Conference Proceedings Citation Index - Science (Web of Science)

Background: Fatigue is a common complaint among individuals with anxiety and mood disorders (AMD) [1]. Subjective fatigue is closely related to cognitive functioning in healthy adult population [2], as well as in other populations, such as individuals with coronary artery disease [3]. Even though cognitive dysfunction and fatigue are both more common in individuals with AMD than in otherwise healthy individuals [4], the relationship between fatigue and cognitive functions is still underexplored. Furthermore, most research on fatigue relies primarily on self-report measures, often lacking objective assessments to compare with. Therefore, the aim of our current study was to investigate the correlations between subjective and objective fatigue and cognitive functions in individuals with AMD. Methods: Three hundred and fourteen individuals (77.7% women and 22.3% men, mean age 40.2 ± 11.9 years) attending a Stress-related disorders day care unit of the Palanga Hospital at Neuroscience Institute of the Lithuanian University of Health Sciences, participated in this cross-sectional study. Diagnosis of AMD was established using the Mini-International Neuropsychiatric Interview. Subjective fatigue was assessed using the Multidimensional Fatigue Inventory-20 (MFI-20), while objective fatigue was evaluated via an exercise capacity (EC) workload test. Cognitive functioning was measured using Digit Span Test, Digit Symbol Test, Trail Making Test (TMT) Parts A and B. Depression and anxiety symptoms were evaluated with The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scale. Associations between fatigue and cognitive functioning were first analysed using univariate regression. Multivariable regression analyses were then conducted, adjusting for age, sex, education, current medication use, history of smoking, depression and anxiety symptoms. Results: In individuals with AMD, univariate regression analyses found associations between subjective and objective fatigue characteristics and cognitive functions. Specifically, higher scores on the MFI-20 subscales for reduced activity and reduced motivation were associated with lower T-scores on TMT Part A (β = −0.117, p = 0.039; β = −0.112, p = 0.048 respectively); higher EC was associated with higher numbers of pairs recalled correctly in Digit Symbol Test (β = 0.195, p = 0.001), higher TMT Part A T-score (β = 0.156, p = 0.011), and higher TMT Part B T-score (β = 0.125, p = 0.041). After completing multivariable regression models adjusting for age, sex, education, current medication use, history of smoking, depression and anxiety scores, only the association between higher EC and higher number of pairs recalled correctly in Digit Symbol Test remained statistically significant (β = 0.227, p = 0.002). Additionally, multivariable regression analysis found that higher EC was independently associated with higher TMT A/B T-scores (β = 0.152, p = 0.046). Conclusions: Overall, in individuals with AMD, objective fatigue, as measured by EC, was independently associated with poorer cognitive functioning, particularly in domains involving incidental learning, recall, and executive functioning. These findings underscore the importance of distinguishing between subjective and objective fatigue measures and their respective impact in cognitive performance. These findings have practical implications for better understanding the relationship between cognitive functions and fatigue in individuals with AMD and provide the basis for future research investigating the relationship between cognitive function and fatigue.

