Interleukin-10 and Interleukin-1ß Cytokines Expression in Leukocytes of Patients with Chronic Peri-Mucositis.

BACKGROUND The purpose of the present research is to analyze the effect of polyphenols and flavonoids substrat (PFS) from plants Calendula officinalis, Salvia fruticosa, Achillea millefolium, and propolis as immunomodulatory in the production of interleukin (IL)-1ß and IL-10 in peripheral blood leukocytes medium (PBLM) in patients who were diagnosed with mucositis of peri-implant tissue compared to patients with healthy implant tissue. It was hypothesized that IL-1ß and IL-10 contribute to the inflammation processes noticed in the diseases of peri-implant tissues. MATERIAL AND METHODS Sixty non-smoking patients were included in this study: patients with healthy implants (HP group) and patients with peri-implant mucositis (MP group). Peri-mucositis was diagnosed by radiologic and clinical examination. The PBLM from MP were treated with PFS at various concentrations. The levels of IL-10 and IL-1ß excreted by the PBLM stimulated and unstimulated with viable Porphyromonas gingivalis test-tube were committed by the enzyme amplified immunoassay sensitivity method. RESULTS Unstimulated and stimulated PBLM and treatment with 5.0 mg/mL or 10.0 mg/mL of PFS in the MP group produced significantly higher levels IL-10 (P<0.001) that analogous mediums of the HP group. The levels of IL-1ß decreased more considerably in the stimulated PBLM of the MP group than in those of HP group (P<0.001) after the treatment with PFS at only 10.0 mg/mL concentration. CONCLUSIONS Theses results suggest that the solution of PFS might offer a new potential for the development of a new therapeutic path to prevent and treat peri-implant mucositis.

Exploring the feasibility of the combination of acoustic voice quality index and glottal function index for voice pathology screening.

PURPOSE: The aim of this study was to explore the diagnostic value of the combination of Acoustic Voice Quality Index (AVQI) and Glottal Function Index (GFI) as a screening tool for voice disorders, and to compare the AVQI measurements obtained using oral and smartphone (SP) microphones. METHODS: A study group consisted of 183 adult individuals including 86 subjects with normal voice and 97 patients with pathological voice. Voice recordings were performed simultaneously with an oral AKG Perception 220 and SP iPhone 6s microphones. To evaluate the diagnostic accuracy differentiating normal and pathological voice, the receiver-operating characteristic statistics [area under curve (AUC), positive and negative likelihood ratios (LR+ and LR-)], and correct classification rate (CCR) were used. RESULTS: The AVQI cut-off scores of 3.31 for oral and 3.32 for SP microphones were associated with very good test accuracy (AUC = 0.857 and AUC = 0.818), resulting in balance between sensitivity and specificity (70.0% vs 86.0% and 70% vs 87.0%). The CCR reached 78%. The combined AVQI and GFI cut-off scores of 6.65 for oral and 7.1 for SP microphones corresponded with excellent test accuracy (AUC = 0.976 and AUC = 0.965) and sensitivity and specificity (93.0% vs 93.0% and 91.0% vs 94%). Very respectable levels of LR+ and LR- both for oral microphone (13.3 and 0.08) and for SP microphone (15.6 and 0.10) voice recordings were achieved. CCRs of 93% and 92% confirmed the results of ROC statistics. CONCLUSIONS: Combination of AVQI and GFI measurements significantly improved diagnostic accuracy in differentiating normal vs pathological voice.

Oral Behaviors and Parafunctions: Comparison of Temporomandibular Dysfunction Patients and Controls.

