1,118 research outputs found
Latent pulmonary hypertension in atrial septal defect: Dynamic stress echocardiography reveals unapparent pulmonary hypertension and confirms rapid normalisation after ASD closure
No full textClosure of atrial septal defects (ASD) prevents pulmonary hypertension, right heart failure and thromboembolic stroke. The exact timing for ASD closure is controversial. In a prospective study to address the question whether unapparent pulmonary hypertension can be revealed prior to right ventricular (RV) remodelling, patients were investigated before and 6, 12, and 24 months after ASD closure using exercise stress echocardiography (ESE) and ergospirometry (n = 24). At rest, RV systolic pressure (RVSP) was normal in 58.8 %, slightly elevated in 26.5 %, and moderately elevated in 11.8 %. One patient showed severe pulmonary hypertension. During ESE, all patients with normal RVSP at rest exhibited an increase (25.7 +/- 1.2 mmHg vs. 45.3 +/- 2.3 mmHg, p < 0.001). After closure the RVSP was lower, both at rest and ESE. RV diameters decreased too. Tricuspid annulus plane systolic excursion (TAPSE) at rest remained lower after closure (24.0 +/- 0.9 vs. 22.0 +/- 0.9 mm, p < 0.05). TAPSE in ESE was elevated, and stayed stable after closure (30.1 +/- 1.8 mm vs. 29.3 +/- 1.6 mm). Before closure, RV systolic tissue velocities (s(a)) at rest were normal and decreased after closure (14.0 +/- 1.0 cm/s vs. 11.5 +/- 0.7 (6 month) vs. 10.6 +/- 0.5 cm/s (12 month), p < 0.05). During ESE, s(a) velocity was similar before and after closure (23.0 +/- 1.3 cm/s vs. 23.3 +/- 1.9 cm/s). Maximal oxygen uptake (VO2/kg) did not differ between baseline and follow-ups. Latent pulmonary hypertension may become apparent in ESE. ASD closure leads to a significant reduction in this stress-induced pulmonary hypertension and to a decrease in the right heart diameters indicating reverse RV remodelling. RV functional parameters at rest did not improve. The VO2/kg did not change after ASD closure
Belonging and not belonging : understanding India in novels by Paul Scott, Ruth Prawer Jhabvala and V.S. Naipaul.
No full textPhDThis thesis is essentially about the "how" and "why" of the Indian
experience as documented in novels by Paul Scott, Ruth Prawer Jhabvala
and V S Naipaul. The study points to the difficulty of arriving at any
conclusive definition of the country and its people. I show that
differences in attitudes, responses or behaviour are both overt and
subtle, and depend upon whether the writer or the character identifies
with the situation or community with which he or she interacts. It is
the individual's sense of belonging or not belonging to his or her own
group - be this along racial, cultural or gender lines - that accounts
for the differing perspectives evident in these novels. The points-of-
view of the outsider and the insider can therefore be seen as
mutual comments upon the other.
Since the struggle between belonging and not belonging becomes acute
when the old meets the new, focus is centred on communities
experiencing change. These include the British in India, West-Indian
Indians and westernised Indians. Despite their differences, all three
communities share similar reasons for either an acceptance or
rejection of the 'Other'. The thesis argues that the need for
emotional stability compels allegiance to the traditional group, while
the desire for individuality encourages surrender to the new. The
former nurtures a sense of belonging while, it is argued, that the
latter is perceived as the hallmark of those who do not belong.
