Infitseerunud seroom üleneva rinnaaordi aneurüsmi resektsiooni järel

Eesti Arst 2014; 93(8):470–47

Autoimmuunne pankreatiit

Eesti Arst 2017; 96(7):415–41

Arterikahjustuste biokeemiline, funktsionaalne ja strukturaalne profileerimine ateroskleroosi korral

Väitekirja elektrooniline versioon ei sisalda publikatsioone.Arterite jäikus iseloomustab arterite laienemisvõimet vererõhu tõusu mõjul. Jäigenenud arterid tõstavad vasaku vatsakese järelkoormust, mis omakorda põhjustab vasaku vatsakese hüpertroofiat ja suurendab müokardi hapnikuvajadust. Lisaks langetab arterite jäigenemine diastoolset vererõhku ja vähendab veelgi koronaarperfusiooni, mis viib circulus vitiosus’e tekkeni. Aordi suurenenud jäikus ennustab iseseisvalt üld- ja kardiovaskulaarset suremust kõrge riskiga patsientidel ja üldrahvastikus. Arterite kaltsifikatsioonil on oluline roll ateroskleroosi patogeneesis. Nii eksperimentaalsete kui kliiniliste uuringute tulemused viitavad sellele, et kaltsiumi ladestumine aordi seinas on reguleeritud mitmete kaltsifikatsiooni aktivaatorite ja inhibiitoritega. Osteoprotegeriin on kaltsifikatsiooni inhibiitor, mis kuulub tuumornekroosi-faktori retseptorite perekonda. Loomkatsetega on näidatud osteoprotegeriini protektiivset rolli ateroskleroosi korral. Osteopontiin kuulub samuti kaltsifikatsiooni inhibiitorite hulka ja osaleb põletiku poolt vahendatud aterosklerootilises protsessis. Vitamiin D on oluline lüli luu ainevahetuse ning südame- ja veresoonkonnahaiguste vahel. Kuid vitamiin D roll arterite kaltsifikatsiooni patogeneesis on vastuoluline - nii vitamiin D defitsiit kui liigsus on seotud arterite väljendunud kaltsifikatsiooniga. Süsteemne krooniline põletik ja tugev kestev oksüdatiivne stress on keskses rollis ateroskleroosi patogeneesis. β2-mikroglobuliin on glükoproteiin, mis osaleb põletikulise protsessi regulatsioonis. β2-mikroglobuliini sisaldus seerumis on suurenenud infektsioonide, autoimmuunhaiguste ja ateroskleroosi korral ning on üldsuremuse riski sõltumatuks teguriks. Oksüdeeritud madala tihedusega lipoproteiin on oksüdatiivse stressi marker, mis omab tugevat proaterogeenset toimet ja ennustab kardiovaskulaarseid tüsistusi ja suremust. Alajäsemete arterite ateroskleroos on levinud haigus, mis avaldub vahelduva lonkamise ja rahuolekuvaludena, kuid võib raskematel juhtudel tüsistuda gangreeniga. Samuti on nendel haigetel oluliselt suurenenud ka müokardi- ja ajuinfarkti tekke risk. Varasemate uuringute tulemused viitavad sellele, et süsteemne krooniline põletik, tugev oksüdatiivne stress ja arterite kaltsifikatsioon ning jäigenemine võivad mõjutada alajäseme arterite ateroskleroosi kliinilist kulgu. Ometi on vähe andmeid nende tegurite vaheliste seoste kohta alajäseme arterite ateroskleroosi korral. Käesolevas uurimustöös leidsime, et alajäsemete arterite ateroskleroosiga patsientidel oli suurenenud aordi jäikus ja kaltsifikatsioon, tõusnud osteoprotegeriini, osteopontiini, β2-mikroglobuliini ning oksüdeeritud madala tihedusega lipoproteiini seerumi tase, kuid vähenenud vitamiin D sisaldus seerumis. Nii osteoprotegeriini, osteopontiini kui ka oksüdeeritud madala tihedusega lipoproteiini seerumi tase oli sõltumatult seotud aordi jäikusega nii ateroskleroosiga patsientidel kui ka kliiniliselt tervetel uuritavatel. β2-mikroglobuliini tase oli iseseisvalt seotud aordi jäikusega ateroskleroosiga patsientidel. Aordi kaltsifikatsioon oli sõltumatult seotud aordi jäikusega nii ateroskleroosiga haigetel kui ka kontrollrühma uuritavatel. Aordi kaltsifikatsioon oli seotud vitamiin D taseme suurenemisega ateroskleroosiga haigetel, kuid vitamiin D taseme vähenemisega tervetel inimestel. Lisaks oli aordi jäikus seotud aterosklerootilise kahjustuse ulatuse ja raskusastmega alajäsemete arterite ateroskleroosiga haigetel.Arterial stiffness describes the rigidity of arterial wall and is one of the earliest detectable manifestations of adverse structural and functional changes within vessel wall. Arterial stiffening increases the left ventricular afterload and promotes development of left ventricular hypertrophy. Moreover, arterial stiffening leads to reduction in diastolic blood pressure, thus diminishing coronary perfusion and causes unbalanced myocardial demand/coronary perfusion pre¬disposing to ischaemia. Aortic stiffness has an independent predictive value for cardiovascular events and all-cause mortality in high-risk patients and in general population. Vascular calcification is another important factor in pathogenesis of atherosclerosis. Experimental and clinical evidence indicate that vascular calcification is an actively regulated process that involves a complex interplay between the promoters and inhibitors of calcification. Osteoprotegerin is an inhibitor of calcification, which is a member of the tumour necrosis factor receptor superfamily. Animal models indicate that osteoprotegerin has a protective role in the arterial system. Osteopontin is also an inhibitor of vascular calcification. It has been shown that osteopontin stimulates inflammatory response and is implicated in the patho¬genesis of atherosclerosis. Vitamin D is another important link between bone metabolism and cardiovascular disease. However, the role of vitamin D in vascular calcification remains controversial. Previous research suggests that both excess and deficiency of vitamin D are pro-moting the development of vascular calcification. Systemic chronic inflammation and high-grade oxidative stress play a key role in development and progression of athero¬sclerosis. The β2-microglobulin has recently emerged as a novel marker of inflammation. Plasma β2-microglobulin is increased in patients with autoimmune diseases, infections and atherosclerosis. A recent population-based study has demonstrated that β2-microglobulin is an independent predictor of all-cause mortality in elderly subjects. Oxidized low-density lipoprotein is a marker of oxidative stress, which exerts strong pro-atherogenic effects and predicts cardiovascular events and mortality. Peripheral arterial disease is a highly prevalent public health problem. The main symptoms of peripheral arterial disease include intermittent claudication, ischaemic rest pain, ulceration and gangrene. Furthermore, patients with the diagnosis of peripheral arterial disease are at high risk of myocardial infarction and stroke. Calcified atherosclerotic arteries, increased arterial stiffness, high-grade oxidative stress and chronic inflammation might influence the clinical course of peripheral arterial disease. However, data about the association between these parameters in patients with peripheral arterial disease are limited. The results of the present study indicate that the patients with peripheral arterial disease had significantly higher aortic stiffness and calcification as well as increased serum levels of osteoprotegerin, osteopontin, β2-microglobulin and oxidized low-density lipoprotein but lower vitamin D levels compared with the controls. Serum osteoprotegerin, osteopontin and oxidized low-density lipoprotein levels were significantly associated with aortic stiffness in the patients with peripheral arterial disease as well as in the healthy subjects. The β2-microglobulin levels were independently associated with aortic stiffness in the patients with symptomatic peripheral arterial disease. Aortic calcification was independently associated with increased aortic stiffness in the patients with peripheral arterial disease and in the clinically healthy subjects. Aortic calcification showed positive correlation with vitamin D levels in the patient group and negative correlation among the control subjects. Finally, aortic stiffness was related to the distribution and severity of atherosclerotic lesions in the lower extremity arteries in patients with peripheral arterial disease