The aim of this study is to evaluate the frequency of oral behaviors in patients with temporomandibular disorders (TMD) and a control group without TMD.In this baseline case-control study, 260 controls and 260 subjects with TMD completed the oral behaviors checklist defined as a "self-report scale for identifying and quantifying the frequency of jaw overuse behavior" and underwent clinical examinations using the DC/TMJ international examination form (version May 12, 2013). Relationships of oral parafunctions' frequencies between groups were examined. The statistical analysis was performed with IBM SPSS Statistics 23 software.Age and gender distribution in the study groups did not reveal statistical differences (P > 0.05). Multivariate logistic regression analysis was conducted to establish system of independent oral behaviors for prognosis TMD. The stepwise regression analysis demonstrated that very frequent expression of holding, tightening, or tense muscles is associated with 10.83 times (P < 0.05) higher risk of TMD, grinding teeth together during waking hours with 4.94 times (P < 0.05) higher risk, and sustained talking with 2.64 times (P < 0.05) higher risk of TMD. By contrast, it was determined that 3 oral behaviors were less common in the TMD patients compared with the control group: clenching teeth together during waking hours, facing grimaces, and yawning (P < 0.05). The individuals with TMD reported a significantly higher frequency of 10 behaviors (P < 0.05), 3 of which may be regarded as independent risk factors for TMD. In addition, 3 oral behaviors were more frequently observed in the healthy subjects than in the TMD patients.

Autonomic disturbances including impaired hand thermoregulation in multiple system atrophy and Parkinson's disease.

Autonomic dysfunction in multiple system atrophy (MSA) comprises cardinal symptoms of orthostatic hypotension (OH) and urinary incontinence. Additionally, cardiovagal and sudomotor abnormalities can be present. Previous studies compared hand skin temperature and its response to cooling in subjects with probable MSA and Parkinson's disease (PD). Significant differences were found indicating that disturbed thermoregulation belongs to MSA autonomic features and could be helpful in differentiation of MSA from PD. The objective of this study was to improve our knowledge about impaired thermoregulation of distal extremities in MSA with parkinsonian features (MSA-P) and PD and to assess the possible interrelations for the different subtypes of autonomic dysfunction in a large cohort of MSA-P, PD and control patients. The patients underwent a standard cooling-rewarming procedure, termed ice test (IT). Electroneurography, heart rate variability, sympathetic skin response and orthostatic tests were performed for the subdivision of the patients. The prevalence of pathological IT was slightly increased in MSA compared with PD and control groups. The presence of pathological IT was related with older patient's age in PD and control groups significantly (p < 0.05). This relation was absent for the MSA patients, who themselves were significantly younger (p = 0.001). Significant association between the presence of pathological IT and OH was determined (p < 0.001). Defective thermoregulation of distal extremities seems to be more severe in the MSA patients. The dysfunction of preganglionic sympathetic neurons might be involved in impaired response to cooling for MSA. The results suggest pathophysiological affinity of impaired sympathetic neurovascular regulation between pathological IT and OH.

Reliability and validity of the Lithuanian Tinnitus Handicap Inventory.

OBJECTIVE: The aim of this study was to determine the reliability and validity of the Lithuanian version of the Tinnitus Handicap Inventory (THI), a self-report measure of perceived tinnitus handicap. MATERIALS AND METHODS: A cross-sectional psychometric validation study was performed in the University Hospital. A total of 248 subjects reporting chronic tinnitus as their primary complaint or secondary to hearing loss were encluded in the study and filled in the Lithuanian version of THI. For assessment of construct validity a subgroup of 55 participants completed the Lithuanian version of the Hospital Anxiety and Depression Scale as a measure of self-perceived levels of anxiety and depression. Test-retest and internal consistency reliability as well as construct validity were calculated. RESULTS: The Lithuanian version of the THI and its subscales showed a robust internal consistency reliability (Cronbach's alpha=0.93) comparable to the original version. Statistically significant correlations were observed between the Lithuanian translation of the THI and the measures of self-perceived levels of anxiety and depression using HADS. Confirmatory factor analysis demonstrated that the three subscales of the THI Lithuanian version corresponded to three different factors, which strongly correlated between themselves. CONCLUSIONS: The results suggest that the Lithuanian version of THI maintains its original validity and may serve as reliable and valid measure of general tinnitus related distress that can be used in a clinical setting to quantify the impact of tinnitus on daily living.

