2,997 research outputs found
Cystatin C, a measure of renal function, as prognostic risk marker in acute heart failure : Studies on the cardiorenal syndrome
No full textAcute heart failure (AHF) is a complex syndrome associated with exceptionally high mortality. Still, characteristics and prognostic factors of contemporary AHF patients have been inadequately studied. Kidney function has emerged as a very powerful prognostic risk factor in cardiovascular disease. This is believed to be the consequence of an interaction between the heart and kidneys, also termed the cardiorenal syndrome, the mechanisms of which are not fully understood. Renal insufficiency is common in heart failure and of particular interest for predicting outcome in AHF. Cystatin C (CysC) is a marker of glomerular filtration rate with properties making it a prospective alternative to the currently used measure creatinine for assessment of renal function.
The aim of this thesis is to characterize a representative cohort of patients hospitalized for AHF and to identify risk factors for poor outcome in AHF. In particular, the role of CysC as a marker of renal function is evaluated, including examination of the value of CysC as a predictor of mortality in AHF.
The FINN-AKVA (Finnish Acute Heart Failure) study is a national prospective multicenter study conducted to investigate the clinical presentation, aetiology and treatment of, as well as concomitant diseases and outcome in, AHF. Patients hospitalized for AHF were enrolled in the FINN-AKVA study, and mortality was followed for 12 months. The mean age of patients with AHF is 75 years and they frequently have both cardiovascular and non-cardiovascular co-morbidities. The mortality after hospitalization for AHF is high, rising to 27% by 12 months.
The present study shows that renal dysfunction is very common in AHF. CysC detects impaired renal function in forty percent of patients. Renal function, measured by CysC, is one of the strongest predictors of mortality independently of other prognostic risk markers, such as age, gender, co-morbidities and systolic blood pressure on admission. Moreover, in patients with normal creatinine values, elevated CysC is associated with a marked increase in mortality. Acute kidney injury, defined as an increase in CysC within 48 hours of hospital admission, occurs in a significant proportion of patients and is associated with increased short- and mid-term mortality. The results suggest that CysC can be used for risk stratification in AHF.
Markers of inflammation are elevated both in heart failure and in chronic kidney disease, and inflammation is one of the mechanisms thought to mediate heart-kidney interactions in the cardiorenal syndrome. Inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) correlate very differently to markers of cardiac stress and renal function. In particular, TNF-α showed a robust correlation to CysC, but was not associated with levels of NT-proBNP, a marker of hemodynamic cardiac stress. Compared to CysC, the inflammatory markers were not strongly related to mortality in AHF.
In conclusion, patients with AHF are elderly with multiple co-morbidities, and renal dysfunction is very common. CysC demonstrates good diagnostic properties both in identifying impaired renal function and acute kidney injury in patients with AHF. CysC, as a measure of renal function, is also a powerful prognostic marker in AHF. CysC shows promise as a marker for assessment of kidney function and risk stratification in patients hospitalized for AHF.Sammandrag på svenska
Akut hjärtsvikt är ett mångfasetterat tillstånd med exceptionellt hög dödlighet. Forskningen har dock inte i tillräckligt stor utsträckning undersökt kliniska karaktärsdrag och prognostiska faktorer hos patienter med akut hjärtsvikt. Njurfunktionen har visat sig spela en nyckelroll för prognosen hos patienter med hjärt-kärlsjukdomar. Mekanismerna bakom detta samband mellan hjärta och njurar, ofta kallat det kardiorenala syndromet, är otillräckligt klarlagda. Nedsatt njurfunktion är vanlig vid hjärtsvikt och därmed av speciellt intresse för bedömning av prognosen vid akut hjärtsvikt. Cystatin C (CysC) är en markör för den glomerulära filtrationen med egenskaper som gör den till ett intressant alternativ till kreatininet, som för närvarande används för att bedöma njurfunktionen. Syftet med avhandlingen är att karaktärisera en representativ grupp patienter med akut hjärtsvikt och att identifiera riskfaktorer för dålig prognos vid akut hjärtsvikt. Särskild vikt läggs vid att utvärdera vilken roll CysC spelar som markör för njurfunktionen, samt vid att bedöma dess värde som prediktor av mortaliteten vid akut hjärtsvikt.
