936 research outputs found
Mauersegler weiter Wege. Mathias Enard: Kompass
No full textAnalysis of the peculiar scientific narrative in the novel of the Prix-Goncourt winning author Mathias Enard
Usporedba ablacije visokom snagom i kratkog trajanja s 'CLOSE'-vođenom izolacijom plućnih vena u srčanoj magnetskoj rezonanci tri mjeseca nakon ablacije
No full textObjective: To compare lesion formation after HPSD versus CLOSE-guided PVI using LGE-MRI three months after ablation. Secondarily, the procedural efficiency was also compared. Methods: A retrospective study of 46 patients who underwent either HPSD or CLOSE-guided PVI for atrial fibrillation at the Sana Klinikum Coburg. After three months, scar formation in 12 anatomical segments around the PVs was assessed using cardiac MRI with late gadolinium enhancement. 19 patients underwent HPSD and 27 patients CLOSE-guided PVI. All of them were relatively similar in terms of age and pre-existing conditions, so that the sample groups are as representative as possible for the population undergoing PVIs. Results: Scar prevalence was generally similar in both groups. While the CLOSE group showed numerically higher scarring in two segments, these differences were not significant after Bonferroni correction. The HPSD group demonstrated a significantly shorter ablation time, left atrial dwell time, and fewer applications. Conclusion: Both ablation groups yielded comparable scar extent on cardiac MRI, but the HPSD group showed greater procedural efficiency, indicating it may be a superior alternative to the CLOSE protocol in clinical practice.Cilj: Usporediti stvaranje ožiljaka nakon ablacije visoke snage i kratkog trajanja (HPSD) u odnosu na „CLOSE“-vođenu izolaciju plućnih vena (PVI) pomoću MRI s kasnim pojačanjem gadolinijem (LGE-MRI) tri mjeseca nakon zahvata. Sekundarno, uspoređena je i proceduralna učinkovitost. Metode: Retrospektivna studija na 46 pacijenata koji su zbog atrijske fibrilacije podvrgnuti HPSD ili „CLOSE“-vođenoj PVI u bolnici Sana Klinikum Coburg. Tri mjeseca nakon zahvata, stvaranje ožiljaka u 12 anatomskih segmenata oko plućnih vena procijenjeno je pomoću srčanog MRI-a s kasnim pojačanjem gadolinijem. 19 pacijenata je bilo u HPSD skupini, a 27 u „CLOSE“-skupini. Obje skupine bile su slične po dobi i prethodnim bolestima, čime su uzorci što reprezentativniji za populaciju koja se podvrgava PVI-u. Rezultati: Učestalost stvaranja ožiljaka bila je općenito slična u obje skupine. Iako je „CLOSE“-skupina pokazala numerički veće stvaranje ožiljaka u dva segmenta, razlike nisu bile statistički značajne nakon Bonferroni korekcije. Skupina HPSD imala je značajno kraće vrijeme ablacije, kraće zadržavanje u lijevom atriju te manji broj aplikacija. Zaključak: Obje metode ablacije rezultirale su usporedivim stvaranjem ožiljaka na srčanom MRI-u, no HPSD protokol pokazao je veću proceduralnu učinkovitost, što ukazuje na njegovu moguću prednost u kliničkoi praksi
Usporedba ablacije visokom snagom i kratkog trajanja s 'CLOSE'-vođenom izolacijom plućnih vena u srčanoj magnetskoj rezonanci tri mjeseca nakon ablacije
No full textObjective: To compare lesion formation after HPSD versus CLOSE-guided PVI using LGE-MRI three months after ablation. Secondarily, the procedural efficiency was also compared. Methods: A retrospective study of 46 patients who underwent either HPSD or CLOSE-guided PVI for atrial fibrillation at the Sana Klinikum Coburg. After three months, scar formation in 12 anatomical segments around the PVs was assessed using cardiac MRI with late gadolinium enhancement. 