Effect of Laryngeal Squamous Cell Carcinoma Tissue Implantation on the Chick Embryo Chorioallantoic Membrane: Morphometric Measurements and Vascularity.

BACKGROUND: The aim of this study was to develop chick embryo chorioallantoic membrane (CAM) model of laryngeal squamous cell carcinoma (LSCC) and to evaluate the morphological and morphometric characteristics and angiogenic features of it. METHODS: Fresh LSCC tissue samples obtained from 6 patients were implanted onto 15 chick embryo CAMs. Morphological, morphometric, and angiogenic changes in the CAM and chorionic epithelium were evaluated up to 4 days after the tumor implantation. Immunohistochemical analysis (34ßE12, CD31, and Ki67 staining) was performed to detect cytokeratins and tumor endothelial cells and to evaluate the proliferative capacity of the tumor before and after implantation on the CAM. RESULTS: The implanted LSCC tissue samples survived on the CAM in all the experiments and retained the essential morphologic characteristics and proliferative capacity of the original tumor. Implants induced thickening of both the CAM (103-417%, p = 0.0001) and the chorionic epithelium (70-140%, p = 0.0001) and increase in number of blood vessels (75-148%, p = 0.0001) in the CAM. CONCLUSIONS: This study clarifies that chick embryo CAM is a relevant assay for implanting LSCC tissue and provides the first morphological and morphometric characterization of the LSCC CAM model that opens new perspectives to study this disease.

Exploring the feasibility of smart phone microphone for measurement of acoustic voice parameters and voice pathology screening.

The objective of this study is to evaluate the reliability of acoustic voice parameters obtained using smart phone (SP) microphones and investigate the utility of use of SP voice recordings for voice screening. Voice samples of sustained vowel/a/obtained from 118 subjects (34 normal and 84 pathological voices) were recorded simultaneously through two microphones: oral AKG Perception 220 microphone and SP Samsung Galaxy Note3 microphone. Acoustic voice signal data were measured for fundamental frequency, jitter and shimmer, normalized noise energy (NNE), signal to noise ratio and harmonic to noise ratio using Dr. Speech software. Discriminant analysis-based Correct Classification Rate (CCR) and Random Forest Classifier (RFC) based Equal Error Rate (EER) were used to evaluate the feasibility of acoustic voice parameters classifying normal and pathological voice classes. Lithuanian version of Glottal Function Index (LT_GFI) questionnaire was utilized for self-assessment of the severity of voice disorder. The correlations of acoustic voice parameters obtained with two types of microphones were statistically significant and strong (r = 0.73-1.0) for the entire measurements. When classifying into normal/pathological voice classes, the Oral-NNE revealed the CCR of 73.7% and the pair of SP-NNE and SP-shimmer parameters revealed CCR of 79.5%. However, fusion of the results obtained from SP voice recordings and GFI data provided the CCR of 84.60% and RFC revealed the EER of 7.9%, respectively. In conclusion, measurements of acoustic voice parameters using SP microphone were shown to be reliable in clinical settings demonstrating high CCR and low EER when distinguishing normal and pathological voice classes, and validated the suitability of the SP microphone signal for the task of automatic voice analysis and screening.

Combined Use of Standard and Throat Microphones for Measurement of Acoustic Voice Parameters and Voice Categorization.

