Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland 2. National Institute for Health and Welfare, Helsinki, Finland

Dydis: px
Rodyti nuo puslapio:

Download "Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland 2. National Institute for Health and Welfare, Helsinki, Finland"

Transkriptas

1 ORIGINAL CONTRIBUTION Rhinology, 49, 90-94, 2011 Antibody responses to tetanus and diphtheria vaccine in chronic and recurrent rhinosinusitis* Olli Tahkokallio 1, Anni Koskinen 1, Erna Kentala 1, Rose-Marie Ölander 2, Petri Severi Mattila 1 1 Department of Otorhinolaryngology, Helsinki University Central Hospital, Finland 2 National Institute for Health and Welfare, Helsinki, Finland Summary Objectives: Chronic rhinosinusitis may be accompanied by impaired immunity despite normal levels of serum immunoglobulins. Immune responses in sinusitis patients have previously been evaluated using polysaccharide vaccines. Our aim was to assess the immune status by evaluating responses to diphtheria and tetanus vaccine. Methods: Specific antibodies were measured before and 2 weeks after vaccination in 25 patients with chronic or recurrent sinusitis and in 30 healthy individuals. The mean age of the patients was 46 years and that of healthy controls 43 years. Results: After vaccination the patients had on average 4.08-fold lower responses to diphtheria toxoid and 2.20-fold lower responses to tetanus than the controls. Fourteen out of 25 patients had antibody levels that did not reach the 95% normal distribution range of healthy controls after either diphtheria or tetanus vaccination. All the patients had normal levels of serum immunoglobulins. Conclusions: A significant proportion of patients with persisting symptoms of rhinosinisitis may have impaired responses to protein vaccines. Responses to protein vaccines may be used to evaluate immune function of sinusitis patients. Key words: sinusitis, vaccination, antibodies, immunoglobulins, immunodeficiency INTRODUCTION Sinusitis is a frequent symptom in profound disorders of antibody mediated immunity such as common variable immune immune deficiency (CVID) (1-3) and hyper IgM syndrome (4,5). This suggests that antibodies are important in the resolution of sinusitis. Thereby, it is not surprising that patients who initially present with chronic rhinosinusitis (CRS), that is defined by inflammation of the mucosal lining of the sinuses lasting more than 12 weeks (6), include patients who have impairments in their antibody-mediated immunity (7). Strategies for the evaluation of immune function in patients with CRS comprise assessments of allergy, measurements of serum IgA, IgM, and IgG subclasses, determination of specific antibody responses to vaccines, and HIV testing (8). As inhalant allergy is a frequent contributing factor, the initial immune evaluation of CRS patients includes allergy testing. Determinations of serum immunoglogulin values are useful, as some CRS patients have abnormal levels. Isolated or combined IgG3, IgG2, or IgA deficiencies have been observed both in adult and pediatric patients with CRS (9-15). Even when serum immunoglobulin levels are within normal limits, antibody mediated-immunity maybe somewhat impaired. An example of this is that, despite serum IgA levels are within normal limits, the average serum IgA levels may still be lower in sinusitis patients than in healthy age and sex matched individuals (16). As some patients have impaired immunity despite normal immunoglobulin levels, vaccine responses have been measured to assess immune function. Impaired responses to pneumococcal or Haemophilus influenzae polysaccharide vaccines have been observed both in children and adults with CRS (17-20). We present here a series of patients, who have normal levels of serum immunoglobulins, but who have continuing symptoms of sinusitis despite sinus surgery and numerous courses of antibiotics. To assess antibody-mediated immunity, we evaluated their responses to tetanus and diphtheria vaccination and compared that to the responses in healthy individuals. MATERIALS AND METHODS Study participants *Received for publication: January 10, 2010; accepted: June 8, 2010 DOI: /Rhino _009693_Tahkokallio.indd :21:46

2 91 Tahkokallio et al. The study patients were selected from 198 adult patients who were admitted between 1995 and 1997 to Jorvi Hospital, Espoo, Finland because of recurrent or chronic rhinosinusitis, and who were evaluated and operated on by one of the authors (O.T.). Inclusion criteria for patients with chronic rhinosinusitis included continuous symptoms of sinus inflammation manifesting as continuously stuffed nose with nasal discharge for more than two years with periodic exacerbations of purulent sinusitis. Inclusion criteria for patients with recurrent rhinosinusitis were more than four episodes of acute sinusitis during the last 12 months or more than two episodes of acute sinusitis a year during the last five years. Between the acute sinusitis episodes the patients were relatively free of sinonasal symptoms. Diagnosis of acute sinusitis was defined when effusion was detected in maxillary sinuses by maxillary sinus punctures or sinus roentgenograms. that had received peroral corticosteroid therapy within the last 12 months were excluded from the study. Of the 25 patients included in the study, 13 patients presented with chronic and 12 patients presented with recurrent rhinosinusitis. The mean age of the patients was 46 years (range 19 to 64 years). Eighteen were female and 7 were male. All the patients underwent endoscopic sinus surgery. The mean preoperative duration of symptoms related to recurrent or chronic sinusitis was 7 years (range 1 to 22 years). Nine of the patients had asthma. Four patients had specific serum IgE antibodies to pollen or animal dust antigens. Nasal polyposis was present in 15 patients. All the patients had normal levels of serum IgA, IgM, IgG, as well as normal levels of IgG subclasses. Thirteen study patients experienced one sinus operation and the rest of them from 2 to 5 operations. Two of the study patients were operated on endoscopically by a modified Lothrop procedure to drain the frontal sinuses. The study patients represented a subpopulation having the most severe spectrum of sinusitis symptoms of the patients admitted to Jorvi hospital. Healthy individuals with no prior history of recurrent of chronic sinusitis were recruited among hospital personnel. Healthy individuals were selected to match the sex and age distribution of the patients. Altogether, 30 control individuals were recruited. Twenty-six were females and 4 were males. The mean age was 43 years (range years). The Ethical Review Committee of the Helsinki University Central Hospital had approved the study. All the study subjects gave written informed consent to participate in the study. The study was conducted in accordance with the regulatory requirements, Good Clinical Practice, and the ethical principles of the Declaration of Helsinki. Vaccination and serum samples All the study participants were vaccinated with tetanus and diphtheria toxin vaccine. The vaccine, Tetanus-d-rokote, was manufactured at the National Public Health Institute, Helsinki. It contained 2 Lf diphtheria and 5 Lf tetanus toxoid absorbed to aluminum phosphate in 0.5 ml (21). It was administered by an intramuscular injection once into the upper deltoid. Vaccination of the patients was performed when the patients did not have any acute exacerbations of their sinus disease. Peripheral blood for serum samples was taken immediately before vaccination and 2 weeks after. Serum samples were stored frozen until analysis. Determination of serum antibody concentrations Diphtheria and tetanus antitoxins were measured by a double antigen EIA (DAE) as described previously (21). The antibody concentrations were reported as international units per ml (IU/mL). Tetanus and diphtheria antitoxin concentrations between IU/mL are conventionally considered as low positive, whereas antitoxin concentrations 0.1 IU/mL are considered positive (22). Concentrations 1 IU/mL indicate a good long-term protection. Statistical analysis Statistical analyses of antibody concentrations were performed after logarithmic transformation of the data. Linear regression was used to compare antibody responses. Fisher exact test was used to calculate the statistical significance of two-way tables. Logistic regression was used to analyze possible parameters associated with a defective antibody response. The analyses were performed using the PASW Statistics 18.0 software (SPSS Inc., Chicago, IL, USA). RESULTS At the start of the trial most study participants had tetanus and diphtheria toxoid antibodies. This reflected previous vaccinations against tetanus and diphtheria. However, some had very low tetanus (2 patients) or diphtheria (1 patient and 4 controls) antitoxin concentrations (< 0.01 IU/mL) before the vaccination. This might indicate that these individuals may not have previously been vaccinated or have received incomplete primary vaccinations. As the primary and secondary antibody responses are likely very different, we excluded these individuals from the analysis. Vaccination induced strong antibody responses 2 weeks after vaccination. Among the patients, diphtheria toxoid induced on the average a 5.74-fold rise (95% CI 3.54 to 9.29) and tetanus toxoid induced on the average a 3.48-fold rise (95% CI 2.19 to 5.51) in antibody concentrations. However, these responses were higher among the healthy controls, a 12.9-fold rise (95% CI 8.13 to 20.4) and a 6.93-fold rise (95% CI 4.38 to 11.0), respectively. When antibody responses were compared between patients and controls, we found lower responses in patients as compared to healthy controls. Diphtheria toxoid induced on the average 4.08-fold lower responses and tetanus toxoid induced on the average 2.20-fold lower responses in patients with rhinosinusitis than in healthy controls (Table 1). Before the vaccination, we could not observe any significant differences in antibody concentrations between the healthy controls and the patients (Table 1). 15_009693_Tahkokallio.indd :21:46