19 patients underwent HPSD and 27 patients CLOSE-guided PVI. All of them were relatively similar in terms of age and pre-existing conditions, so that the sample groups are as representative as possible for the population undergoing PVIs. Results: Scar prevalence was generally similar in both groups. While the CLOSE group showed numerically higher scarring in two segments, these differences were not significant after Bonferroni correction. The HPSD group demonstrated a significantly shorter ablation time, left atrial dwell time, and fewer applications. Conclusion: Both ablation groups yielded comparable scar extent on cardiac MRI, but the HPSD group showed greater procedural efficiency, indicating it may be a superior alternative to the CLOSE protocol in clinical practice.Cilj: Usporediti stvaranje ožiljaka nakon ablacije visoke snage i kratkog trajanja (HPSD) u odnosu na „CLOSE“-vođenu izolaciju plućnih vena (PVI) pomoću MRI s kasnim pojačanjem gadolinijem (LGE-MRI) tri mjeseca nakon zahvata. Sekundarno, uspoređena je i proceduralna učinkovitost. Metode: Retrospektivna studija na 46 pacijenata koji su zbog atrijske fibrilacije podvrgnuti HPSD ili „CLOSE“-vođenoj PVI u bolnici Sana Klinikum Coburg. Tri mjeseca nakon zahvata, stvaranje ožiljaka u 12 anatomskih segmenata oko plućnih vena procijenjeno je pomoću srčanog MRI-a s kasnim pojačanjem gadolinijem. 19 pacijenata je bilo u HPSD skupini, a 27 u „CLOSE“-skupini. Obje skupine bile su slične po dobi i prethodnim bolestima, čime su uzorci što reprezentativniji za populaciju koja se podvrgava PVI-u. Rezultati: Učestalost stvaranja ožiljaka bila je općenito slična u obje skupine. Iako je „CLOSE“-skupina pokazala numerički veće stvaranje ožiljaka u dva segmenta, razlike nisu bile statistički značajne nakon Bonferroni korekcije. Skupina HPSD imala je značajno kraće vrijeme ablacije, kraće zadržavanje u lijevom atriju te manji broj aplikacija. Zaključak: Obje metode ablacije rezultirale su usporedivim stvaranjem ožiljaka na srčanom MRI-u, no HPSD protokol pokazao je veću proceduralnu učinkovitost, što ukazuje na njegovu moguću prednost u kliničkoi praksi
Les commissions électorales en Afrique de l'Ouest
No full text[author: Mathias Hounkpe ; Ismaila Madior Fall]Electronic ed.: Abuja ; Bonn : FES, 201
Paul Bourget, écrivain engagé
No full textPaul Bourget, A committed writer, Yehoshua Mathias.
In the France of the early twentieth century, Paul Bourget's figure is that of a successful novelist who became gradually a «committed author». A monarchist, deeply conservative, passionate defender of religion and the family as the vital bases of the social order, he thus became the bard of the bourgeois ethic faced with the destabilization of modernity.Mathias Yehoshua. Paul Bourget, écrivain engagé. In: Vingtième Siècle, revue d'histoire, n°45, janvier-mars 1995. pp. 14-29
„Nature must be felt“ – Alexander von Humboldt, pioneer of an ecological worldview and protagonist of „transversal reason“
No full textDer Text erinnert zum 250sten Geburtsjahr an Alexander von Humboldt, ein Vordenker für eine ökologische Sicht der Welt und ein früher Protagonist „transversaler Vernunft“. Er ist als Ideengeber für die „neuen Naturtherapien“, für die Integrative Therapie und für eine ökologische Sicht in der Psychotherapie eine unverzichtbare Quelle. Einige aus dieser Perspektive wichtige Aspekte seines Denkens und Werkes werden aufgezeigt. Er ist ein Referenzautor für transversales und integratives Konzeptualisieren in unserer Zeit.The text commemorates the 250th year of birth of Alexander von Humboldt, a thought leader for an ecological view of the world and an early protagonist of „transversal reason“. He is an indispensable source of ideas for the „new nature therapies“, for integrative therapy and for an ecological viewpoint in psychotherapy. Some important aspects of his thinking and work are shown from this perspective. He is a reference author for transversal and integrative conceptualization in our time.https://www.fpi-publikation.de/gruene-texte/17-2019-petzold-h-g-mathias-wiedemann-u-natur-muss-gefuehlt-werden-alexander-v-humboldt/peerReviewedpublishedVersio
