Thesis (Ph.D.)--Indiana University, 2009. / Title from screen (viewed on December 1, 2009). Department of Anatomy and Cell Biology, Indiana University-Purdue University Indianapolis (IUPUI). Advisor(s): Zao C. Xu, Feng C. Zhou, Charles R. Yang, Theodore R. Cummins. Includes vitae. Includes bibliographical references (leaves 115-135).

Context: As one of the major causes of death and disability in Canada, research into the treatment and prevention of acute cerebrovascular syndrome (ACVS) remains a priority for clinicians, researchers and the general public. Understanding the relationship between current treatment practices of a rapid stroke clinic and patient outcomes is an essential part of measuring success and considering opportunities for quality improvement. Objective: This study compared the 90-day and 1-year hospital admission and mortality outcomes of patients who were referred to and seen in a rapid stroke clinic (the shows) following an initial transient neurological event (TNE) with those who were referred to but not seen in the same clinic (the no-shows). The specific outcomes examined were stroke events, cardiovascular events and all other hospital events. Methods: In this post-test only non-equivalent group design, data on patient outcomes was collected in the Victoria-based Stroke Rapid Assessment Unit (SRAU) between 2007 and 2013. Analysis included an assessment of group equivalency for possible confounders (age, sex and severity score) and two sets of multivariate logistic regressions were conducted on nine outcomes. Results: An independent t-test revealed there was a statistically significant difference between the mean age of the shows (mean= 68.26) and no-shows (mean= 69.90) (p<0.01). While the proportion of males and females in each of the groups was similar (Fisher’s Exact test, p = 0.831, ns), the severity score of the treatment group (mean= 3.64) was statistically more severe in the show group than the no-show group (mean= 3.50; t = 2.137, p<0.05). Controlling for age, sex and severity score, the odds ratios (ORs) were calculated to compare the odds of various outcomes in the treated (shows) versus the untreated (no-shows) patients groups. ORs for the 90-day and 1-year hospital admissions for stroke-related events were 0.071 (p<0.01) and 0.091 (p<0.01), respectively; the OR for 1-year stroke deaths was 0.167 (p<0.01), indicating a strong protective factor related to attending the clinic appointment. For the cardiovascular outcomes, the ORs for hospitalizations were 0.967 (ns) at 90-days and 0.978 (ns) within 1-year and the OR for the 1-year cardiac-related deaths was 0.391 (ns). For all other outcomes, the ORs were 0.525 (p<0.01) for hospitalizations within 90-days, 0.579 (p<0.01) for hospitalizations within 1-year and 0.299 (p<0.01) for deaths within 1-year. These findings remained consistent with re-analysis excluding subjects who had an event within 5.4 days of their initial TNE. These latter finding largely rules out the possibility that the primary reason the no-shows did not make their clinic appointment, was due to a subsequent hospital event. Conclusion: The ORs for the outcomes show a protective effect of stroke and all other hospital outcomes (but not cardiac events) for patients treated in the rapid assessment clinic. The exclusion of patients who experienced an outcome while waiting for a clinic appointment, lowered the protective effect of the treatment and emphasized the need for rapid assessment but did not alter the main study conclusions. Future research that explores factors influencing appointment adherence and patient attitudes towards acute treatment of TNEs might reveal strategies that could help to reduce the number of patients that remain untreated and at a higher risk for poor outcomes. / Graduate

