Ziel dieser Diplomarbeit ist Ähnlichkeiten und Untershiede in der Erziehung der polnishen und litaunishen Kinder festzustellen, die durch Deviationsverhalten gekennzeichnet sind. Im Laufe der Arbeit wurde die pedagogische und psychologische Literatur der beiden Länder analysiert, die mit diesem Problem verbunden ist. Damit wurden die Hauptfaktoren festgestellt, die das Deviativnsverhalten der Kinder und Jugendlichen in Polen und Litauen beeinflussen. In der Dimplomarbeit wurden juristische Basys der Kinderrechtschutz in Polen und Litauen sowoll auch der Niveau der prophylastischen Tätigkeit mit den Kindern analysiert, die Veranlagung zur Deviationsverhalten haben.

The influence of pathologies to blood pressure and velocity in blood vessels.

The influence of pathologies to blood pressure and velocity in blood vessels.

Physical load, age and gender influence to blood pressure and maximal stresses in the pathological blood vessel palaces was studies in this work. The main research subject – pathological blood vessel and its blood flow processes that depend on physical load, pathology degree and type, age, gender and blood vessels stress characteristics. The main aim of this work – to examine blood flow characteristics, local blood pressure, stress distribution in the pathological blood vessels dependent physical load assessing blood vessels mechanical properties variations due to age, gender, blood vessel pathology type; to make simplified human efficiency evaluation methodology. The paper analyse a few main tasks: to explore physical load, blood vessels pathology degree, age and gender influence to blood pressure and tensions increase in the pathological blood vessels locations; experimentally determine blood flow rates changes in pathological blood vessels assessing; additionally investigate blood pressure and heart rate characteristics variations during set physical load and human working age range. This paper consists of introduction, four chapters, summary, literature and authors publications theses lists and two annexes. Introductory chapter discusses the test problem, work topicality, research subject, also formulates work subject and tasks, and describes research methodology, work scientific novelty, practical value of the work results, defended propositions. In the introduction end... [to full text] / Disertacijoje nagrinėjama fizinio krūvio, amžiaus bei lyties įtaka kraujo spaudimui ir didžiausiems įtempiams pažeistoje kraujagyslės vietoje. Pagrindinis tyrimo objektas – ligos pažeista kraujagyslė ir joje vykstantys kraujo tėkmės procesai, priklausantys nuo fizinio krūvio dydžio, pažeidimo laipsnio ir rūšies, amžiaus, lyties, bei šių veiksnių įtaka didžiausiems įtempiams ir spaudimui pažeistose vietose. Pagrindinis disertacijos tikslas – ištirti kraujo tėkmės charakteristikas, lokalinį kraujo spaudimą, įtempių pasiskirstymą pažeistose kraujagyslėse priklausomai nuo fizinio krūvio, įvertinant kraujagyslių mechaninių savybių pokytį dėl amžiaus, lyties, kraujagyslės pažeidimo rūšies, ir sudaryti supaprastintą darbingumo verti-nimo metodiką. Darbe sprendžiami keli uždaviniai: ištirti fizinės apkrovos dydžio, kraujagyslių pažeidimų laipsnio, amžiaus ir lyties įtaką kraujo spaudimui ir įtempių padidėjimui pažeistose kraujagyslių vietose; ekspe-rimentiniu būdu nustatyti kraujo tėkmės rodiklių pokyčius pažeistose kraujagyslėse; ištirti kraujo spaudimo ir širdies susitraukimų dažnio charakteristikų pokyčius nustatytame fizinio krūvio ir žmogaus darbingo amžiaus intervale. Disertaciją sudaro įvadas, keturi skyriai, rezultatų apibendrinimas, naudotos literatūros ir autorės publikacijų disertacijos tema sąrašai ir du priedai. Įvadiniame skyriuje aptariama tiriamoji problema, darbo aktualumas, aprašomas tyrimų objektas, formuluojamas darbo tikslas bei uždaviniai, aprašoma tyrimų... [toliau žr. visą tekstą]