FINN-AKVA är en finländsk prospektiv multicenter-studie som utförs för att undersöka akut hjärtsvikt: klinisk bild, etiologi, komorbiditet, behandling och mortalitet. Patienter med akut hjärtsvikt som intagits på sjukhus rekryterades till FINN-AKVA-studien och följdes under 12 månader med avseende på mortaliteten. Medelåldern för personerna som ingår i studien är 75 år. De har ett flertal grundsjukdomar, både kardiovaskulära och icke-kardiovaskulära. Mortaliteten efter akut hjärtsvikt är hög, 27 % på 12 månader. Resultaten i avhandlingen visar att försämrad njurfunktion är mycket vanligt vid akut hjärtsvikt. CysC upptäcker en nedsatt njurfunktion hos 40 % av patienterna och är dessutom en av de faktorer som är starkast relaterad till mortaliteten, även om man beaktar andra vanliga riskmarkörer så som ålder, kön, grundsjukdomar och systoliskt blodtryck. Studien påvisar att höga nivåer av CysC har samband med en ökad mortalitet även hos patienter med normala kreatininvärden. Akut njursvikt, i studien definierad som en ökning av CysC-nivåerna med 0.3mg/l under de första två dygnen av sjukhusvistelsen, konstateras hos en betydande andel av patienterna och medför också en ökad mortalitet, både omedelbar och på längre sikt under uppföljningstiden. Resultaten antyder att CysC är användbar för riskbedömning vid akut hjärtsvikt.
Förhöjda nivåer av olika inflammatoriska cytokiner, såsom interleukin-6 (IL-6) och tumörnekros faktor alfa (TNF-α) har påvisats både vid hjärtsvikt och vid kronisk njursjukdom. Inflammationen antas vara en av mekanismerna vid växelverkan mellan hjärta och njurar i det kardiorenala syndromet. IL-6 och TNF-α uppvisar rätt olika korrelation med markörer för njurfunktion och hjärtsvikt (NT-proBNP). Speciellt stark var korrelationen mellan CysC och TNF-α, som i sin tur inte korrelerade med NT-proBNP. CysC var dock en bättre riskmarkör för mortaliteten än de inflammatoriska markörerna.
Sammanfattningsvis kan konstateras att patienter med akut hjärtsvikt är äldre personer, har många grundsjukdomar, och att nedsatt njurfunktion är mycket vanlig. CysC visar sig ha goda diagnostiska egenskaper både för att upptäcka försämrad njurfunktion och akut njursvikt hos patienter med akut hjärtsvikt. CysC är också en stark prognostisk markör vid akut hjärtsvikt. CysC bör betraktas som en lovande markör för bedömningen av njurfunktionen och riskbedömningen hos patienter med akut hjärtsvikt.Tiivistelmä suomeksi
Akuutti sydämen vajaatoiminta on monimuotoinen oireyhtymä johon liittyy poikkeuksellisen suuri kuolleisuus. Siitä huolimatta näiden potilaiden kliinisiä piirteitä ja ennustetekijöitä on puutteellisesti tutkittu. Munuaistoiminta on noussut vahvaksi ennustetekijäksi sydän- ja verisuonisairauksissa. Tätä sydämen ja munuaisten välistä yhteyttä kuvataan nimellä kardiorenaalinen syndrooma, mutta sen mekanismit ovat huonosti tunnettuja. Munuaisten vajaatoiminta on tavallinen sydämen vajaatoimintapotilailla, ja siksi erityisen mielenkiinnon kohteena kuolleisuuden ennustajana akuutissa sydämen vajaatoiminnassa. Kystatiini C (CysC) on glomerulusfiltraation mittari jonka ominaisuudet tekevät siitä mielenkiintoisen vaihtoehdon nykyisin käytössä olevalle kreatiniinille munuaistoiminnan merkkiaineena.
