1,189 research outputs found
Bewertung des Langzeitverlaufs nach Katheterablation von intermittierendem und persistierendem Vorhofflimmern mittels Tele-EKG: Prognostische und therapeutische Implikationen.
No full textDie durch bahnbrechende Studien von Haissaguerre et al. (Haissaguerre, Jais et al. 1998) initiierte elektrophysiologische Therapie mittels Hochfrequenzablation ist in den letzten Jahren fast zu einer Standardtherapie in der Behandlung des Vorhofflimmerns geworden.
Bei der Überwachung des Therapieerfolgs mittels Tele-EKG zeigten sich im Wesentlichen zwei Aspekte als besonders imponierend.
Zum Einen die Überlegenheit der täglichen Überwachung mit Hilfe des Tele-EKGs gegenüber einer herkömmlichen 12-Kanalableitung oder eines 24-Stunden-EKG.
Zum Anderen die eher schwache Korrelation von Symptom und objektiver Diagnose speziell bei Patienten, die im EKG Vorhofflimmern zeigten (Klemm, Ventura et al. 2006).
Mit vorliegender Arbeit konnte gezeigt werden, dass eine hohe Erfolgsrate sowohl für Patienten mit intermittierendem Vorhofflimmern, als auch für Patienten mit persistierendem Vorhofflimmern für die Pulmonalvenenisolation nachzuweisen ist.
Ebenso konnte der zusätzliche Nutzen einer Substratmodifikation bei Patienten mit persistierendem Vorhofflimmern aufgezeigt werden (Willems, Klemm et al. 2006). So ergab sich hier ein deutlicher Signifikanzunterschied von p=0,017 zu Gunsten der zusätzlich erzeugten Linien im linken Vorhof gegenüber der alleinigen Pulmonalvenenisolation. Insgesamt konnte hier eine Erfolgsrate von 68% erzielt werden.
Bei Patienten mit intermittierendem VHF konnte der zusätzliche Nutzen einer Substratmodifikation nicht nachgewiesen werden. Hier ergab sich kein Signifikanzunterschied (p=0,62).
Des Weiteren wurde der Frage nachgegangen, ob durch die Gabe eines ACE-Inhibitors respektive eines AT-1 Blockers das reverse Remodelling des Vorhofmyokards Unterstützung findet und wie dies zum Heilungserfolg beiträgt. Es konnte anhand von 214 Casematch-Patienten ein signifikanter Unterschied (p=0,019) in der Prognose dieser beiden, medikamentös unterschiedlich behandelten, Patientengruppen verdeutlicht werden.
Ein positiver Effekt von ACE-Inhibitoren und AT1-Blockern für Patienten mit persistierendem VHF nach Cardioversion konnte bereits nachgewiesen werden (Madrid, Bueno et al. 2002; Ueng, Tsai et al. 2003).
Das in der vorliegenden Arbeit untersuchte Patientenkollektiv scheint nun den Schluss zuzulassen, diese Erkenntnisse auch auf Patienten mit intermittierendem Vorhofflimmern ausweiten zu können
Device therapy for rate control: pacing, resynchronisation and AV node ablation
No full textAbstract not availableDennis H. Lau, Anand Thiyagarajah, Stephan Willems, Thomas Rostock, Dominik Linz, Martin K. Stiles, David Kaye, Jonathan M. Kalman, Prashanthan Sander
Efficacy and Safety of Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in the Elderly
No full textAV-Knoten-Reentrytachykardien (AVNRT) gehören zu den am häufigsten auftretenden paroxysmalen supraventrikulären Tachykardien. Prinzipiell können sie in jedem Lebensabschnitt auftreten, gehäuft jedoch zwischen dem 30. und 40. Lebensjahr. Durch den demographischen Wandel in unserer Gesellschaft, gewinnt auch die Wahl einer langfristig sinnvollen und kostengünstigen Therapie einer AVNRT bei älteren Patienten an Bedeutung. Allerdings wurde bisher die Katheterablation bei älteren Patienten nicht als erste und langfristig sinnvolle Therapiemassnahme empfohlen, da das Risko eines höhergradigen AV-Blockes mit Schrittmacherpflichtigkeit höher als bei jüngeren Patienten eingestuft wurde. In diese Studie wurden 578 Patienten eingeschlossen, die zwischen Februar 1998 und Juli 2004 