„Natur muss gefühlt werden“ – Alexander von Humboldt, Vordenker einer ökologischen Weltsicht und Protagonist „transversaler Vernunft“
No full textDer Text erinnert zum 250sten Geburtsjahr an Alexander von Humboldt, ein Vordenker für eine ökologische Sicht der Welt und ein früher Protagonist „transversaler Vernunft“. Er ist als Ideengeber für die „neuen Naturtherapien“, für die Integrative Therapie und für eine ökologische Sicht in der Psychotherapie eine unverzichtbare Quelle. Einige aus dieser Perspektive wichtige Aspekte seines Denkens und Werkes werden aufgezeigt. Er ist ein Referenzautor für transversales und integratives Konzeptualisieren in unserer Zeit.The text commemorates the 250th year of birth of Alexander von Humboldt, a thought leader for an ecological view of the world and an early protagonist of „transversal reason“. He is an indispensable source of ideas for the „new nature therapies“, for integrative therapy and for an ecological viewpoint in psychotherapy. Some important aspects of his thinking and work are shown from this perspective. He is a reference author for transversal and integrative conceptualization in our time.https://www.fpi-publikation.de/polyloge/25-2019-petzold-h-g-mathias-wiedemann-u-natur-muss-gefuehlt-werden-alexander-v-humboldt/peerReviewedpublishedVersio
Kliničke koristi i prognostička vrijednost proteina koji veže masne kiseline srčanog tipa, miokardijalne kreatin kinaze i specifičnih ehokardiografskih parametara desne klijetke za stratifikaciju rizika normotenzivnih bolesnika s plućnom embolijom
No full textThe treatment of acute pulmonary artery embolism remains a challenge for modern medicine.
While the risk-adapted treatment strategies for the groups with high and low mortality risk are
essentially uncontroversial, uncertainty remains in patients with intermediate risk PE about the
appropriate risk stratification and management. Despite therapy, the mortality rate of this form
of pulmonary embolism is about 5-16%. It is possible that current concepts for risk
stratification, based on the use and combination of troponin I (TnI) with imaging techniques
such as echocardiography, only transfer to this patient group in limited capacity. Therefore,
clinical research is increasingly focusing on other cardiac-specific biomarkers, such as cardiac
muscle-specific fatty acid binding protein (H-FABP), which is already being used successfully
in early-stage cardiac infarction diagnostics.
Aim of the study
The present study investigates the prognostic value of new myocardial laboratory markers as
well as specific right ventricular echo parameters and contributes to risk stratification in PE
with intermediate mortality risk.
Material and Methods
Between 2005 and 2010, 161 patients with proven PE and an initial systolic blood pressure
above 90 mmHg were enrolled. All patients underwent TnI, creatine kinase isoenzyme MB
(CK-MB), CK and D-dimers determination at the routine cardiology laboratory. All patients
continued to receive a commercially available qualitative H-FABP rapid test (threshold 7
ng/ml). The routine echocardiographic examination with measurement of ventricular size ratios
(RV/LV index), the mTDI parameters, the TAPSE and other standard parameters took place on
the admission day. An intermediate mortality risk was based on the guidelines for
echocardiographic signs of right ventricular dysfunction (RVD) or elevated cardiac muscle
specific laboratory parameters. The primary endpoint was the 30-day mortality due to PE. The
secondary endpoint was the occurrence of a complicated clinical course, defined by therapy
escalation in the form of catecholamine administration, thrombolysis or embolectomy or
resuscitation.