Koronaararterite kompuutertomograafiline angiograafia südame isheemiatõve diagnostikas

Südame isheemiatõve käsitluses on ateroskleroosi varajane tuvastamine ja selle ulatuse hindamine olulise prognostilise ja edasist ravi määrava väärtusega. Kuvamistehnoloogiate areng on parandanud mitteinvasiivsete meetodite täpsust koronaararterite hindamisel ning nende uuringute kliiniline kasutegur on pidevalt suurenemas. Koronaararterite kompuutertomograafilisest angiograafiast (KTA), mis on olnud aastaid vähe tuntud metoodika seisuses, on saamas pingutusstenokardia esmane radioloogiline uurimisvõte, millel on mitmeid eeliseid traditsiooniliste uuringute ees. Koos vooludünaamikat, perfusiooni ja aterosklerootilise naastu struktuuri hindavate komponentidega võimaldab KTA detailselt kirjeldada nii koronaararterite stenoose kui ka nende põhjustatud müokardi isheemilisi muutusi. Koronaararterite KTA-l on praeguse seisuga suur potentsiaal südame isheemiatõve diagnostika arengus ning selle rakendamine tagab patsiendikesksema ja terviklikuma haiguskäsitluse

An Account of Valuing

This dissertation addresses the question: What is it to value something? Valuing is not reducible to a form of desire or belief. I suggest that valuing is a commitment to seeing an object as valuable, and argue that this way of understanding valuing explains its core characteristics and helps us to answer questions about love, special oughts, and meaningfulness in life