3 Vaccine responses in sinusitis 92 Confounding factors, particularly the antibody level before the vaccination may have caused a bias. To test this, we did linear regression where the pre-vaccination antibody level, gender, and age, as well as the study subject group (patient vs. control), were entered as independent variables and the post-vaccination antibody level was entered as the dependent variable. The analysis revealed that after correcting for the above confounding factors the patients had on average 2.72-fold lower (95% CI 1.51 to 4.89, p = 0.001) and 2.33-fold lower (95% CI 1.64 to 3.31, p < 0.001) antitoxoid responses to diphtheria and tetanus, respectively. This implied that the patients had low responses irrespective of age, gender, or the pre-vaccination antibody level. To approximate a normal antibody response to diphtheria and tetanus vaccination, we plotted the post-vaccination antibody concentrations in a graph (Figure 1). The antibody responses in patients were variable in that some patients had responses comparable to that of the healthy controls but some had clearly lower responses than the healthy controls. Such low responders did not develop high enough antibody concentrations that would reach the 95% normal distribution range of healthy controls. Eleven (46%) out of 24 patients (p < 0.001) and 7 (30%) out of 23 patients (p = 0.02) were such low responders to diphtheria and tetanus toxoids, respectively (Figure 1). Out of 25 patients, 14 (56%) were low responders to either diphtheria or tetanus (p < 0.001) and 4 (16%) patients had low responses to both diphtheria and tetanus. We then evaluated whether an abnormal antibody response would correlate with any clinical symptoms or findings. Although the number of patients who presented with recurrent as opposed to chronic rhinosinusitis was somewhat higher among the low responders, the difference was not statistically significant (Table 2). We could not observe any significant association between vaccine responses and polyposis, asthma, or the presence of serum IgE antibodies to pollen or animal dust antigens (Table 2). There were no statistically significant differences in serum immunoglobulin concentrations between defective vs. normal responders (data not shown). Antibody concentration (IU/ml) two weeks after vaccination A. Diphtheria B. Tetanus DISCUSSION Comparison of the responses after vaccination revealed that antibody responses to tetanus or diphtheria toxoids were low in approximately half of our rhinosinusitis patients. This may indicate a generalized impairment of antibody responses in a significant proportion of rhinosinusitis patients that may predispose them for the disease. Alternatively, it is possible that a chronic inflammation in the nasal sinuses may secondarily impair systemic antibody responses. This could further impair the ability to recover from sinusitis. We excluded patients who had been using oral steroids within the last 12 months. Despite this, many of our patients were users of inhaled steroids. This could have impaired vaccine responses. However, our patients were free of acute symptoms Figure 1. Antibody responses 2 weeks after diphtheria and tetanus toxoid vaccination. A. Diphtheria toxoid antibody concentrations in healthy control individuals and in CRS patients. B. Tetanus toxoid antibody concentrations in healthy control individuals and in CRS patients. Each antibody value is indicated by a circle. The 95% normal distribution of antibody concentrations and the geometric mean antibody concentration in healthy control individuals is indicated by a box and a line, respectively. at the time of the vaccination and the use for inhaled steroids may have not been very excessive at that time. This suggests that the use of inhaled steroids are likely to not have introduced a strong bias to our results. It should be emphasized that the antibody responses measured represented secondary responses, as tetanus and diphtheria vaccination has been included in the Finnish vaccination pro- 15_009693_Tahkokallio.indd :21:46

4 93 Tahkokallio et al. Table 1. Comparison of antibody responses to vaccination between rhinosinusitis patients and controls. Geometic mean Geometic mean Ratio of the geometric means (95% CI) p-value (range) in IU/mL (range) in IU/mL between controls and patients Diphtheria toxoid antibodies n = 24 n = 26 before vaccination 0.38 ( ) 0.70 ( ) 1.82 ( ) weeks after vaccination 2.22 (0.1-31) 9.08 (1.6-45) 4.08 ( ) < Tetanus toxoid antibodies n = 23 n = 30 before vaccination 3.40 ( ) 3.75 (0.1-24) 1.10 ( ) weeks after vaccination 11.8 (1.8-71) 25.9 (7.0-51) 2.20 ( ) < Table 2. Correlation of co-morbidities with a defective antibody response. The values are numbers of patients unless otherwise stated. Normal response Defective response Either diphtheria or tetanus Both diphtheria and tetanus n = 11 n = 14 OR (95% CI) n = 4 OR (95% CI) Recurrent rhinosinusitis 4 (36%) 8 (57%) 2.33 (0.46 to 11.81) 2 (50%) 1.75 (0.17 to 17.68) Polyposis 7 (63%) 8 (57%) 0.76 (0.15 to 3.87) 2 (50%) 0.57 (0.06 to 5.78) Asthma 3 (27%) 6 (43%) 2.00 (0.37 to 10.92) 3 (75%) 8.00 (0.58 to ) Serum IgE antibodies to 2 (18%) 2 (14%) 0.75 (0.09 to 6.39) 0 (0%) pollen or animal dust gram of children already for 50 years. In addition, our study individuals had already tetanus and diphtheria antibodies at the start of the trial and those who had extremely low levels of antibodies were excluded from the analysis. Thus, patients with rhinosinusitis may have impairments in secondary antibody responses. Before vaccination, we could not observe any statistically significant differences between the patients and controls in tetanus and diphtheria antibody concentrations. The average pre-vaccination antibody concentrations were very similar in patients and controls. After including the pre-vaccination antibody level in the linear regression analyses, the patients had still on the average lower antibody responses than the controls. This supports the conclusion that a subset of our patients had an impaired antibody response to vaccination. We made an attempt to analyze the phenotype of patients who had impairments in antibody responses. Our analysis showed that the patient may have an impaired antibody response regardless of the presence of polyposis and irrespective if the patient had chronic or recurrent symptoms of sinusitis. with recurrent sinusitis tended to have more frequently defective vaccine responses, but our study was too small to address if this was real. The study patients represented patients who had especially severe symptoms of chronic or recurrent sinusitis despite endoscopic surgery. As the severity and type of symptoms are rather variable among rhinosinusitis patients, it is possible that the true prevalence of impaired antibody mediated immunity in patients who initially present with chronic or recurrent rhinosinusitis is much lower than observed in our study and are patients who may represent the most extreme spectrum of disease severity. Nevertheless, our study shows than when the clinician faces a patient with persisting or recurrent symptoms of sinusitis, the patient may suffer from an impairment of antibody-mediated immunity. Impaired responses to vaccination to polysaccharide antigens have previously been observed in CRS suggesting that a subset of patients has impairments of antibody-mediated immunity (17-20). Some of these patients may benefit from intravenous immunoglobulin therapy (19). Our results imply that, in addition to polysaccharide vaccines, vaccine responses to protein antigens can be used in the evaluation of antibody-mediated immunity of rhinosinisitis patients. Antibody responses to protein as compared to polysaccharide antigens are distinct as they are different in the mechanisms how antigen presenting cells present the antigen to B lymphocytes as well as different in their potency to elicit secondary responses (23). Thereby, concurrent evaluation of both protein and polysaccharide vaccine responses may give more information of immune abnormalities among patients with recurrent or chronic infections. REFERENCES 1. Knight AK, Cunningham-Rundles C. Inflammatory and autoimmune complications of common variable immune deficiency. Autoimmun Rev. 2006; 5: Ogershok PR, Hogan MB, Welch JE, et al. Spectrum of illness in pediatric common variable immunodeficiency. Ann Allergy 15_009693_Tahkokallio.indd :21:46

