1,290 research outputs found
Herzersatzverfahren – Möglichkeiten der langfristigen mechanischen Kreislaufunterstützung
No full textIn Switzerland 200’000 people suffer from congestive heart failure. Approximately 10’000 patients find themselves in an advanced state of the disease. When conservative treatment options are no longer available heart transplantation is the therapy of choice. Should this not be an option due to long waiting lists or medical issues assist device therapy becomes an option. Assist device therapy is separated in short-term and long-term support. Long-term support is nowadays performed with ventricular assist devices (VADs). The native heart is still in place and supported in parallel to the remaining function of the heart. The majority of patients are treated with a left ventricular assist device (LVAD). The right ventrical alone (RVAD) as well as bi-ventricular support (BiVAD) is rarely needed. The modern VADs are implantable and create a non-pulsative bloodflow. A percutaneous driveline enables energy supply and pump-control. Indication strategies for VAD implantations include bridge to transplant (short term support), bridge to candidacy and bridge to transplant. VADs become more and more a definite therapeutic option (destination therapy). VAD therapy might be a realistic alternative to organ transplantation in the near future.In der Schweiz leben aktuell etwa 200'000 Menschen mit einer Herzinsuffizienz.
Etwa 10'000 Patienten befinden sich in einem fortgeschrittenen Stadium. Sind
die konservativen Möglichkeiten ausgeschöpft, stellt die Herztransplantation
die beste Option in der Behandlung der terminalen Herzinsuffizienz dar. Ist eine
Transplantation wegen strikter Auswahlkriterien und langen Wartezeiten nicht
möglich kommen mechanische Kreislaufunterstützungssysteme zum Einsatz.
Bei der mechanischen Kreislaufunterstützung unterscheidet man zwischen
kurzfristiger und langfristiger Unterstützung. Die längerfristige Herzersatztherapie
erfolgt heute meist mit Pumpen, welche die Herzfunktion unterstützen
(ventricular assist device = VAD) wobei das native Herz am Ort verbleibt und die
Pumpe parallel zur evtl. verbleibenden Restfunktion des Herzens arbeitet. Bei
der Mehrzahl der Patienten ist die Unterstützung der linksventrikulären Funktion
ausreichend (left ventricular assist device = LVAD); der rechte Ventrikel alleine
(RVAD) resp. eine bi-ventrikuläre Unterstützung (BiVAD) müssen seltener durchgeführt
werden. Die modernen Systeme sind implantierbar, erzeugen einen
kontinuierlichen Blutfluss und sind durch ein transkutan ausgeleitetes Kabel
(driveline) verbunden mit der Stromversorgung und dem Steuerungsantrieb. Bei
den Indikationen kommen verschiedene Überbrückungsstrategien zur Anwendung:
bridge to decision (kurzfristige Unterstützung), bridge to candidacy,
bridge to transplant. Immer häufiger werden Herzunterstützungssysteme als
definitive Therapieoption implantiert (destination therapy). In Zukunft wird
sich weiter die destination therapy etablieren und sich die LVAD-Implantation
einen Platz als Alternative zur Herztransplantation verschaffen
Oestrogen synthesis in the hippocampus: Role in axon outgrowth
No full textOvarian oestrogens have been postulated to be neuroprotective. It has also been shown that considerable amounts of oestrogens are synthesised in hippocampal neurones. In the present study, we focused on a potential role of hippocampus-derived oestradiol compared to gonad-derived oestradiol on axon outgrowth of hippocampal neurones. To address the role of hippocampus-derived oestradiol, we inhibited oestrogen synthesis by treatment of neonatal hippocampal cell cultures with letrozole, a specific aromatase inhibitor. As an alternative, we used siRNA against steroidogenic acute regulatory protein (StAR). Axon outgrowth and GAP-43 expression were significantly down-regulated in response to letrozole and in siRNA-StAR transfected cells. The effects after inhibition of oestrogen synthesis in response to letrozole and in siRNA-StAR transfected cells were reversed by oestrogen supplementation. No difference was found between ovariectomised animals, cycling animals at pro-oestrus and ovariectomised and subsequently oestradiol-treated animals. However, high pharmacological doses of oestradiol promoted axon outgrowth, which was possible to abolish by the oestrogen receptor antagonist ICI 182,780. Our results show that oestradiol-induced neurite outgrowth is very likely mediated by genomic oestrogen receptors and requires higher doses of oestradiol than physiological serum concentrations derived from the gonads
Friendship, love, and brotherhood in medieval Europe, c. 1000-1200
No full textIn this book, Lars Hermanson discusses how religious beliefs and norms steered attitudes to friendship and love, and how these ways of thinking affected social identity and political behaviour. With examples taken from eleventh- and twelfth-century northern Europe, the author investigates why friendship was praised both by brotherhoods of aristocratic warriors and by brethren within monastery walls. Social and political functions rested on personal connections rather than a strong central state in the High Middle Ages. This meant that friendship was an important pragmatic instrument for establishing social order and achieving success in the game of politics
Diagnostik, Therapie und Prophylaxe von respiratorischen Viren bei lungentransplantierten Patienten
No full textLung transplant recipients have a life-long profound immunosuppression which makes them prone to respiratory tract infections, in particular viral infections during the winter season. Since the respiratory tract infections may have potentially severe consequences, we recommend early diagnosis and treatment. We obtain nasopharyngeal swabs for viral and bacteriological examination and then treat pre-emptively with antivirals, broad-band antibiotics and often also with intravenous immunoglobulins. Treatment duration is often longer than in immunocompetent patients. As preventive measures we provide vaccination against seasonal influenza and recommend specific daily hygiene measures.