mit symptomatischen AVNRT durch eine Katheterablation der langsamen Leitungsbahn therapiert wurden. Die Patienten wurden in Abhängigkeit von Ihrem Alter in zwei Gruppen eingeteilt. In Gruppe 1 waren Patienten im Alter < 75 Jahren (n 508). Gruppe 2 enthielt Patienten im Alter > 75 Jahren (n 70). Ziel dieser Studie war es, den Erfolg und die Komplikatiosrate, insbesondere im Hinblick auf die Induktion eines höhergradigen AV-Blockes, durch Katheterablation bei älteren Patienten zu untersuchen. In Zusammenschau der Ergebnisse, die eine geringe Rezidivrate und keinen höhtergradigen AV- Block bei den älteren Patienten im Vergleich zu den jüngeren Patienten aufweisen, zeigt diese Studie, dass die Katheterablation der langsamen Leitungsbahn bei älteren Patienten mit AVNRT eine sichere und effektive Methode darstellt. Bisherige Vorbehalte bezüglich eines grösseren Risikos im Alter sind nach den Ergebnissen dieser Studie nicht mehr aufrechtzuerhalten. Somit sollte die Katheterablation auch bei älteren Patienten als Therapie der 1. Wahl eingesetzt werden.Atrioventricular nodal reentrant tachycardia (AVNRT) is the most commom regular supraventricular tachycardia. The incidence of AVNRT in very elderly patients has become of increased clinical relevance due the demographic change with an increased life expectancy of the general population. Radiofrequency catheter ablation is the first line therapie in patients with AVNRT and is associated with high success and a low complication rate. There are only small number of studies available investigating the incidence of the induction of an atrioventricular block by slow pathway ablation in elderly patients. However, advanced age has been suggested to be a risk factor for the induction of an AV block during slow-pathway ablation. The aim of the study was to investigate the success and complication rate, particularly the induction of an AV block by slow-pathway ablation in elderly patients. Between February 1998 and July 2004 all patients referred to our institution for an electrophysiological study and therapie having symptomatic AVNRT were included and divided into two groups with regard to their age. A total number of 578 patients were included. Group 1 included patients < 75 years (in total 508 patients)and group 2 included patients
> 75 years (in total 70 patients). In regard to the results of this study slow-pathway ablation in elderly patients is both effective and safe and should be considered as the first line therapy
Violence in defeat: the Wehrmacht and late-war society in East Prussia, 1944-1945
No full textDuring the battles for East Prussia in the final year of the Second World War, the ruthless conduct of
German troops resulted in vast material and personal damage. By focusing on the besieged ‘Festung
Königsberg’ in the spring of 1945, this dissertation argues that the violence that transpired in Germany
in 1945 can only be understood by devoting sustained attention to local actors and factors. By combining
social history and military history approaches, the research restores agency to the German army, the
Wehrmacht, as an active participant in the radicalisation of the German home front. This case study
demonstrates that due to the fragmentation of Germany, the decisions and orders of Wehrmacht
commanders had a disproportionately large impact at a local level. The radical nature of these decisions
was the direct result of the commanders’ violent experiences during the preceding years, while the
barbarised mindset of the rank-and-file encouraged the rigorous enforcement of military authority. The
dissertation’s findings contribute to four themes within the historiography of the Second World War.
