Rimante Cerkauskiene

Recommender System to Analyze Student's Academic Performance

A sufficient amount of studies worldwide prove an interrelation linking student learning productivity and interest in learning to physiological parameters. An interest in learning affects learning productivity, while physiological parameters demonstrate such changes. Since the research by the authors of the present article confirmed these interdependencies, a Recommender System to Analyze Students Academic Performance (Recommender System hereafter) has been developed. The Recommender System determines the level of learning productivity integrally by employing three main techniques (physiological, psychological and behavioral). This Recommender System, developed by these authors, uses motivational, educational persistence and social learning theories and the database of best global practices based on above theories to come up with recommendations for students on how to improve their learning efficiency. The Recommender System can pick learning materials taking into account a students learning productivity and the degree to which learning is interesting. Worldwide research includes various scientists who conducted in-depth studies on the different and very important areas of physiological measurements and intelligent systems. We did not manage to find any physiological measurements or any intelligent or integrated system that would take physiological parameters of students, analyze their learning efficiency and, in turn, provide recommendations.

Multiple-Criteria Analysis of Life Cycle of Energy-Efficient Built Environment

For a broader application of the life cycle of energy-efficient built environment in the practice of various countries, more attention needs to be paid not only on the selected most rational processes and solutions, the interest level of the stakeholders, but also on the micro-, meso- and macro-level factors. The authors of this article developed the life cycle of energy-efficient built environment model and different decision support systems over the course of two international projects (IDES-EDU and LEAN CC). Based on this model, professionals involved in design and realization of life cycle of energy-efficient built environment can develop a lot of the alternatives as well as assessing them and making the final choice of the most efficient variant. The model and two systems (Energy Efficient House DSS for cooling and decision support system for assessment of energy generation technologies) are briefly described in this chapter.

Neutral pH and low–glucose degradation product dialysis fluids induce major early alterations of the peritoneal membrane in children on peritoneal dialysis

The effect of peritoneal dialysates with low-glucose degradation products on peritoneal membrane morphology is largely unknown, with functional relevancy predominantly derived from experimental studies. To investigate this, we performed automated quantitative histomorphometry and molecular analyses on 256 standardized peritoneal and 172 omental specimens from 56 children with normal renal function, 90 children with end-stage kidney disease at time of catheter insertion, and 82 children undergoing peritoneal dialysis using dialysates with low-glucose degradation products. Follow-up biopsies were obtained from 24 children after a median peritoneal dialysis of 13 months. Prior to dialysis, mild parietal peritoneal inflammation, epithelial-mesenchymal transition and vasculopathy were present. After up to six and 12 months of peritoneal dialysis, blood microvessel density was 110 and 93% higher, endothelial surface area per peritoneal volume 137 and 95% greater, and submesothelial thickness 23 and 58% greater, respectively. Subsequent peritoneal changes were less pronounced. Mesothelial cell coverage was lower and vasculopathy advanced, whereas lymphatic vessel density was unchanged. Morphological changes were accompanied by early fibroblast activation, leukocyte and macrophage infiltration, diffuse podoplanin presence, epithelial mesenchymal transdifferentiation, and by increased proangiogenic and profibrotic cytokine abundance. These transformative changes were confirmed by intraindividual comparisons. Peritoneal microvascular density correlated with peritoneal small-molecular transport function by uni- and multivariate analysis. Thus, in children on peritoneal dialysis neutral pH dialysates containing low-glucose degradation products induce early peritoneal inflammation, fibroblast activation, epithelial-mesenchymal transition and marked angiogenesis, which determines the PD membrane transport function.

Reduced Microvascular Density in Omental Biopsies of Children with Chronic Kidney Disease.