Results
In total, 16 out of 161 (9.9%) patients died within 30 days after hospital admission. The
deceased had significantly higher plasma levels of TnI, and CK-MB compared to survivors. A positive H-FABP test was found in 26 patients, of whom 15 (57.7%) died. In contrast, one of
135 H-FABP-negative patients died (0.7%, H-FABP positive vs. negative P <0.001).
Stratification according to TnI resulted in a mortality rate of 19.7% (13 out of 66) among TnIpositive patients and 3.2% among those that were TnI-negative (3 out of 95, P = 0.001). In
echocardiography, H-FABP positives exhibited significantly greater RV/LV indices (1.02 ±
0.21 vs. 0.86 ± 0.22, P = 0.001) compared to H-FABP negatives, and a significantly lower
TAPSE (13.7 ± 4.0 mm vs. 19.1 ± 4.7 mm, P <0.001). There were no significant differences
for the mTDI parameters. Multivariate logistic regression analysis identified H-FABP (OR 27.1
95% CI 2.1 - 352.3), CK-MB (OR 5.3 95% CI 1.3 - 23.3) and the systolic blood pressure on
admisson (OR 1.2 95% CI 1.1 - 1.3) as independent predictors of 30-day mortality. The
combination of positive H-FABP test and increased CK-MB resulted in a particularly high
mortality risk: 14 of 16 patients with this laboratory constellation (87.5%) died. Conversely,
the survival probability of H-FABP-negative patients was over 99%.
There was an increased risk of a complicated clinical course with a positive H-FABP test
(OR 4.8 95% CI 1.1 - 21.1) and reduced TAPSE (OR 1.3 95% CI 1.2 - 1.5). TAPSE values
above 17.5mm made a complicated course unlikely in 98% of the cases.
Conclusion
Our data support the hypothesis that H-FABP could be a promising prognostic marker in
intermediate risk PE being highly associated with an unfavorable short-term outcome. Its
clinical value in risk stratification seems to be superior to that of cardiac troponins. The
combination of elevated H-FABP and CK-MB plasma levels indicates a particularly high risk
of mortality. The clinical value of CK-MB in risk stratification of PE is unclear and might be
underestimated and further studies are required. Increased H-FABP values correlate with
echocardiographic markers of RVD. MTDI is not suitable for risk stratification in this patient
group. Additional studies are necessary to identify which specific echocardiographic
parameters are the most useful in risk assessment in acute PE with intermediate risk mortality.Liječenje akutne embolije plućne arterije i dalje ostaje izazov za suvremenu medicinu. Iako su
strategije liječenja prilagođene riziku za skupine s visokim i niskim rizikom od smrtnosti u
osnovi nesporne, kod bolesnika sa srednjim rizikom za plućnu emboliju ostaje neizvjesnost o
odgovarajućoj stratifikaciji rizika i zbrinjavanja pacijenta. Unatoč terapiji, stopa smrtnosti od
ovog oblika plućne embolije je oko 5-16%. Moguće je da se trenutni koncepti za stratifikaciju
rizika, temeljeni na upotrebi i kombinaciji troponina I (TnI) s tehnikama slikovnog prikaza,
poput ehokardiografije, prenose na ovu grupu bolesnika u ograničenom kapacitetu. Stoga se
klinička istraživanja sve više fokusiraju na druge specifične srčane biomarkere, poput srčanomišićnog proteina koji veže masne kiseline (H-FABP), koji se već uspješno koristi u ranoj fazi
dijagnostičkog postupka srčanog infarkta.
Cilj studije
Ova studija istražuje prognostičku vrijednost novih laboratorijskih markera miokarda, kao i
specifične parametre ultrazvuka desnog ventrikula te doprinosi stratifikaciji rizika u pacijenata
s plućnom embolijom sa srednjim rizikom smrtnosti.
