Cerebral circulation and the sympathetic nervous system in patients with traumatic brain injury or subarachnoid hemorrhage

Maintenance of adequate cerebral microcirculation is necessary to avoid cerebral ischemia after severe traumatic brain injury and non-traumatic subarachnoid hemorrhage. After severe traumatic brain injury the blood-brain-barrier is disrupted and transcapillary leakage will contribute to the development of vasogenic brain edema. The edema causes a compromised microcirculation.Systemic complications and cerebral vasospasm observed after non-traumatic subarachnoid hemorrhage may be associated with an activated sympathetic nervous system. Although in-creased concentrations of plasma and urinary norepinephrine are found in patients following subarachnoid hemorrhage, this does not necessarily indicate an activated sympathetic nervous system. To adequately assess an activation of the sympathetic nervous system both release and removal processes of norepinephrine must be considered.A therapy focused on physiological principles for volume regulation and preserved microcir-culation following traumatic brain injury was evaluated in two clinical studies. Prostacyclin may improve cerebral microcirculation after severe traumatic brain injury due to its inhibition of platelet/leukocyte aggregation and adhesion to endothe-lium. Safety profile and outcome after prostacyclin administration was evaluated in the sec-ond study. With an isotope dilution technique the duration and magnitude of the sympathetic nervous activation in patients following subarachnoid hemorrhage was measured and the presumed inhibitory effect of clonidine on sympathetic nervous activation was tested.Favorable outcome after severe traumatic brain injury was 71% in both studies and the mor-tality rate was 13% and 3% respectively. Prostacyclin did not cause any severe side effects. Patients following subarachnoid hemorrhage exhibited an extreme elevation in sympathetic nervous system activity that persisted for at least one week after the insult. Contrary to what would be expected, clonidine did not reduce sympathetic nervous activation in patients fol-lowing subarachnoid hemorrhage

Survival and growth success of russian olive (Elaeagnus angustifolia L.), salt cedar (Tamarix smyrnensis bunge) and white poplar (Populus alba l.) seedlings in salt-sodic central anatolia areas with gypsum and sulfur applications

YÖK Tez No: 588825İç Anadolu'daki vadi tabanlarının önemli bir kısmı tuzlu-sodik toprak özelliği göstermektedir. Bu çalışmada jips ve kükürt uygulaması ile tuzlu-sodik topraklardan fazla sodyumun yıkanarak toprağın iyileştirilmesi amaçlanmıştır. Toprağa kimyasal işlemler uygulandıktan sonra ılgın (Tamarix smymensis Bunge), iğde (Elaeagnus angustifolia L.) ve akkavak (Populus alba L.) fidanları dikilerek yaşama oranları ve büyüme performansları takip edilmiştir. Üç yaşındaki fidanlar 2013 sonbaharında 1,5 X 1,5 m aralıklarla deneme ünitelerine dikilmiştir. 2015 Eylül sonu fidanların yaşama oranları belirlenerek boy ve çap ölçümleri gerçekleştirilmiştir. İkinci büyüme sezonu sonunda %80 'lik bir oranla en fazla yaşama yüzdesine ılgın türünün sahip olduğu belirlenmiştir. Akkavak bütün işlem alanlarında ortalama %36'lık bir yaşama yüzdesi göstermiştir. İğde jips ve kükürt uygulanan sahalarda 50 cm boy büyümesi yaparken kontrol sahalarında sadece 25 cm boy büyümesi yapabilmiştir. İğde fidanlarının çap ortalaması da jips ve kükürt uygulanan sahalarda 9.3 mm olarak ölçülürken kontrol sahalarında bu değer 5 mm olarak kaydedilmiştir. Akkavak ise jips ve kükürt uygulanan alanlarda kontrol sahalarına göre %42 daha fazla büyüme gerçekleştirmiştir. Ilgının büyümesi bakımından ise sahalar arasında istatistiki olarak önemli bir farklılık bulunamamıştır. Denenen türlerden de iğdenin bütün sahalarda en iyi yaşama oranını ve büyüme performansını gösterdiği ortaya çıkmıştır.An important part of the valley bases in Central Anatolia shows salt-sodic soil characteristics. In this study, it is aimed to improve the soil by washing more sodium than salty-sodic soils with gypsum and sulfur application. After chemical treatment was applied to the soil, tamarisk (Tamarix Smymensis Bunge), spindle (Elaeagnus angustifolia L.) and abele (Populus alba L.) seedlings were planted, and their survival rates and growth performances were followed. Three-year-old seedlings were planted in trial units in the autumn of 2013 at 1.5 X 1.5 m intervals. By the end of September 2015, height and diameter measurements of saplings were made. At the end of the second growth season, it was determined that 80% of the tamarisk had the highest percentage of life. Abele showed an average survival rate of 36% in all processing areas. While spindle was 50 cm in gypsum and sulfur were applied, it was able to grow only 25 cm in the control areas. The average diameter of the seedling saplings was measured as 9.3 mm in gypsum and sulfur treated areas and this value was recorded as 5 mm in the control areas. Abele achieved 42% more growth in gypsum and sulfur treated areas than in control areas. In terms of Tamarisk growth, no statistically significant difference was found between the sites. Among the tested species, spindle was found that the spindle showed the best survival rate and growth performance in all fields