5 Vaccine responses in sinusitis 94 Asthma Immunol. 2006; 97: Oksenhendler E, Gerard L, Fieschi C, et al. Infections in 252 patients with common variable immunodeficiency. Clin Infect Dis. 2008; 46: Plebani A, Soresina A, Rondelli R, et al. Clinical, immunological, and molecular analysis in a large cohort of patients with X-linked agammaglobulinemia: an Italian multicenter study. Clin Immunol. 2002; 104: Winkelstein JA, Marino MC, Ochs H, et al. The X-linked hyper- IgM syndrome: clinical and immunologic features of 79 patients. Medicine 2003; 82: Jackson LL, Kountakis SE. Classification and management of rhinosinusitis and its complications. Otolaryngol Clin North Am. 2005; 38: Shapiro GG, Virant FS, Furukawa CT, et al. Immunologic defects in patients with refractory sinusitis. Pediatrics 1991; 87: Wise MT, Hagaman DD. An immunological approach to chronic and recurrent sinusitis. Curr Opin Otolaryngol Head Neck Surg. 2007; 15: Lund VJ, Scadding GK. Immunologic aspects of chronic sinusitis. J Otolaryngol. 1991; 20: Scadding GK, Lund VJ, Darby YC, et al. IgG subclass levels in chronic rhinosinusitis. Rhinology 1994; 32: Armenaka M, Grizzanti J, Rosenstreich DL. Serum immunoglobulins and IgG subclass levels in adults with chronic sinusitis: evidence for decreased IgG3 levels. Ann Allergy 1994; 72: Aghamohammadi A, Mohammadi J, Parvaneh N, et al. Progression of selective IgA deficiency to common variable immunodeficiency. Int Arch Allergy Immunol. 2008; 147: Janzi M, Kull I, Sjöberg R, et al. Selective IgA deficiency in early life: association to infections and allergic diseases during childhood. Clin Immunol. 2009; 133: Costa Carvalho BT, Nagao AT, Arslanian C, et al. Immunological evaluation of allergic respiratory children with recurrent sinusitis. Pediatr Allergy Immunol. 2005; 16: Vanlerberghe L, Joniau S, Jorissen M. The prevalence of humoral immunodeficiency in refractory rhinosinusitis: a retrospective analysis. B-ENT. 2006; 2: Tahkokallio O, Seppälä IJ, Sarvas H, et al. Concentrations of serum immunoglobulins and antibodies to pneumococcal capsular polysaccharides in patients with recurrent or chronic sinusitis. Ann Otol Rhinol Laryngol. 2001; 110: Silk H, Zora J, Goldstein J, et al. Response to pneumococcal immunization in children with and without recurrent infections. J Asthma 1998; 35: Epstein MM, Gruskay F. Selective deficiency in pneumococcal antibody response in children with recurrent infections. Ann Allergy Asthma Immunol. 1995; 75: Sethi DS, Winkelstein JA, Lederman H, et al. Immunologic defects in patients with chronic recurrent sinusitis: diagnosis and management. Otolaryngol Head Neck Surg. 1995; 112: May A, Zielen S, von Ilberg C, et al. Immunoglobulin deficiency and determination of pneumococcal antibody titers in patients with therapy-refractory recurrent rhinosinusitis. Eur Arch Otorhinolaryngol. 1999; 256: Ölander RM, Wuorimaa T, Käyhty H, et al. Booster response to the tetanus and diphtheria toxoid carriers of 11-valent pneumococcal conjugate vaccine in adults and toddlers. Vaccine 2001; 20: Ramsay ME, Rao M, Begg NT, et al. Antibody response to accelerated immunisation with diphtheria, tetanus, pertussis vaccine. Lancet 1993; 342: Gonzalez-Fernandez A, Faro J, Fernandez C. Immune responses to polysaccharides: lessons from humans and mice. Vaccine 2008; 26: Petri S Mattila Department of Otorhinolaryngology Helsinki University Central Hospital Haartmaninkatu 4 E P.O. Box Helsinki Finland Tel: petri.mattila@hus.fi 15_009693_Tahkokallio.indd :21:46

Civilinės aviacijos administracija

Civilinės aviacijos administracija SAFA programa. Aktualūs klausimai Andrejus Golubevas Skrydžių priežiūros skyriaus vyriausiasis specialistas 2012-11-12 1 Prezentacijos turinys SAFA programos teisinis pagrindas SAFA programos principai

Detaliau

NEPRIKLAUSOMO AUDITORIAUS IŠVADA UAB Vilniaus gatvių apšvietimo elektros tinklai akcininkui Nuomonė Mes atlikome UAB Vilniaus gatvių apšvietimo elektr

NEPRIKLAUSOMO AUDITORIAUS IŠVADA UAB Vilniaus gatvių apšvietimo elektros tinklai akcininkui Nuomonė Mes atlikome UAB Vilniaus gatvių apšvietimo elektr NEPRIKLAUSOMO AUDITORIAUS IŠVADA UAB Vilniaus gatvių apšvietimo elektros tinklai akcininkui Nuomonė Mes atlikome UAB Vilniaus gatvių apšvietimo elektros tinklai (toliau Įmonė) finansinių ataskaitų, kurias