Materijali i metode
Između 2005. i 2010. godine u istraživanje je uključeno 161 pacijenta s dokazanom plućnom
ebmolijom i početnim sistoličkim krvnim tlakom većim od 90 mmHg. Za sve pacijente
provedeno je mjerenje TnI, kreatin kinaze MB (CK-MB), CK i D-dimera u laboratoriju za
rutinsku kardiologiju. Kod svih bolesnika učinjen je komercijalno dostupan kvalitativni brzi
test H-FABP (prag osjetljivosti od 7 ng/ml). Rutinski ultrazvučni pregled s mjerenjem omjera
veličine ventrikula (RV/LV indeks), mTDI parametrima, TAPSE i drugim standardnim
parametrima obavljen je na dan prijema. Definicija srednje razine rizika od smrtnog ishoda
zasnovana je na smjernicama za ultrazvučne znakove disfunkcije desne klijetke (RVD) ili na
povišenim vrijednostima specifičnih laboratorijskih parametara za srčani mišić. Primarni
promatrani ishod bila je smrtnost unutar 30 dana zbog plućne embolije. Sekundarni promatrani
ishod bila je pojava kompliciranog kliničkog tijeka, definiranog eskalacijom terapije u obliku
primjene kateholamina, trombolize ili embolektomije ili reanimacije.
Rezultati
Ukupno je 16 od 161 (9,9%) bolesnika umrlo u roku od 30 dana nakon prijema u bolnicu.
Ispitanici koji su preminuli imali su značajno više razine TnI i CK-MB u plazmi, u usporedbi s preživjelima. Pozitivan test H-FABP pronađen je kod 26 bolesnika, od kojih je njih 15 (57,7%)
umrlo. Suprotno tome, jedan od 135 bolesnika s negativnim H-FABP je umro (0,7%, pozitivan
H-FABP u odnosu na negativan P<0,001). Stratifikacija prema TnI rezultirala je pojavom
smrtnosti od 19,7% (13 od 66) među TnI-pozitivnim pacijentima i 3,2% među onima koji su
bili TnI-negativni (3 od 95; P=0,001). U ehokardiografiji, ispitanici s pozitivnim H-FABP
pokazali su značajno veće RV/LV indekse u usporedbi s H-FABP negativnima (1,02 ± 0,21 u
odnosu na 0,86 ± 0,22; P=0,001) i značajno niži TAPSE (13,7 ± 4,0 mm nasuprot 19,1 ± 4,7
mm; P<0,001). Nije bilo značajnih razlika za mTDI parametre. Multivarijantnom logističkom
regresijskom analizom utvrđeni su H-FABP (OR=27,1; 95% CI 2,1 - 352,3), CK-MB (OR=5,3;
95% CI 1,3 - 23,3) i sistolički krvni tlak pri prijemu (OR=1,2 95% CI 1,1 - 1.3) kao neovisni
prediktori 30-dnevne smrtnosti. Kombinacija pozitivnog H-FABP testa i povišenog CK-MB
rezultirala je s posebno visokim rizikom od smrtnosti: umrlo je 14 od 16 bolesnika s ovom
kombinacijom laboratorijskih nalaza (87,5%). Suprotno tome, vjerojatnost preživljavanja
bolesnika s negativnim H-FABP testom iznosila je preko 99%.
Zabilježen je povećan rizik od kompliciranog kliničkog tijeka u bolesnika s pozitivnim HFABP testom (OR=4,8; 95% CI 1,1- 21,1) i smanjenim TAPSE (OR=1,3; 95% CI 1,2 - 1,5).
Bolesnici s vrijednostima TAPSE iznad 17,5 mm imali su nekompliciran tijek bolesti u 98%
slučajeva.