Background: Impaired Health related Quality of Life (HRQoL) is a common burden among individuals with mental health conditions, especially in those with anxiety and mood disorders (AMD). Obsessive–compulsive personality disorder (OCPD) is one of the most common personality disorders in the general population, is even more prevalent in individuals with AMD, and has also been linked to excessive mental fatigue in this group. Nevertheless, there have been very few studies exploring the impact of OCPD on HRQoL in patients with AMD. Our objective was to investigate the relationship between OCPD and HRQoL in individuals with AMD. Methods: A cross-sectional study included 235 persons (with a mean age of 41 and SD of 12 years) with AMD attending the Stress Disorders Unit at Hospital Palanga Clinic, Neuroscience Institute, Lithuanian University of Health Sciences. The SF-36 scale was used to assess eight aspects of HRQoL: physical functioning, rolephysical functioning, bodily pain, general health, vitality, social functioning, role-emotional functioning, and mental health. The Compulsive Personality Assessment Scale (CPAS) was used to assess features associated with OCPD. The nine-item Patient Health Questionnaire (PHQ-9) and seven-item Generalized Anxiety Disorder scale (GAD-7) were used to assess depression and anxiety symptoms in individuals with AMD. Two-tailed Student’s t-test or Fisher’s χ2 were used to compare socio-demographic, clinical, HRQoL, depression, and anxiety characteristics between individuals with and without OCPD. Subsequently, separate multivariable linear regression analyses were performed within each group (OCPD and non-OCPD) to examine the associations between OCPD traits and HRQoL, while controlling for potential confounders. Results: Subjective social functioning, mental health, vitality and general health perception were found to be worse in individuals with OCPD in comparison to group with no OCPD. In individuals with OCPD, the links between OCPD traits and HRQoL remained significant only in the domain of vitality (β = –0.236, p < 0.042), after controlling for age, gender, education, marital status, medication use and depressive and anxiety symptoms. OCPD trait severity was not associated with HRQoL domains in individuals without OCPD. Conclusions: In individuals with AMD, the presence of OCPD was related to poorer HRQoL, particularly in the vitality domain, after controlling for socio-demographic and clinical characteristics. This study sheds new light on the impact of OCPD on quality of life in individuals with AMD and aligns with our previous findings linking OCPD to mental fatigue. Limitations of the study include its cross-sectional design and use of brief measures to assess anxiety/ depressive symptom severity. Future research should now explore mechanisms underlying these associations, and evaluate whether the findings generalise to larger, more diverse samples.

BACKGROUND: Dual bronchodilation has shown a positive effect on cardiac function in patients with chronic obstructive pulmonary disease (COPD).

AIMS AND OBJECTIVES: To evaluate the efficacy of tiotropium/olodaterol (TIO/OLO) fixed-dose combination on lung, right ventricular function and serum troponin I in patients with moderate COPD.

METHODS: Plethysmography, cardiac magnetic resonance imaging and serum troponin I were evaluated in patients with newly diagnosed moderate COPD before treatment with TIO/OLO and after 12 weeks.

RESULTS: Thirty-four subjects were enrolled, 25 completed the study. After 12 weeks residual volume (RV) decreased from 158% (IQR 41.5) to 141% (IQR 39) (p=0.025), RV-to-total lung capacity (TLC) ratio from 133% (IQR 22) to 122% (IQR 27.5) (p=0.004) and functional residual capacity-to-TLC ratio from 118% (IQR 18) to 113% (IQR 12.5) (p=0.015). The median right ventricular ejection fraction at baseline was 59% (IQR 11) and did not change significantly. Right ventricular global longitudinal strain improved from -22.72% (IQR 6.44) to -23.97% (IQR 7.51) (p=0.021). Right ventricular end-systolic, end-diastolic and stroke volumes (all indexed for body surface area) did not change during the study. All patients had normal serum troponin I levels at baseline which decreased after 12 weeks (from 1.27 [IQR 0.51] to 1.09 pg/ml [IQR 0.23], p=0.034).

CONCLUSION: COPD treatment with TIO/OLO not only improves lung function but also might have a positive effect on right ventricular strain and reduce serum troponin I levels. Due to cardiovascular involvement in COPD early use of dual bronchodilation is very important.

Recent studies show that impaired mitochondrial dynamics is a key driver of immune cell activation in skin conditions such as psoriasis and atopic dermatitis. Although current treatments can be effective, they are frequently limited by inconsistent patient responses, side effects, and high prices. Plant-derived nanovesicles (PDNVs) represent a promising alternative, having demonstrated anti-inflammatory activity and the capacity to deliver bioactive molecules to target cells. The impact of PDNVs on mitochondrial dynamics in inflammatory diseases has not yet been investigated. In this study, we assessed bioenergetics and mitochondrial dynamics in human dermal fibroblasts with psoriasis-like phenotype, induced by a cytokine cocktail (IL-17, IL-22, and TNF-α). PDNVs were isolated using polymer-based precipitation, characterised by nanoparticle tracking analysis and Cryo-EM imaging. Cellular bioenergetics was analyzed by Agilent Seahorse, mitochondrial morphology - through fluorescence microscopy combined with ImageJ processing. Inflammatory mediator levels were quantified using the Luminex xMAP system. Results revealed that PDNVs reversed the PLI-induced reduction in overall mitochondrial respiration and mitigated the PLI-driven increase in glycolysis efficiency. They also restored and significantly enhanced summed branch length and network branch number, indicating reversal of mitochondrial fragmentation and improved network complexity. Notably, the extent of these effects was comparable to that of the Drp1-dependent fission inhibitor Mdivi1. Additionally, PDNVs reduced PLI-induced secretion of IL-4, IL-13, and IL-18, suggesting suppression of Th2-mediated inflammatory responses. Mdivi1 exerted a similar cytokine-lowering effect. Collectively, these findings demonstrate that PDNVs improve mitochondrial function and morphology in inflamed fibroblasts. They also reduce PLI-induced cytokine secretion, which may be linked to their ability to reverse fragmentation, as Mdivi1 produced similar effects on both mitochondrial dynamics and inflammatory profiles. This points to PDNVs as a promising therapeutic strategy for psoriasis and atopic dermatitis. Further exploration of PDNVs on mitochondrial alterations could guide the development of novel therapies for chronic inflammatory skin diseases.

