Lithuanian University of Health Sciences

How the Internet is used and any negative outcomes of engagement with it—especially with regards to children—is a topic of great interest, bearing legitimate investigation. Proposed identifiers of problematic internet use(PIU) include aspects of use in correlation with distress or impairment across biological, psychological, sociological, and/or occupational/academic functioning. Adolescents and those with vulnerabilities across developmental or sociological domains are particularly susceptible. Although validated instruments have been utilized to assess PIU, concerns surrounding the methodology, currency, and some validation measures of existing and cross-sectional screening tools and a lack of those with true external validity and variance, combined with some disagreement surrounding PIU, have impeded its diagnostic acceptance. Current investigative approaches to PIU include clarifying problematic gambling and gaming criteria, psychotherapeutic therapy, pharmacological interventions, and non-invasive neurostimulation therapies targeting cortical brain regions. As child screen time appears to be increasing, further research, ethical health/social policy changes, and digital literacy programs are strongly endorsed. To avoid online engagement dysregulating or harming children, digital policy youth user protection standards, pragmatic key player dialogues, transparent reassessments of digital-centric business models without compromising less resourced countries, and even globally agreed child online safety regulations are also recommended.

The aim to assess quality of life (QoL) and profile of mood states in patients with childhood-onset hypopituitarism and growth hormone (GH) deficiency during the discontinuation of recombinant growth hormone (rGH) replacement therapy at the transition from adolescence to adulthood. Methods mood states and QoL were assessed in 136 (85 men, 51 women, age 16.8 ± 1.1 years) patients during discontinuation of rGH replacement and 82 (40 men, 42 women, age 16.5 ± 1.7 years) control individuals using the Profile of Mood States2 (POMS2) and the Quality of Life - Assessment of Growth Hormone Deficiency in Adults (QoL-AGHDA) questionnaires. Results No difference in QoL was between patients and controls, but patients had higher levels of tension-anxiety (median 9.0 score vs. 6.0 score, p < 0.001), depression-dejection (median 9.0 score vs. 8.0 score, p = 0.042), fatigue-inertia (median 9.0 score vs. 6.0 score, p < 0.001), confusion-bewilderment (median 4.0 score vs. 3.0 score, p = 0.003) than controls. Basal cortisol concentration correlated negatively with QoL-AGHDA score (r = −0.288, p = 0.012), depression-dejection score (r = −0.317, p = 0.005). Height correlated negatively with anger-hostility (r = −0.223, p = 0.010), fatigue-inertia (r = −0.188, p = 0.030) scores. Body mass index (BMI) correlated positively with fatigue-inertia score (r = 0.181, p = 0.040). Age at the discontinuation of rGH replacement correlated negatively with QoL-AGHDA score (r = −0.204, p = 0.026), depression-dejection (r = −0.460, p = 0.021), anger-hostility (r = −0.190, p = 0.040), fatigue-inertia (r = −0.205, p = 0.026) scores. Conclusion mood states (higher tension-anxiety, depression-dejection, fatigue-inertia, confusion-bewilderment), but not disease-specific QoL are impaired in patients with childhood-onset growth hormone deficiency during the discontinuation of rGH replacement therapy at the transition from adolescence to adulthood.

Background Pulmonary lymphangiomatosis (PL) is an ultrarare disease characterized by diffuse infiltration of the lung, pleura and/or mediastinum by abnormal lymphatic proliferation. Consented diagnostic or treatment approaches are not established. We therefore aimed to collect data on diagnostics and treatments in a cohort of patients with PL from a tertiary center for rare lung diseases. Methods Clinical, radiological and outcome data from PL patients were collected retrospectively. Results 12 patients were diagnosed between 1996 and 2022 in our center. PL was diagnosed more commonly in female (58%), never smokers (75%) and younger patients (mean age 42 years). Main clinical symptoms comprised haem- and chyloptysis (58%) and dyspnea on exertion (83%). Pulmonary function was mostly restrictive (mean VC 59%) with impaired DLCO (mean 65%). Radiological assessment mainly showed mediastinal involvement (83%), and pleural effusion (67%), pleural thickening (67%) and bronchial wall thickening (67%) while interstitial changes were rare. Diagnosis was confirmed by surgical or transbronchial cryobiopsy. 8 patients were treated with sirolimus, 3 of these combined with a surgical intervention and in one case surgical intervention was necessary 9 months after initiation of sirolimus. Clinical and radiological improvement was demonstrated for all patients treated with sirolimus. 1 patient received a lung transplant due disease progression. Survival rates were 90% after a mean follow up of at least 3 months. Conclusion This case series illustrates the variability of the clinical presentation of PL. Among our patients, those treated with sirolimus showed significant clinical, functional and radiological improvement. However, further investigation is needed to understand the pathogenesis of lymphangiomatosis in order to establish therapeutic approaches.

