Studijų centras (02.22)

Introduction. The handbook provides recommendations that regulate the process of preparing the final master's theses (henceforth, FMT) in the integrated study programme Medicine. The document outlines the principles of work planning, research ethics, methodological requirements and scientific communication, thereby ensuring academic quality and the reliability of the research. [...].

Introduction Trimethylamine N-oxide (TMAO), a gut microbiota metabolite, may potentially contribute to cardiac remodeling. Trimethylamine is generated through the breakdown of dietary L-carnitine, choline, and lecithin in the human gut. Subsequently, it undergoes oxidation in the liver, resulting in the formation of TMAO. Elevated TMAO levels have been implicated in conditions such as atherosclerosis, acute myocardial infarction, and cardiovascular mortality. In 2021, experimental studies conducted on rat models revealed a correlation between heightened circulating TMAO levels and the deterioration of cardiac systolic function.

Purpose The present study aims to explore the potential of the gut microbiota metabolite TMAO in predicting improvement in left ventricular ejection fraction (LVEF) among patients who have experienced ST-segment elevation myocardial infarction (STEMI).

Methods In this prospective cohort study, STEMI patients undergoing primary percutaneous coronary intervention (PCI) were assessed for left ventricular ejection fraction (LVEF) using two-dimensional cardiac ultrasound at baseline and 12 months. Venous blood collected at three-month follow-up was centrifuged to obtain plasma stored at −80 °C. Plasma TMAO levels were measured using a TMAO ELISA kit (Bioassay Technology Laboratory, Shanghai, China). Coronary flow reserve (CFR), and index of microvascular resistance (IMR) were assessed using the coronary pressure wire at 3-month follow-up.

Results There were 200 participants in the study. A multivariate model incorporating TMAO, IMR, and CFR showed a ROC AUC of 0.857, indicating a high degree of predictive accuracy. In this model, we have found that elevated IMR and TMAO values were associated with lower odds of LVEF improvement (OR: 0.941, 95% CI: 0.910-0.973, p < 0.001), and (OR: 0.777, 95% CI: 0.665-0.909, p = 0.002), respectively. On the contrary, higher CFR values are associated with higher odds of LVEF improvement (OR: 2.438, 95% CI: 1.064-5.585, p = 0.035).

Conclusion Elevated TMAO levels are linked to reduced odds of LVEF recovery post-STEMI. This highlights the crucial role of gut microbiota in shaping cardiac recovery, suggesting a potential avenue for targeted interventions in enhancing LVEF outcomes.

Background Coronary microvascular dysfunction (CMD) is a common complication of ST-segment elevation myocardial infarction (STEMI) and can lead to adverse cardiovascular events.

Methods This is a non-randomized, observational, prospective study of STEMI patients with multivessel disease who underwent primary PCI, grouped based on whether they underwent balloon pre-dilatation stenting or direct stenting of the culprit lesion. For each procedure, we also recorded instances where aspiration thrombectomy was performed and when intracoronary glycoprotein IIb/IIIa inhibitors were administered. 3-months post-PCI, coronary physiology of the culprit vessel was assessed using a coronary pressure/temperature sensor-tipped guidewire (Pressure Wire X; Abbott Vascular, Santa Clara, CA, United States). This assessment involved measuring both the coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR). The primary endpoint was the prevalence of CMD at 3 months, defined as IMR ≥ 25 and CFR < 2.5. Secondary endpoints included major adverse cardiovascular events (MACE) at 12-months.

Results 200 patients were enrolled; most were men (59.5%) with a median age of 65.5 years. One-hundred and four (52%) underwent balloon pre-dilatation before stenting and 96 (48%) underwent direct stenting. Aspiration thrombectomy was performed in 49 cases (24.5%), and intracoronary glycoprotein IIb/IIIa inhibitors were administered in 45 cases (22.5%). The prevalence of CMD at 3 months was lower in the direct stenting group than in the balloon pre-dilatation stenting group (10.4% vs. 34.6%; p < 0.001). Aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors were associated with lower odds of CMD (OR=0.24, p = 0.008 and OR=0.20, p = 0.005, respectively). Notably, MACE in patients who underwent direct stenting was lower than in those who underwent balloon pre-dilatation before stenting (14% vs. 27%; p = 0.046).

Conclusions In STEMI patients with multivessel disease, direct stenting of the culprit lesion, aspiration thrombectomy and administration of intracoronary glycoprotein IIb/IIIa inhibitors was associated with a lower prevalence of CMD at 3-months and lower incidence of MACE at 12 months compared with balloon pre-dilatation stenting. Further studies are required to confirm these results.

Background: The index of microcirculatory resistance (IMR) is calculated from the mean transit time of bolus thermodilution during pharmacologically induced hyperemia. IMR has emerged as an invasive technique for measuring coronary microcirculation. The current study aimed to investigate the association of elevated IMR and new onset of atrial fibrillation (NOAF) in patients after the event of ST- elevation myocardial infarction (STEMI). Methods: Our study comprised STEMI patients with multivessel disease who were 40 years or older. IMR was assessed after undergoing successful staged percutaneous coronary interventions (PCI) using a calibrated coronary physiology wire (Pressure Wire X; Abbott Vascular, Santa Clara, CA, United States). Patients were classified based on their IMR level. A high IMR was characterized as a value of 25 U or more. The primary outcome was the presence of atrial fibrillation 12 months after an ST-elevation myocardial infarction. Statistical analyses were performed using the SPSS 20.0 software. The value of p < 0.05 was considered as statistically significant. Results: 149 patients were classified as having a normal IMR, while 51 had an elevated IMR. Patients with elevated IMR levels were predominately female (32.9% vs. 62.7%; p < 0.001) and had a higher incidence of a history of diabetes mellitus (18.1 % vs. 43.1%; p < 0.001) than those with normal IMR levels. However, there were no differences in age or other risk factors between the two groups. NOAF at 12-month follow-up was significantly higher in the elevated IMR group (4.7% vs. 29.4%; p <0.001). Conclusion: Our study demonstrates that in patients undergoing staged PCI after a STEMI event, an elevated IMR was associated with a higher incidence of atrial fibrillation at 12-month follow-up.