Tensions arise when both these needs demand to be met. What I show to
be ironic in this struggle between belonging and not belonging is that
those things which individuals overtly reject are often unexpressed
parts of their personal pysche. The barrier between "them" and "us" is
therefore very fragile
The calcium channel blocker felodipine attenuates the positive hemodynamic effects of the beta-blocker metoprolol in severe dilated cardiomyopathy - A prospective, randomized, double-blind and placebo-controlled study with invasive hemodynamic assessment
No full textBackground: In addition to standard therapy with ACE-inhibitors, digitalis and diuretics, beta-adrenergic receptor blockers have become a widely accepted strategy in the treatment of chronic heart failure. The role of calcium antagonists in CHF however remains controversial. To evaluate if a combination therapy of metoprolol and felodipine might improve hemodynamic parameters, a randomized and placebo-controlled study was designed. Methods and results: Sixty-three patients with DCMP, LVEF 3 months in NYHA II-III on standard medication were prospectively treated with either a) a combination of metoprolol+felodipine (MF group, n=20), b) metoprolol+felodipine-placebo (MP group, n=23), or c) metoprolol-placebo+felodipine-placebo (PP group, n=20). Compared to baseline, LVEF and LVEDD significantly improved after 6 months in the MP group (LVEF: 36 +/- 2% vs 29 +/- 2%, p<0.01; LVEDD: 68 +/- 3 mm vs 64 +/- 3 mm, p<0.05), whereas in the other treatment groups only minor changes were observed. A significant benefit in hemodynamic parameters as determined by right heart catheterization was noted also only in the MP group with a marked reduction in PAP mean (17 vs 24 mmHg, p<0.01), PCWP (10 vs 15 mmHg, p<0.001) resulting in a significant increase in cardiac and stroke volume index at rest with no marked changes in the MF and PP group. Conclusion: beta-blocker treatment in CHF patients improves left ventricular function and additionally invasive hemodynamic measurements both at rest and during exercise. In contrast, the combined therapy with the long-acting calcium antagonist felodipine neutralizes these beneficial effects of metoprolol therapy to almost placebo level, providing evidence based on hemodynamic measurements that this combination should be avoided in patients with CHF. (C) 2008 Elsevier Ireland Ltd. All rights reserved
Testimony of Ruth Kleppe Aatvaag
No full textKleppe Aatvaag was a witness for the plaintiff, and co-author on a paper that the plaintiff felt demonstrated prior art, thus invalidating the Cetus PCR patents
Queere Lesarten des Buchs Ruth und der Schöpfungsberichte
No full textThe author offers queer readings of two selected texts from the Hebrew Bible, namely ways of reading the Book of Ruth and the two accounts of creation in the Book of Genesis. Her discussion of this biblical story and the creation accounts shows the diversity of possible queer interpretations based on particular understandings of queer or on different approaches to the queer theory. Referring to the Book of Ruth, the authors explains why certain biblical passages are especially suited to queer appropriation for lesbian, bi-sexual and polyamorous midrashim and ceremonies (1.1.). She describes the blurring of sexually defined roles in the Hebrew Bible (1.2.). She offers a line of argument analogous to a biblical Halakha for queer persons today (1.3.). In connection with the creation stories, queer readings are presented in accordance with approaches of the queer theoreticians Monique Wittig and Judith Butler (2.1.). Finally, the author points to the interpretation of a biblical figure as androgynous (2.2.) To concentrate exclusively on the issue of sexuality (in connection with queer) is a result of contemporary concerns. In conclusion, she deals with the striking points of overlap between the blurring of sexually defined roles, ethnicity, religion, age, survival and power(lessness) in the Book of Ruth and her queer re-reading of Gen 1:27 in reference to the creation of humankind
Outsourcing and Skill Imports: Foreign High-Skilled Workers on H-1B and L-1 Visas in the United States