Detaliau

Vilius Grabauskas Jūratė Klumbienė Janina Petkevičienė Edita Šakytė Vilma Kriaučionienė Aurelijus Veryga Ritva Prättälä SUAUGUSIŲ LIETUVOS ŽMONIŲ GYVE

Vilius Grabauskas Jūratė Klumbienė Janina Petkevičienė Edita Šakytė Vilma Kriaučionienė Aurelijus Veryga Ritva Prättälä SUAUGUSIŲ LIETUVOS ŽMONIŲ GYVE Vilius Grabauskas Jūratė Klumbienė Janina Petkevičienė Edita Šakytė Vilma Kriaučionienė Aurelijus Veryga Ritva Prättälä SUAUGUSIŲ LIETUVOS ŽMONIŲ GYVENSENOS TYRIMAS, 2008 Health Behaviour among Lithuanian

Detaliau

Priedai

Priedai Priedai Priedas Nr. 3 Įvesti duomenys Na- smūgių dažnumas į 1km' Na= 2 v 4 4 C2= 1 - objekto konstrukcija L- objekto ilgis L= 24 C3= 1 - objekto vertė W- objekto plotis W= 12 C4= 1 - žmonių kiekis objekte

Detaliau

AB Linas Agro Group 2018 m. spalio 31 d. eilinio visuotinio akcininkų susirinkimo BENDRASIS BALSAVIMO BIULETENIS GENERAL VOTING BALLOT at Annual Gener

AB Linas Agro Group 2018 m. spalio 31 d. eilinio visuotinio akcininkų susirinkimo BENDRASIS BALSAVIMO BIULETENIS GENERAL VOTING BALLOT at Annual Gener 1 AKCININKAS SHAREHOLDER FIZINIS ASMUO / NATURAL PERSON Vardas, pavardė Name, surname Asmens kodas: Personal code: JURIDINIS ASMUO / LEGAL PERSON Juridinio asmens pavadinimas Name of legal person Juridinio

Detaliau

Vilius Grabauskas Jūratė Klumbienė Janina Petkevičienė Edita Šakytė Vilma Kriaučionienė Aurelijus Veryga SUAUGUSIŲ LIETUVOS ŽMONIŲ GYVENSENOS TYRIMAS,

Vilius Grabauskas Jūratė Klumbienė Janina Petkevičienė Edita Šakytė Vilma Kriaučionienė Aurelijus Veryga SUAUGUSIŲ LIETUVOS ŽMONIŲ GYVENSENOS TYRIMAS, Vilius Grabauskas Jūratė Klumbienė Janina Petkevičienė Edita Šakytė Vilma Kriaučionienė Aurelijus Veryga SUAUGUSIŲ LIETUVOS ŽMONIŲ GYVENSENOS TYRIMAS, 2012 Health Behaviour among Lithuanian Adult Population,

Detaliau

Microsoft Word - Acute Coronary Syndrome in Patients, Younger Than 60 Years. Common Characteristics of these patients.doc

Microsoft Word - Acute Coronary Syndrome in Patients, Younger Than 60 Years. Common Characteristics of these patients.doc Medical sciences (208) 5 Acute coronary syndrome in patients, younger than 60 years. Common characteristics of these patients Andrius Romeika, Artūras Smirnovas Lietuvos sveikatos mokslų universitetas,

Detaliau

CDK4/6 kelio aktyvacija onkologijoje, molekulinių biomarkerių detekcija ir jų inhibicijos biologija Vaidas Dirsė, Rimvydas Norvilas

CDK4/6 kelio aktyvacija onkologijoje, molekulinių biomarkerių detekcija ir jų inhibicijos biologija Vaidas Dirsė, Rimvydas Norvilas CDK4/6 kelio aktyvacija onkologijoje, molekulinių biomarkerių detekcija ir jų inhibicijos biologija Vaidas Dirsė, Rimvydas Norvilas CDK nuo ciklinų priklausoma kinazė Ciklinai CKI Ciklinų kinazių inhibitoriai

Detaliau

AVK SUPA PLUS COUPLING 621/61 Tensile, for PE and PVC pipes, NF approved EPDM sealing 001 AVK Supa Plus is a range of tensile couplings, flange adapto

AVK SUPA PLUS COUPLING 621/61 Tensile, for PE and PVC pipes, NF approved EPDM sealing 001 AVK Supa Plus is a range of tensile couplings, flange adapto AVK SUPA PUS COUPING 1/61 Tensile, for PE and PVC pipes, NF approved EPM sealing AVK Supa Plus is a range of tensile couplings, flange adaptors and end caps dedicated for PE and upvc pipes. Supa Plus couplings

Detaliau

Vienlusčių įtaisų projektavimas

Vienlusčių įtaisų projektavimas Vienlusčių įtaisų projektavimas 5 paskaita Baigtiniai būsenų automatai Baigtinis būsenų automatas: angl. Finite State Machine (FSM) FSM yra nuosekliai būsenas keičiantis automatas su "atsitiktine" kitos

Detaliau

AB Linas Agro Group 2018 m. spalio 31 d. eilinio visuotinio akcininkų susirinkimo BENDRASIS BALSAVIMO BIULETENIS GENERAL VOTING BALLOT at Annual Gener

AB Linas Agro Group 2018 m. spalio 31 d. eilinio visuotinio akcininkų susirinkimo BENDRASIS BALSAVIMO BIULETENIS GENERAL VOTING BALLOT at Annual Gener AKCININKAS THE SHAREHOLDER FIZINIS ASMUO / NATURAL PERSON Vardas, pavardė Name, surname Asmens kodas Personal code JURIDINIS ASMUO / LEGAL PERSON Juridinio asmens pavadinimas Name of legal person Juridinio

Detaliau

DARBO SUTARTIS

DARBO SUTARTIS PATVIRTINTA Lietuvos Respublikos švietimo ir mokslo ministro 2016 m. lapkričio 16 d. įsakymu Nr. V-1011 (Studento praktinio mokymo sutarties pavyzdinė forma) STUDENTO PRAKTINIO MOKYMO PAVYZDINĖ SUTARTIS

Detaliau

Clenil and associated names - Art 30

Clenil and associated names - Art 30 II priedas Mokslinės išvados 5 Mokslinės išvados Beklometazono dipropionatas (BDP) yra gliukokortikoidas ir aktyviojo metabolito, beklometazono- 17-monopropionato, provaistas. Kontroliuojant bronchinę

Detaliau

MHAIA Estimation of Production rd Stage

MHAIA Estimation of Production rd Stage PROBABILISTIC ESTIMATION OF HASS AVOCADO PRODUCTION ESTIMATION IN THE AREA OF THE STATE OF MICHOACAN OF HASS AVOCADO PRODUCTION IN THE AREA OF THE STATE OF MICHOACAN CERTIFIED TO EXPORT TO THE USA SEASON

Detaliau

Microsoft Word - AIKOS IKUP1

Microsoft Word - AIKOS IKUP1 STUDIJŲ PROGRAMA. IKIMOKYKLINIO UGDYMO PEDAGOGIKA Parametrai Studijų programos pavadinimas Ikimokyklinio ugdymo pedagogika Studijų programos valstybinis kodas 653X11005 Studijų programos kodas pagal Tarptautinę