Leptin levels after subarachnoid haemorrhage are gender dependent

Background: Subarachnoid hemorrhage (SAH) is a neurological disease where the majority of the patients are critically ill. The adipokine leptin has in cerebral emergencies been related to severity of disease and to adverse outcome. The aim of this study was to examine leptin levels over time after SAH and associations to gender, age, body mass index, severity of disease, parenteral lipids, systemic organ failure and outcome. Methods: Prospective observational study in 56 patients. Leptin was obtained 0-240 h after SAH, in 48 h intervals. Severity of disease was assessed with the Hunt and Hess score, organ failure with the sequential organ failure assessment score, and outcome with Glasgow outcome scale. Leptin levels in the SAH group were compared with controls from the same geographical area. Results: At admission, Leptin was significantly higher in SAH patients compared to controls, both in female (28.6 +/- 25.6 vs 13.0 +/- 2.3 ng/mL, p = 0.001) and male patients (13.3 +/- 8.4 vs 4.3 +/- 0.7 ng/mL, p = 0.001). Leptin levels remained stable over time. Female patients had significantly higher leptin levels than male patients, and deceased female patients had higher leptin levels than female survivors (85.5 +/- 20.5 vs 50.5 +/- 34.6, n = 4/35, p < 0.05). Leptin levels did not differ between male survivors and non-survivors. Leptin levels were not associated with severity of disease, organ failure or parenteral lipids. Conclusion: Leptin levels were significantly higher in both male and female patients compared to controls. Higher leptin levels were related to outcome and organ failure in women but not in men. When analysing leptin levels gender-related differences should be considered

AS Aldaris strategic governance improvement directions.

Maģistra darba tēma ir A/S „ALDARIS” stratēģiskās vadīšanas pilnveidošanas virzieni. Savukārt darba mērķis ir izpētīt un analizēt A/S „ALDARIS” uzņēmuma darbību, tās stratēģiskās vadīšanas virzienus, jo A/S „ALDARIS” ir viena no senākajām un lielākajām alus darītavām Latvijā, turklāt uzņēmuma zīmols mūsdienās kļuvis atpazīstams arī ārpus valsts robežām. A/S „ALDARIS” ir viens no vadošajiem alus ražotājiem Latvijas alus nozarē. Maģistra darba pirmajā nodaļā tiek pētīta alus nozare Latvijas tautsaimniecībā, alus kultūra, tradicionālā pieeja un attīstības gaita. Otrajā nodaļā tiek pētīta pirmā saskarsme ar Carlsberg Grupu, uzņēmuma pievienošanās vienam no pasaules līderiem alus ražošanas nozarē, kā arī tiek aplūkotas valsts likumdošanas izmaiņas saistībā ar akcīzes nodokļa maiņām, kas būtiski ietekmē alus nozares uzņēmumus. Trešajā nodaļā tiek pētītas vadības stratēģijas, izveidota SVID analīze, kā arī veikta aptauja, lai noskaidrotu patērētāju viedokli par uzņēmuma darbību. Ceturtajā nodaļā tiek pētīta nākotnes vīzija par uzņēmuma attīstību, jaunu produktu ieviešana tirgū, papildus motivācijas sistēma, kā arī izvērtēta vadītāja un līderu loma uzņēmumā. A/S „ALDARIS” uzņēmuma analizējamais periods ir no 2008. - 2018.gadam. Maģistra darbs uzrakstīts latviešu valodā un tas sastāv no 93 lappuses, 2 pielikumiem, 14 tabulām, 25 attēliem un darbā tika izmantoti 77 literatūras avotiem.The theme of the master degree work is AS Aldaris strategic governance improvement directions. In turn, the aim of the work ir explore and analyze AS Aldaris the activities of the company, it’s strategic directions of management, because company is one of the oldest and largest breweries in Latvia, besides, the company’s brand has no become recognizable also abroad. AS Aldaris is one of the leading breweries in the Latvian beer industry. The first chapter of the master’s paper investigates the beer industry in the national economy of Latvia, the culture of beer, the tradiciocal approach and the course of development. The second chapter examines the first contact with the Carlsberg Group, the company's accession to one of the world's leaders in the beer industry, and examines changes in national legislation regarding excise tax changes that have a significant impact on beer industry companies. The third chapter examines management strategies, develops SWOT analysis, and conducts a survey to find out the views of consumers about the company's operations. The fourth chapter examines the future vision of the company's development, the introduction of new products on the market, an additional motivation system, and assesses the role of manager and leaders in the company. The analyzing period of the AS Aldaris is from 2008 to 2018. The Master job is written in Latvian and ir consist of 93 pages, 2 supplements, 14 appendixes, 25 pictures, 77 literature resources were used in the wor