Lungentransplantierte sind lebenslang stark immunsupprimiert und daher anfällig für respiratorische Infektionen, insbesondere für virale Infektionen in der kalten Jahreszeit. Da die respiratorischen Infektionen schwerwiegende gesundheitliche Folgen haben können, aber häufig zu Beginn nur geringe Symptome verursachen, ist eine Frühdiagnostik und Frühbehandlung enorm wichtig. Neben der Diagnostik mit Nasen- oder Rachenabstrichen für virologische und bakteriologische Untersuchungen, ist die zeitnahe Behandlung mit Virostatika, Breitband-Antibiotika und oft auch Immunglobulinen empfohlen. Die Behandlungsdauer ist oftmals länger als bei Immunkompetenten. Als vorbeugende Massnahmen sind die Grippeimpfung und präventivhygienische Massnahmen im Alltag empfohlen
Utopia i kryzys. Lars T. Lih i rozważania wokół komunizmu wojennego
No full textThe article concerns the policy of ‘war communism’ in Soviet Russia during the civil war. In historiography, there are two dominant views regarding this phenomenon – while some researchers argue that it was a crisis policy (pragmatic and determined by external circumstances), others are inclined to claim that it was a utopian policy (a frantic attempt to immediately implement the communist ideal). Based on the revisionist works by Lars T. Lih, the author argues with the interpretation of the Bolshevik utopian policy, focusing on the analysis of three basic elements of this interpretation, namely: the contingent policy in the countryside, Leon Trotsky’s book entitled Terrorism and Communism and the work entitled The ABC of Communism by Nikolai Bukharin and Yevgeni Preobrazhensky. Thus, the article is an attempt to create a different picture of the Bolshevik policy in the first years after the revolution from the one that is popular in the Polish historical discourse
Cholesterol-Promoted Synaptogenesis Requires the Conversion of Cholesterol to Estradiol in the Hippocampus
No full textCholesterol of glial origin promotes synaptogenesis (Mauch et al., (2001) Science 294:1354-1357). Because in the hippocampus local estradiol synthesis is essential for synaptogenesis, we addressed the question of whether cholesterol-promoted synapse formation results from the function of cholesterol as a precursor of estradiol synthesis in this brain area. To this end, we treated hippocampal cultures with cholesterol, estradiol, or with letrozole, a potent aromatase inhibitor. Cholesterol increased neuronal estradiol release into the medium, the number of spine synapses in hippocampal slice cultures, and immunoreactivity of synaptic proteins in dispersed cultures. Simultaneous application of cholesterol and letrozole or blockade of estrogen receptors by ICI 182 780 abolished cholesterol-induced synapse formation. As a further approach, we inhibited the access of cholesterol to the first enzyme of steroidogenesis by knock-down of steroidogenic acute regulatory protein, the rate-limiting step in steroidogenesis. A rescue of reduced synaptic protein expression in transfected cells was achieved by estradiol but not by cholesterol. Our data indicate that in the hippocampus cholesterol-promoted synapse formation requires the conversion of cholesterol to estradiol. (C) 2009 Wiley-Liss, Inc.Deutsche Forschungsgemeinschaft [Ru 436/4-4
Does remediation save lives? On the cost of cleaning up arsenic-contaminated sites in Sweden
No full textSwedish environmental policy is based on 16 environmental quality objectives (Gov. Bill 2000/01:130 and Gov.Bill 2004/05:150).1 One of the most challenging objectives,‘A non toxic environment’, has two interim targets that concern remediation of contaminated sites. In sum, they state that the highest priority should be given to sites posing the highest risks to human health and the environment.2 By eliminating pollutants in soil, groundwater and sediment, the interim targets aim to reduce risks to human health and the environment. In Sweden, 83,000 sites are potentially contaminated due to previous industrial activities. According to the Swedish Environmental Protection Agency (EPA), the administrator of the governmental funds for remediation, approximately 1500 of these sites contain contaminant concentrations that could seriously harm human health and the environment (Swedish EPA, 2008a). To reach the interim targets, all these sites need to be remediated by 2050. Remediation of contaminated sites has so far cost more than SEK 3,000 million.3 The approximated cost to mitigate the potential risks at the most harmful sites is estimated at SEK 