Detaliau

STUDENTŲ, ATRINKTŲ ERASMUS+ STUDIJOMS SU STIPENDIJA, SĄRAŠAS/ LIST OF STUDENTS THAT HAVE BEEN AWARDED WITH ERASMUS+ SCHOLARSHIPS Nr. Fakultetas/ Facul

STUDENTŲ, ATRINKTŲ ERASMUS+ STUDIJOMS SU STIPENDIJA, SĄRAŠAS/ LIST OF STUDENTS THAT HAVE BEEN AWARDED WITH ERASMUS+ SCHOLARSHIPS Nr. Fakultetas/ Facul STUDENTŲ, ATRINKTŲ ERASMUS+ STUDIJOMS SU STIPENDIJA, SĄRAŠAS/ LIST OF STUDENTS THAT HAVE BEEN AWARDED WITH ERASMUS+ SCHOLARSHIPS Nr. Fakultetas/ Faculty Prašymo numeris / Application number Mokslo ir studijų

Detaliau

2014 September 30. Journal of Medical Sciences, ISSN: EARLY DIAGNOSTIC FEATURES OF KIDNEY CANCER Dr. Lilija Butkevičienė 1, Rasita Zamblausk

2014 September 30. Journal of Medical Sciences, ISSN: EARLY DIAGNOSTIC FEATURES OF KIDNEY CANCER Dr. Lilija Butkevičienė 1, Rasita Zamblausk EARLY DIAGNOSTIC FEATURES OF KIDNEY CANCER Dr. Lilija Butkevičienė 1, Rasita Zamblauskaitė 1, Žilvinas Pavilionis 2 Lithuanian University of Health Sciences, Radiology clinics. ABSTRACT Objective: To evaluate

Detaliau

Programų sistemų inžinerija Saulius Ragaišis, VU MIF

Programų sistemų inžinerija Saulius Ragaišis, VU MIF Programų sistemų inžinerija 2014-02-12 Saulius Ragaišis, VU MIF saulius.ragaisis@mif.vu.lt SWEBOK evoliucija Nuo SWEBOK Guide to the Software Engineering Body of Knowledge, 2004 Version. IEEE, 2004. prie

Detaliau

Microsoft Word - Deposits and withdrawals policy 400.doc

Microsoft Word - Deposits and withdrawals policy 400.doc DEPOSITS AND WITHDRAWALS POLICY / LĖŠŲ ĮDĖJIMO IR NUĖMIMO POLITIKA TeleTrade-DJ International Consulting Ltd 2011-2017 TeleTrade-DJ International Consulting Ltd. 1 Bank Wire Transfers: When depositing

Detaliau

Microsoft Word - Value of computed tomography in assessment of acute pancreatitis severity degree and its correlation with outcomes of the disease.doc

Microsoft Word - Value of computed tomography in assessment of acute pancreatitis severity degree and its correlation with outcomes of the disease.doc Medical sciences (2019) 1 10 Value of computed tomography in assessment of acute pancreatitis severity degree and its correlation with outcomes of the disease Tomas Tvarijonas 1, Gertrūda Rudaitytė 1,

Detaliau

LIETUVOS AGRARINĖS EKONOMIKOS INSTITUTAS

LIETUVOS AGRARINĖS EKONOMIKOS INSTITUTAS LITHUANIAN INST ITUTE OF AGRARI AN ECONOMICS LITHUANIAN FAMILY FARM PROFITABILITY: THE ECONOMIC DIMENSION OF SUSTAINABILITY SCIENTIFIC STUDY 218 Tomas BALEŽENTIS, Virginia NAMIOTKO, Lina NOVICKYTĖ Baležentis,

Detaliau

Saziningumo_pasizadejimu_eskperimentas_8(a5)

Saziningumo_pasizadejimu_eskperimentas_8(a5) L i e t u v o s s k y r i u s KAS MOKSLEIVIUS SKATINA ELGTIS SĄŽININGAI? PRAKTINIS VADOVAS VILNIUS, 2019 Transparency International Lietuvos skyrius yra ne pelno siekianti, nepolitinė, nevyriausybinė organizacija,

Detaliau

A-M-K_nr-10_maketas_I.indd

A-M-K_nr-10_maketas_I.indd 12 ISSN 1822-1645 http://dx.doi.org/10.7720/1822-1645.10.1 Dortmundo technikos universitetas, Twente universitetas Technical University of Dortmund, University of Twente Studentai kaip kokybės užtikrinimo

Detaliau

Gerontologija 2009; 10(4): GERONTOLOGIJA Mokslinis straipsnis Sergančių galvos smegenų insultu pacientų, reabilituotų trijose reabilitacijos p

Gerontologija 2009; 10(4): GERONTOLOGIJA Mokslinis straipsnis Sergančių galvos smegenų insultu pacientų, reabilituotų trijose reabilitacijos p Gerontologija 2009; 10(4): 214 222 GERONTOLOGIJA Mokslinis straipsnis Sergančių galvos smegenų insultu pacientų, reabilituotų trijose reabilitacijos paslaugas teikiančiose įstaigose, charakteristika A.

Detaliau

Skiepijimo rekomendacijos inkstų ligomis sergantiems pacientams

Skiepijimo rekomendacijos inkstų ligomis sergantiems pacientams SUAUGUSIŲJŲ RIZIKOS GRUPIŲ SKIEPIJIMO LIETUVOJE REKOMENDACIJOS Lietuvos infektologų draugija, 2017 m. 1 1. Inkstų ligomis sergančių pacientų skiepijimo rekomendacijos Lėtinė inkstų liga, kai GFG 59 30

Detaliau

Register your product and get support at Indoor wireless headphones SHC8535 SHC8575 LT Vartotojo vadovas

Register your product and get support at   Indoor wireless headphones SHC8535 SHC8575 LT Vartotojo vadovas Register your product and get support at www.philips.com/welcome Indoor wireless headphones SHC8535 SHC8575 LT Vartotojo vadovas SHC8535 SHC8535 A a b B a c d b e f c C D E F a G b H I 1 Kas yra rinkinyje

Detaliau

A-M-K_nr-11_maketas_trump.indd

A-M-K_nr-11_maketas_trump.indd 66 ISSN 1822-1645 (Print), ISSN 2345-0258 (Online) http://dx.doi.org/10.7220/2345-0258.11.3 Fernando Cardoso Sousa, Ileana Pardal Monteiro, René Pellissier Algarvės universitetas, Algarvės universitetas,

Detaliau

Microsoft Word asis TAS.DOC

Microsoft Word asis TAS.DOC Tarptautinių audito ir užtikrinimo standartų valdyba 501-asis TAS 2009 balandis Tarptautinis audito standartas Audito įrodymai konkretūs svarstymai dėl atskirų sričių 1 International Auditing and Assurance

Detaliau

SPECIALIOSIOS UŽDAROJO TIPO PRIVATAUS KAPITALO INVESTICINĖS BENDROVĖS INVL TECHNOLOGY AUDITO KOMITETO NUOSTATAI BENDROJI DALIS 1. Šie specialiosios už