Väitöskirjan tavoitteena on kuvata edustava aineisto akuuttia sydämen vajaatoimintaa sairastavia potilaita ja tunnistaa akuutin sydämen vajaatoiminnan huonon ennusteen tekijöitä. Erityisenä tavoitteena on tutkia CysC:tä munuaistoiminnan merkkiaineena akuutissa sydämen vajaatoiminnassa ja selvittää sen merkitystä kuolleisuuden ennustetekijänä.
FINN-AKVA on suomalainen prospektiivinen monikeskustutkimus akuutin sydämen vajaatoiminnan kliinisestä ilmentymästä, etiologiasta, liitännäissairauksista, sekä hoidosta ja kuolleisuudesta. Tutkimukseen otettiin akuutin sydämen vajaatoiminnan takia sairaalahoitoon joutuneita potilaita, ja kuolleisuutta seurattiin 12 kuukauden ajan. Potilaiden keski-ikä oli 75 vuotta, ja heillä esiintyi paljon sydän- ja verisuonisairauksia sekä useita muita liitännäissairauksia. Kuolleisuus sairaalahoitojakson jälkeisen vuoden aikana oli korkea (27 %).
Tutkimuksessa CysC:llä todetaan alentunutta munuaistoimintaa 40 %:lla akuutin sydämen vajaatoimintapotilaiden joukosta. Munuaistoiminta, CysC:llä mitattuna, on yksi vahvimmista itsenäisistä kuolleisuuden ennustajista senkin jälkeen, kun muut tavanomaiset riskitekijät on otettu huomioon. Niilläkin potilailla joilla kreatiniini on normaali, koholla olevaan CysC-arvoon liittyy huomattavasti korkeampi kuolleisuus. Akuutti munuaisvaurio, määritelmänä CysC-arvon nousu 0.3 mg/l kahden vuorokauden sisällä sairaalaan tulosta, havaitaan merkittävällä osalla potilaista, ja siihen liittyy lisääntynyt kuolleisuus sekä lyhyellä että keskipitkällä aikavälillä. Tulosten perusteella vaikuttaa siltä, että CysC on käyttökelpoinen merkkiaine riskinarvioon akuutissa sydämen vajaatoiminnassa.
Kohonneita pitoisuuksia tulehduksellisia sytokiineja, kuten interleukiini-6 (IL-6) ja tuumorinekroositekijä alfa (TNF-α), on todettu sekä sydämen että munuaisten vajaatoiminnassa. Tulehduksen ajatellaan olevan mukana välittäjänä sydämen ja munuaisten välisessä vuorovaikutuksessa, kardiorenaalisessa syndroomassa. IL-6 ja TNF-α korreloivat eri tavalla munuaistoimintaa ja sydämen kuormitusta (NT-proBNP) kuvaaviin merkkiaineisiin. Etenkin TNF-α:lla on vankka korrelaatio CysC:n kanssa, mutta ei taas assosioidu NT-proBNP-tasoihin. CysC:n verrattuna tulehdusmerkkiaineiden vaikutus ennusteeseen on heikompi.