The 12th International St Gallen conference on breast cancer (2011) proposed patient categorization for systemic therapy, based on intrinsic breast cancer subtypes, defined by imunohistochemistry (IHC) test results. Since this classification is based on semi-quantitative expression of IHC biomarker expression, an issue of defining and applying cutoff values remains. Essential improvement in the IHC testing has become possible with digital image analysis tools enabling quantitative evaluation of the IHC data. This study explores data obtained by digital image analysis methods applied to evaluate a comprehensive biomarker dataset (p53, AR, p16, BCL2, SATB1, HIF1) along with well established (ER, PR, HER2, Ki67) biomarkers. Also, an extensive set of genetic and epigenetic biomarkers has been tested. For the first time, the dataset of 10 IHC biomarkers, evaluated by digital analysis was explored by the means of factor analysis to establish the intrinsic factors of biological variation and informative value of IHC biomarkers and their combinatiions. The results also provided insights into the significance and combinatorial effects of the established and relatively new biomarkers (p16, SATB1, HIF1, Ki67/BCL2, etc.). / XII tarptautinėje St Gallen krūties vėžio konferencijoje (2011) Ekspertų komisijos priimta nauja pacientų klasifikacija sisteminei terapijai atlikti, paremta biologiniais krūties vėžio subtipais, kurie apibrėžiami imunohistocheminiu tyrimu (IHC). Tačiau ši nauja navikų klasifikacija iš esmės pagrįsta pusiau kiekybiniu biožymenų raiškos vertinimu, todėl išlieka aktuali ribinių verčių nustatymo problematika. Esminiai pokyčiai IHC tyrimų srityje galimi atsiradus skaitmeninio vaizdinimo technologijoms, leidžiančiomis IHC tyrimų rezultatus analizuoti kiekybiniais parametrais. Darbe naudojant skaitmeninį vaizdo analizės metodą atliktas išsamus biologinių žymenų tyrimas leido palyginti svarbių, tačiau nepakankamai ištirtų (p53, AR, p16, BCL2, SATB1, HIF1) IHC žymenų informatyvumą su esamų prognozinių žymenų (ER, PR, HER2, Ki67) rodikliais. Ištirtas platus genetinių ir epigenetinių krūties vėžio žymenų spektras. Pirmą kartą 10 IHC žymenų rinkinio, įvertinto skaitmeninės analizės būdu, duomenys panaudoti faktorinės analizės metodu nustatyti jų variacijų vidinius veiksnius, atskleidžiančius biologinius dėsningumus ir IHC žymenų bei jų derinių informatyvumą. Šios analizės rezultatai leido naujai įvertinti publikuotų krūties vėžio IHC žymenų bei jų derinių (p16, SATB1, HIF1, Ki67/BCL2 ir kt.) informatyvumą.

XII tarptautinėje St Gallen krūties vėžio konferencijoje (2011) Ekspertų komisijos priimta nauja pacientų klasifikacija sisteminei terapijai atlikti, paremta biologiniais krūties vėžio subtipais, kurie apibrėžiami imunohistocheminiu tyrimu (IHC). Tačiau ši nauja navikų klasifikacija iš esmės pagrįsta pusiau kiekybiniu biožymenų raiškos vertinimu, todėl išlieka aktuali ribinių verčių nustatymo problematika. Esminiai pokyčiai IHC tyrimų srityje galimi atsiradus skaitmeninio vaizdinimo technologijoms, leidžiančiomis IHC tyrimų rezultatus analizuoti kiekybiniais parametrais. Darbe naudojant skaitmeninį vaizdo analizės metodą atliktas išsamus biologinių žymenų tyrimas leido palyginti svarbių, tačiau nepakankamai ištirtų (p53, AR, p16, BCL2, SATB1, HIF1) IHC žymenų informatyvumą su esamų prognozinių žymenų (ER, PR, HER2, Ki67) rodikliais. Ištirtas platus genetinių ir epigenetinių krūties vėžio žymenų spektras. Pirmą kartą 10 IHC žymenų rinkinio, įvertinto skaitmeninės analizės būdu, duomenys panaudoti faktorinės analizės metodu nustatyti jų variacijų vidinius veiksnius, atskleidžiančius biologinius dėsningumus ir IHC žymenų bei jų derinių informatyvumą. Šios analizės rezultatai leido naujai įvertinti publikuotų krūties vėžio IHC žymenų bei jų derinių (p16, SATB1, HIF1, Ki67/BCL2 ir kt.) informatyvumą. / The 12th International St Gallen conference on breast cancer (2011) proposed patient categorization for systemic therapy, based on intrinsic breast cancer subtypes, defined by imunohistochemistry (IHC) test results. Since this classification is based on semi-quantitative expression of IHC biomarker expression, an issue of defining and applying cutoff values remains. Essential improvement in the IHC testing has become possible with digital image analysis tools enabling quantitative evaluation of the IHC data. This study explores data obtained by digital image analysis methods applied to evaluate a comprehensive biomarker dataset (p53, AR, p16, BCL2, SATB1, HIF1) along with well established (ER, PR, HER2, Ki67) biomarkers. Also, an extensive set of genetic and epigenetic biomarkers has been tested. For the first time, the dataset of 10 IHC biomarkers, evaluated by digital analysis was explored by the means of factor analysis to establish the intrinsic factors of biological variation and informative value of IHC biomarkers and their combinatiions. The results also provided insights into the significance and combinatorial effects of the established and relatively new biomarkers (p16, SATB1, HIF1, Ki67/BCL2, etc.).