Background Endothelial dysfunction is an early manifestation of cardiovascular disease (CVD) and consistently observed in patients with chronic kidney disease (CKD). We hypothesized that CKD is associated with systemic damage to the microcirculation, preceding macrovascular pathology. To assess the degree of “uremic microangiopathy”, we have measured microvascular density in biopsies of the omentum of children with CKD. Patients and Methods Omental tissue was collected from 32 healthy children (0–18 years) undergoing elective abdominal surgery and from 23 age-matched cases with stage 5 CKD at the time of catheter insertion for initiation of peritoneal dialysis. Biopsies were analyzed by independent observers using either a manual or an automated imaging system for the assessment of microvascular density. Quantitative immunohistochemistry was performed for markers of autophagy and apoptosis, and for the abundance of the angiogenesis-regulating proteins VEGF-A, VEGF-R2, Angpt1 and Angpt2. Results Microvascular density was significantly reduced in uremic children compared to healthy controls, both by manual imaging with a digital microscope (median surface area 0.61% vs. 0.95%, p<0.0021 and by automated quantification (total microvascular surface area 0.89% vs. 1.17% p = 0.01). Density measured by manual imaging was significantly associated with age, height, weight and body surface area in CKD patients and healthy controls. In multivariate analysis, age and serum creatinine level were the only independent, significant predictors of microvascular density (r2 = 0.73). There was no immunohistochemical evidence for apoptosis or autophagy. Quantitative staining showed similar expression levels of the angiogenesis regulators VEGF-A, VEGF-receptor 2 and Angpt1 (p = 0.11), but Angpt2 was significantly lower in CKD children (p = 0.01). Conclusions Microvascular density is profoundly reduced in omental biopsies of children with stage 5 CKD and associated with diminished Angpt2 signaling. Microvascular rarefaction could be an early systemic manifestation of CKD-induced cardiovascular disease.

Population-Based Screening for Selective Immunoglobulin A (IgA) Deficiency in Lithuanian Children Using a Rapid Antibody-Based Fingertip Test

Background Selective immunoglobulin A (IgA) deficiency is the most common inherited immunodeficiency disorder world-wide. An early diagnosis is advocated because of the increased risk of infections, autoimmune diseases, and allergic reactions. We investigated the usefulness of a rapid point-of-care test in detecting for IgA deficiency in a population with a previously unknown prevalence. Material/Methods Altogether, 1000 children aged 11–13 years from randomly selected Lithuanian schools were enrolled. A point-of-care test with a fingertip sample was used to screen for the presence of IgA deficiency in children whose parents gave consent. Those with suspected IgA deficiency were referred to hospital for further clinical examination and confirmation of the diagnosis. In addition, their medical histories were compared with those of 30 age- and sex-matched healthy controls. Results IgA deficiency was suspected in one girl and in three boys on the basis of the rapid test, and the diagnosis was confirmed for all four cases (prevalence 0.4%, 95% confidence interval 0.16–1.02%). There was no difference in disease history or complications between IgA-deficient children and healthy controls. Conclusions The rapid antibody test is a practical and accurate method to diagnose selective IgA deficiency in children. The prevalence of IgA deficiency among Lithuanian schoolchildren is 1:250.

Adolescent with acute psychosis due to anti-N-methyl-D-aspartate receptor encephalitis: successful recovery

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a relatively new autoimmune disorder of the central nervous system. We report the first case of anti-NMDAR autoimmune encephalitis combined with anti-voltage-gated potassium channel (anti-VGKC) antibodies in Lithuania in a 16-year-old girl. The patient was admitted to psychiatry unit because of an acute psychotic episode. She was unsuccessfully treated with antipsychotics, and electroconvulsive therapy was initiated because of her rapidly deteriorating condition. Electroconvulsive therapy improved the patient’s condition even before the initiation of immunomodulatory therapy. The abrupt onset, atypical and severe course of psychosis, poor response to antipsychotic treatment, and signs of flu-like prodromal period led to the search of non-psychiatric causes. Although with considerable delay, she was screened for an autoimmune encephalitis. Positive anti-NMDA receptor antibodies were found in the cerebrospinal fluid, but not in serum. In addition, serum was found positive for antinuclear antibodies and anti-VGKC antibodies but negative for CASPR2 and LGI1 antibodies. The girl was treated with intravenous immunoglobulin and methylprednisolone with satisfactory response, although infrequent orofacial movements, emotional lability, and learning deficits remained upon discharge. The reported case suggests that multiple antibodies could be present, and that electroconvulsive therapy may have a role in symptomatic treatment of autoimmune encephalitis.