SPECIALIOSIOS UŽDAROJO TIPO PRIVATAUS KAPITALO INVESTICINĖS BENDROVĖS INVL TECHNOLOGY AUDITO KOMITETO NUOSTATAI BENDROJI DALIS 1. Šie specialiosios už SPECIALIOSIOS UŽDAROJO TIPO PRIVATAUS KAPITALO INVESTICINĖS BENDROVĖS INVL TECHNOLOGY AUDITO KOMITETO NUOSTATAI BENDROJI DALIS 1. Šie specialiosios uždarojo tipo privataus kapitalo investicinės bendrovės

Detaliau

DB sukūrimas ir užpildymas duomenimis

DB sukūrimas ir užpildymas duomenimis DB sukūrimas ir užpildymas duomenimis Duomenų bazės kūrimas Naujas bendrąsias DB kuria sistemos administratorius. Lokalias DB gali kurti darbo stoties vartotojasadministratorius. DB kuriama: kompiuterio

Detaliau

Microsoft Word - URTICARIA AND ITS DIFFERENTIAL DIAGNOSIS FROM BLISTERING SKIN DISEASES.docx

Microsoft Word - URTICARIA AND ITS DIFFERENTIAL DIAGNOSIS FROM BLISTERING SKIN DISEASES.docx Medical sciences (2019) 1 6 Urticaria and its differential diagnosis from blistering skin diseases Agnė Alseikaitė 1 ¹Lithuanian university of health sciences,medical academy, faculty of medicine, Kaunas,

Detaliau

LIETUVOS RESPUBLIKOS VALSTYBINIO PATENTŲ BIURO DIREKTORIAUS

LIETUVOS RESPUBLIKOS VALSTYBINIO PATENTŲ BIURO DIREKTORIAUS Įsakymas netenka galios 2015-11-24: Lietuvos Respublikos valstybinis patentų biuras, Įsakymas Nr. 3R-72, 2015-11-20, paskelbta TAR 2015-11-23, i. k. 2015-18546 Dėl Lietuvos Respublikos valstybinio patentų

Detaliau

Antros kartos TKI lūkesčiai ir STOP tyrimai

Antros kartos TKI lūkesčiai ir STOP tyrimai Antros kartos TKI lūkesčiai ir STOP tyrimai: LML taps išgydoma? Neringa Gailiūtė 2012.07.21 LML išgydoma? Pacientui: viltis, kad galima išgyti nėra šalutinio vaistų poveikio Visuomenei: gydymo kaina Pasveikimas

Detaliau

Vertimas iš anglų kalbos Question: Could you please provide clarity to one section of the tender document? In the document it states (using a google t

Vertimas iš anglų kalbos Question: Could you please provide clarity to one section of the tender document? In the document it states (using a google t Vertimas iš anglų kalbos Question: Could you please provide clarity to one section of the tender document? In the document it states (using a google translator) Before entering the Tender, the Tenderer

Detaliau

VIZOS GAVIMAS-INFO

VIZOS GAVIMAS-INFO KAIP KREIPTIS DĖL VIZOS 1. Sumokėkite konsulinį mokestį. Kiekvieno besikreipiančio dėl vizos asmens vardu, įskaitant mažamečius vaikus ir pensininkus, turi būti sumokėtas negrąžinamas konsulinis mokestis.

Detaliau

Dalyvavimo COST veiklos IC1201 Behavioural Types for Reliable Large-Scale Software Systems (BETTY) valdymo komiteto posėdyje ATASKAITA Vieta: Viešbuči

Dalyvavimo COST veiklos IC1201 Behavioural Types for Reliable Large-Scale Software Systems (BETTY) valdymo komiteto posėdyje ATASKAITA Vieta: Viešbuči Dalyvavimo COST veiklos IC1201 Behavioural Types for Reliable Large-Scale Software Systems (BETTY) valdymo komiteto posėdyje ATASKAITA Vieta: Viešbučio Grand Hotel Palatino konferencijų salė, Roma (Italija)

Detaliau

Ekonomikos inžinerija, Globalioji ekonomika NR. Baigiamojo darbo temos pavadinimas Baigiamojo darbo vadovas, kontaktai 1. Globalizacijos poveikis X se

Ekonomikos inžinerija, Globalioji ekonomika NR. Baigiamojo darbo temos pavadinimas Baigiamojo darbo vadovas, kontaktai 1. Globalizacijos poveikis X se Ekonomikos inžinerija, Globalioji ekonomika NR. Baigiamojo darbo temos pavadinimas Baigiamojo darbo vadovas, kontaktai 1. Globalizacijos poveikis X sektoriaus įmonių specializacijos lygiui. Impact of Globalization

Detaliau

PATVIRTINTA: LASF žiedo komiteto, Originali teksto kalba - lietuvių. The original text language is Lithuanian Turinys (Content) 1. TAISYKLĖSE NAUDOJAM

PATVIRTINTA: LASF žiedo komiteto, Originali teksto kalba - lietuvių. The original text language is Lithuanian Turinys (Content) 1. TAISYKLĖSE NAUDOJAM PATVIRTINTA: LASF žiedo komiteto, Originali teksto kalba - lietuvių. Turinys (Content) 1. TAISYKLĖSE NAUDOJAMOS SĄVOKOS 3 2. BENDROSIOS NUOSTATOS 4 3. KOMANDOS, KOMANDŲ SUDARYMAS. LENKTYNIŲ DALYVIAI 5

Detaliau

CERTIFICATE OF CONFORMITY EU INPUTS Document number: CE The CAAE Certification Service as an authorized certification entity in the Europe

CERTIFICATE OF CONFORMITY EU INPUTS Document number: CE The CAAE Certification Service as an authorized certification entity in the Europe CERTIFICATE OF CONFORMITY EU INPUTS Document number: CE-016781-2018 The CAAE Certification Service as an authorized certification entity in the European Union, in application of the control regime defined

Detaliau

Klausimas: Could you please provide clarity to one section of the tender document? In the document it states (using a google translator) Before enteri

Klausimas: Could you please provide clarity to one section of the tender document? In the document it states (using a google translator) Before enteri Klausimas: Could you please provide clarity to one section of the tender document? In the document it states (using a google translator) Before entering the Tender, the Tenderer must transfer to the LOU

Detaliau

Vorikonazolio koncentracijos stebėsena Roberta Petrauskaitė

Vorikonazolio koncentracijos stebėsena Roberta Petrauskaitė Vorikonazolio koncentracijos stebėsena Roberta Petrauskaitė Planas Ê Vaisto charakteristika Ê Vorikonazolio (VRC) terapinės dozės monitoravimo (TDM) multicentrinis tyrimas, nutrauktas anksčiau nei planuota

Detaliau

Slide 1

Slide 1 Rinogeninės intraorbitinės komplikacijos Dr. Darius Rauba Rez. Vaida Limantaitė 2011 11 30, Vilnius Rinogeninės akiduobinės komplikacijos: Problemos aktualumas Dažniausia vienpusio egzoftalmo priežastis

Detaliau

Monetos_1-8 taisytas indd

Monetos_1-8 taisytas indd LIETUVOS MONETOS LITHUANIAN COINS LIETUVOS MONETOS LITHUANIAN COINS L I E T U V O S B A N K A S 2 0 0 6 UDK 737(474.5)(091) Li301 Teksto autoriai / Text by Arûnas Dulkys, Stanislovas Sajauskas, Juozas