Background and Purpose: Enacting and enforcing restrictions on availability of alcohol are essential measures to prevent easy access to alcohol by young people and other vulnerable and high-risk groups. The Baltics (Lithuania, Latvia and Estonia) implemented several alcohol control policy measures from 2001 to 2020. This provides an opportunity to measure alcohol control policy specific impacts on population health within multiple high-income countries, that all have relatively high alcohol consumption rates. Methods: We analyzed legislations passed in the Baltics from 2001to 2020 and identified four major alcohol availability reduction measures. Using interrupted timeseries methodology, we evaluated what impact alcohol availability restrictions have on the gender specific alcohol-attributable mortality. Using the same methodology, we evaluated policy effects on various causes of death subgroups. Additionally, we looked into impacts on the emergency room visits and weekly patterns of alcohol- attributable male mortality. Data: These observational studies utilized monthly alcohol attributable mortality data from 2001 to 2020 for the Baltics. Results: Negative policy impact effect coefficients indicating de-crease in mortality were observed for all four alcohol availability policies implemented in Lithuania, Latvia and Estonia. The alcohol availability policy effect was higher for males than females in all three countries. The implementation of the policy was associated with small in-creases in all-cause and injury-related emergency room visits for both sexes, but proportionally larger decreases in emergency room visits for alcohol poisonings for men. Results showed that weekly average age-standardized death rates (SDRs) for alcohol poisoning decreased from 2.35 to 1.75 (p < 0.001), SDRs for external causes of death decreased from 28.09 to 22.71 (p = 0.001), and SDRs for circulatory diseases decreased from 102.99 to 91.75 (p < 0.001). Conclusions: Alcohol availability restrictions in the Baltics were not only associated with mortality decreases, but also with decreases in emergency room visits. The reduction of the hours when alcohol can be sold was associated with a change in a weekly pattern of alcohol-attributable male mortality.

Purpose: To summarize and examine the evidence of alcohol taxation and pricing policies in a project evaluating Baltic alcohol policies. Methods: Various interrupted time-series models using the other countries as controls for regional secular trends. Data: The studies utilized yearly or monthly health and economic data from the Baltic counties which was obtained from official national databases. Results: The international research literature demonstrates that the alcohol excise taxation in general is entirely passed-though to alcohol price, and the increase in price due to the increase in alcohol taxes is associated with the decline in alcohol consumption. The evidence from the natural experiments in the Baltics (Lithuania, Latvia, Estonia) supports the above, and complements the evidence by showing the positive effects of the increases of excise taxes especially if the tax increases reduce alcohol affordability. There was no major increase in unrecorded alcohol consumption observed when the alcohol taxation is increased. One of the exemplary taxation increases in a period of near ideal experimental environment was observed in Lithuania when alcohol tax for beer and wine was more then doubled in 2017 which ultimately lead to a sudden increase in a budget revenue (a 22% increase in just one year, adjusted to 2023costs), alcohol per capita consumption has declined (a reduction by7% or by 0.9 liters of pure alcohol per capita in a year), and more thana thousand alcohol attributable deaths were averted within the first year after the tax increase. Conclusions: Increasing alcohol taxation linked to increased government revenue despite the popular though that it may cause a decline in tax revenues. The evidence from the Baltic alcohol control policy evaluation also demonstrates that the increase in alcohol taxes re-duces alcohol consumption and alcohol related harm.