First, it contributes to the recent debate surrounding the German Volksgemeinschaft by drawing
attention to the limits of loyalty to the regime, and the actors and events that prompted this fidelity to
shift. Secondly, by analysing a large number of unused archival sources, it provides the first in-depth
urban history of everyday life in Königsberg during its 1945 siege. Thirdly, it challenges the
conventional historiographical view in which fanatical Party officials were the main perpetrators of late-war
violence by emphasising the significance of the Wehrmacht as a key actor. Even though large
numbers of German troops operated in close proximity to German civilians, their conduct has hardly
been considered as an explanation of the events of 1945. Lastly, this dissertation combines and
transcends the different perspectives on German domestic and martial law, suggesting that the two were
ever more closely intertwined as the war progressed, resulting in a shift of behavioural patterns. The
focus on Königsberg and its immediate surroundings has allowed for a re-examination of late-war
society, being the first to focus attention on the triadic relationship of Wehrmacht, Party, and civilian
population
Brand personality appeal in retailing: Comparing fashion- and grocery retailing
No full textIn a mature retail market, branding can offer retailers opportunities for setting themselves apart. This study examines the construct 'brand personality appeal' (BPA; Freling et al., 2011) in retailing. Two consumer surveys are administered, on fashion retailing (n = 104) and grocery retailing (n = 101), focusing on (1) store personality, (2) BPA, and (3) retailer brand equity. A SmartPLS estimation shows that 'enthusiasm' is a personality trait that appeals to consumers regardless of the retail context, whereas 'sophistication' matters more in fashion retailing and 'unpleasantness' in grocery retailing. BPA is a significant driver of retail brand equity, regardless of the retail context.The author would like to thank Dimitry Dessers, a master thesis student in the MSc Applied Economics (Hasselt University), for his help in the data collection for this study, and Prof. Dr. Em. Gilbert Swinnen, for his thoughtful comments on the design of this study and for his valuable support in the early stages of this research
Le filage du fil de l'histoire: fantaisie et création de fiction narrative dans l'oeuvre de Patrick Corillon
No full textLe Benshi d’Angers (The Benshi of Angers, 2011), a performance by the contemporary artist Patrick Corillon, during which the artist tells the story of a fictive daydream, constitutes the starting point of this contribution. The author’s analysis of the work has led to a consideration whether Freud’s « Creative Writers and Day-Dreaming » (1908 e), in which he postulates a relation between “phantasying” and literary creation, may clarify the creative process that generated the artist’s work. In answer to this question, the author refines Freud’s hypothesis, for Corillon’s work, by arguing for a relationship between the creation of narrative fiction and sleep fantasy, as conceived by Pierre Fédida. The artist benefits from moments of insomnia in order to transform them into creative moments and during this creative process the “potential space” may engender itself. This hypothesis is consolidated by the study of a second work by Patrick Corillon, La Forêt des Origines (The Wood of the Origins, 2008)
Application of Value Methodology to Improve Preservation of Infrastructural Assets in Rijkswaterstaat
No full textValue Methodology (VM) is proposed by Dr. Frits Willems from Grontmij, as a possible way to help solve the problems. VM is a strong problem-analyzing and decision-making tool which matches the problem framework. Besides, based on an insight of its development and applications in other Government agencies, and comparisons with other relative methods, a conclusion is drawn that it is worthwhile researching on VM to see how it can help. VM is the starting point of this thesis research. The objective is to develop a framework of the application of Value Methodology, in order to identify maintenance improvements on infrastructural assets and guide decision-making on renewal and modification projects.BouwprocessenBouwCivil Engineering and Geoscience
Low myocardial energetic efficiency is associated with increased mortality in aortic stenosis
No full textObjectives In hypertension, low myocardial energetic efficiency (MEEi) has been documented as an integrated marker of metabolic and left ventricular (LV) myocardial dysfunction. We tested the predictive performance of MEEi in initially asymptomatic aortic stenosis (AS) patients free from diabetes and known cardiovascular disease.Methods Data from 1703 patients with mostly moderate AS enrolled in the Simvastatin and Ezetimibe in Aortic Stenosis study followed for 4.3 years was used. MEE was calculated from Doppler stroke volume/([heart rate/60]) and indexed to LV mass (MEEi). The threshold value for MEEi associated with increased mortality was identified in generalised additive model with smoothing splines. Covariables of MEEi were identified in logistic regression analysis. Outcome was assessed in Cox regression analysis and reported as HR and 95% CI.Results MEEi <0.34 mL/s per gram was associated with increased cardiovascular mortality (n=80) (HR 2.53 (95% CI 1.50 to 4.28)) and all-cause mortality (n=155) (HR 1.74 (95% CI 1.20 to 2.52)) (both p<0.01). The association was independent of confounders of low MEEI (<0.34 mL/s per gram) identified in multivariable logistic regression analysis, including more severe AS, higher body mass index, lower LV midwall shortening and ejection fraction and presence of hypertension. Comparison of the Cox models with and without MEEi among the covariables demonstrated that MEEi significantly improved the prognostic yield (both p<0.01).Conclusions In patients with initially asymptomatic AS, low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during 4.3 years follow-up, independent of known prognosticators.Trial registration number NCT00092677
Paul Willems y el onirismo en la narración: La cathédrale de brume (traducción al español)
No full textEl presente trabajo se centra en la traducción al español de uno de los relatos con mayor contenido simbólico de uno de los mayores exponentes de la literatura belga del pasado siglo XX: Paul Willems. En primer lugar se analiza la relevancia de la figura del autor en su contexto histórico-social, que pone de manifiesto la repercusión que han tenido en su producción literaria las vivencias y experiencias acumuladas a lo largo de su vida. A continuación, se recoge el original de La cathédrale de brume en lengua francesa acompañado de una propuesta de traducción a la lengua española, en la que se pretende reflejar la carga simbólica que se desprende del relato.This paper aims to focus on the translation into Spanish of the symbolic tale La cathédrale de brume, by Paul Willems. This author could be considered as one of the most representative writer of the Belgian literature in the 20th century. Firstly, we study the importance of Paul Willems inside his social and historical contexts. Moreover, we analyze his experiences, which highlight their influence in his literary works. Secondly, we offer the original tale in French, together with our proposal of translation into Spanish. Our translation tries to reflect the symbolic charge of La cathédrale de brume
L’enjeu de l’écriture dans La cathédrale de brume, de Paul Willems, en parallèle avec d’autres oeuvres françaises
No full textEn este Trabajo de Fin de Grado, presentamos un análisis literario del relato La
catedral de niebla, del autor belga Paul Willems (1912-1997). La aventura que se
desarrolla en este cuento parece ser una peregrinación nocturna a una catedral de vapor.