OBJECTIVE: The aim of the present study was to evaluate the reliability of the measurements of acoustic voice parameters obtained simultaneously using oral and contact (throat) microphones and to investigate utility of combined use of these microphones for voice categorization. MATERIALS AND METHODS: Voice samples of sustained vowel /a/ obtained from 157 subjects (105 healthy and 52 pathological voices) were recorded in a soundproof booth simultaneously through two microphones: oral AKG Perception 220 microphone (AKG Acoustics, Vienna, Austria) and contact (throat) Triumph PC microphone (Clearer Communications, Inc, Burnaby, Canada) placed on the lamina of thyroid cartilage. Acoustic voice signal data were measured for fundamental frequency, percent of jitter and shimmer, normalized noise energy, signal-to-noise ratio, and harmonic-to-noise ratio using Dr. Speech software (Tiger Electronics, Seattle, WA). RESULTS: The correlations of acoustic voice parameters in vocal performance were statistically significant and strong (r = 0.71-1.0) for the entire functional measurements obtained for the two microphones. When classifying into healthy-pathological voice classes, the oral-shimmer revealed the correct classification rate (CCR) of 75.2% and the throat-jitter revealed CCR of 70.7%. However, combination of both throat and oral microphones allowed identifying a set of three voice parameters: throat-signal-to-noise ratio, oral-shimmer, and oral-normalized noise energy, which provided the CCR of 80.3%. CONCLUSIONS: The measurements of acoustic voice parameters using a combination of oral and throat microphones showed to be reliable in clinical settings and demonstrated high CCRs when distinguishing the healthy and pathological voice patient groups. Our study validates the suitability of the throat microphone signal for the task of automatic voice analysis for the purpose of voice screening.

Predictive value of early near-infrared spectroscopy monitoring of patients with traumatic brain injury.

BACKGROUND AND OBJECTIVE: Traumatic brain injury (TBI) is the leading cause of death and disability in young adults. Study aimed to define the predictive value of early near-infrared spectroscopy (NIRS) monitoring of TBI patients in a Lithuanian clinical setting. MATERIALS AND METHODS: Data of 61 patients was analyzed. Predictive value of early NIRS monitoring, computed tomography data and regular intensive care unit (ICU) parameters was investigated. RESULTS: Twenty-six patients expressed clinically severe TBI; 14 patients deceased. Patients who survived expressed higher NIRS values at the periods of admission to operative room (75.4%±9.8% vs. 71.0%±20.5%; P=0.013) and 1h after admission to ICU (74.7%±1.5% vs. 61.9%±19.4%; P=0.029). The NIRS values discriminated hospital mortality groups more accurately than admission GCS score, blood sugar or hemoglobin levels. Admission INR value and NIRS value at 1h after admission to ICU were selected by discriminant analysis into the optimal set of features when classifying hospital mortality groups. Average efficiency of classification using this method was 88.9%. When rsO2 values at 1h after admission to ICU did not exceed 68.0% in the left hemisphere and 68.3% in the right hemisphere, the hazard ratio for death increased by 17.7 times (P<0.01) and 5.1 times (P<0.05), respectively. CONCLUSIONS: NIRS plays an important role in the clinical care of TBI patients. Regional brain saturation monitoring provides accurate predictive data, which can improve the allocation of scarce medical resources, set the treatment goals and alleviate the early communication with patients' relatives.

Relationship of clinical and microbiological variables in patients with type 1 diabetes mellitus and periodontitis.

BACKGROUND: The aim of the study was to analyze how metabolic control of type 1 diabetes is related to clinical and microbiological periodontal parameters. MATERIAL AND METHODS: The study involved 56 subjects aged from 19 to 50 years divided into 2 groups: healthy subjects (the H group), and diabetic (type 1 diabetes) patients with chronic untreated generalized periodontitis (the DM group). The glycosylated hemoglobin value (HbA1c) was determined using the UniCel DxC 800 SYNCHRON System (Beckman Coulter, USA), and the concentration in blood was measured by the turbidimetric immunoinhibition method. A molecular genetic assay (Micro-IDent plus, Germany) was used to detect periodontopathogenic bacteria in plaque samples. Periodontitis was confirmed by clinical and radiological examination. RESULTS: Fusobacterium nucleatum, Capnocytophaga species, and Eikenella corrodens were the most frequently found bacteria in dental plaque samples (77.8%, 66.7%, and 33.4%, respectively), whereas Aggregatibacter actinomycetemcomitans was identified 40.7% less frequently in the DM group than in the H group. The strongest relationship was observed between the presence of 2 periodontal pathogens - F. nucleatum and Capnocytophaga spp. - and poorer metabolic control in type 1 diabetes patients (HbA1c) and all clinical parameters of periodontal pathology. CONCLUSIONS: Periodontal disease was more evident in type 1 diabetic patients, and the prevalence of periodontitis was greatly increased in subjects with poorer metabolic control.