Yhteenvetona voi todeta, että akuuttia sydämen vajaatoimintaa sairastavat potilaat ovat iäkkäitä, varsin monisairaita, ja etenkin munuaisten vajaatoiminta on tavallinen löydös. CysC osoittaa hyviä diagnostisia ominaisuuksia, sekä alentuneen munuaistoiminnan että akuutin munuaisvaurion havaitsemiseen akuuttia sydämen vajaatoimintaa sairastavilla potilailla. Munuaistoiminnan merkkiaineena CysC on myös vahva ennustetekijä. CysC vaikuttaa lupaavalta merkkiaineelta munuaistoiminnan arviointiin ja akuutin sydämen vajaatoimintapotilaiden riskinarvioon.ei saavutettav
Report of Governor Johan Rising, 1655, on New Sweden
No full textGovernor Johan Rising reports to the Swedish government and royalty on the status of New Sweden (present-day New Jersey). He also reports on other Swedish colonies in the area. He asks that single women and skilled tradesmen be sent to the colonies. Rising also reports that attacks from neighboring Indian tribes are increasing. He has found some protection by forming an alliance with English settlers, but the cost is high, and his colony owes the English money and supplies. Rising asks that Sweden send them money so that they can pay off their debts, build ships that would establish a trading dominance with the West Indies, and cultivate land and crops to gain more profit. Reports from New World governors were sent back to their native countries via ships. Rising sent this report in June of 1655, but Sweden did not recieve the report until November of 1655. This article is part of a Primary Source Material collection compiled by the New Sweden Commemorative Commission in 1988
Report of Governor Johan Printz, 1647, on New Sweden
No full textGovern Johan Printz, the governor of New Sweden (later to become New Jersey), reports on the status of the colony and the settlers. Many freemen have arrived to settle in New Sweden, but the criminals and military men who were conscripted to the colony want to return to Sweden. Of the freemen, very few are skilled, so Governor Printz asks that blacksmiths, tanners, tailors, carpenters, and butchers be sent to the colony. Additionally, he asks for single women. Printz also reports on two new Swedish colonies that have been established along the Delaware River. However, Dutch settlers have become very aggressive by re-purchasing land from the Indians that the Swedish had already bought. They are also interrupting trade between the Swedes and the Indians, as well as instigating the Indians to attack the Swedes. Printz directed the construction of some storage houses along common trade routes to win back trade from the Indians. However, fighting has erupted between different Native tribes as each tries to establish dominance in trading with the colonies. This article is part of a Primary Source Material collection compiled by the New Sweden Commemorative Commission in 1988
Relation of the surrender of New Sweden, by Governor Johan Clason Rising, 1655
No full textGovernor Johan Rising of New Sweden reports to Sweden on the August 1655 Dutch attack on New Sweden's Fort Christina. The Dutch traveled from New Amsterdam (present-day New York) and easily captured a New Sweden outpost. Rising sent men to the outpost to fend of the Dutch, but the Dutch defeated them and took them as prisoners, leaving Fort Christina without fighting men and supplies. The Dutch then put the Fort under seige. A few days later, Rising surrendered the Fort. He and the Swedish colonists were ordered to either return to Sweden, or to remain in the New World in service to the Dutch. This article is part of a Primary Source Material collection compiled by the New Sweden Commemorative Commission in 1988
The past, present and future of social media in project management
No full textGreen Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Integral Design & Managemen
An operationalization of Stevenson’s conceptualization of entrepreneurship as opportunity-based firm behavior
No full textThis is the author-version of article published as: Brown, Terrence and Davidsson, Per and Wiklund, Johan (2001) An operationalization of Stevenson’s conceptualization of entrepreneurship as opportunity-based firm behavior. Strategi
Social media for improving metro rail project operations
No full textGreen Open Access added to TU Delft Institutional Repository 'You share, we take care!' - Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Integral Design & Managemen
The social challenges of low carbon development