Purpose: Return on Investment analyses can help decision makers decide about different policy options Methods: We used the 2017 increase in alcohol excise taxation of 112% for beer, 111% for wine, and 23% for ethyl alcohol (spirits)as example. This taxation change resulted in a marked decrease in alcohol affordability. Costs were measured according to World Health Organization standards based on Lithuanian public data. Benefits were derived from the difference of direct (healthcare, childcare, legal) and indirect costs between 12 months pre- and post-enactment of the policy. All costs and benefits were expressed in 2023 Euros (€).Results: Overall, there were substantial net benefits from reductions in productivity losses and increases in tax revenue. Tax revenue increased substantially by 20%, or more than €100 million, in the first-year post enactment, and the productivity losses decreased over the same time period by about the same amount (−17%), the latter based on marked reductions in premature mortality in all alcohol-attributable causes of death. In addition, healthcare costs decreased by about €3.8 million (−5%). On the other hand, childcare and legal costs increased compared to the year before, by €5.3 million (+7%)and €4.6 million (+5%), respectively. The final ROI was 616 to 1, i.e., for each Euro invested, the return was €616.Conclusions: An increase in alcohol excise taxation at a magnitude which reduces the affordability of alcohol can yield a significant re-turn on investment.

Background and Objectives: Postoperative pain is common in the first 24 hours after brain surgery and is often undertreated for the fear of masking neurosurgical pathology or depressing ventilation. The aim of our study was to compare diierent types of analgesia and its eiect on postoperative pain reduction in patients undergoing craniotomy for brain tumor removal. Methods: The study included 141 adult craniotomy patients that were randomly separated into three equal groups. A group with scalp nerve blockade (B) and wound infiltration (I) received 0.25% bupivacaine combined with 1% lidocaine and 1:200,000 epinephrine. One gram of paracetamol and 2 mg/kg ketoprofen were administered intravenously (IV) after skin closure in a group with systemic analgesia (S). Pain intensity was evaluated after 1, 3, 6, and 24 h postoperatively using a visual analogue scale (VAS). The amount of rescue analgesia (ketorolac, paracetamol, and pethidine) and the duration for its first requirement were recorded. Results: One hundred and forty-one patients were included in the prospective, randomised, double - blind study. The main pain scores were significantly lower in the groups with regional anesthesia compared to group S after 1 hour (group B Median (ME) = 5, group I ME = 8, group S ME = 37), after 3 hours (group B ME = 8, group I ME = 5, group S ME = 16) and after 6 hours (group B ME = 8.5, group I ME = 12, group S ME = 16), p < 0.05. Significantly lower pain scores were observed in the group with a scalp nerve blockade (ME = 8) compared to the group with systemic analgesia (ME = 19.5) or wound infiltration (ME = 12.5) after 24 h, p < 0.05. Regional anesthesia ensured a stable analgesic eiect for all 24 h. Fewer rescue analgesics were required in groups B (ketorolac 68.1%, paracetamol 10.0 %) and I (ketorolac 80.9%, paracetamol 12.8%) compared to patients in group S (ketorolac 93.6%, paracetamol 40.0%), p = 0.001. The duration for the requirement of the first rescue analgesia was significantly longer in Groups B and I compared to Group S (B: 514 ± 471 min; I: 398 ± 418 min; S: 149 ± 128 min), p = 0.000. Discussion and Conclusion: The results of our study show that most patients experience pain in the early postsurgical hours. Scalp nerve blockade significantly reduced the incidence and severity of pain after a craniotomy and the amount of rescue analgesia used in this group of patients in the first 24 hours after craniotomy

