Kirurgilise ravi tulemused ja biomarkerite seos haiguse patogeneesi ning riskiga kõhuaordi aneurüsmi ja alajäseme arterite haigusega patsientidel

Väitekirja elektrooniline versioon ei sisalda publikatsiooneKõhuaordi aneurüsm (AAA) on aordi raske haigus, mille eluohtlik tüsistus – rebend – põhjustab suremust üle 80%. Seetõttu on haiguse õigeaegne diagnoosimine ja ravi väga olulised. Haiguse levimus ja esinemissagedus on langenud viimase 20 aastaga, tänapäeval on haiguse levimus 65-aastasel meestel vahemikus 1.3-3.3%. Alajäseme arterite haigus (PAD) on süsteemse ateroskleroosi ilming, mille levimus on ligikaudu 3% vanusegrupis 45-49 eluaastat ja tõustes umbes 18% vanusegrupis 60-90 eluaastat. Kogu maailmas on PAD haiged aladiagnoositud ja- ravitud ning nende südame ja veresoonkonna haigustest tingitud risk on väga kõrge. Käesolevas töös hindasime kirurgilise ja endovaskulaarse ravi tulemusi AAA ja PAD haigetel ning uurisime funktsionaalsete ja biokeemiliste markerite rolli haiguse patogeneesis ja riskis. Leidsime, et plaanilise aordikirurgia 30-, 90-päeva ja 5-aasta kogusuremuse määrad olid vastavalt 0.9%, 2.6% ja 32%. Rebenenud AAA haigetel olid 30-, 90-päeva ja 5-aasta kogusuremuse määrad vastavalt 22.9%, 33.3% ja 55.1%. Leidsime samuti, et 30-päeva suremus, tüsistused ja kordusinterventsioonid plaanilise endovaskulaarse ja avatud kirurgilise ravi korral olid võrdsed. Endovaskulaarne aordi stentproteseerimine oli ühtlasi 5-aasta suremuse sõltumatu riskifaktor. Neli aminohapet ja neli fosfatidüülkoliini olid AAA haigetel tervetega võrreldes statistiliselt oluliselt madalamas kontsentratsioonis. Samas ei esinenud ainsatki metaboliiti, mis oleks eristunud kiire ja aeglase kasvuga AAA haigetel, ega ka metaboliite, mille abil eristada kiire ja aeglase kasvuga AAA patsiente tervetest inimestest. PAD haigete postoperatiivne suremus rekonstruktiivsetel operatsioonidel alloveeniga infraingvinaalses segmendis oli 3.7%, transplantaadi kumulatiivne läbitavus oli 30. päeval, 3. ja 5. aastal vastavalt 82.9%, 38.7% ja 21.3%. Leidsime samuti, et PAD haigetel oli üldise ning südame ja veresoonkonna haiguste suremuse risk sõltumatult seotud langenud väikeste arterite elastsusega.Abdominal aortic aneurysm (AAA) is a complex pathology with a high mortality rate (around 80%) due to its complication, AAA rupture, which is why timely treatment is crucial. AAA prevalence and incidence rates have decreased over the last 20 years, the current prevalence in 65-year-old men is between 1.3% and 3.3%. Peripheral artery disease (PAD) or lower extremity arterial disease is a manifestation of systemic atherosclerosis with a prevalence of 2.7-3% in population aged 45-49 years, increasing up to 18.2 % in persons aged 60-90 years. However, PAD patients remain underdiagnosed and -treated with regard to guideline-directed medical therapy. In the present thesis, patients with elective and emergency AAA and with symptomatic PAD were studied. We aimed to evaluate the results of surgical and endovascular therapy of patients with elective AAA (eAAA) and ruptured (rAAA) and symptomatic PAD; and to determine the role of functional and biochemical markers in pathogenesis and risk prediction in these patients. In patients with eAAA, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In patients with rAAA, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. 30-day mortality, and complication and reintervention rates for endovascular aneurysm repair (EVAR) and open surgical repair in eAAA patients were similar. The EVAR procedure is an independent risk factor for 5-year mortality. The levels of only four amino acids and four phosphatidylcholines were found to be significantly lower after adjustment for confounders among the AAA patients compared with the controls. There were no differences in the metabolites distinguishing the AAA patients with slow or fast growth from the controls, or distinguishing the patients with slow growth from those with fast growth. The rate of operative mortality in PAD patients was 3.7%, the cumulative patency rate for all bypass operations was 82.9%, 38.7% and 21.3% at 30 days, 3 and 5 years, respectively. Small artery elasticity above the median was independently associated with decreased all-cause and cardiovascular disease mortality in PAD patients.https://www.ester.ee/record=b552436

Variability of substrate utilization during exercise relative to VO2vt and VO2max