No full textThis book explores the social implications and challenges of low-carbon development. The argument of the book is that a broad understanding of low-carbon development is essential for mitigating climate change and enabling development in a carbon-constrained world, but there are risks that low-carbon development might come at a price that is both social and economic. These risks need to be carefully assessed and reduced. The main aim of the book is to explore, critically analyse and propose different ways of understanding low-carbon development from a social perspective in both developed and developing countries. The author uses concepts such as low-carbon development, social policy, sustainable development and environmental justice to understand the social implications of low-carbon development projects. The book first elaborates the need to understand the social issues and challenges of low-carbon development in both developed and developing countries. It then discusses five contemporary challenges of low-carbon development: * the social consequences of Chinese hydropower dams in the Mekong region; * the cost of the transition to renewable energies such as wind energy in Germany; * the challenges of carbon offsetting in Brazil; * the nexus of fuel-inefficient housing and fuel poverty in England; * solar power for refugees in Africa. The book fills a crucial gap for researchers, postgraduates, practitioners and policy-makers in the fields of climate change, development and social policy. Johan Nordensvard is a Lecturer in Social Policy at the University of Southampton, UK
Johan Risell Samlade dikter : Utgivna med inledning och kommentarer av Lars Burman
No full textJohan Risell, Samlade dikter. Utgivna med inledning och kommentarer av Lars Burman. (Johan Risell, Collected Poems. Edited with introduction and commentary by Lars Burman.) Skrifter utgivna av Svenska Vitterhetssamfundet. Svenska författare. Ny serie, xxxii + 296 p. Stockholm. ISBN 978-91-7230-213-6 Johan Risell (1697–1724) was a highly acclaimed Swedish poet during the early 18th century. However, he has gradually been forgotten, possibly because of his early death and the changing times and literary ideals, but mainly because only seven poems have been known to his name. During the 20th century, he did not receive attention.Due to a recent manuscript find in Karlstad in Värmland, 61 poems by Risell are now known. This volume presents a critical edition of his poems. Notwithstanding his death at the age of only 27, Risell is shown to have been a diligent and varied author, writing orations and occasional verse to further his career, but also excelling in satires and songs to entertain his friends. It is clear that he performed his orations and songs, and he appears as a Swedish example of an early modern singer-songwriter. The student setting of Uppsala was important. In many of his poems and songs he celebrates a joyful bohemian way of life, in others, he appears as a melancholic lover. His vivid imagination, emotional appeal and oral qualities are to be noted. The themes of love and war are prominent. His more than two dozen song-texts are particularly notable, as it is shown that many of these were widely spread during the 18th century, though without attribution. They appear in handwritten songbooks and a few were printed in chapbooks. Johan Risell was a vicar’s son from Värmland and Dalsland, who matriculated at Uppsala University 1717, but never received a degree. After working as a tutor for richer families, he finally was appointed »stadssekreterare« (a local administrative position calling for some training in law) in Köping. He died in Uppsala before he could take up office.Vetenskaplig textkritisk utgåva. Critical edition.</p
Johan Risell Samlade dikter : Utgivna med inledning och kommentarer av Lars Burman
No full textJohan Risell, Samlade dikter. Utgivna med inledning och kommentarer av Lars Burman. (Johan Risell, Collected Poems. Edited with introduction and commentary by Lars Burman.) Skrifter utgivna av Svenska Vitterhetssamfundet. Svenska författare. Ny serie, xxxii + 296 p. Stockholm. ISBN 978-91-7230-213-6 Johan Risell (1697–1724) was a highly acclaimed Swedish poet during the early 18th century. However, he has gradually been forgotten, possibly because of his early death and the changing times and literary ideals, but mainly because only seven poems have been known to his name. During the 20th century, he did not receive attention.Due to a recent manuscript find in Karlstad in Värmland, 61 poems by Risell are now known. This volume presents a critical edition of his poems. Notwithstanding his death at the age of only 27, Risell is shown to have been a diligent and varied author, writing orations and occasional verse to further his career, but also excelling in satires and songs to entertain his friends. It is clear that he performed his orations and songs, and he appears as a Swedish example of an early modern singer-songwriter. The student setting of Uppsala was important. In many of his poems and songs he celebrates a joyful bohemian way of life, in others, he appears as a melancholic lover. His vivid imagination, emotional appeal and oral qualities are to be noted. The themes of love and war are prominent. His more than two dozen song-texts are particularly notable, as it is shown that many of these were widely spread during the 18th century, though without attribution. They appear in handwritten songbooks and a few were printed in chapbooks. Johan Risell was a vicar’s son from Värmland and Dalsland, who matriculated at Uppsala University 1717, but never received a degree. After working as a tutor for richer families, he finally was appointed »stadssekreterare« (a local administrative position calling for some training in law) in Köping. He died in Uppsala before he could take up office.Vetenskaplig textkritisk utgåva. Critical edition.</p
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