Introduction Although integrated alcohol policies, characterised by being consistent, structurally connected and interdependent, are considered to be best practices, very few evaluations of such policies exist. We evaluated the impact of two phases of integrated alcohol policies implemented in Lithuania in 2008/2009 and 2017/2018 on adult (15+ years of age) alcohol per capita consumption. Methods Alcohol per capita consumption was the main outcome, based on national data from Statistics Lithuania. Time‐series analyses using generalised additive mixed models were used, and unrecorded consumption trends were examined. A sensitivity analysis was conducted with data from the World Health Organization. Results The two phases of integrated alcohol policies were associated with average reductions in adult alcohol per capita consumption of almost 1 litre (−0.88 L; 95% confidence interval −1.43; −0.34). Sensitivity analyses with comparable international data on Lithuania yielded similar results. Discussion and Conclusions Integrated alcohol policies had a substantial effect on the average level of consumption. However, the effect of major single policies for Lithuania and other Baltic countries has been estimated to be of about the same magnitude. We conclude that in order to be successful, integrated alcohol policies should include at least one major effective population‐based policy.

Background The alcohol industry uses many of the tobacco industry’s strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence. Methods As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards. Results There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration. Conclusion Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.

Introduction It is known that symptoms of major depressive disorder (MDD) are associated with neurodegeneration, that lipopolysaccharide (LPS) can induce symptoms of MDD, and that blood LPS levels are elevated in neurodegeneration. However, it is not known whether blood LPS and cytokine levels correlate with MDD, cognition and brain structure, and this is tested in this study. Methods and analysis This cross-sectional study includes individuals with MDD (n = 100) and a control group of individuals with no one-year history of a mental disorder (n = 50). A comprehensive evaluation is performed, including the collection of basic sociodemographic information, data on smoking status, body mass index, course of MDD, past treatment, comorbid diseases, and current use of medications. Diagnosis of MDD is performed according to the WHO’s [2019] International Classification of Diseases and related health problems by psychiatrist and severity of MDD is evaluated using the Montgomery–Åsberg Depression Scale. The Cambridge Neuropsychological Test Automated Battery is used to evaluate cognitive functioning. Venous blood samples are taken to measure genetic and inflammatory markers, and multiparametric brain magnetic resonance imaging is performed to evaluate for blood-brain barrier permeability, structural and neurometabolic brain changes. Descriptive and inferential statistics, including linear and logistic regression, will be used to analyse relationships between blood plasma LPS and inflammatory cytokine concentrations in MDD patients and controls. The proposed sample sizes are suitable for identifying significant differences between the groups, according to a power analysis. Administrative information Trial registration: Clinicaltrials.gov NCT06203015.

Background and Objectives: Breast cancer is a leading cause of cancer-related deaths globally. This study investigates the impact of genetic polymorphisms in DNA methyltransferases (DNMT1 and DNMT3A) on breast cancer pathomorphology and patient prognosis. Specifically, we focused on DNMT1 polymorphisms rs2228611 and rs2228612 and DNMT3A polymorphisms rs2276598 and rs752208. Materials and Methods: Conducted at the Institute of Oncology of the Lithuanian University of Health Sciences, this study included 201 Lithuanian women with early-stage breast cancer. DNA was extracted from peripheral blood samples, and genotyping for the specified polymorphisms was performed using the PCR-RFLP assay. Statistical analyses were applied to evaluate associations between polymorphisms and clinicopathological characteristics. Results: The non-carriers of the DNMT1 rs2228611 G allele were less likely to be diagnosed at an older age, while the DNMT3A rs752208 T allele was linked to lower-grade tumors. Survival analysis indicated a potential relationship between DNMT3A rs752208 and overall survival, although no significant findings were observed in progression-free or metastasis-free survival. Conclusions: This study suggests that the DNMT1 and DNMT3A polymorphisms may influence breast cancer pathomorphology and prognosis. The DNMT1 rs2228611 G allele may be associated with earlier onset, and the DNMT3A rs752208 T allele might correlate with less aggressive tumors. These findings underscore the potential of DNMT gene polymorphisms as prognostic biomarkers in breast cancer, warranting further investigation with larger sample sizes.