Darbas atliktas Lietuvos Sveikatos Mokslų Universiteto Veterinarijos Akademijos Patologijos centre nuo 2012 metų sausio iki 2013 metų spalio mėnesio. Darbo tema: Kačių ovariohisterektomijos statistinių duomenų ir gimdos bei kiaušidžių patomorfologinių tyrimų analizė. Tyrimo tikslas - atlikti kačių ovariohisterektomijos statistinių duomenų ir gimdos bei kiaušidžių patomorfologinių tyrimų analizę. Tyrimo tema aktuali dėl vis didėjančio kačių reprodukcijos susidomėjimo, siekiant susilaukti sveikų palikuonių. Tyrimų objektas – katės (patelės, Felis catus), kurioms buvo atlikta OHE. Ištirti 227 kačių organai (n=227), ir apklausius jų šeimininkus, surinkti statistiniai duomenys. Vertinamos kiaušidės ir gimda, jų topografija, dydis, spalva, konsistencija, kvapas ir forma. Organai vertinami iš išorės, vėliau pjūvyje. OHE metu, įtarus patologijas, paimti kiaušidžių ir gimdos mėginiai histopatologiniam tyrimui. Ištirta 16 kačių kiaušidžių ir 13 gimdų. Mėginiai dažyti hematoksilinu ir eozinu. Kiaušidžių ir gimdos patologijos katėms diagnozuojamos retai (apie 7 proc.) ir dauguma aptinkamos rutininės OHE metu. Kiaušidėse dažniausiai aptinkami pakitimai - cistos, gimdoje - piometra. Vidutinis kačių, sergančių piometra amžius - 6 metai. Statistiniai duomenys apskaičiuoti Microsoft Office Excel 2007. Darbo apimtis - 56 puslapiai, naudoti 47 literatūros šaltiniai, 6 lentelės, 34 paveikslai. / This work was carried out in the period of 2012 January to 2013 October at the Pathology Center of the Veterinary Academy of the Lithuanian University of Health Sciences. The title of work is “The analysis of feline ovariohysterectomy statistics and ovarian and uterus pathomorphological researches”. The aim of the study: to perform cats OHE statistics and ovarian and uterus pathomorphological investigations analysis. The research theme is relevant due to increasing interest in feline reproduction, in order to have healthy offsprings. The object of study is the cats (female, Felis catus), which has been conducted OHE. There were examined 227 cats ovaries and uterus. Pet's owners were interviewed in order to get statistical data. Topography, size, color, texture, smell and shape of ovaries and uteruses were estimated. Organs were examined from the outside, later in the section. Samples for histopathological examination were taken due to suspected pathology. There were tested 16 cats ovaries and 13 uteruses. They were stained by hematoxylin and eosin. Cats ovary and uterus pathology are rare (about 7%) and diagnosed mostly by daily OHE. Cysts mostly are diagnosed in ovaries, in uterus – pyometra. Average age of cats with pyometra is 6 year. Average age of cats, which was operated – 30 months. OHE is performed to terminate cats reproduction. Statistical data analysis was rated by Microsoft Excel 2007. The volume of work is 56 pages, 6 tables and 34 pictures. Total count of... [to full text]

Problemos aktualumas: Jaunesniame mokykliniame amžiuje (I-IV kl.) formuojasi nauji, svarbūs vaiko psichikos bruožai, kurių pagrindu ugdosi labai svarbios savybės ¬­ savistaba, s¬ugebėjimas analizuoti savo poelgius ir kt. sudaro sąlygas formuotis valingam dėmesiui. Tačiau pastaruoju metu aktualia problema tampa auganti karta, kurioje yra nemažai vaikų, turinčių emocinių ir elgesio sutrikimų, kurie turi neigiamą reikšmę vaiko tolesnei psichikos raidai. Apžvelgiant kokybinių mokslinių tyrimų publikacijas Lietuvoje pasigendama mokslinių darbų, kuriuose emocijų ir elgesio problemos būtų tirtos taikant objektyvias standartizuotas metodikas. Dažniausiai duomenys renkami taikant anketavimo metodą, kurio autoriai būna patys tyrėjai. Šiuo metu užsienio šalyse emocijų ir elgesio sutrikimams vertinti plačiai naudojama BASC-2 metodika (Behavior Assessment System for Children, Reynolds ir Kamphaus, 2004, 2005), kuria galima nustatyti vaikų asmenų emocijų, jausmų ir elgesio modelių (pozityvaus ir klinikinio) ypatumus. Tyrimo objektas – 4 kl. mokinių elgsenos ir emocijų problemos. Tyrimo tikslas: Ištirti 4 kl. mokinių savo elgsenos ir emocijų problemų vertinimą ir palyginti jį su auklėtojos įvertinimu. Uždaviniai: 1. Ištirti ir palyginti 4 kl. mokinių internalių ir eksternalių problemų vertinimą mokinių ir mokytojo požiūriu. 