Sin embargo, creemos poder identificar bajo esta historia corriente la descripción del
recorrido que sigue Willems para conseguir escribir. Nuestro objetivo es precisamente
sacar a la luz este original proceso metaliterario. En lo que respecta a la metodología,
hemos escogido la técnica del comentario compuesto, muy extendida en el mundo
académico francés. El comentario nos ha permitido discernir las diferentes ideas que se
encuentran entremezcladas en el relato y revelar el contenido simbólico del mismo. De
esta manera, hemos demostrado que, en esta historia de Paul Willems, la naturaleza
tiene una importancia primordial como fuente de inspiración, de ahí que sea sublimada
al rango de mito. También hemos constatado que las creaciones de Willems se basan en sus recuerdos personales, que son trabajados por el sueño antes de convertirse en
escritura. Por último, hemos revelado el papel contradictorio del silencio, un elemento
que, en realidad, refleja fielmente la duplicidad de la existencia que concibe el escritor
belga.Dans ce Trabajo de Fin de Grado, nous présentons une analyse littéraire du récit La
cathédrale de brume, de l’auteur belge Paul Willems (1912-1997). L’enjeu de cette
nouvelle semble être un pèlerinage nocturne vers une cathédrale de vapeur. Or, nous
savons repérer sous cette histoire banale la description du parcours que Willems
emprunte pour aboutir à l’écriture. Notre objectif est justement de faire ressortir ce
processus métalittéraire qui se devine à peine et dont nous soulignons l’originalité. Du
point de vue méthodologique, nous avons opté pour le commentaire composé, qui jouit
d’une haute considération dans le milieu universitaire français. Il nous a permis de
rassembler les différentes idées qui demeuraient mélangées dans le récit et de dévoiler
le contenu symbolique du même. Nous avons donc prouvé que, dans cette nouvelle de
Paul Willems, la nature tient une importance de premier ordre en tant que source
d’inspiration, d’où sa sublimation au rang de mythe. Nous avons également montré que
les créations de Willems puisent nécessairement de ses souvenirs personnels, qui sont
travaillés par le rêve avant de devenir écriture. Nous avons enfin dévoilé le rôle
contradictoire que détient le silence, un élément qui, en réalité, est un fidèle miroir de la
conception duelle de l’existence de l’écrivain belge.In this Trabajo de Fin de Grado, we present a literary analysis of the story The
Cathedral of Mist, by the Belgian author Paul Willems (1912-1997). The main
adventure of this tale seems to be a night pilgrimage to a steam cathedral. However, we
are able to identify under this commonplace story the description of the path that
Willems follows to reach writing. Our objective is precisely to bring out this original
metalitrary process. With respect to the methodology, we have chosen the compound
commentary, a technique that is largely used in the French academic world. It allowed
us to bring together the different ideas that remained mixed in the tale and to reveal the
symbolic content of the same. This way, we have proved that, in this short story by Paul
Willems, nature is of prime importance as a source of inspiration, hence its sublimation
to the status of myth. We have also shown that Willems' creations are based on his
personal memories, which are worked on by the dream before becoming writing.
Finally, we have revealed the contradictory role of silence, an element that is actually a
faithful mirror of the Belgian writer's dual conception of existence.Departamento de Filología Francesa y AlemanaGrado en Lenguas Modernas y sus Literatura
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