Lieberg, Erika M., M.S., May 2007 Health and Human Performance Variability of substrate utilization during exercise relative to VO2vt and VO2max Chairperson: Steven E. Gaskill PURPOSE: The purpose of this study was to determine to the stability of ventilatory threshold (VT) as a set point for prescription of exercise intensity. METHODS: Fifty-eight healthy adults (males n = 28, females n = 30) performed VO2max and steady state testing. The VO2max test used a treadmill ramp protocol to determine VO2max and VO2vt. The results were used to determine workload exercise relative to VO2vt and VO2max (70% VO2vt ? 40% VO2max, 90% VO2vt ? 50% VO2max, 125% VO2vt ? 65% VO2max). During the steady state test, subjects walked for 4 minutes at each of the workloads associated with the six exercise intensities. These stages were sequentially completed in the order of increasing intensity. Ventilation (VE), respiratory gas-exchange ratio (RER), VO2, and VCO2 were measured continuously and heart rate and rate of perceived exertion (RPE) were collected each minute. RESULTS: The mean overall variance of RER at the %VO2vt intensities was significantly less than at the %VO2max intensities (%VO2vt = 0.030±0.025, %VO2max = 0.041±0.029, p\u3c0.001). The mean RER variance was not different between genders relative to %VO2vt (p\u3e0.05). For males and females, the variance in RER was significantly less when evaluated at 70% and 90% of VO2vt than at 40% and 50% of VO2max respectively (p\u3c0.001). When the RER mean variance values were compared at the 125%VO2vt vs. 65%VO2max, RER variance values within subjects (males, females and overall) were not different (p\u3e0.05). Similar patterns in RER variance were seen when compared by body mass index (BMI) or fitness. CONCLUSIONS: Using % VO2vt is a viable method to prescribe exercise intensity during research and/or training, with overall lower RER variance, especially when the intensity of exercise is below the ventilatory threshold

Mandlikivi. Haigusjuhu kirjeldus ja kirjanduse ülevaade

31aastane naispatsient suunati TÜ Kliinikumi näo- ja lõualuukirurgi konsultatsioonile seoses pikaajaliste kaebustega valulike neelamishäirete ning tükitunde suhtes kurgus. Kaebuste põhjuseks oli vasakpoolses mandlis paiknev kaltsifikaat. Mandlikive tuleb kliinilises praktikas ette harva ning levinuima patogeneesimehhanismi järgi seostatakse nende teket sagedaste tonsilliitidega. Raviks kasutatakse tonsillektoomiat. Eesti Arst 2009; 88(6):438−44

Exploring Perimeter and Area with 4th Graders

I am going to teach basic introductory geometry skills to 4th graders using Geometry’s Sketchpad. At this age, children are only beginning to learn about geometry in their math classes, and I would like for the students to understand these basic concepts using technology. This problem is so important for the students to learn early, and learn correctly. These skills will involve finding the area and perimeter of regular polygons, basic skills using Geometry’s Sketchpad, and activities that will apply these introductory concepts; directly correlating within the national geometry standards of mathematics. Children use geometry everyday, even when they don’t realize they are using them (actually we all do). But the most important concept for the children is to recognize shapes and structures. If they can identify the use of geometry, then it will automatically trigger the children to think; think in a mathematical state of mind. Thinking mathematically creates questions and also answers questions. With Geometry’s Sketchpad, children can learn these skills much earlier because they can construct, observe, calculate and assess everything independently. Fortunately this contemporary technology is becoming more available in elementary classrooms. These concepts are most likely new to the students at the lower levels; therefore, teaching basic Geometry’s Sketchpad skills to 4th graders will be a great introduction to beginning geometry. According to the national geometry standards for fourth graders, children will be able to analyze characteristic and properties of two-dimensional geometric shapes and develop mathematical arguments about geometric relationships. In these activities, I will explain the basic concepts of perimeters and areas of polygons with and without Geometry’s Sketchpad. I will then give specific instructions on how to use the Sketchpad, next I will transition into three fun activities where the students can use what they’ve learned and understand how these skills can be associated with their own lives. These activities will include the national standards by having the children specify locations and describe spatial relationships using coordinate on Geometer’s Sketchpad and other representational systems such as the geoboards. This will not only give students a fundamental introduction to geometry, but will provide them with knowledge for future application. Most importantly, students will become aware how mathematics and specifically geometry can be used in their everyday lives. Again incorporating these national standards by using visualization, spatial reasoning, geometric modeling to solve problems and apply the problems to analyze mathematical situations

Considerazioni sul genere letterario dei Commentarii di Cesare e Cicerone

In Cicero’s opinion, Caesar’s Commentaries are not historia in the sense of historia ornata

Sul testo di Saffo 31.17 ss.

A new supplement to the end of Sappho’ ode 31

I motivi principali dell'elegia augustea

A survey of several motifs of Latin elegy, with special attention devoted to Catullus’ influence on Roman love poetry: the covenant between lovers; the longing for a family and a quiet life; the alleged irrelevance of the love poet; country and natural world; the poet and the gods; domina and servitium amoris; despair and death wis

L’integrazione di Catullo 95.4

The author discusses former conjectures on Catull. 95.4 and suggests to fill the gap with versiculorum anno illepide pepigit

Il concetto di pax in Properzio

Interpretation of several passages of Propertius evoking the idea of peace, in both private and public life: in the latter, pax also has a moral and political meaning

Associations of NF-kappaB and Bax with Apoptosis in Varicose Veins of Women of Different Age Groups

The study aimed at detecting apoptotic endothelial cells (ECs) and smooth muscle cells (SMCs) together with determining expression of NF-kappaB (p105/p50) and Bax in varicose vein walls. Women (n = 35) undergoing the excision of varicose veins were divided into 3 groups: younger than 35 years (I), 36–50 years (II), and older than 50 years (III). Apoptosis was determined by the TUNEL method, NF-kappaB and Bax expression by immunohistochemistry. The percentage of apoptotic ECs and SMCs in the layers of varicose vein wall increased in groups II and III. NF-kappaB expression had the lowest level in Group II with particularly low level in the media. Contrariwise, Bax expression levels in Group II were increased. The study revealed that in varicose veins ECs and SMCs apoptosis increased with advancing age. If increase in apoptosis during earlier stages of varicosities is probably regulated by intrinsic pathway, then in older patients other signaling pathways may be involved