No full textThis working paper looks in detail at the H-1B and L-1 visa programs for temporary employment in the United States. Based on official data from the US Citizenship and Immigration Services and the US Department of State, H-1B and L-1 visa issuance rapidly increased in the late 1990s, followed by a marked slowdown after 2001. This points to the highly cyclical nature of both visa programs. Indian nationals and immigrants working in computer-related occupations dominate the H1-B and L-1 population in the United States, but these two groups are also found to be the most cyclical segment, with very large declines in inflows after 2001. The total population of H-1B visaholders in 2003 is estimated to range between 387,000 and 746,000, of which 160,000 to 306,000 were Indian nationals. As all data on H-1B/L-1 visaholders are gross numbers and gross jobs data for comparable categories are absent, the extent of the impact of these visa programs on the US labor market cannot be gauged precisely. A broad range of US industries and educational institutions are found to be employing H-1B recipients, with the IT industry being the dominant sector. Evidence of aggressive wage-cost cutting, including paying H-1B recipients only the legally mandated 95 percent of the prevailing US wage, is found among some H-1B employers, although no systematic abuse of the system is present.Outsourcing, offshoring, high-skilled labor, immigration, H1B/L-1 visas
besondere Indikationen und neue therapeutische Strategien
No full textEinleitung Der interventionelle Verschluß eines einfachen Vorhofseptumdefekts (ASD) vom Sekundumtyp und eines persistierenden Foramen ovale (PFO) ist zur Routinemethode gereift (1). Die Intervention wird unter Röntgendurchleuchtung (Strahlenexposition) durchgeführt. Sie ist wegen der geringen Invasivität auch bis ins hohe Alter mit deutlich niedrigerem Risiko als eine Operation durchführbar (2). Die hier vorgestellten Arbeiten haben systematisch untersucht, welche Möglichkeiten bestehen, bei der Intervention auf eine Strahlenexposition zu verzichten (3-6), welche interventionellen Möglichkeiten bei multiplen Defekten und Vorhofseptumaneurysmen bestehen (7,8) und welche Auswirkungen ein restriktiver linker Ventrikel auf die hämodynamische Adaptation nach Defektverschluß haben kann (9-11). Methodik Alle Untersuchungen wurden im Rahmen der klinischen Routine im Herzkatheterlabor am sedierten Patienten mit Vorhofseptumdefekt vom Sekundumtyp, persistierendem Foramen ovale, perforiertem Vorhofseptumaneurysma oder multiperforiertem Vorhofseptum durchgeführt. 1. Es wurde eine Methode zum Verschluß von Vorhofseptumdefekten unter alleiniger Ultraschallkontrolle entwickelt, d.h. unter vollständigem Verzicht auf die sonst notwendige Röntgenstrahlung. 2. Die Morphologie von Vorhofseptumaneurysmen und multiperforierten Vorhofsepten wurde analysiert und im Hinblick auf die interventionellen Verschlußmöglichkeiten klassifiziert. Dabei wurde auch die Möglichkeit der simultanen Implantation mehrerer Okkluder mit einbezogen. 3. Zur Erkennung von Patienten mit einem restriktiven linken Ventrikel, der unmittelbar nach ASD-Verschluß insuffizient werden könnte, wurde eine Methode der präinterventionellen hämodynamischen Evaluation etabliert. Dazu wird die Vorlast und die diastolische Funktion des linken Ventrikels unter temporärem Verschluß des ASD mit einem Okklusionsballon untersucht. Demaskiert sich eine linksventrikuläre Restriktion, so wird als Therapiekonzept der Ventrikel auf den interventionellen Verschluß durch eine prophylaktische 'Konditionierung' mittels Diuretika und Inotropika vorbereitet. Resultate 1. Interventioneller ASD-Verschluß ohne Strahlenexposition Wir konnten zeigen, daß der interventionelle ASD-Verschluß ohne Einsatz von Röntgenstrahlung durchführbar ist (3). Dies gilt für die präinterventionelle Diagnostik, die invasive Größenmessung (Ballonsizing) (6) und den interventionelle Verschluß selbst (4). Als einziges bildgebendes Verfahren für die Intervention dient die Echokardiographie. Im Vergleich zum Standardprocedere waren beim Verzicht auf eine Strahlenexposition gleich gute Ergebnisse zu erzielen, die Prozedurdauer war vergleichbar. Beim spontan atmenden Patienten sind für diese Methode höhere Dosen an Sedierung erforderlich, um die längere Verweilzeit der transösophagealen Echokardiographiesonde zu ermöglichen (5). Der Amplatzer Occluder ist wegen seiner guten Sichtbarkeit im transösophagealen Ultraschall, seiner Rotationssymmetrie und seiner einfachen Plazierung für diese neue Methode des ASD-Verschlusses ohne Röntgenstrahlung besonders geeignet. 