African Americans experience a disproportionate mortality, morbidity, and disability associated with ischemic stroke. Traditional risk factors offer some explanation for this finding, but novel risk factors have not been explored. APOE4 genotype, which is more prevalent in African Americans demonstrate a pro-inflammatory phenotype that may result in an exaggerated inflammatory response associated with ischemic stroke, resulting in worse outcomes. The purpose of this study was to examine relationships among APOE genotypes, inflammatory markers (CD11β, platelet leukocyte aggregates, IL-1β, IL-6, IL-8, and tissue necrosis factor alpha), the anti-inflammatory marker, IL-10, and risk factors (hypertension, diabetes type II, obesity, hyperlipidemia, and smoking) in African Americans at 3 days post stroke. Twenty five patients were enrolled with 12 patients in the APOE4 group and 13 patients in the non-APOE4 group. In the APOE4 group, 75% were male compared to 54% in the non-APOE4 group. The average age in the APOE4 group was 56.5 ± 9.0 compared to 66 ± 16.0 years in the non-APOE4 group. Females in the APOE4 group were younger with ages comparable to men. All participants had hypertension. Forty two percent of patients in the APOE4 group had two risk factors and 46% of patients in the non-APOE4 group had three risk factors. Major findings included 1) there were no statistical difference between inflammatory markers and APOE genotypes, and 2) the APOE4 carrier was not a predictor for overall inflammatory load among African Americans with ischemic stroke. The study was underpowered and small effect sizes were not sufficient to create statistical findings. This was the first study to examined APOE genotypes, inflammatory markers, and risk factors among African Americans with ischemic stroke. More studies are needed to not only investigate novel risk factors, but to also characterize inflammatory and genetic mechanisms with ischemic stroke and their associated outcomes among African Americans. Such studies may lead to primary and secondary prevention of ischemic stroke and reduce the health disparities associated with ischemic stroke among African Americans.

Disertacijoje nagrinėjamos medicininių vaizdų analizės problemos, taikant vaizdų spektrus. Pagrindiniai tyrimo objektai yra galvos kompiuterinės tomogramos bei magnetinio rezonanso angiogramos. Šie objektai yra svarb��s medicininės diagnostikos rezultatai, kurių detali analizė bei interpretacija leidžia parinkti tinkamiausią paciento gydymo būdą. Pagrindinis disertacijos tikslas yra sukurti metodikas ir algoritmus, skirtus automatiniam min÷tų vaizdų apdorojimui bei analizei. Sukurtų algoritmų taikymo sritis yra medicininė programinė įranga. Taip pat disertacijoje siekiama ištirti dažninio ir erdvinio dažninio spektrų taikymo galimybes medicininių vaizdų apdorojime ir analizėje, siekiant aptikti ir pažymėti vaizduose ligų sritis arba kitas specifines sritis. Darbe sprendžiami keli pagrindiniai uždaviniai: smegenų ir išeminio insulto sričių aptikimas tomogramose bei kraujagyslių pėdsakų sričių aptikimas angiogramose. Pirmasis uždavinys suformuluotas, atsižvelgiant į palyginti didelį išeminio insulto paplitimą ir jo diagnostikos aktualumą. Antrasis siejasi su aneurizmos srities aptikimo angiogramose problema. Disertaciją sudaro šeši skyriai, iš kurių paskutinis – rezultatų apibendrinimas. / The main idea of current PhD thesis is an analysis of frequency and joint space-frequency representations of medical images. The objects of investigation are digital images of computed tomography and magnetic resonance angiography of human brain. These objects are essential diagnostic results which require a detail visual analysis and interpretation for the successive selection of treatment. The aim of work covers the development of methods and algorithms suitable for automatic analysis of medical images which may be implemented in medical software. The other purpose encompasses an investigation of Fourier and Haar wavelet transforms in the analysis and processing of medical images. The result of analysis is assumed as an enhancement and segmentation of suspected regions of diseases or other specific regions. There are two main tasks under consideration. First one is an automatic detection of region of brain and ischemic stroke in the images of computed tomography. Second one is a detection of traces of blood vessels in magnetic resonance angiography images. The first task is formulated in the view of wide distribution and high relevance of diagnosis of ischemic stroke. Second task is related with the detection of diseases of blood vessels. The thesis is divided into six chapters including the conclusion’s chapter.

The aim of this work - to estimate an association of metabolic syndrome (MS) with ischemic heart disease (IHD) in middle-aged Kaunas population and to propose the model for preventing prevalence of MS. Material and methods. Analysis was performed for 1336 persons aged 35-64 years (603 men and 733 women) - the participants of health survey which has been carried out according to the MONICA study protocol. MS was defined by Adult Treatment Panel III criteria for the presence of three or more from five components: central obesity (waist circumference >102/88 cm (men/women)); fasting plasma glucose ≥6.1 mmol/l; triglycerides ≥1.7 mmol/l; high density lipoprotein cholesterol <1.04/1.3 mmol/l (men/women); systolic/diastolic blood pressure ≥130 and/or 85 mmHg. IHD was diagnosed as previous myocardial infarction, angina pectoris or ischemic changes in electrocardiogram. Lifestyle habits were evaluated using frequency questionnaire. The relationship between MS and IHD in consideration of age and smoking habits was estimated using logistic regression. Results. Prevalence of MS in the study population was 19.4 percent for men and 26.3 percent for women. Prevalence of MS among men and women increased with age. Hypertension was the most frequent component of MS (64.1 percent for men and 54.2 percent. for women). The rate of IHD was 14.3 percent for men and 19.4 percent for women. Risk of IHD in subjects with MS in comparing to subjects without MS was higher: odds ratio 1.98 (95 percent... [to full text]