60,000 million.4 The Swedish government’s funding for remediation presently comes in the form of a directed grant (sakanslag). The directed grant, administrated by the Swedish EPA, subsidises remediation of contaminated sites that were contaminated prior to modern environmental legislation (in 1969) or for which no liable party can be found. The directed grant amounts to approximately 455 millions annually, which corresponds to about 10 percent of the annual national funds for environmental protection (Gov. Bill 2007/08:1). To make it possible to prioritise among contaminated sites, the Swedish EPA has developed a method for risk assessment called the ‘MIFO’ (i.e. the Method for Inventory of Contaminated Sites). The risk assessment does not take into account the actual exposure at a contaminated site. Risk is instead assessed based on divergence from guideline values for acceptable concentrations given a standardised (i.e. worst case) exposure situation on an individual level. This means that a site can be remediated without any individuals actually being exposed. The expected risk reduction is consequently not quantified. This eliminates the possibility of valuing the risk reduction, which should be weighed against the remediation cost. The purpose of this paper is to analyse how health effects, in the form of cancer risks, from sites contaminated by arsenic are valued implicitly in remediation. By using an environmental medicine approach that takes exposure into account, and without underestimating the potential health consequences of arsenic exposure, our purpose is to place arsenic risk management in the overall picture of live-saving interventions. In the case of cancer prevention, it is necessary to recognise that focus on an environmental carcinogen like arsenic may draw public attention – and funding – away from mental health risks like ambient air pollution and indoor radon. Although environmental pollution accounts for less than ten percent of all cancer cases (Harvard Centre for Cancer Prevention, 1996; Saracci and Vineis, 2007), environmental factors are important to recognize since they may be preventable. We emphasise, however, the inefficiency in becoming overly concerned about small risks while, at the same time, losing sight of the large risks. If society’s spending on lifesaving measures with small effects (i.e. a small number of lives saved) crowds out spending on lifesaving measures with large effects, then remediation can, in fact, even be said to waste lives. By using data on 23 arsenic-contaminated sites in Sweden, we estimate the sitespecific cancer risks and calculate the cost per life saved by using the sites’ remediation costs. Our results show that the cost per life saved through remediation is much higher than that associated with other primary prevention measures, indicating that the ambition level of Swedish remediation may be too high.
Environmental crisis, sectoral versus integral: The agency of change: Dialogue
No full textToday we experience and acknowledge the nexus of ecology, culture and politics as a moving objective, defined by local realities placed within global developments. Large-scale change is no longer a distant probability but an approaching condition, which forces us to accept instability and envision sustainability transitions as the ground of future inhabitation. When looking closer into atmospheric, water (riverine, maritime, deltaic), and land systems and their inherent uncertainties we realize the agency that local sensitivities, culture and planning regimes have in defining the success or failure of sustainable development. This dialogue will question what the real ground of preMarsent and future urbanization is, imagining adaptive and transformative change as material and ecologically sensitive practices to site, context and culture.This dialogue is the transcription of the round table talk on the International Forum on Urbanism held in Delft on 26 November 2021. Lars Marcus, Chris Zevenbergen and Carola Hein presented their work in the light of the environmental crisis, sectoral versus integral: the agency of change. With moderator Fransje Hooimeijer they elaborated and related their work in a discussion around the main questions of history, the longue durée, disciplinarity and agency of change.Urban DesignHistory, Form & Aesthetic
Lars Polten, Zwangssterilisation und „Euthanasie“ im Erinnern und Erzählen. Biografische Interviews mit Betroffenen und Angehörigen
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