The most important throat-related symptoms suggestive of chronic tonsillitis as the main indication for adult tonsillectomy.

BACKGROUND AND OBJECTIVE: The literature lacks data about the evaluation of throat-related symptoms proving chronic tonsillitis as the most common indication for adult tonsillectomy. Therefore, the aim of this study was to assess the most important throat-related symptoms suggestive of chronic tonsillitis in adults. MATERIAL AND METHODS: A prospective cohort study was carried out. The analysis of throat-related symptoms (complaints, tonsillitis rate, pharyngeal signs, and antistreptolysin-O titer) in 81 adults with histologically confirmed chronic tonsillitis was conducted. RESULTS: Recurrent tonsillitis was the most common complaint (74.1%). The mean number of tonsillitis episodes was 3.6 (SD, 1.9) times per year. There were no significant differences comparing the frequencies of all the analyzed pharyngeal signs (P>0.05). The antistreptolysin-O titer (mean, 279.8; SD, 211.6 UL) was pathological in 33.3% of patients. The study identified the most important throat-related symptoms revealing chronic tonsillitis: tonsillar cryptic debris (OR, 8.84; 95% CI, 1.93-40.53; P=0.005) and enlarged anterior cervical lymph nodes along with the frequency of tonsillitis episodes exceeding 3 times per year (OR, 8.27; 95% CI, 1.33-51.57; P=0.024). The classification accuracy of 85.2% was obtained. CONCLUSIONS: Tonsillar cryptic debris and enlarged regional lymph nodes along with recurrent tonsillitis could support the diagnosis of chronic tonsillitis in adults when considering tonsillectomy.

Correlation between the basic video laryngostroboscopic parameters and multidimensional voice measurements.

OBJECTIVE: The aim of this study is to evaluate the correlations among the basic video laryngostroboscopic (VLS) parameters and vocal function assessed using a multidimensional set of perceptive, acoustic, aerodynamic, and subjective measurements. METHODS: Digital VLS recordings and multidimensional voice assessment were performed for 108 individuals, namely 26 healthy and 82 patients with mass lesions of vocal folds and paralysis. The VLS variables (glottal closure, regularity, mucosal wave on the affected/healthy side, symmetry of vibration, and symmetry of image) were rated and quantified on a visual analog scale. Correlations among the VLS parameters and results of acoustic voice analysis and voice range profile (VRP), data of subjective (voice handicap index [VHI] and glottal function index [GFI]), perceptual (G-grade, R-roughness, B-breathiness, A-asthenic scale), and dysphonia severity index (DSI) measurements were tested using Pearson's correlation coefficient. RESULTS: The intercorrelations of VLS parameters in vocal performance were moderate to strong and statistically significant for the entire functional measurements obtained through different modalities. The definitive correlations between VLS and VRP parameters were as follows: r=0.69-0.79 for normal profile coverage, r=0.67-0.76 for dynamic intensity, and r=0.67-0.74 for maximum intensity. All VLS parameters correlated moderately with VHI, GFI, and DSI (r=0.5-0.65, r=0.4-0.57, and r=0.61-0.69, respectively). The strongest correlations were found between VLS parameters and G factor of the GRBA scale (r=0.68-0.88). CONCLUSIONS: Correlation analysis of the vibratory pattern of the vocal folds obtained via VLS provides more comprehensive insight into the pathophysiology of phonation and suggests the documented and measurable evidence of complex mechanisms of vocal outcome.

Quantitative evaluation of video laryngostroboscopy: reliability of the basic parameters.