2. Išanalizuoti ir palyginti mokinių problemų mokykloje patiriamus sunkumus jų pačių ir mokytojo vertinimu. 3. Ištirti ir palyginti mokinių asmeninio prisitaikymo... [toliau žr. visą tekstą] / Topicality of the problem: At the primary – school age (I – IV forms) new important formatives of a childs mentality start farming. They are basic for developing such important qualities as self – observation, ability to analyze ones actions and others that help to maintain volitional attention. However a new generation has recently become an urgent problem because there are a lot of children with behavioral and emotional disorders and that has negative influence on the further development of mentality. After surveying the publications of scientific studies in Lithuania it can be stated that there are no studies in which emotional and behavioral problems would be analyzed using objective standardized methods. The data is usually collected using questionnaire method the investigators themselves. At present BASC – 2 methodic (Behavior Assessment System for Children, Reynolds and Kamhaus, 2004, 2005), which makes it possible to establish peculiarities of models (positive and clinical) of childrens emotions, feelings and behavior is being widely used in foreign countries for estimation emotional and behavioral disorders. The object of the study – emotional and behavioral problems in 4 th formers. The aim of the study: To examine the 4 th formers estimation of their behavior and emotions and to compare it with the class – teachers estimation. The tasks: 1. To examine and compare the estimation of the 4 th formers internal and external problems both, in their own and their teacher... [to full text]

<p>Cilj ovog istraživanja bio je da se utvrdi razlika u debljini sloja retinalnih nervnih vlakana (RNFL) i parametara glave očnog živca kod pacijenata sa preperimetrijskim glaukomom i pacijenata sa glaukomom otvorenog ugla (POAG) u odnosu na zdravu populaciju, kao i da se utvrdi razlika u debljini RNFL i parametara glave očnog živca kod pacijenata sa POAG u odnosu na stepen progresije bolesti. Materijal i metode: U ovu kliničku, analitičku i opservacionu, po tipu &bdquo;slučaj-kontrola&ldquo; studiju, bilo je uključeno 120 pacijenata. Na osnovu kliničkog nalaza formirane su četiri grupe. Prva grupa (grupa zdravih): 30 pacijenata bez glaucoma i drugih očnih bolesti. Druga grupa (grupa sa početnim POAG): 30 pacijenata sa POAG, sa karakterističnim o&scaron;tećenjem glave očnog živca i RNFL, kod kojih je srednja vrednost devijacije standardizovane automatske perimetrije MD&lt;-6dB (prema Hodap klasifkaciji) sa karakterističnim glaukomskim ispadima u vidnom polju. Treća grupa (grupa sa srednje uznapredovalim POAG): 30 pacijenata sa POAG, kod kojih je srednja vrednost devijacije standardizovane automatske perimetrije MD od -6dB do -12dB (prema Hodap klasifkaciji). Četvrta grupa (grupa sa preperimetrijskim glaukom): 30 pacijenata sa promenama na glavi očnog živca karakterističnim za glaukomsku neuropatiju, kod kojih ne postoje funkcionalni ispadi tj. standardna automatizovana perimetrija pokazuje normalne vrednosti MD parametara (od -2 dB do +2dB). Kod svih pacijenata bio je urađen kompletan oftalmolo&scaron;ki pregled, kompjuterizovano vidno polje i optička koherentna tomografija peripapilarne regije RNFL i glave očnog živca (na aparatu Stratus OCT 3000, Carl Zeiss Meditec). Rezultati su pokazali da je debljina RNFL-a kod pacijenata sa početnim POAG manja u odnosu na zdravu populaciju. Najveće sniženje debljine RNFL je u sektorima 1,6,7 i 8h. Jedino u sektoru 4h i 9h ne dolazi do smanjenja debljine RNFL-a. Najveće smanjenje debljine RNFL je u gornjem