Therapeutic Hypothermia in Children and Adults with Severe Traumatic Brain Injury.

Great expectations have been raised about neuroprotection of therapeutic hypothermia in patients with traumatic brain injury (TBI) by analogy with its effects after heart arrest, neonatal asphyxia, and drowning in cold water. The aim of this study is to review our present knowledge of the effect of therapeutic hypothermia on outcome in children and adults with severe TBI. A literature search for relevant articles in English published from year 2000 up to December 2013 found 19 studies. No signs of improvement in outcome from hypothermia were seen in the five pediatric studies. Varied results were reported in 14 studies on adult patients, 2 of which reported a tendency of higher mortality and worse neurological outcome, 4 reported lower mortality, and 9 reported favorable neurological outcome with hypothermia. The quality of several trials was low. The best-performed randomized studies showed no improvement in outcome by hypothermia-some even indicated worse outcome. TBI patients may suffer from hypothermia-induced pulmonary and coagulation side effects, from side effects of vasopressors when re-establishing the hypothermia-induced lowered blood pressure, and from a rebound increase in intracranial pressure (ICP) during and after rewarming. The difference between body temperature and temperature set by the biological thermostat may cause stress-induced worsening of the circulation and oxygenation in injured areas of the brain. These mechanisms may counteract neuroprotective effects of therapeutic hypothermia. We conclude that we still lack scientific support as a first-tier therapy for the use of therapeutic hypothermia in TBI patients for both adults and children, but it may still be an option as a second-tier therapy for refractory intracranial hypertension

How does the management of Lake Vättern following principles of ecosystem-based management?

En minskning av biologisk mångfald och andra naturvärden har lett till en växande förståelse för naturens komplexitet och människans begränsningar i att förutsäga förändringar i ekosystem. I ekosystemansatsen, som härstam- mar från FN:s Konvention om biologisk mångfald, förespråkas ett eko- systemperspektiv för att främja ett hållbart nyttjande av ekosystemen. Eko- systembaserad fiskförvaltning (EBFF) strävar efter att implementera eko- systemansatsen i fiskförvaltningen genom ett helhetsperspektiv på akva- tiska system. I Sveriges näst största sjö Vättern bedrivs en fiskförvaltning och denna rapport har syftet att utvärdera hur Vätterns förvaltning följer principer för en EBFF. Detta ska göras genom litteraturstudier av EBFF, av förvaltningen av Vättern och under besök på Länsstyrelsen i Jönköping. Litteraturstudierna uppvisar ett omfattande material utarbetat för att förvalta Vätterns ekosystem. Samförvaltningen Samförvaltning Fiske medför en plattform för samarbete och kunskapsutbyte och klyftan mellan intressent och myndighet upplevs som mindre. Samförvaltningen ökar engagemang och delaktighet mellan berörda aktörer, forskare och myndigheter. Förvaltningen i Vättern bedöms ha ett ekosystembaserat tankesätt med många goda exempel på utförande och ett flertal av principerna följs. Genom ett effektivt kunskapsutbyte mellan intressenter och över sektorer möjliggörs nya insikter och infallsvinklar i frågor. Information sprids med transparens och beslutsunderlag involverar de dialoger som förs. Den tydliga ansvarsfördelningen minskar konflikter och effektiviserar arbetet. Brister finns i tre principer som också är svåra att beskriva. Förvaltandet av ekosystemens integritet, deras dynamik och mot ett hållbart nyttjande brister till följd av begränsad data och kunskap. Samtidigt som ekosystemen ska vara självorganiserande har människans nyttjande av ekosystemen förändrat dem oåterkalleligt och hon måste därför erkännas som en del av deras naturliga historia.A loss of biodiversity and other natural values is has led to a developing understanding of nature’s complexity and human restrictions in understanding holistic ecosystems. The ecosystem approach, that originates from the United Nations’ Convention of Biological Diversity (CBD), advocates an ecosystem perspective to promote a sustainable use of the ecosystems. Ecosystem-based fisheries management (EBFM) implements the Ecosystem Approach in fisheries management. In the second largest lake of Sweden, Lake Vättern, a fisheries management is pursued and the purpose of this report is to assess how the management of Lake Vättern is following principles of EBFM. Literature studies of both EBFM and of the management of Lake Vättern and a visit for one week at the county administrative board of Jönköping county have been undertaken. The study exhibit a comprehensive material developed to administer the ecosystems of Lake Vättern. Due to the strategy of co-management, the management has a platform for cooperation and exchange of knowledge and the gap between stakeholder and authorities seems to have decreased. The co-management enhances commitment and participation between involved stakeholders, scientist and authorities. The management of Lake Vättern has an ecosystem-based way of thinking and holds many good examples of EBFM in practice and follows most of the principles. Through the effective exchange of knowledge between stakeholders and across sectors, new insights and angles appear in various issues. Information spreads with transparency and decisions consider the conversations. A distinct distribution of responsibilities minimizes conflicts and streamlines the work. Shortcomings exist in three of the principles that also are difficult to describe. Management of the ecosystem integrity and its dynamics, and pursuing a sustainable development, meet difficulties due to a shortage of data and knowledge. As the ecosystems simultaneously should be selforganizing, human use has changed them irreversibly and humans therefore need to be accepted as a part of the natural history of ecosystems

Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

Background: Migraine attacks occur spontaneously in those who suffer from the condition, but migraine-like attacks can also be induced artificially by a number of substances. Previously published evidence makes the meninges a likely source of migraine related pain. This article investigates the effect of several vasodilators on meningeal arteries in order to find a connection between the effect of a substance on a meningeal vessel and its ability to artificially induce migraine. Methods: A myograph setup was used to test the vasodilator properties of the substances acetylcholine (ACh), sodium nitroprusside (SNP), sildenafil, prostaglandin E2 (PGE2), pituitary adenylate cyclase activating peptide-38 (PACAP-38), calcitonin gene-related peptide (CGRP) and NaCl buffer on meningeal arteries from human and rat. An unpaired t-test was used to statistically compare the mean Emax(%) at the highest concentration of each substance to the Emax(%) of NaCl buffer. Results: In the human experiments, all substances except PACAP-38 had an Emax (%) higher than the NaCl buffer, but the difference was only significant for SNP and CGRP. For the human samples, clinically tested antimigraine compounds (sumatriptan, telcagepant) were applied to the isolated arteries, and both induced a significant decrease of the effect of exogenously administrated CGRP. In experiments on rat middle meningeal arteries, pre-contracted with PGF2α, similar tendencies were seen. When the pre-contraction was switched to K+ in a separate series of experiments, CGRP and sildenafil significantly relaxed the arteries. Conclusions: Still no definite answer can be given as to why pain is experienced during an attack of migraine. No clear correlation was found between the efficacy of a substance as a meningeal artery vasodilator in human and the ability to artificially induce migraine or the mechanism of action. Vasodilatation could be an essential trigger, but only in conjunction with other unknown factors. The vasculature of the meninges likely contributes to the propagation of the migrainal cascade of symptoms, but more research is needed before any conclusions can be drawn about the nature of this contribution

The G protein-coupled oestrogen receptor 1 agonist G-1 disrupts endothelial cell microtubule structure in a receptor-independent manner.

The G protein-coupled oestrogen receptor GPER1, also known as GPR30, has been implicated in oestrogen signalling, but the physiological importance of GPER1 is not fully understood. The GPER1 agonist G-1 has become an important tool to assess GPER1-mediated cellular effects. Here, we report that this substance, besides acting via GPER1, affects the microtubule network in endothelial cells. Treatment with G-1 (3 μM) for 24 h reduced DNA synthesis by about 60 % in mouse microvascular endothelial bEnd.3 cells. Treatment with 3 μM G-1 prevented outgrowth of primary endothelial cells from mouse aortic explants embedded in Matrigel. Treatment with G-1 (0.3-3 μM) for 24 h disrupted bEnd.3 cell and HUVEC microtubule structure in a concentration-dependent manner as assessed by laser-scanning confocal immunofluorescence microscopy. G-1-induced (3 μM) disruption of microtubule was observed also after acute (3 and 6 h) treatment and in the presence of the protein synthesis inhibitor cycloheximide. Disruption of microtubules by 3 μM G-1 was observed in aortic smooth muscle cells obtained from both GPER1 knockout and wild-type mice, suggesting that G-1 influences microtubules through a mechanism independent of GPER1. G-1 dose dependently (10-50 μM) stimulated microtubule assembly in vitro. On the other hand, microtubules appeared normal in the presence of 10-50 μM G-1 as determined by electron microscopy. We suggest that G-1-promoted endothelial cell anti-proliferation is due in part to alteration of microtubule organization through a mechanism independent of GPER1. This G-1-promoted mechanism may be used to block unwanted endothelial cell proliferation and angiogenesis such as that observed in, e.g. cancer