Zaključak
Naši podaci podržavaju hipotezu da bi H-FABP mogao biti obećavajući prognostički biljeg za
plućnu emboliju s intermedijarnim rizikom jer je snažno povezan s nepovoljnim kratkoročnim
ishodom. Čini se da je njegova klinička vrijednost u stratifikaciji rizika veća od srčanih
troponina. Kombinacija povišene razine H-FABP i CK-MB u plazmi ukazuje na posebno visok
rizik od smrtnog ishoda. Klinička vrijednost CK-MB u stratifikaciji rizika od plućne embolije
je nejasna i moguće podcijenjena te su potrebne daljnje studije. Povećane vrijednosti H-FABP
koreliraju s ultrazvučnim markerima disfunkcije desne klijetke. MTDI nije pogodan za
stratifikaciju rizika u ovoj skupini bolesnika. Potrebne su dodatne studije kako bi se utvrdilo
koji su ultrazvučni parametri najkorisniji za procjenu rizika za smrtni ishod u bolesnika s
akutnom plućnom embolijom srednjeg rizika
Kliničke koristi i prognostička vrijednost proteina koji veže masne kiseline srčanog tipa, miokardijalne kreatin kinaze i specifičnih ehokardiografskih parametara desne klijetke za stratifikaciju rizika normotenzivnih bolesnika s plućnom embolijom
No full textThe treatment of acute pulmonary artery embolism remains a challenge for modern medicine.
While the risk-adapted treatment strategies for the groups with high and low mortality risk are
essentially uncontroversial, uncertainty remains in patients with intermediate risk PE about the
appropriate risk stratification and management. Despite therapy, the mortality rate of this form
of pulmonary embolism is about 5-16%. It is possible that current concepts for risk
stratification, based on the use and combination of troponin I (TnI) with imaging techniques
such as echocardiography, only transfer to this patient group in limited capacity. Therefore,
clinical research is increasingly focusing on other cardiac-specific biomarkers, such as cardiac
muscle-specific fatty acid binding protein (H-FABP), which is already being used successfully
in early-stage cardiac infarction diagnostics.
Aim of the study
The present study investigates the prognostic value of new myocardial laboratory markers as
well as specific right ventricular echo parameters and contributes to risk stratification in PE
with intermediate mortality risk.
Material and Methods
Between 2005 and 2010, 161 patients with proven PE and an initial systolic blood pressure
above 90 mmHg were enrolled. All patients underwent TnI, creatine kinase isoenzyme MB
(CK-MB), CK and D-dimers determination at the routine cardiology laboratory. All patients
continued to receive a commercially available qualitative H-FABP rapid test (threshold 7
ng/ml). The routine echocardiographic examination with measurement of ventricular size ratios
(RV/LV index), the mTDI parameters, the TAPSE and other standard parameters took place on
the admission day. An intermediate mortality risk was based on the guidelines for
echocardiographic signs of right ventricular dysfunction (RVD) or elevated cardiac muscle
specific laboratory parameters. The primary endpoint was the 30-day mortality due to PE. The
secondary endpoint was the occurrence of a complicated clinical course, defined by therapy
escalation in the form of catecholamine administration, thrombolysis or embolectomy or
resuscitation.
Results
In total, 16 out of 161 (9.9%) patients died within 30 days after hospital admission. The
deceased had significantly higher plasma levels of TnI, and CK-MB compared to survivors. A positive H-FABP test was found in 26 patients, of whom 15 (57.7%) died. In contrast, one of
135 H-FABP-negative patients died (0.7%, H-FABP positive vs. negative P <0.001).
Stratification according to TnI resulted in a mortality rate of 19.7% (13 out of 66) among TnIpositive patients and 3.2% among those that were TnI-negative (3 out of 95, P = 0.001). In
echocardiography, H-FABP positives exhibited significantly greater RV/LV indices (1.02 ±
0.21 vs. 0.86 ± 0.22, P = 0.001) compared to H-FABP negatives, and a significantly lower
TAPSE (13.7 ± 4.0 mm vs. 19.1 ± 4.7 mm, P <0.001). There were no significant differences
for the mTDI parameters. Multivariate logistic regression analysis identified H-FABP (OR 27.1
95% CI 2.1 - 352.3), CK-MB (OR 5.3 95% CI 1.3 - 23.3) and the systolic blood pressure on
admisson (OR 1.2 95% CI 1.1 - 1.3) as independent predictors of 30-day mortality. The
combination of positive H-FABP test and increased CK-MB resulted in a particularly high
mortality risk: 14 of 16 patients with this laboratory constellation (87.5%) died. Conversely,
the survival probability of H-FABP-negative patients was over 99%.