Tyrimo problema – išeminės širdies ligos išsivystymui yra svarbūs keli faktoriai, kurių pavienė įtaka yra įrodoma, tačiau svarbu išsiaiškinti, ar egzistuoja šių rizikos veiksnių tarpusavio sąsajos. Tyrimo tikslas - nustatyti išemine širdies liga sergančiųjų pacientų psichologinės – elgesio rizikos veiksnių ypatumus stacionarinės reabilitacijos laikotarpiu. Tyrime dalyvavo 204 Abromiškių Reabilitacinės Ligoninės kardiologinio skyriaus pacientai (110 vyrų, 94 moterys; amžiaus vidurkis – 64,29m.). Tyrimo metodika: remiantis klausimynu, buvo įvertinti tiriamųjų demografiniai rodikliai – amžius, lytis, išsilavinimas. Iš pacientų ligų istorijų buvo surinkti duomenys apie išeminės širdies ligos formą ar kitą diagnozę, arterinį kraujo spaudimą bei antsvorį. Požiūris į rūkymą, alkoholio vartojimą, taip pat fizinio aktyvumo lygmuo bei subjektyvus sveikatos vertinimas buvo nustatyti pagal tiriamųjų atsakymus į atitinkamus klausimus. Stresogeninis elgesys įvertintas Rosenman‘o elgesio tipo interviu. Tyrimo metu buvo gauti tokie rezultatai: vyrai yra labiau linkę vartoti tabaką bei alkoholį, jų fizinio aktyvumo lygmuo aukštesnis, lyginant su moterimis. Jaunesnio amžiaus moterys buvo labiau linkusios vartoti alkoholį nei vyresnės, o jaunesnio amžiaus vyrai buvo fiziškai aktyvesni nei vyresni. Aukštesnio išsilavinimo pacientai buvo labiau fiziškai aktyvūs nei žemesnio išsilavinimo. Išeminės širdies ligos forma ir arterinis kraujo spaudimas nėra susiję nei su tabako, nei su alkoholio... [toliau žr. visą tekstą] / There are some factors, which are significant for ischemic heart disease development; their discrete influence is evidence – based, but it is important to ascertain if there are relationships among these factors. The purpose of the study is to evaluate ischemic heart disease patients‘ psychological – behavioral risk characteristics, during in - patients’ rehabilitation period. The subjects of this study were 204 ischemic heart disease patients from Abromiskes Rehabilitational Hospital, cardiological department (110 men, 94 women; mean age – 64,29m.). The demographical patients‘ indicators – age, gender, education, were gathered using a questionnaire. The data about ischemic heart disease form or other diagnosis, arterial blood pressure, overweight were taken from medical history. The attitude towards smoking, alcohol use also physical activity level, subjective health status was measured by using special questions. Stressogenic behavior was valuated by using Rosenman‘s behavior type‘s interview. The results of the study showed that men are more likely to use tobacco and alcohol, their physical activity level is higher, comparing with women. Younger women were more likely to use alcohol, comparing with older women. Younger men were more physically active, comparing with older men. Patients with higher education were more physically active, comparing with patients with lower education. Ischemic heart disease form and arterial blood pressure were not related with tobacco or... [to full text]