OBJECTIVE: The purpose of this study was to evaluate quantitatively the basic parameters of the video laryngostroboscopy (VLS) and determine the sensitivity and specificity of these parameters discriminating healthy and pathological voice classes. METHODS: Digital VLS recordings were performed for 159 individuals: 26 healthy and 133 patients. VLS variables (glottal closure, regularity, mucosal wave on the affected/healthy side, symmetry of vibration, and symmetry of image) were rated two times with the time interval of 1 year by three laryngologists. To evaluate interrater and test-retest reliability, intraclass correlation coefficients (ICCs) were calculated. To evaluate sensitivity and specificity of the VLS parameters, discriminant analysis was used. RESULTS: Moderate to almost perfect levels (ICC 0.46-0.90) of interrater reliability were revealed for most of the basic VLS parameters. The ICC of the interrater reliability was highest for symmetry of glottal image; the most problematic VLS parameter for rating was mucosal wave on the healthy side. ICC of the test-retest reliability were 0.71-0.95, P<0.001. An optimum system of VLS parameters discriminating normal and pathological voice subgroups with sensitivity 96.3% and specificity 100% included glottal closure and mucosal wave on the affected side. CONCLUSIONS: The quantitative evaluation of the VLS using basic parameters showed to be reliable in clinical settings and demonstrated high sensitivity and specificity distinguishing healthy and pathological voice patient groups.

MGMT, GATA6, CD81, DR4, and CASP8 gene promoter methylation in glioblastoma.

BACKGROUND: Methylation of promoter region is the major mechanism affecting gene expression in tumors. Recent methylome studies of brain tumors revealed a list of new epigenetically modified genes. Our aim was to study promoter methylation of newly identified epigenetically silenced genes together with already known epigenetic markers and evaluate its separate and concomitant role in glioblastoma genesis and patient outcome. METHODS: The methylation status of MGMT, CD81, GATA6, DR4, and CASP8 in 76 patients with primary glioblastomas was investigated. Methylation-specific PCR reaction was performed using bisulfite treated DNA. Evaluating glioblastoma patient survival time after operation, patient data and gene methylation effect on survival was estimated using survival analysis. RESULTS: The overwhelming majority (97.3%) of tumors were methylated in at least one of five genes tested. In glioblastoma specimens gene methylation was observed as follows: MGMT in 51.3%, GATA6 in 68.4%, CD81 in 46.1%, DR4 in 41.3% and CASP8 in 56.8% of tumors. Methylation of MGMT was associated with younger patient age (p < 0.05), while CASP8 with older (p < 0.01). MGMT methylation was significantly more frequent event in patient group who survived longer than 36 months after operation (p < 0.05), while methylation of CASP8 was more frequent in patients who survived shorter than 36 months (p < 0.05). Cox regression analysis showed patient age, treatment, MGMT, GATA6 and CASP8 as independent predictors for glioblastoma patient outcome (p < 0.05). MGMT and GATA6 were independent predictors for patient survival in younger patients' group, while there were no significant associations observed in older patients' group when adjusted for therapy. CONCLUSIONS: High methylation frequency of tested genes shows heterogeneity of glioblastoma epigenome and the importance of MGMT, GATA6 and CASP8 genes methylation in glioblastoma patient outcome.

Association of language dysfunction and age of onset of benign epilepsy with centrotemporal spikes in children.

BACKGROUND: Language dysfunction in children with benign epilepsy with centrotemporal spikes (BECTS) has been well recognized but data regarding its risk factors are heterogenous. AIMS: To assess language function in children with BECTS and its association with the age of epilepsy onset. METHODS: We assessed language function in 61 children with BECTS and 35 age and sex-matched controls. Children with BECTS performed significantly worse on all language tasks as compared to controls and overall better language function was positively correlated with older age of the child. Early age at seizure onset demonstrated significant negative correlation with language dysfunction, age below 6 years being related to the lowest performance scores. There was no relationship between the language function and the laterality of epileptic focus, seizure treatment status, or the duration of epilepsy. CONCLUSION: Children with BECTS have language difficulties that are more pronounced in younger age group. Despite better language functioning in older children with BECTS, their verbal abilities remain inferior to those of children without epilepsy. Early age at seizure onset is a significant factor predicting worse language functioning in children with BECTS.