Heart rhythm measurements over time reflect important elements of Autonomic Nervous System dynamics. Synchronization among the heart rhythms of multiple participants has been observed, but this study uses the first global dataset collected that measures synchronization at several locations across the globe continuously for multiple weeks. For 15 days, 104 participants located in California (USA), Lithuania, Saudi Arabia, New Zealand, and England underwent continuous ambulatory heart rhythm monitoring. They were not instructed to perform tasks together. Significant long-term correlations were observed across participants within the same region, for just the groups in Saudi Arabia and New Zealand. This is surprising, given that each participant has an individualized life and distinct heart rate. In a different analysis using population-mean cosinor, only in these two locations was a significant circaseptan (about 7-day) rhythm observed. It appears that weekly rhythms in these groups partially contribute to correlations, in addition to long-term movements. A hypothesis with supporting evidence is proposed to explain this, that participants in these groups were socially closer than in the other groups. It would then appear that heart rhythms synchronize over the long term due to social connectedness, even when they are not physically near each other or performing tasks together.

Objectives To determine the association of housing items and amenities with psychological wellbeing (PWB) and their relationship with all-cause and cardiovascular disease (CVD) mortality. Methods This study was based on the framework of the HAPIEE study. Data from the Lithuanian Mortality Register were used to evaluate CVD and all-cause mortality from baseline survey (2006–2008) till 2023. The logistic regression model and multivariate Cox regression model were applied for data analysis. Results The multivariable regression models showed that the material aspects of people’s lives influenced their PWB status: increasing the number of housing items per 1 unit significantly increased the odds ratio (OR) of higher PWB status for males [OR = 1.14 (95% CI 1.11–1.18)] and females [OR = 1.13 (95% CI 1.11–1.17)] and decreased the risk of all-cause and CVD mortality in females [respectively HR = 0.93 (95% CI 0.91–0.96) and HR = 0.91 (95% CI 0.87–0.95)] and in males [respectively HR = 0.92 (95% CI 0.90–0.94) and HR = 0.90 (95% CI 0.87–0.93)]. Conclusion These data suggest that the household items and amenities influenced PWB and may be used as risk factors in assessing the risk of all-cause and CVD mortality.

An odontogenic cutaneous sinus tract is considered an uncommon skin lesion resulting from a dental infection. In most cases of periapical abscesses, the sinus tract emerges intraorally, but rarely may appear on the cutaneous surface. The nonspecific clinical symptoms and diverse appearance of such lesions can lead to misdiagnosis and mistreatment of patients. In cases of non‐healing facial lesions, it is recommended to consider referring the patient for a comprehensive dental examination to prevent inappropriate treatment.

Background/Objectives: Positive body image is linked to improved mental and physical well-being, healthier lifestyles, and fewer unhealthy weight control behaviors. Cultural factors also play a role in influencing body appreciation. This study investigated the associations between body appreciation, body weight, lifestyle factors, and subjective health among bachelor’s students in Lithuania and Poland. Methods: A cross-sectional online survey was conducted with 1290 students from universities in both countries. The Body Appreciation Scale-2 (BAS-2) measured body appreciation, while participants provided self-reported data on their dietary habits, physical activity, sleep, health perceptions, and body weight and height. Linear regression models explored associations between BAS-2 scores, actual and perceived body weight, lifestyle habits, and subjective health. Results: Gender and country-based differences in body appreciation were observed. Lithuanian female students reported a higher median BAS score of 33 compared to 32 among Polish female students (p = 0.02), despite having a higher median BMI (22.3 kg/m² vs. 21.1 kg/m², p = 0.001). Positive body appreciation was linked to healthier dietary behaviors, such as higher consumption of fruits, vegetables, fish, and regular breakfasts. Additionally, greater physical activity and sufficient sleep were associated with higher body appreciation, while higher intake of sweets, sugary drinks, and fast food correlated with lower BAS-2 scores. Both BMI and perceived weight were negatively associated with body appreciation, particularly among females. Conclusions: Body appreciation is closely linked to body weight, healthier lifestyle, and positive health perceptions, suggesting that promoting healthier habits may improve body appreciation.