Detaliau

klinikinės praktinės apžvalgos VAIKŲ NEFROKALCINOZĖ IR INKSTŲ AKMENLIGĖ NUO SIMPTOMŲ IKI DIAGNOZĖS PAEDIARIC NEPHROCALCINOSIS AND NEPHROLITHIASIS FROM

klinikinės praktinės apžvalgos VAIKŲ NEFROKALCINOZĖ IR INKSTŲ AKMENLIGĖ NUO SIMPTOMŲ IKI DIAGNOZĖS PAEDIARIC NEPHROCALCINOSIS AND NEPHROLITHIASIS FROM VAIKŲ NEFROKALCINOZĖ IR INKSTŲ AKMENLIGĖ NUO SIMPTOMŲ IKI DIAGNOZĖS PAEDIARIC NEPHROCALCINOSIS AND NEPHROLITHIASIS FROM SYMPTOMS TO DIAGNOSIS Dovilė Ruzgienė 2, Neringa Umbrasienė 2, Agnė Čerkauskaitė

Detaliau

274 PRIEDAI K priedas. Elektroninio vartotojo gyvavimo ciklo tyrimo duomenų charakteristikos K.1 lentelė. Klausimyno dalies, skirtos elektroninio vart

274 PRIEDAI K priedas. Elektroninio vartotojo gyvavimo ciklo tyrimo duomenų charakteristikos K.1 lentelė. Klausimyno dalies, skirtos elektroninio vart 274 PRIEDAI K priedas. Elektroninio vartotojo gyvavimo ciklo tyrimo duomenų charakteristikos K.1 lentelė. Klausimyno dalies, skirtos elektroninio vartotojo gyvavimo ciklo analizei, patikimumo vertinimas

Detaliau

rp_ IS_2

rp_ IS_2 Page 1 of 5 Pagrindinė informacija Juodoji aromatizuota arbata su miško uogomis Exemption Flags Exempt from Artwork Exempt from NEP Reporting Produkto pavadinimas Country Lipton Brand Name Forest Fruits

Detaliau

Slide 1

Slide 1 H2020 Pažangos sklaida ir dalyvavimo plėtra Informacinis renginys, Lietuvos mokslo taryba Živilė Ruželė, zivile.ruzele@lmt.lt 2019 m. birželio 7 d. Turinys 1. Plėtros stipendijos 2. Patarimai Twinning

Detaliau

805-asis Tarp TAS 2009 balandis Tarptautinis audito standartas Specialūs svarstymai atskirų finansinių ataskaitų ir atskirų finansinės ataskaitos elem

805-asis Tarp TAS 2009 balandis Tarptautinis audito standartas Specialūs svarstymai atskirų finansinių ataskaitų ir atskirų finansinės ataskaitos elem 805-asis Tarp TAS 2009 balandis Tarptautinis audito standartas Specialūs svarstymai atskirų finansinių ataskaitų ir atskirų finansinės ataskaitos elementų, sąskaitų ir straipsnių auditas 1 International

Detaliau

Kantos Master - Draft Annex I at start of procedure

Kantos Master - Draft Annex I at start of procedure II priedas Mokslinės išvados ir pagrindas keisti rinkodaros leidimų sąlygas 6 Mokslinės išvados Kantos Master ir susijusių pavadinimų (žr. I priedą) mokslinio vertinimo bendroji santrauka Bendroji informacija

Detaliau

PowerPoint Presentation

PowerPoint Presentation Programų sistemų inžinerija 2018-02-07 Saulius Ragaišis, VU MIF saulius.ragaisis@mif.vu.lt Klausytojai: Susipažinimas Išklausyti programų sistemų inžinerijos kursai Profesinė patirtis Dabar klausomi pasirenkami

Detaliau

VILNIUS GEDIMINAS TECHNICAL UNIVERSITY Vytautas DUMBLIAUSKAS DEVELOPMENT AND APPLICATION OF TOUR-BASED TRAVEL DEMAND MODEL FOR PLANNING OF URBAN TRANS

VILNIUS GEDIMINAS TECHNICAL UNIVERSITY Vytautas DUMBLIAUSKAS DEVELOPMENT AND APPLICATION OF TOUR-BASED TRAVEL DEMAND MODEL FOR PLANNING OF URBAN TRANS VILNIUS GEDIMINAS TECHNICAL UNIVERSITY Vytautas DUMBLIAUSKAS DEVELOPMENT AND APPLICATION OF TOUR-BASED TRAVEL DEMAND MODEL FOR PLANNING OF URBAN TRANSPORT NETWORKS DOCTORAL DISSERTATION TECHNOLOGICAL SCIENCES,

Detaliau

Programos Leader ir žemdirbių mokymo metodikos centras Centre for Leader Programme and Agricultural Training Methodology LEADER ĮGYVENDINIMO APŽVALGA

Programos Leader ir žemdirbių mokymo metodikos centras Centre for Leader Programme and Agricultural Training Methodology LEADER ĮGYVENDINIMO APŽVALGA Programos Leader ir žemdirbių mokymo metodikos centras Centre for Leader Programme and Agricultural Training Methodology LEADER ĮGYVENDINIMO APŽVALGA Patirtis, pamokos, perspektyvos LEADER IMPLEMENTATION

Detaliau

Neiškiliojo optimizavimo algoritmas su nauju bikriteriniu potencialiųjų simpleksų išrinkimu naudojant Lipšico konstantos įvertį

Neiškiliojo optimizavimo  algoritmas su nauju bikriteriniu potencialiųjų simpleksų išrinkimu naudojant Lipšico konstantos įvertį Neiškiliojo optimizavimo algoritmas su nauju bikriteriniu potencialiųjų simpleksų išrinkimu naudojant Lipšico konstantos įvertį. Albertas Gimbutas 2018 m. birželio 19 d. Vadovas: Prof. habil. dr. Antanas

Detaliau

Turinys Bendrovės vadovo žodis...2 Bendrovės valdymo struktūra...4 Bendrovės pagrindinės veiklos pobūdis...6 Bendrovės 2008 metų veiklos apžvalga...8

Turinys Bendrovės vadovo žodis...2 Bendrovės valdymo struktūra...4 Bendrovės pagrindinės veiklos pobūdis...6 Bendrovės 2008 metų veiklos apžvalga...8 Turinys Bendrovės vadovo žodis...2 Bendrovės valdymo struktūra...4 Bendrovės pagrindinės veiklos pobūdis...6 Bendrovės 2008 metų veiklos apžvalga...8 Garantijų portfelio analizė...10 Rizikos valdymas...22

Detaliau

MUITINĖS DEPARTAMENTAS PRIE LIETUVOS RESPUBLIKOS FINANSŲ MINISTERIJOS BENDRO NAUDOTOJŲ VALDYMO SISTEMOS, ATITINKANČIOS EUROPOS KOMISIJOS REIKALAVIMUS,