1. Ištyrus homocisteino koncentraciją kraujo serume ir trombocitų agregaciją kraujo plazmoje su pagrindiniais natūriniais agregantais (adenozino difosfatas, adrenalinas, kolagenas) sergančiųjų ūminiais galvos smegenų kraujotakos sutrikimais, nustatyta koreliacija tarp:  padidėjusios homocisteino koncentracijos ir insulto su dideliu neurologiniu deficitu, išeminės širdies ligos, kreatinino ir C-reaktyviojo baltymo koncentracijų;  vidinės miego arterijos stenozės laipsnio ir homocisteino koncentracijos kraujo serume;  homocisteino koncentracijos kraujo serume ir amžiaus;  padidintos homocisteino koncentracijos ir pasikartojančio insulto, todėl homocisteino koncentracijos lygis gali būti panaudotas kaip prognostinis rodiklis naujam ar kartotiniam ūminiam galvos smegenų kraujotakos sutrikimui išsivystyti. 2. Trombocitų agregacija turtingoje trombocitais plazmoje ūminio išeminio galvos smegenų kraujotakos sutrikimo periode statistiškai patikimai padidėja insultu sergančiųjų grupėje, nepriklausomai nuo susirgimo sunkumo. 3. Profilaktinės aspirino dozės hiperhomocisteinemijos fone dalį ligonių neapsaugo nuo išeminio insulto išsivystymo. Aspirino vartojimas turi veiksmingesnį antiagregacinį poveikį moterims, nei vyrams: moterų plazmoje trombocitų agregacijos intensyvumas buvo žemesnis su visais agonistais, o vyrų trombocitai, atvirkščiai, į juos reagavo viršnorminiu atsaku. 4. Išeminiu insultu sirgusių ligonių kraujyje dažniau randami policitemija, padidėjęs leukocitų... [toliau žr. visą tekstą] / 1. When examining homocysteine concentration in blood serum and platelet aggregation in plasma using nature aggregants (adenosine diphosphate, adrenalin, collagen) in patients with acute cerebrovascular disorders, the positive corelation was found between the following parameters:  the elevated amount of homocysteine and stroke with the high neurological deficit, ischemic heart disease, creatinin and C-reactive protein concentrations;  the degree of internal carotid artery stenosis and homocysteine concentration in blood serum;  homocysteine concentration in blood serum and age;  elevation of homocysteine concentration and recurrent stroke, thus, homocysteine concentration may be a predisposing indicator to the development of new or recurrent acute cerebrovascular disorder. 2. Platelet aggreagation in platelet-rich plasma during the period of acute cerebrovascular disorder statistically significantly increases in stroke group independent upon severity of illness. 3. Preventive aspirin doses in the light of hyperhomocysteinemia do not protect a certain part of patients from ischemic stroke development (among the debatable causes of this outcome may be aspirin resistance). Aspirin intake has a more effective antiaggregate influence on women than men: the intensity of platelet aggregation in women plasma was lower using all agonists, while in men, on the contrary, platelets responded by reaching levels above normal. 4. The patients, who experienced ischemic stroke... [to full text]

The aim of this study was to determine the characteristics of the remodeling of the heart right ventricle as well as the changes in the interstitial fibrillar collagen network of myocardium during pre-infarction, acute myocardial infarction and post-infarction development stages of IHD.Indications of right ventricle remodeling are estimated in all development stages of IHD. The concentric type of the right ventricle hypertrophy develops in patients with chronic IHD yet till the first acute MI occurs, i.e. in the pre-infarction period, due to the prolonged myocardial ischemia: its mass and endocardial surface area was bigger than the same parameters of the control group. In this stage of the development of the IHD the variation of right and left ventricle geometrical (endocardial area) and mass parameters was toughly related (linear relationship, r≥0, 5, p<0,05) and irrespective from the total stenotic lesion of the coronary arteries (index of stenosis). In the periods of acute MI and post-infarction IHD these parameters did not vary significantly, i.e. the concentric type hypertrophy of the right ventricle persists. The percentage volume, perimeter, number of bundles areas of the interstitial fibrillar collagen network increase significantly in the pre-infarction period, comparing with the control group and persists in later stages of IHD.