Background The index of microcirculatory resistance (IMR) is calculated from the mean transit time of bolus thermodilution during pharmacologically induced hyperemia. IMR has emerged as an invasive technique for measuring coronary microcirculation. The current study aimed to investigate the association of elevated IMR and new onset of atrial fibrillation (NOAF) in patients after the event of ST- elevation myocardial infarction (STEMI) [...]. Methods Our study comprised STEMI patients with multivessel disease who were 40 years or older. IMR was assessed after undergoing successful staged percutaneous coronary interventions (PCI) using a calibrated coronary physiology wire (Pressure Wire X; Abbott Vascular, Santa Clara, CA, United States). Patients were classified based on their IMR level. A high IMR was characterized as a value of 25 U or more. The primary outcome was the presence of atrial fibrillation 12 months after an ST-elevation [...]. Results 149 patients were classified as having a normal IMR, while 51 had an elevated IMR. Patients with elevated IMR levels were predominately female (32.9% vs. 62.7%; p < 0.001) and had a higher incidence of a history of diabetes mellitus (18.1 % vs. 43.1%; p < 0.001) than those with normal IMR levels. However, there were no differences in age or other risk factors between the two groups. NOAF at 12-month follow-up was significantly higher in the elevated IMR group (4.7% vs. 29.4%; p <0.001). [...]. Conclusion Our study demonstrates that in patients undergoing staged PCI after a STEMI event, an elevated IMR was associated with a higher incidence of atrial fibrillation at 12-month follow-up. [...].

The processes of globalisation and internationalisation significantly influence changes in higher education. Rising demands on higher education, technological development determine the desire to foster studies of the highest quality. Overall mission of the World Federation of Medical Education (WFME) is to improve the health for all through promotion of high-quality medical education. Enhancing the quality of medical education is a priority of the Lithuanian University of Health Sciences. The University has its own quality assurance system, where quality primarily is perceived as the quality of studies. The University’s quality culture, as a culture of continuous improvement and positive change, is based on the values defined in the University’s mission. Lithuanian University of Health Sciences internal quality assurance system is based on the policy of study quality assurance, continuous study quality control and improvement, external quality evaluation and international recognition and evaluation. The quality assurance system of LSMU in this article is provided as an example with a deep tradition of fostering quality culture and ensuring quality.

This paper presents several troubling issues with learning, highlighting some moments of problem-based learning (PBL) in the post-pandemic medical education. Based on some initial research as well as institutional and personal experiences, the learning challenges arising in post-pandemic universities are briefly considered. The urgent shift to an online learning environment was sudden and rough with the view of keeping university studies alive. The good news is that pandemic pedagogy catalyses and accelerates fresh insights into online teaching and learning. In the context of PBL, we need to focus on what problems in what form students will solve, and what the group online collaboration will look like under no illusions of free flow. There are no unequivocal answers to newly arising questions, however, to visualise future learning the thirst for sharing light and/or hard experiences has grown significantly and will continue growing.

Inovatyvus mokymasis ir e. mokymosi kompetencija tapo labai svarbi įžengus į skaitmeninį amžių, kada mokymo/si, gyvenimo, darbo ir verslo modeliai sparčiai keičiasi. Dėka inovatyvių technologijų inspiruotos kaitos atsiranda poreikis mokytis viso gyvenimo metu. Asmenys privalo nuolat prisitaikyti prie pokyčių, o tam turi keisti sampratą į mokymąsi ir mokymosi būdus bei kompetenciją. Mokymasis tampa nebe epizodine patirtimi, o nuolatine gyvenimo dalimi, suteikianti vertingiausią prekę – asmens gebėjimą mokytis. Auštajam mokslui tenka užduotis iš naujo peržiūrėti nusistovėjusį aukštojo mokslo programų teikimą ir konstruoti atvirojo mokymosi koncepcijomis paremtas mokymosi programas, jog atlieptų besimokančiųjų poreikį ir gebėjimą mokytis nuotoliniu mokymosi būdu. Įvadas Skaitmeninė ir sumani Europos Sąjungos verslo ir visuomenės transformacija suteikia Europai didžiulį augimo potencialą. Aukštasis mokslas gali pasitelkti savo stipriąsias puses pažangių skaitmeninių technologijų srityje ir stipriai įsitvirtinti tradiciniuose sektoriuose, kad galėtų pasinaudoti įvairiomis galimybėmis, konstruojant atvirojo mokymosi principu paremtas ir kokybiškas mokymosi galimybes. Mokymosi kultūros transformaciją apibūdina pažangių mokymo/si technologijų sintezė, inovatyvios pedagoginės paradigmos[...].

The environment, place, type and curriculum of higher education programmes are the essential factors encouraging the re-examination of the established quality assessment criteria for higher education programmes. Open learning concepts require a change in attitudes regarding the quality of higher education and the concept of teaching and learning. The article analyses the transformation experienced by the learner during the period of high-quality studies from traditional studies to the open learning culture. How can quality learning transformation be measured? The aim: to test the assessment methodology of open learning opportunities responding to the quality of higher education provided. Methods: analysis of scientific literature, case study, survey throughout the course. A case of one mixed course has been investigated. The target group is fifth year medical students of the Lithuanian University of Health Sciences. [...].