The "Lund Concept" for the treatment of severe head trauma - physiological principles and clinical application.

The Lund Concept is an approach to the treatment of severe brain trauma that is mainly based on hypotheses originating from basic physiological principles regarding brain volume and cerebral perfusion regulation. Its main attributes have found support in experimental and clinical studies. This review explains the principles of the Lund Concept and is intended to serve as the current guide for its clinical application. The therapy has two main goals: (1) to reduce or prevent an increase in ICP (ICP-targeted goal) and (2) to improve perfusion and oxygenation around contusions (perfusion-targeted goal). The Lund therapy considers the consequences of a disrupted blood-brain barrier for development of brain oedema and the specific consequences of a rigid dura/cranium for general cerebral haemodynamics. It calls attention to the importance of improving perfusion and oxygenation of the injured areas of the brain. This is achieved by normal blood oxygenation, by maintaining normovolaemia with normal haematocrit and plasma protein concentrations, and by antagonizing vasoconstriction through reduction of catecholamine concentration in plasma and sympathetic discharge (minimizing stress and by refraining from vasoconstrictors and active cooling). The therapeutic measures mean normalization of all essential haemodynamic parameters (blood pressure, plasma oncotic pressure, plasma and erythrocyte volumes, PaO2, PaCO2) the use of enteral nutrition, and avoidance of overnutrition. To date, clinical outcome studies using the Lund Concept have shown favourable results

Den kreativa rörelsen mot kunskap - en studie om betydelsen av skolbibliotek för elever

Sammanfattning: Syftet med uppsatsen är att söka reda på vilken betydelse som eleverna lägger vid skolbiblioteket samt vad denna betydelse har för elevernas sökande efter kunskap. Vi undersöker även skolans inverkan och vad de tekniska verktygen har för betydelse för användandet av skolbiblioteket. Det finns flera saker som har betydelse för elevers kunskapssökande. I uppsatsen ligger fokus på skolbiblioteket, skolan som institution och tillgången till datorer. Det är elevernas perspektiv som är centrala och därav används fokusgruppintervjuer för att belysa gruppens bild av skolbibliotek och undervisningen på den aktuella skolan. Det är tre fokusgrupper i olika åldrar från en skola på Hisingen. De variabler som undersöks är placeringen av klassrum i förhållande till skolbiblioteket samt lärarens roll i förhållande till elevers användning av biblioteket. I teori och tidigare forskning beskrivs tydligt att skolbiblioteket som rum är viktig för att eleverna ska ges mening åt sitt kunskapssökande och bör vara en del av undervisningen. Skolbiblioteket är också en symbol för kunskap och är positivt laddad för elever. Genom intervjuerna framkom att betydelsen av skolbibliotek fortfarande är viktig för eleverna i deras kunskapssökning men att de inte får möjlighet att använda rummet. Skolbiblioteket har speciella öppettider men hindras också av lärarna som inte väljer att använda sig av biblioteket i deras undervisning. Flera lärare tar fram nödvändigt material innan lektionerna och hänvisar ibland till specifika hemsidor på Internet. Eleverna upplever att datorn är det som är lättast att använda vid inhämtning av information men trots detta uppfattas den tryckta boken som mer tillförlitlig. Resultatet från uppsatsen har betydelse för läraryrket eftersom det rum som är starkt förknippat med kunskap och lärande, skolbiblioteket, inte längre brukas aktivt i skolan. Den verksamme pedagogen bör därmed använda skolbiblioteket och guida eleven i dennes kunskapssökande