Darbo tikslas: Įvertinti pacientų ir medikų pasitenkinimą ir paklusnumą naudojantis ir teikiant telekardiologijos paslaugas. Tyrimo uždaviniai: 1. Įvertinti pacientų paklusnum�� naudojantis telemedicinos paslauga. 2. Palyginti gydytojų ir pacientų pasitenkinimą taikyta telekardiologijos sistema klinikinėje praktikoje. 3. Įvertinti pacientų pasitenkinimą gydymu, teikiant telemedicinos paslaugą. Tyrimo metodai: Tyrime dalyvavo Kauno medicinos universiteto klinikų Kardiologijos skyriaus pacientai, kuriems pastebėti vainikinės širdies ligos požymiai ir paskirta AKJO operacija. Pacientai buvo suskirstyti į tiriamąją ir kontrolinę grupes. Tiriamosios grupės pacientai naudojosi telemedicinos paslauga, o kontrolinė grupės pacientai – nesinaudojo. Taip pat dalyvavo telemedicinos paslauga besinaudojusius pacientus konsultavę gydytojai-kardiologai. Tyrimo klausimynams naudota Likerto skalė. Duomenys apdoroti ir buvo analizuojami naudojant statsitinį duomenų analizės paketą SPSS 12.0. Hipotezės apie dviejų požymių nepriklausomumą buvo tikrinamos naudojant Mann-Whitney U testo kriterijaus p reikšmę (p<=0,05). Rezultatai: Pilotinis tyrimas atskleidė naujųjų technologijų silpnąsias puses, kurios turėtų būti tobulinamos, norint trečio lygio ligoninėse teikti kokybiškas ir kvalifikuotas sveikatos priežiūros paslaugas. Išvados: Taikant telekardiologijos paslaugas pacientams sergantiems išemine širdies liga buvo lengviau tiksliai įvykdyti visus gydytojo nurodymus, 83% respondentų nekilo... [toliau žr. visą tekstą] / The aim of this study was to evaluate patients and medics satisfaction and obedience using and rendering facilities of cardiology. The tasks: 1. To evaluate patients obedience using facilities of telemedicine. 2. To compare patients and medics satisfaction rendering cardiological system during clinical practice. 3. To evaluate patients satisfaction of treatment, rendering facilities of telemedicine. Methods of research: In the research were participated patients from Kaunas medicine university clinics Cardiology department, who had symptoms of coronary disease of heart and who was prescribed AKJO surgery. Patients were dispended to exploratory and share majority groups. Patients of exploratory group were using facilities of telemedicine, patients of share majority group weren’t. Cardiologists, who consulted patients, who were using facilities of telemedicine, participated too. Licert’s scale was used to compose questionnaire. Information was processed and analyzed using statistical pack SPSS 12.0 which analyses information. Hypothesis about independence of two features was verified using criterion mean p (p<=0,05) of Mann-Whitney U test. Results: Pilot study uncovered blind sides of newest technologies, which should be improved to render qualified facilities. Conclusion: Rendering facilities of telecardiology for patients with ischemic disease of heart were easy to fulfill all medics’ prescriptions accurate, 83 percent of respondents did not have any problems using gadget... [to full text]

Images of CT and MRI are grayscale images and usually they are analyzed by radiologists on display either on transparency screen. Then objects in images are recognized by their properties like average luminosity of the region, localization, shape, dimensions, etc. The process of visual recognition is affected by many factors. The totality of factors determines uncertainties of diagnostics. More and more often there are used software utilities in the analysis of images which help to lower the uncertainties and speed up the analysis time. The aim of the work is investigation of medical image processing and analysis using frequency and joint space-frequency domains and developing of algorithms suitable for segmentation of regions of diseases. / Žmogaus galvos KT bei MR vaizdus analizuoja apmokyti diagnostikos specialistai – radiologai. Vaizdai, kuriuos turi analizuoti radiologas, yra pilkieji vaizdai, pateikiami monitoriuje arba skaidrėse. Juose tiriami objektai yra atpažįstami pagal tam tikrų vaizdo sričių pilkumo lygį, išsidėstymą, formą, dydį ir kitus požymius. Atpažinimo procesui turi įtakos eilė veiksnių, kurių visuma lemia diagnostines neapibrėžtis. Jų sumažinimui bei diagnostikos paspartinimui vis plačiau taikoma pagalbinė kompiuterinė programinė įranga, kuri, be to, suteikia daug papildomų trimačio vizualizavimo ir skaičiavimo galimybių. Šio darbo tikslas yra ištirti medicininių vaizdų analizės ir apdorojimo galimybes, taikant dažninius ir erdvinius dažninius spektrus, bei sudaryti algoritmus, skirtus ligų sričių ar kitų specifinių vaizdo sričių segmentavimui.