There was an increased risk of a complicated clinical course with a positive H-FABP test
(OR 4.8 95% CI 1.1 - 21.1) and reduced TAPSE (OR 1.3 95% CI 1.2 - 1.5). TAPSE values
above 17.5mm made a complicated course unlikely in 98% of the cases.
Conclusion
Our data support the hypothesis that H-FABP could be a promising prognostic marker in
intermediate risk PE being highly associated with an unfavorable short-term outcome. Its
clinical value in risk stratification seems to be superior to that of cardiac troponins. The
combination of elevated H-FABP and CK-MB plasma levels indicates a particularly high risk
of mortality. The clinical value of CK-MB in risk stratification of PE is unclear and might be
underestimated and further studies are required. Increased H-FABP values correlate with
echocardiographic markers of RVD. MTDI is not suitable for risk stratification in this patient
group. Additional studies are necessary to identify which specific echocardiographic
parameters are the most useful in risk assessment in acute PE with intermediate risk mortality.Liječenje akutne embolije plućne arterije i dalje ostaje izazov za suvremenu medicinu. Iako su
strategije liječenja prilagođene riziku za skupine s visokim i niskim rizikom od smrtnosti u
osnovi nesporne, kod bolesnika sa srednjim rizikom za plućnu emboliju ostaje neizvjesnost o
odgovarajućoj stratifikaciji rizika i zbrinjavanja pacijenta. Unatoč terapiji, stopa smrtnosti od
ovog oblika plućne embolije je oko 5-16%. Moguće je da se trenutni koncepti za stratifikaciju
rizika, temeljeni na upotrebi i kombinaciji troponina I (TnI) s tehnikama slikovnog prikaza,
poput ehokardiografije, prenose na ovu grupu bolesnika u ograničenom kapacitetu. Stoga se
klinička istraživanja sve više fokusiraju na druge specifične srčane biomarkere, poput srčanomišićnog proteina koji veže masne kiseline (H-FABP), koji se već uspješno koristi u ranoj fazi
dijagnostičkog postupka srčanog infarkta.
Cilj studije
Ova studija istražuje prognostičku vrijednost novih laboratorijskih markera miokarda, kao i
specifične parametre ultrazvuka desnog ventrikula te doprinosi stratifikaciji rizika u pacijenata
s plućnom embolijom sa srednjim rizikom smrtnosti.
Materijali i metode
Između 2005. i 2010. godine u istraživanje je uključeno 161 pacijenta s dokazanom plućnom
ebmolijom i početnim sistoličkim krvnim tlakom većim od 90 mmHg. Za sve pacijente
provedeno je mjerenje TnI, kreatin kinaze MB (CK-MB), CK i D-dimera u laboratoriju za
rutinsku kardiologiju. Kod svih bolesnika učinjen je komercijalno dostupan kvalitativni brzi
test H-FABP (prag osjetljivosti od 7 ng/ml). Rutinski ultrazvučni pregled s mjerenjem omjera
veličine ventrikula (RV/LV indeks), mTDI parametrima, TAPSE i drugim standardnim
parametrima obavljen je na dan prijema. Definicija srednje razine rizika od smrtnog ishoda
zasnovana je na smjernicama za ultrazvučne znakove disfunkcije desne klijetke (RVD) ili na
povišenim vrijednostima specifičnih laboratorijskih parametara za srčani mišić. Primarni
promatrani ishod bila je smrtnost unutar 30 dana zbog plućne embolije. Sekundarni promatrani
ishod bila je pojava kompliciranog kliničkog tijeka, definiranog eskalacijom terapije u obliku
primjene kateholamina, trombolize ili embolektomije ili reanimacije.
Rezultati
Ukupno je 16 od 161 (9,9%) bolesnika umrlo u roku od 30 dana nakon prijema u bolnicu.