Activity of neutrophil ß-glucuronidase in diabetic and nondiabetic patients with chronic generalized periodontitis and healthy subjects.

OBJECTIVE. The aim of the study was to establish the dynamics of ß-glucuronidase activity in subjects suffering from type 1 diabetes and chronic untreated generalized periodontitis, subjects suffering from chronic untreated generalized periodontitis only, and control subjects not suffering from generic diseases with healthy periodontal tissue. MATERIAL AND METHODS. The study involved 165 19-50-year-old subjects who were divided into three groups: healthy subjects (n=55), subjects with chronic untreated generalized periodontitis (n=55), and subjects with type 1 diabetes and chronic untreated generalized periodontitis (n=55). Neutrophilic leukocytes of peripheral venous blood were exposed to bacterial stimuli: opsonized zymosan, nonopsonized Staphylococcus aureus, and prodigiosan. The activity of ß-glucuronidase was determined by the spectrofluorimetry method. RESULTS. The diagnostic value of changes in ß-glucuronidase activity of neutrophilic leukocytes markedly increased in all study groups after stimulation of neutrophilic leukocytes by opsonized zymosan, nonopsonized Staphylococcus aureus, and prodigiosan as compared to control media not exposed to any stimulus (P<0.001). The strongest relationship (canonical correlation coefficient eta, 0.993) between the intensity of periodontal pathology markers and the activity of ß-glucuronidase of neutrophilic leukocytes in incubated media in patients with type 1 diabetes mellitus and periodontitis was found under the effect of nonopsonized Staphylococcus aureus. CONCLUSIONS. If periodontal impairment is severe, diabetes mellitus possibly causes a faster destruction of the periodontal tissue and presents a higher risk of periodontitis for patients with diabetes.

Neonatal outcomes of very preterm infants admitted to a tertiary center in Lithuania between the years 2003 and 2005.

The objectives of the study are to investigate gestational age-specific mortality and neonatal outcomes in preterm infants admitted to a tertiary center in Lithuania, and to make comparison with tertiary centers in western countries. Three hundred thirty-eight newborns born at ≤ 32 weeks of gestation and with birth weight ≤ 1,500 g between 1 January 2003 and 31 December 2005, admitted to the neonatal intensive care unit at Kaunas Medical University Hospital, were prospectively investigated. Mortality and associations between maternal, perinatal, and neonatal variables and short-term outcomes were examined for two gestational age (GA) groups (group I, extremely preterm, 22-27 weeks GA; group II, very preterm, 28-32 weeks GA). Mortality in group I was 53.5% and 2.9% in group II. GA <28 weeks, Apgar score <5 at 5 min, and birth weight <1,000 g posed the highest risk for death. Overall, 78.2% of the surviving infants were discharged from hospital without adverse short-term outcomes. The incidence of bronchopulmonary dysplasia (BPD) was 6.3%, of retinopathy of prematurity (ROP) requiring treatment 4.2%, of intraventricular hemorrhage (IVH) III-IV 10.9%, and for cystic periventricular leukomalacia (cPVL) 8.0%. In conclusion, a decade after introduction of perinatal programs, mortality in the very preterm group is similar to those reported from cohorts in western countries. In the extremely preterm group, however, mortality is still higher. Neonatal outcomes such as ROP are now similar, and BPD is lower to those in other cohorts, whereas the incidence of brain lesions is still higher. We speculate that differences in outcomes between studies may be explained by differences in resources, definitions, and treatment routines.

Expression of matrix metalloproteinases (MMP-2 and MMP-9) in recurrent respiratory papillomas and laryngeal carcinoma: clinical and morphological parallels.