P E D I A T R I C O R I G I N A L Severe traumatic brain injury in pediatric patients: treatment and outcome using an intracranial pressure targeted therapy- the Lund concept Springer-Verlag 2005

Abstract Objective: This study evaluated the outcome of treatment according to the Lund concept in children with severe traumatic brain injury and investigated whether the preset goals of the protocol were achieved. Design and setting: A twocenter retrospective study in neurointensive care units at university hospitals. Patients: Forty-one children with severe traumatic brain injury from blunt trauma and arriving at hospital within 24 h after injury. Median age was 8.8 years (range 3 months-14.2 years), Glasgow Coma Scale 7 (3-8), and Injury Severity Score 25 (16-75). All children had pathological findings on initial computed tomography. All developed intracranial hypertension, and survivors required intensive care longer than 72 h. Interventions: Treatment according to the principles of the Lund concept. Measurements and results: Neurosurgery was required in 46% of the children. Survival rate was 93% and favorable outcome (Glasgow Outcome Score 4 or 5) was 80% at long-term follow-up (median 12 months postinjury, range 2.5-26). The preset physiological and biochemical goals were achieved in over 90% of observations. Conclusions: Treating pediatric patients with severe traumatic brain injury, according to the Lund concept, results in a favorable outcome when the protocol is followed

Sympathetic activation and inflammatory response in patients with subarachnoid haemorrhage.

OBJECTIVE: The aim of this study was to evaluate the correlation between sympathetic nervous activation and the immune response in patients following subarachnoid haemorrhage (SAH). DESIGN AND SETTING: Clinical study in a neurosurgical intensive care unit. PATIENTS AND PARTICIPANTS: Fourteen patients with acute non-traumatic SAH were included. Fifteen healthy, age-matched volunteers served as controls for measurement of catecholamine spillover. INTERVENTION: Blood sampling for C3a, C5b-9, IL-6, IL-8 and norepinephrine kinetic determination was made within 48 h, at 72 h and on the 7th-10th day after the SAH. MEASUREMENTS AND RESULTS: SAH patients exhibited a profound increase in the rate of norepinephrine spillover to plasma at 48 h, 72 h and 7-10 days after the insult, 3-4 times that in healthy individuals. The plasma levels of C3a, IL-6 and C5b-9 were significantly elevated at 48 h, at 72 h and 7-10 days after the SAH, but the plasma level of IL-6 decreased significantly 7-10 days after the SAH. There was no relationship between the magnitude of sympathetic activation and the levels of inflammatory markers. CONCLUSIONS: Following SAH a pronounced activation of the sympathetic nervous system and the inflammatory system occurs. The lack of significant association between the rate of spillover of norepinephrine to plasma and the plasma levels of inflammatory markers indicates that the two processes, sympathetic activation and the immune response, following SAH are not quantitatively linked. In spite of a persistent high level of sympathetic activation the plasma level of IL-6 decreased significantly one week after SAH