Ispitanici koji su preminuli imali su značajno više razine TnI i CK-MB u plazmi, u usporedbi s preživjelima. Pozitivan test H-FABP pronađen je kod 26 bolesnika, od kojih je njih 15 (57,7%)
umrlo. Suprotno tome, jedan od 135 bolesnika s negativnim H-FABP je umro (0,7%, pozitivan
H-FABP u odnosu na negativan P<0,001). Stratifikacija prema TnI rezultirala je pojavom
smrtnosti od 19,7% (13 od 66) među TnI-pozitivnim pacijentima i 3,2% među onima koji su
bili TnI-negativni (3 od 95; P=0,001). U ehokardiografiji, ispitanici s pozitivnim H-FABP
pokazali su značajno veće RV/LV indekse u usporedbi s H-FABP negativnima (1,02 ± 0,21 u
odnosu na 0,86 ± 0,22; P=0,001) i značajno niži TAPSE (13,7 ± 4,0 mm nasuprot 19,1 ± 4,7
mm; P<0,001). Nije bilo značajnih razlika za mTDI parametre. Multivarijantnom logističkom
regresijskom analizom utvrđeni su H-FABP (OR=27,1; 95% CI 2,1 - 352,3), CK-MB (OR=5,3;
95% CI 1,3 - 23,3) i sistolički krvni tlak pri prijemu (OR=1,2 95% CI 1,1 - 1.3) kao neovisni
prediktori 30-dnevne smrtnosti. Kombinacija pozitivnog H-FABP testa i povišenog CK-MB
rezultirala je s posebno visokim rizikom od smrtnosti: umrlo je 14 od 16 bolesnika s ovom
kombinacijom laboratorijskih nalaza (87,5%). Suprotno tome, vjerojatnost preživljavanja
bolesnika s negativnim H-FABP testom iznosila je preko 99%.
Zabilježen je povećan rizik od kompliciranog kliničkog tijeka u bolesnika s pozitivnim HFABP testom (OR=4,8; 95% CI 1,1- 21,1) i smanjenim TAPSE (OR=1,3; 95% CI 1,2 - 1,5).
Bolesnici s vrijednostima TAPSE iznad 17,5 mm imali su nekompliciran tijek bolesti u 98%
slučajeva.
Zaključak
Naši podaci podržavaju hipotezu da bi H-FABP mogao biti obećavajući prognostički biljeg za
plućnu emboliju s intermedijarnim rizikom jer je snažno povezan s nepovoljnim kratkoročnim
ishodom. Čini se da je njegova klinička vrijednost u stratifikaciji rizika veća od srčanih
troponina. Kombinacija povišene razine H-FABP i CK-MB u plazmi ukazuje na posebno visok
rizik od smrtnog ishoda. Klinička vrijednost CK-MB u stratifikaciji rizika od plućne embolije
je nejasna i moguće podcijenjena te su potrebne daljnje studije. Povećane vrijednosti H-FABP
koreliraju s ultrazvučnim markerima disfunkcije desne klijetke. MTDI nije pogodan za
stratifikaciju rizika u ovoj skupini bolesnika. Potrebne su dodatne studije kako bi se utvrdilo
koji su ultrazvučni parametri najkorisniji za procjenu rizika za smrtni ishod u bolesnika s
akutnom plućnom embolijom srednjeg rizika
Erstellung eines Leitfadens mit Arbeitshilfen, Mustern und Ablaufplänen für eine effiziente Verwaltung von Wohnungseigentümergemeinschaften
No full textIn dieser Bachelorarbeit werden die unterschiedlichen Vorgänge und Tätigkeiten die bei der Verwaltung von Wohnungseigentümergemeinschaften in der Firma THL Immobilien
GmbH entstehen untersucht und verbessert, um rechtssichere und effiziente Ablaufpläne für diese zu erstellen. Dabei werden aktuell verwendete Verträge, Musterschreiben und Formulare an die geltenden gesetzlichen Regelungen angepasst bzw. erweitert oder neu
geschrieben
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