In this study, we have synthesized novel 4-acetophenone moiety-bearing functionalized imidazole derivatives containing S-, and N-ethyl substituents and evaluated their anticancer activity. Their anticancer activity was studied against human breast carcinoma (MDA-MB-231), human prostate carcinoma (PPC-1), and human glioblastoma (U-87). Compounds 4, 9, 14, and 22 were identified as the most promising anticancer agents from a series of imidazole derivatives. They showed the highest cytotoxicity by MTT assay against MDA-MB-231, PPC-1 and U-87 cell lines. Compounds 14 and 22 were most selective against PPC-1 and U-87 cell lines, and their EC50 values against these cell lines ranged from 3.1 to 47.2 µM. Most tested compounds showed lower activity against the triple-negative breast cancer MDA-MB-231 cell line. None of the imidazole derivatives possessed an inhibiting effect on the migration of PPC-1 and U-87 cells by ‘wound’ healing assay. In spheroid assay, the most promising were compounds 14 and 22, especially in PPC-1 3D cultures. They efficiently reduced both the size and the viability of PPC-1 spheroid cells.

Background: Periprosthetic fractures following total hip arthroplasty are serious complications occurring in up to 2.4% of primary cases, contributing to significant morbidity, extended hospital stays, and elevated healthcare costs. Predicting these fractures remains a challenge despite advances in surgical techniques and prosthetic materials. Methods: This study analyzed 1,634,615 cases of primary THA from the NIS database (2016–2019) using propensity score matching to compare outcomes between patients with and without intraoperative periprosthetic fractures. Predictive models, including logistic regression, decision tree, and deep neural network, were evaluated for their ability to predict fracture risk. Results: Patients with periprosthetic fractures exhibited a 14-fold increase in pulmonary embolism risk, a 12-fold increase in infections, and a 5-fold increase in hip dislocations. Fractures extended hospital stays (3.8 vs. 2.5 days) and added approximately USD 32,000 in costs per patient. The predictive models yielded low accuracy (AUC max = 0.605), underscoring the complexity of predicting periprosthetic fractures. Conclusions: Intraoperative periprosthetic fractures in THA significantly elevate complication rates, costs, and length of stay. Despite extensive modeling efforts, accurate prediction remains difficult, highlighting the need to focus on preventive strategies, such as improved surgical techniques and real-time intraoperative monitoring.

Background/Objectives: This study aims to investigate whether Signal Transducer and Activator of Transcription 4 (STAT4) influences the anti-tumor immune response and is possibly involved in the initiation or relapse of pituitary adenomas (PAs) by examining STAT4 polymorphisms and serum levels. This research seeks to uncover potential connections that could inform future therapeutic strategies and improve our understanding of PA pathogenesis. Materials and Methods: This study was conducted at the Laboratory of Ophthalmology, Lithuanian University of Health Sciences. DNA was extracted from peripheral venous blood samples, and the genotyping of four STAT4 SNPs (rs7574865, rs10181656, rs7601754, and rs10168266) was performed using real-time PCR with TaqMan® Genotyping assays. The serum STAT4 levels were measured via ELISA, and the optical density was read at 450 nm. Genotype frequencies, allele distributions, and serum STAT4 levels were statistically analyzed to assess associations with pituitary adenoma occurrence. Results: A binary logistic regression revealed that the STAT4 rs7574865 GT + GG genotypes vs. TT were associated with 1.7-fold increased odds of PA occurrence under the dominant genetic model (p = 0.012). The stratification by gender showed no significant associations in females; however, in males, the STAT4 rs10168266 CC + CT genotypes compared to TT were linked to 2.5-fold increased odds of PA under the dominant genetic model (p = 0.005). STAT4 rs10181656, rs7574865, rs7601754, and rs10168266 were analyzed to evaluate the associations with the pituitary adenoma size. We found that the STAT4 rs7574865 GG genotype was statistically significantly less frequent in the macro PA group compared to in the reference group (p = 0.012). For PA relapse, the rs7574865 G allele was less frequent in the PA group without relapse (p = 0.012), and the GT + GG genotypes were associated with a 1.8-fold increase in the PA group without relapse occurrence (p = 0.008). The serum STAT4 levels were higher in the PA patients compared to those of the reference group (p < 0.001). Elevated STAT4 serum levels were observed in PA patients with the STAT4 rs10181656 CC or CG genotypes (CC: p = 0.004; CG: p = 0.023), and with the rs7574865 GG or GT genotypes (GG: p = 0.003; GT: p = 0.021). The PA patients with the STAT4 rs7601754 AA genotype exhibited higher serum levels compared to those of the reference group (p < 0.001). Similarly, higher serum levels were found in the PA patients with the STAT4 rs10168266 CC or CT genotypes (CC: p = 0.004; CT: p = 0.027). A haplotype frequency analysis revealed no statistically significant results. Conclusions: The STAT4 genotypes were significantly associated with the PA occurrence, size, and relapse. Elevated serum STAT4 levels were observed in the PA patients, highlighting its potential role in PA pathogenesis.