 weeks after the end of treatment. Results: The primary outcome was an improvement of liver stiffness at the end of treatment (p = 0.004), except for patients with diabetes mellitus type 2 (p = 0.49). Logistic regression analysis revealed factors associated with > 20% decrease of liver stiffness values: lower degree of steatosis in liver tissue biopsy (p = 0.053); no history of interferon-based therapy (p = 0.045); elevated liver enzymes (p = 0.023–0.036); higher baseline liver stiffness value (p = 0.045) and absence of splenomegaly (p = 0.035). Hepatocellular carcinoma developed in 4 (5.7%) patients, all with high alpha-fetoprotein values (p = 0.0043) and hypoechoic liver mass (p = 0.0001), three of these patients had diabetes mellitus type 2. Conclusions: Liver stiffness decrease was significant as early as 12 weeks after the end of treatment. Patients with diabetes and advanced liver disease are at higher risk of developing non-regressive fibrosis and hepatocellular carcinoma even after successful treatment

Pancreas segmentation in CT images: state of the art in clinical practice

Pancreas adenocarcinoma is a lethal diseasewith poor outcomes. With increasing incidence worldwide, it is predicted to become the second leading cause of cancer death in many countries. The main factor influencing disease outcome is the tumor stage at the time of diagnosis. The first step to successfully diagnose and treat pancreatic cancer is the efficient recognition and segmentation of the target organ. Several methods based on deep learning and data fusion for pancreas segmentation have been developed and applied over the years. This paper presents a state of the art in the application ofthe existing methods that have been presented for the pancreas and pancreatic cyst detection and segmentation.The most successful method so far has accuracy equal to 90.18% and AUC equal to 94.55%.Also,this paper looks into software designed for 3D segmentationthat is simple and potentially mightbe used by users from non-medical fields

Magnetic resonance imaging reduces the rate of unnecessary operations in pregnant patients with suspected acute appendicitis: a retrospective study

Purpose: This is a retrospective single-institution study performed to compare the rate of unnecessary operations in pregnant women with suspected acute appendicitis with and without the use of MRI. Methods: The study subjects were all pregnant women with suspected acute appendicitis admitted to a tertiary institution from January 2012 to December 2019. If acute appendicitis was not excluded clinically and by ultrasound (US), laparoscopies were performed until May 2017 (US-only group). MRI was added as a diagnostic tool when US was inconclusive from May 2017 (US + MRI group). Surgery was considered unnecessary when no inflamed appendix was found. The rate of unnecessary surgery, postoperative complications, length of stay were analyzed. Results: Seventy-six women were included in the study; 38 women in the US-only group and 38 women in the US + MRI group. There were no differences in admission characteristics between the groups. One of 38 women (2.6%) underwent unnecessary surgery in the US + MRI group vs. 10 of 38 (26.3%) in the US-only group (P = 0.007). The patients in the US + MRI group were significantly less likely to undergo a diagnostic operation than in the US-only group (5.26% vs. 55.3%, respectively; P < 0.001) and their hospital stay was significantly shorter (0.74 ± 1.64 days vs. 3.7 ± 3.0 days, respectively; P < 0.001). The obstetric outcomes were not different between the groups. MRI had a sensitivity of 83.3% and specificity of 100% in the series. Conclusion: The rate of unnecessary surgery was significantly reduced in pregnant women, who underwent MRI after inconclusive transabdominal US