Background Microvascular obstruction (MVO) represents a significant unmet clinical need in patients with ST-segment elevation myocardial infarction (STEMI). Currently, there is no routine measurement of MVO in the catheterization laboratory. The MOCA I first-in-human study evaluates the safety and feasibility of a novel, real-time, catheter-based system to detect MVO immediately after primary percutaneous coronary intervention (PPCI), and to immediately deliver intracoronary therapeutic agents. Methods MOCA I enrolled anterior STEMI patients within 6 hours from symptom onset. Immediately following successful PPCI, the dedicated Controlled Flow Infusion (CoFI) system was used to measure back pressure by occluding the infarct-related artery for a minimal duration with the proprietary CoFI balloon catheter whilst distally infusing Ringer’s Lactate. These data were processed to a novel pressure parameter (PCoFI) for diagnosing MVO. All patients were scheduled to undergo cardiac magnetic resonance imaging (CMRI) 3-5 days after PPCI, representing the criterion-standard method to quantify MVO. Results The CoFI device and procedure were shown safe with a diagnostic procedural success rate of 92%. Final diagnostic performance population includes 34 STEMI patients with complete data sets. MVO was detected in 65% of patients by CMRI. These patients had increased PCoFI compared with patients without MVO (142.68 ± 18.44 mm Hg vs 114.73 ± 8.56 mm Hg; P < 0.001). ROC analysis identified the optimal PCoFI value for identification of MVO, resulting in a sensitivity of 91%, specificity 92%, accuracy 91%, and AUC 0.92 for thresholds in the range of 121.5-127 mm Hg (P < 0.001). Infarct size and area at risk were significantly higher in patients with PCoFI ≥124 mm Hg compared with those with PCoFI <124 mm Hg (IS: 17.02% ± 7.28% vs 8.70% ± 10.11% [P = 0.006]; area at risk: 40.86% ± 12.29% vs 31.95% ± 16.07% [P = 0.047]). Conclusions This study demonstrates that the CoFI system provides accurate and timely diagnosis of MVO immediately following PPCI, when salvage of myocardium may still be possible. The method presents potential for emerging therapies as well as for improving efficacy of existing treatments in STEMI.

Background Imaging methods can identify coronary plaques at high risk of rupture. Preclinical data have demonstrated the favorable effects of cryotherapy on the stabilization of high-risk plaques. We report the first-in-human (FIH) application of intracoronary cryotherapy for the stabilization of high-risk plaques. Methods This is a multicenter, prospective, single-arm study, including patients presenting with acute coronary syndromes (ST-segment elevation myocardial infarction [STEMI], non-STEMI, or UA) and a high-risk nonobstructive plaque in a nonculprit vessel. After successful PCI of the culprit lesion, patients underwent coronary computed tomography angiography (CTA) to screen for the presence of high-risk plaques. Patients then underwent cryotherapy guided by intravascular ultrasound (IVUS). Coronary cryotherapy is a rapid-exchange balloon-based technology that delivers nitric oxide, reaching temperatures of −20 °C at the level of the lesion. The primary endpoint was the occurrence of any cryotherapy procedure-related complication or any major adverse cardiovascular events at 90 days. Patients were followed noninvasively with coronary CTA at 3 and 9 months. Results We report the preliminary results of the first 12 patients included in the study. The mean age was 65 ± 10 years, and 75% were men. The target lesions for cryotherapy were in the LAD, LCX, and RCA for 25%, 33%, and 42% of patients, respectively. The median diameter stenosis was 40% (Q1, Q3: 36%, 43%). In IVUS, the median reference vessel diameter was 2.90 mm (Q1, Q3: 2.74, 3.26 mm), and the median minimal lumen area was 4.07 mm2 (Q1, Q3: 3.63, 4.43 mm2). The mean cryoballoon size was 3.30 ± 0.40 mm. There were no procedural complications. At 90 days, no major cardiovascular adverse events were reported. At the 9-month coronary CTA follow-up (n = 4), there was a trend toward a reduction in plaque volume (Δ volume = −6 mm³; 95% CI: −94.6 to 107.0 mm³), with stable fractional flow reserve derived from CT values (FFRCT Δ lesion = −0.08; 95% CI: −0.28 to 0.45). Conclusion In this preliminary report of the Polarstar FIH study, the application of cryotherapy for vulnerable plaque stabilization was safe. Coronary CTA results showed a trend toward a reduction in plaque volume with a positive impact on epicardial conductance.