The task of the present study was to investigate the expression of MMP-2 and MMP-9 in recurrent respiratory papillomas (RRP) and accomplish a comparative analysis with those in laryngeal squamous cell carcinoma (LSCC). The immunohistochemical expression of MMP-2 and MMP-9 was investigated in specimens taken from RRP (n = 38) and LSCC (n = 39) patient groups, and the normal tissue of vocal fold (n = 12, control group). The expression of MMP-2 and MMP-9, both in epithelium and stroma cells, was graded on a semiquantitative scale, ranging from 0 (no expression) to 18 points (high expression). Statistically significant differences in the expression of MMP-2 and MMP-9, both in epithelium and stroma among the RRP, LSCC patients and control group (epithelium) with the LSCC group having the highest MMPs expression scores were revealed. However, no statistically significant correlations among expression of MMPs and clinical and/or morphological features were found in the group of RRP patients. The MMP-2 stroma value of 10.4 points was determined as the optimum point (limiting value) for separating RRP and LSCC patient groups. Results of the present study indicate that the expression of both MMP-2 and MMP-9 are up-regulated early in development of laryngeal papillomas, when the benign neoplastic lesion begins and the next determinant step is concerned with the occurrence of malignization. These results seem promising, as they may improve our understanding of the molecular events leading to the papilloma formation and development, however, further research is needed.

Categorizing normal and pathological voices: automated and perceptual categorization.

OBJECTIVES: The aims of the present study were to evaluate the accuracy of an elaborated automated voice categorization system that classified voice signal samples into healthy and pathological classes and to compare it with classification accuracy that was attained by human experts. MATERIAL AND METHODS: We investigated the effectiveness of 10 different feature sets in the classification of voice recordings of the sustained phonation of the vowel sound /a/ into the healthy and two pathological voice classes, and proposed a new approach to building a sequential committee of support vector machines (SVMs) for the classification. By applying "genetic search" (a search technique used to find solutions to optimization problems), we determined the optimal values of hyper-parameters of the committee and the feature sets that provided the best performance. Four experienced clinical voice specialists who evaluated the same voice recordings served as experts. The "gold standard" for classification was clinically and histologically proven diagnosis. RESULTS: A considerable improvement in the classification accuracy was obtained from the committee when compared with the single feature type-based classifiers. In the experimental investigations that were performed using 444 voice recordings coming from 148 subjects, three recordings from each subject, we obtained the correct classification rate (CCR) of over 92% when classifying into the healthy-pathological voice classes, and over 90% when classifying into three classes (healthy voice and two nodular or diffuse lesion voice classes). The CCR obtained from human experts was about 74% and 60%, respectively. CONCLUSION: When operating under the same experimental conditions, the automated voice discrimination technique based on sequential committee of SVM was considerably more effective than the human experts.

Tumor grade-related NDRG2 gene expression in primary and recurrent intracranial meningiomas.

Approximately 30% of all primary CNS tumors are meningiomas. Depending on histological type, meningiomas can recur as follows: benign--with five-year recurrence of 5%, atypical--recurrence approximately 40%, and anaplastic with recurrence of 50-80%. In an attempt to understand the molecular mechanism of meningioma recurrence we investigated the N-Myc downstream-regulated gene 2 (NDRG2), which has recently been described as important in suppressing cellular carcinogenesis in different types of cancer. The objective of the study was to investigate NDRG2 gene expression at the mRNA level in primary and recurrent meningiomas as a potential marker of tumor aggressiveness, malignancy, and recurrence. Primary and recurrent meningiomas of WHO grades I, II, and III from 35 patients operated on between 2005 and 2008 year at the Department of Neurosurgery of Kaunas Medical University Hospital (Lithuania) were studied. Using the qRT-PCR method we measured NDRG2 gene expression at the mRNA level in primary (n = 24) and recurrent (n = 11) meningiomas. Statistically significant differences in NDRG2 gene expression level were observed between primary and recurrent meningioma groups (P < 0.05) and between benign (WHO grade I) and atypical (WHO grade II) meningiomas (P < 0.05). No statistically significant differences were observed (P > 0.05) among histological subtypes of benign (WHO grade I) meningiomas: fibrous, meningothelial, and transitional. In accordance with our results, reduction of NDRG2 gene expression at the mRNA level could help to explain malignant progression and predisposition to recurrence in meningiomas.