i donjem kvadrantu, te oni imaju visoku specifičnost za diskriminaciju između zdravih i pacijenata sa početnim POAG. Parametri glave očnog živca: volumen ekskavacije, vertikalni C/D, horizontalni C/D i ukupni C/D odnos kod pacijenata sa početnim POAG povećani su u odnosu na zdravu populaciju. Parametri glave očnog živca: povr&scaron;ina neuroretinalnog oboda i volumen neuroretinalnog oboda, kod pacijenata sa početnim POAG smanjeni su u odnosu na zdravu populaciju. Debljina RNFL kod pacijenata sa srednje uznapredovalim POAG smanjena je i u odnosu na pacijente sa početnim POAG i u odnosu na zdravu populaciju (59,69&plusmn;10,63 &mu;m vs 73,44&plusmn;12,16&mu;m vs 105,57&plusmn;11,34 &mu;m). Parametri glave očnog živca prate ove promene. Ukupna povr&scaron;ina glave očnog živca se statistički značajno ne menja između zdravih osoba, pacijenata sa početnim i srednje uznapredovalim glaukomom otvorenog ugla i kod pacijenata sa preperimetrijskim glaukomom, te ovaj parametar ne determini&scaron;e glaukomsku bolest. Postojanje i napredovanje glaukoma kod pacijenata dovodi do istanjenja&nbsp; peripapilarnog RNFL &scaron;to je praćeno povećanjem ekskavacije glave očnog živca. Sa smanjenjem MD vrednosti dolazi do sledstvenih promena većine parametara. Postoji pozitivna korelacija između uznapredovalosti galukoma i srednje vrednosti debljine RNFL. Promena ove vrednosti najbolje pokazuje da dolazi do progresije POAG. Parametri glave očnog živca koji najbolje oslikavaju progresiju glaukoma su: ukupni C/D, vertikalni C/D i horizontalni C/D odnos. Debljina RNFL-a kod pacijenata sa preperimetrijskim glaukomom je značajno manja u od nosu na zdravu populaciju (83,65&plusmn;9,24&mu;m vs 105,57&plusmn;11,34&mu;m). To se posebno izražava u gornjem kvadrantu, dok u temporalnom kvadrantu ne dolazi do promena. Parametar S zajedno sa srednjom vrednosti debljine RNFL predstavljaju najbolje pokazatelje nastajanja preperimetrijskog glaukoma. Sektor 1h je sektor sa visokom specifično&scaron;ću za diskriminaciju izmeĎu zdravih i pacijenata sa preperimetrijskim glaukomom. Parametri glave očnog živca: volumen ekskavacije, vertikalni C/D, horizontalni C/D i srednji C/D odnos, kod pacijenata sa preperimetrijskim glaukomom statistički su značajno povećavani i u odnosu na zdravu populaciju. Parametri glave očnog živca: povr&scaron;ina neuroretinalnog oboda i volumen neuroretinalnog oboda, kod pacijenata sa preperimetrijskim glaukomom statistički su značajno manji u odnosu na zdravu populaciju. Najbolji prediktori nastanka i napredovanja glaukomske bolesti su sledeći parametri: AvgThic, debljina RNFL po kvadrantima-S,I,N; parametric debljine RNFL: Smax, Savg, Iavg; kao i parametri PNO: RimArea, RimVol, DiscArea, CupAear, C/DHorRat, C/DVertRat, C/DAreaRat. ROC kriva je pokazala da su sledeću parametri lo&scaron;i marker za progresiju bolesti: debljine RNFL kavdranta T, Imax i upVol. Zaključak: Određivanje parametara glave očnog živca i debljine peripapilarnih RNFL kod pacijenata sa glaukomom, optičkom koherentnom tomografijom, predstavlja metodu koja izdvaja pacijente sa preperimetrijskim glaukomom od zdrave populacije. Ono posebno ukazuje na sektore, kvadrante i parametre koji su najosetljiviji na glaukomsku noksu i koji prvi postaju patolo&scaron;ki pri nastanku glaukoma. Takođe, ukazuje i na razliku između pojedinih stepena glaukomske bolesti. Na ovaj način se omogućuje sigurna i rana dijagnoza glaukoma, njegovo pravovremeno lečenje i bolja prognoza kod pacijenata sa POAG.</p> / <p>Aim: The aim of this study was to determine the difference in thickness of retinal nerve fibre layer (RNFL) and parameters of optic nerve head in patients with preperimetric glaucoma and in patients with open angle glaucoma (POAG) in comparison to healthy population, as well as to determine the difference in thickness of RNFL and parameters of optic nerve head in patients with POAG according to progression of the disease. Material and methods: This clinical study was analytical and opservational, &bdquo;case-control&ldquo; type of study. 