MUITINĖS DEPARTAMENTAS PRIE LIETUVOS RESPUBLIKOS FINANSŲ MINISTERIJOS BENDRO NAUDOTOJŲ VALDYMO SISTEMOS, ATITINKANČIOS EUROPOS KOMISIJOS REIKALAVIMUS, MUITINĖS DEPARTAMENTAS PRIE LIETUVOS RESPUBLIKOS FINANSŲ MINISTERIJOS BENDRO NAUDOTOJŲ VALDYMO SISTEMOS, ATITINKANČIOS EUROPOS KOMISIJOS REIKALAVIMUS, SUKŪRIMO VERSIJA: v0.10 Vilnius 2018 TURINYS 1 Windows

Detaliau

GEOGRAFIJA T. 45. Nr. 2. P Lietuvos mokslų akademija, 2009 Lietuvos mokslų akademijos leidykla, 2009 Interaktyvių žemėlapių funkcionalum

GEOGRAFIJA T. 45. Nr. 2. P Lietuvos mokslų akademija, 2009 Lietuvos mokslų akademijos leidykla, 2009 Interaktyvių žemėlapių funkcionalum GEOGRAFIJA. 2009. T. 45. Nr. 2. P. 85 94 Lietuvos mokslų akademija, 2009 Lietuvos mokslų akademijos leidykla, 2009 Interaktyvių žemėlapių funkcionalumo nacionaliniuose atlasuose kvalimetrinė analizė Vilniaus

Detaliau

Pažanga gydant vaikų onkologines ligas Lietuvoje

Pažanga gydant vaikų onkologines ligas Lietuvoje Pažanga gydant vaikų onkologines ligas Lietuvoje Vaikų okohematologijos centras Vaikų ligoninė, Vilniaus universiteto Santariškių klinikų filialas Dr. Jelena Rascon 2014-02-15 Vaikų onkohematologinė pagaba

Detaliau

Gerontologija 2014; 15(3): GERONTOLOGIJA Mokslinis straipsnis Kineziterapijos programos taikymo ir gyvenimo kokybės sąsajos atokiuoju periodu

Gerontologija 2014; 15(3): GERONTOLOGIJA Mokslinis straipsnis Kineziterapijos programos taikymo ir gyvenimo kokybės sąsajos atokiuoju periodu Gerontologija 2014; 15(3): 166 176 GERONTOLOGIJA Mokslinis straipsnis Kineziterapijos programos taikymo ir gyvenimo kokybės sąsajos atokiuoju periodu po galvos smegenų insulto Robertas Pečeliūnas 1,2,

Detaliau

VPA Nr. 31

VPA Nr. 31 ISSN 1648-2603 (print) ISSN 2029-2872 (online) KAUNO TECHNOLOGIJOS UNIVERSITETAS MYKOLO ROMERIO UNIVERSITETAS VIEŠOJI POLITIKA IR ADMINISTRAVIMAS Nr. 31 TECHNOLOGIJA KAUNAS 2010 Vyriausieji redaktoriai:

Detaliau

LCON F4F PROJECT MAYO DECORATIVE 3 L IS_3 LT

LCON F4F PROJECT MAYO DECORATIVE 3 L IS_3 LT Page 1 of 10 Reason For Issue Key Words Key Word Customers / MSU Customers / MSU Customers / MSU Unilever Czech Republic/Slovakia Unilever Poland & Baltics Unilever SCE Value Manufacturers Classification

Detaliau

0_Pradzia.indd

0_Pradzia.indd KLAIPĖDA UNIVERSITY SOCIAL SCIENCE FACULTY REGIONAL FORMATION AND DEVELOPMENT STUDIES Journal of Social Sciences No. 1 (21) Klaipėda, 2017 Regional Formation and Development Studies Klaipėda University

Detaliau

79 ISSN , ISSN (online) DOI: LIETUVOS CHIRURGIJA Lithuan

79 ISSN , ISSN (online) DOI:     LIETUVOS CHIRURGIJA Lithuan 79 ISSN 1392 0995, ISSN 1648 9942 (online) DOI: http://dx.doi.org/10.15388/lietchirur.2016.1.9957 http://www.chirurgija.lt LIETUVOS CHIRURGIJA Lithuanian Surgery 2016, 15 (2 3), p. 79 83 Duktalinė karcinoma

Detaliau

PR_COD_1amCom

PR_COD_1amCom Europos Parlamentas 2014-2019 Piliečių laisvių, teisingumo ir vidaus reikalų komitetas 2016/0225(COD) 23.3.2017 ***I PRANEŠIMO PROJEKTAS dėl pasiūlymo dėl Europos Parlamento ir Tarybos reglamento, kuriuo

Detaliau

Slide 1

Slide 1 Horizontas 2020 teminės srities Mokslas su visuomene ir visuomenei 2018 2020 m. darbo programa ir kvietimų tematika Horizontas 2020 teminės srities Mokslas su visuomene ir visuomenei informacinė diena

Detaliau

BENDROJI INFORMACIJA

BENDROJI INFORMACIJA GYVENIMO APRAŠYMAS BENDROJI INFORMACIJA Vardas: Pavardė: Mokslinis vardas ir laipsnis: Pareigos: Mindaugas Krutinis Docentas, technologijos mokslų daktaras Docentas Telefono numeris: +370 656 32656 El.

Detaliau

Microsoft Word - Avoidance of allergens in patients with asthma and allergic rhinitis.docx

Microsoft Word - Avoidance of allergens in patients with asthma and allergic rhinitis.docx Medical sciences (2018) 1 6 Avoidance of allergens in patients with asthma and allergic rhinitis Rūta Palionytė, 1 Artūras Smirnovas 1 1 Lietuvos sveikatos mokslų universitetas, Medicinos fakultetas ABSTRACT

Detaliau

European Commission

European Commission EUROPOS KOMISIJA PRANEŠIMAS SPAUDAI Briuselis, 2014 m. vasario 11 d. Laisvas judėjimas. Europos Komisija skelbia tyrimo apie judžių ES piliečių integracijos patirtį šešiuose miestuose rezultatus ES piliečiai

Detaliau

Dokumentų leidimui laikinai gyventi Lietuvos Respublikoje gauti pateikimo ir leidimų laikinai gyventi Lietuvos Respublikoje užsieniečiams išdavimo, ke

Dokumentų leidimui laikinai gyventi Lietuvos Respublikoje gauti pateikimo ir leidimų laikinai gyventi Lietuvos Respublikoje užsieniečiams išdavimo, ke (įstaigos pavadinimas) GAUTA Nr. PRAŠYMAS IŠDUOTI LEIDIMĄ LAIKINAI GYVENTI LIETUVOS RESPUBLIKOJE APPLICATION FOR THE ISSUE OF A TEMPORARY RESIDENCE PERMIT IN THE REPUBLIC OF LITHUANIA (data / date) Prašau

Detaliau

Viesasis Nr. 17_tirazui.p65

Viesasis Nr. 17_tirazui.p65 MYKOLO ROMERIO UNIVERSITETAS KAUNO TECHNOLOGIJOS UNIVERSITETAS ISSN 1648 2603 VIEÐOJI POLITIKA IR ADMINISTRAVIMAS Nr. 17 Vilnius * Mykolo Romerio universiteto Leidybos centras * 2006 1 Vyriausieji redaktoriai:

Detaliau