The role of distance education in the modern educational space

The article reveals the role of distance education in the modern educational space. The purpose of the article is to clarify the role of distance education in the modern educational space. The research is based on methodological, theoretical and practical levels. The development of distance education is considered from the following directions: online courses, the results of analytical reviews are shown, the possibility of using distance learning in institutions of higher education as a separate approach to learning or together with traditional forms of the educational process; distance universities. The possibilities of distance education, which are now offered by institutions of higher education, are proven, the forms of distance classes are considered, and their diversity is shown, examples of obtaining such education in different countries of the world are given. Features of distance universities are listed: simplified admission to the university; the availability of education is limited only by knowledge of the relevant language, technical capabilities, and funds; exams at leading distance universities are mostly conducted face-to-face, which prevents fraud, although there are additional costs for students. The most common types of distance education, which are the most essential in the educational space of society, are considered

Nutiseade kui leitud võlukepp? Vanemate vaade väikelaste L1-st erineva keele omandamisele YouTube’i abil

Artiklis keskendume tehnoloogia arengule kui mõjutegurile, mis kujundab keelekeskkonda ning toetab mitme keele arengut väikelapse- ja koolieelses eas. Uurimuse ajendiks on juhtum, kus telerit mittevaatavast eestikeelsest perest pärit kaks last hakkasid end mängusituatsioonides väljendama inglise keeles, olles sellega varem kokku puutunud vaid YouTube’i vahendusel meelelahutuse eesmärgil. YouTube’i kui digitaalse õpiruumi fenomeni paremaks mõistmiseks viisime lapsevanematega läbi poolstruktureeritud standardiseerimata paariintervjuud, et uurida, kuidas on võimalik kodus enne kooliiga toetada L1-st erineva keele omandamist nutiseadmete ja YouTube’i abil. Intervjuude analüüsimisel kasutasime kvalitatiivse sisuanalüüsi meetodit. Uurimistulemusena selgus, et vanemate rollid on dünaamilised ning need muutuvad lapse kognitiivse, sotsiaalse ja keelelise arengu käigus koosvaatamisest mentorluseni. *** "A smart device as a magic wand? Parents’ perspective on the impact of YouTube on young children’s second language acquisition" The present article explores the role of technology in shaping language environments and supporting the acquisition of multiple languages among young children and preschoolers. The study focuses on a case where children from an Estonian-speaking family, pseudonymised as Karola and Oskar, began expressing themselves in English in gaming situations, having previously encountered the language primarily through entertainment content on YouTube. Karola started emulating English-speaking YouTubers at the age of five and even created her own videos, while Oskar mainly used English when playing with his toys. The study aims to answer three research questions: when and how the children started using smart devices; how their choices in online content evolved as the children grew; and what roles the parents played in this process. To better understand the phenomenon of YouTube as a digital learning space, a semi-structured non-standardized paired interview was conducted with the children's parents. The goal was to investigate how it is possible to support the acquisition of a language different from L1 at home using smart devices and YouTube. The analysis of the interviews employed qualitative content analysis methods. The results reveal that children started watching short cartoons and animated songs in L1 at the age of one or two. However, as the number of appropriate resources in Estonian on YouTube was limited, they soon opted for cartoons and videos in English. As children grew, they selected the content to watch on the basis of the characters they could relate to. The language in the videos also progressed from simple clearly pronounced words and phrases to fluent authentic use of English. The analysis indicated that parental roles are dynamic and evolve alongside the child's cognitive, social, and linguistic development, ranging from supervision during media consumption to active mentorship

Arterite jäikus ning unearteri sise- ja keskkesta paksus kui subkliinilise elundikahjustuse näitajad arteriaalse hüpertensiooni haigetel

Arteriaalne hüpertensioon on maailmas surmapõhjustest esikohal. Hüpertensioonihaige riski määramisel võetakse aluseks vererõhu väärtused, riski tegurid, subkliinilise elundi kahjustuse ja väljakujunenud kardiovaskulaarse haiguse olemasolu. Järjest enam tähele panu on hakatud pöörama subkliinilise elundikahjustuse määramisele, kuna varajane kardiovaskulaarhaiguste preventsioon on nendel haigetel väga tähtis. Uudsed võimalused subkliinilise elundi kahjustuse määramiseks on aordi pulsilaine kiiruse (pulse wave velocity, PWV) ning une arteri sise- ja keskkesta paksuse (intimamedia thickness, IMT) hindamine. Aordi PWV ja unearteri IMT ennustavad hüpertensioonihaige haigestumist ning suremust südame-veresoonkonnahaigustesse. Anti hüpertensiivsel ravil on lisaks vererõhku alandavale mõjule sub kliinilist elundi kahjustust pidurdav toime. Selle artikli eesmärgiks on anda ülevaade PWV ja IMT hindamisest kardiovaskulaarhaiguste preventsioonis. Eesti Arst 2010; 89(4):251−25

Welfare and Values in Europe: Transitions related to Religion, Minorities and Gender (WaVE). Case study report D9 : ROMANIA - Megdidia Case study report

Welfare and Values in Europe. Transitions related to Religion, Minorities, Gende