120 patients were included. On the basis of clinical finding 4 groups were formed. First group (healthy): 30 patients without glaucoma and with no other ocular disease. Second group (group of patients with mild POAG): 30 patients with POAG, with characteristical optic nerve head and RNFL damage, in whom the value of standard deviation of standardised automatic perimetry is MD&lt;-6dB (according to Hodap classification) with typical glaucomatous visual field defects. Third group (group of patients with moderate POAG): 30 patients with POAG in whom the mean value of standard deviation of standardised automatic perimetry, MD is from -6dB to -12dB (according to Hodap classification). Fourth group (group of patients with preperimetric glaucoma): 30 patients with changes of optic nerve head that are typical of glaucomatous neuropathy in whom there are no functional changes and with normal values of MD parameters of standardised automatic perimetry. In all patients complete ophthalmological examination, complete visual field and optic coherent tomography of peripapillar region of RNFL and optic nerve head (using Stratus OCT 3000, Carl Zeiss Meditec) were performed.The results showed that thickness of RNFL in patients with mild POAG is lesser than in healthy subjects. The greatest decrease in RNFL thickness is in sectors 1,6,7 and 8h. Only in sectors 4h and 9h there is no decrease in RNFL thickness. The greatest decrease in RNFL thickness is in upper and lower quadrant, so they are highly specific in determination between healthy subjects and patients with mild POAG. Parameters of optic nerve head such as: excavation volume, vertical C/D, horisontal C/D and total C/D ratio in patients with mild POAG are higher comparing to healthy population. Parameters of optic nerve head such as: neuroretinal rim area and neuroretinal rim volume in patients with mild POAG are lower than in healthy population. RNFL thickness in patients with moderate POAG is lesser than in patients with mild POAG, as well as in healthy subjects. Optic nerve head parameters follow these changes. Total optic nerve head area does not change in healthy subjects, in patients with mild and moderate open angle glaucoma and in patients with preperimetric glaucoma, so this parameter does not determine glaucomatous disease. The existence and progression of glaucoma in patients leads to thinning of peripapillar RNFL which is followed by increase of excavation of optic nerve head. With decrease of MD value there are consecutive changes in most parameters. There is positive correlation between progression of glaucoma and average thickness of RNFL. The change of this value shows the best if there is progression of POAG. Paremeters of optic nerve head that are the best determinants of progression of glaucoma are: total C/D, vertical C/D and horisontal C/D ratio. Thickness of RNFL in patients with preperimetric glaucoma is significantly lesser than in healthy subjects. It is particularly seen in upper quadrant, while in temporal quadrant there are no changes. Parameter S together with mean value of RNFL thickness is the best parameter of appearance of preperimetric glaucoma. Sector 1h is the sector that is highly specific in discrimination between healthy subjects and patients with preperimetric glaucoma. Optic nerve head parameters such as: volume of excavation, vertical C/D, horizontal C/D and C/D mean ratio in patients with preperimetric glaucoma are statistically significantly higher than in healthy population. Optic nerve head parameters such as: neuroretinal rim area and neuroretinal rim volume in patients with preperimetric glaucoma are statistically significantly lower than in healthy population. The best predictors of appearance and progression of glaucomatous disease are: AvgThic, RNFL thickness in quadrants: S,I,N; RNFL:Smax, Savg, Iavg; as well as PNO: RimArea, RimVol, DiscArea, CupAear, C/DHorRat, C/DVertRat, C/DAreaRat. ROC curve has shown that the following parameters are bad markers for progression of the disease: RNFL thickness in quadrant T, Imax and CupVol. Conclusion: Determination of parameters of optic nerve head and peripapillar RNFL in patients with glaucoma using optical coherent tomography represents the method that distinguishes the patients with preperimetric glaucoma from healthy subjects. It particularly points the sectors, quadrants and parameters that are the most sensitive to glaucomatous disease and that first become pathological when disease appears. It also indicates the difference between certain levels of glaucomatous disease. In this way safe and early diagnosis of glaucoma is provided, as well as adequate therapy and better prognosis in patients with POAG.</p>

<p>Akutni respiratorni distres sindrom (ARDS) predstavlja klinički sindrom koji se manifestuje te&scaron;kom respiratornom insuficijencijom sa razvojem akutnog edema pluća u odsustvu znakova popu&scaron;tanja leve polovine srca. S obzirom da ovaj sindrom ima heterogenu etiologiju, progresivan tok i visoku stopu mortaliteta, pravovremena i tačna dijagnoza esencijalna je u primeni efektivne i rane terapije, a samim tim i u pobolj&scaron;anju prognoze bolesti. Cilj ove doktorske disertacije bio je da se ispita povezanost kliničke i patohistolo&scaron;ke dijagnoze ovog sindroma, kao i da se analiziraju i uporede vrednosti kliničkih parametara neophodnih za postavljanje dijagnoze ARDS-a sa patohistolo&scaron;kim parametrima o&scaron;tećenja plućnog tkiva. Studija je obuhvatila 67 pacijenata Instituta za plućne bolesti Vojvodine koji su umrli pod kliničkom slikom ARDS-a i/ili kod kojih je na obdukciji patohistolo&scaron;ki dokazan ARDS. Za postavljanje kliničke dijagnoze ARDS-a kori&scaron;ćeni su kriterijumi The American-European Consensus Conference iz 1994. Nakon semikvantitativne analize patohistolo&scaron;kih parametara difuznog alveolarnog o&scaron;tećenja određivan je histolo&scaron;ki stadijum ARDS-a i svi pacijenti podeljeni su u dve grupe: I grupa - pacijenti u eksudativnoj fazi i II grupa - pacijenti u proliferativnoj fazi difuznog alveolarnog o&scaron;tećenja. Formirane grupe pacijenata upoređivane su u odnosu na vrednosti kliničkih parametara 12h pre smrtnog ishoda. U cilju procene prisustva komorbiditeta analizirani su indeks telesne mase (engl. body mass index- BMI) i podaci o prethodno dijagnostikovanoj arterijskoj hipertenziji. Kod svih pacijenata uključenih u studiju upoređivane su kliničke dijagnoze sa obdukcionim nalazom. Za klasifikaciju autopsijskih dijagnoza kori&scaron;ćena je Goldman-ova klasifikacija. Na osnovu provedenog istraživanja, do&scaron;lo se do zaključka da slaganje klinički dijagnostikovanih i patohistolo&scaron;ki potvrđenih slučajeva ARDS-a iznosi 68%. Senzitivnost kliničke dijagnoze ARDS-a iznosi 82%, a pozitivna prediktivna vrednost 80%. Pacijenti sa nalazom eksudativne faze DAD-a u plućnom tkivu su u najvećem procentu imali klinički težak ARDS, dok su se pacijenti sa nalazom proliferativne faze sindroma če&scaron;će manifestovali pod kliničkom slikom srednje te&scaron;kog ARDS-a, odnosno utvrđeno je da postoji statistička povezanost između nižih vrednosti PaO2/FiO2 i teže faze ARDSa. Patohistolo&scaron;kom analizom promena u plućnom tkivu nađeno je da najvažnija obeležja eksudativne faze ARDS-a predstavljaju: hijaline membrane, edem i krvarenje, dok su se kao najvažnija obeležja proliferativne faze ARDS-a izdvojili: proliferacija pneumocita tipa II, intersticijalna i mutilantna fibroza i organizirajuća pneumonija. Kod pacijenata sa kliničkom dijagnozom ARDS-a kod kojih ARDS nije i patohistolo&scaron;ki dokazan, najče&scaron;ći nalaz na plućima bila je fibrinozno-purulentna bronhopneumonija. Analizom etiolo&scaron;kih faktora koji doprinose razvoju ovog sindroma otkriveno je da je ARDS najče&scaron;će nastao kao posledica delovanja direktnih/pulmonalnih činilaca: pneumonije i virusa gripa H1N1. Najzastupljeniji komorbiditeti prisutni kod pacijenata sa ARDS-om bili su sistemska hipertenzija i gojaznost. Najzad, kod svih pacijenata uključenih u istraživanje upoređivane su kliničke dijagnoze sa obdukcionim nalazom i na osnovu Goldman-ove klasifikacije kliničke dijagnoze i obdukcioni nalaz slažu se u 72% slučajeva. Rezultati ove studije mogli bi se upotrebiti u daljim istraživanjima kako bi omogućili bolji dijagnostički pristup ovom problemu, a samim tim i bolji terapijski pristup i smanjivanje stope mortaliteta.</p> / <p>Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by severe respiratory failure with development of acute pulmonary edema in the absence of left heart failure signs. Since this syndrome has a heterogeneous etiology, progressive course and high mortality, timely and accurate diagnosis is essential in the implementation of effective and early treatment, and therefore in improving the prognosis of the disease. The aim of this PhD thesis was to examine the association between clinical and pathohistological diagnosis of this syndrome, as well as to analyze and compare the values of clinical parameters necessary for the diagnosis of ARDS with pathohistological parameters of diffuse alveolar damage. The study included 67 patients of the Institute for Lung Diseases who died under clinical picture of ARDS and / or in which, at the autopsy, pathohistological diagnosis of ARDS was set. To set up a clinical diagnosis of ARDS the criteria of the American-European Consensus Conference in 1994 were used. After a semi-quantitative analysis of histopathological parameters of diffuse alveolar damage, all patients were divided into two groups: Group I - patients in the exudative stage and Group II - patients in the proliferative phase of diffuse alveolar damage. Formed groups of patients were compared with respect to clinical parameters values 12 h before death. In order to assess the presence of comorbidities body mass index (BMI) and data on previously diagnosed arterial hypertension were analyzed. In all patients included in the study the clinical diagnosis were compared with autopsy findings according to Goldman&#39;s classification. According to this study, agreement of clinically diagnosed and histologically confirmed cases of ARDS is 68%. The sensitivity of clinical diagnosis of ARDS is 82%, and positive predictive value is 80%. Patients with exudative phase of DAD most frequently had a severe form of ARDS, whereas patients with proliferative phase often manifested with moderate form of ARDS, ie it was found that there is a statistical association between lower values PaO2 / FiO2 and more severe phase of ARDS. Pathological analysis of changes in lung tissue revealed that the most important characteristics of exudative phase of ARDS are: hyaline membrane, edema and bleeding, while the most important features of the proliferative phase of ARDS are: the proliferation of type II pneumocytes, interstitial fibrosis and mutilating and organizing pneumonia. In patients with a clinical diagnosis of ARDS in which ARDS was not pathohistologically proven, the most common finding in the lungs was fibrinous-purulent bronchopneumonia. The analysis of etiological factors that contribute to the development of this syndrome discovered that ARDS usually develop as a result of pulmonary factors: pneumonia and influenza virus H1N1. The most common comorbidities present in patients with ARDS were systemic hypertension and obesity. Finally, in all patients included in the study clinical diagnosis and autopsy findings were compared and based on Goldman&#39;s classification clinical diagnosis and autopsy findings are in agreement in 72% of cases. The results of this study could be used in further research to enable better diagnostic approach to this problem, and therefore a better therapeutic approach and reducing mortality rates.</p>