2. Verschluß morphologisch komplexer Vorhofseptumdefekte Auch multiperforierte Vorhofsepten können interventionell erfolgreich verschlossen werden. Bei dicht nebeneinander liegenden Defekten ist dies mit einem Occluder, der alle Defekte abdeckt, möglich, bei weiter auseinanderliegenden Defekten ist die simultane Implantation zweier Occluder sinnvoll. Zwei Occluder führen mit größerer Sicherheit zu einem Verschluß ohne Restshunt (7). Multiple Defekte sind häufig mit einem Vorhofseptumaneurysma vergesellschaftet. Im Hinblick auf die Interventionsmöglichkeiten läßt sich diese Anomalie in vier Gruppen unterteilen: Aneurysma mit PFO (Typ A), mit ASD (Typ B), mit mehreren dicht nebeneinander liegenden Defekten (Typ C) und große Aneurysmen mit einer Vielzahl irregulär verteilter Perforationen (Typ D). Die ersten drei Formen lassen sich interventionell verschließen. Dabei gelingt zumindest eine Teilstabilisierung der Aneurysmen (8). 3. Vorhofseptumdefekte und restriktiver linker Ventrikel Wir konnten zeigen, daß insbesondere bei älteren Patienten mit ASD eine verdeckte linksventrikuläre Restriktion vorliegen kann. Ein interventioneller ASD-Verschluß kann bei diesen Patienten zur akuten kardialen Dekompensation führen (9). Als Hinweis auf eine gestörte linksventrikuläre Compliance fanden wir bei temporärer Okklusion des Defekts einen deutlichen Anstieg des linksatrialen Drucks und einen gestörten Mitralklappeneinstrom (10). Nach einer prophylaktischen 'Konditionierung' des linken Ventrikels mittels vorlastsenkenden und inotropiesteigernden Medikamenten (Diuretika, Phosphodiesterasehemmer, Katecholamine) gelang bei fast allen Patienten der interventionelle ASD-Verschluß mit guter Adaptation des Ventrikels, ohne daß es zur kardialen Dekompensation kam (11). Schlußfolgerungen Die in dieser Habilitationsschrift ausgeführten Arbeiten haben weiterführende Fragestellungen und Grenzbereiche des interventionellen Verschlusses von ASD und PFO aufgezeigt und neue interventionelle Therapiestrategien dargestellt. Dadurch ist es möglich, im klinischen Alltag weniger Röntgenstrahlung und Röntgenkontrastmittel zu verwenden, auch morphologisch komplexe Defekte standardisiert zu behandeln und selbst im hohen Alter bei Vorliegen einer linksventrikulären restriktiven Dysfunktion Defekte mit geringem Risiko zu verschließen.Introduction Interventional closure of the simple secundum type atrial septal defect (ASD) and of persistent foramen ovale (PFO) has developed into a routine procedure (1). The intervention is carried out under X-ray monitoring (X-ray exposure). Since it is minimally invasive it can be carried out even in patients of advanced age with significantly less risk than an operation (2). The work presented here investigates systematically the possibilities of carrying out the intervention without X-ray exposure (3-6) and in the case of multiple defects and atrial aneurysms (7, 8). It also looks at the effects of a restrictive left ventricle on hemodynamic adaptation after closure of the defect (9-11). Methods All examinations were carried out as part of the clinical routine of the heart catheter laboratory in sedated patients with a secundum type atrial septal defect, persistent foramen ovale, perforated atrial aneurysms or multiply perforated atrial septum. 1. A method was developed whereby the closure of atrial septal defects can be carried out solely under echocardiographic monitoring, i.e. completely without X-ray exposure. 2. The morphology of atrial septal aneurysms and multiply perforated atrial septum was analyzed and classified with regard to the possibilities of interventional closure. The possibility of simultaneous implantation of several occluders was also considered. 3. To recognize patients with a restrictive left ventricle, which might become insufficient directly after ASD closure, a method of preinterventional hemodynamic evaluation was established. This involves examining preload and the diastolic function of the left ventricle during temporary closure of the ASD with an occlusion balloon. If this procedure reveals left ventricular restriction, the ventricle is prepared for interventional closure by prophylactic conditioning by means of diuretics and inotropes. Results 1. Interventional ASD Closure without X-Ray Exposure We were able to show that interventional ASD closure is possible without the use of X-rays (3). This applies to the preinterventional diagnostic procedures, invasive size measurement (balloon sizing) (6) and the interventional closure itself (4). The sole imaging procedure used for the intervention is echocardiography. In comparison with the standard procedure, the results are equally good and the duration of the procedure is comparable. In the spontaneously breathing patient higher sedative doses are necessary so that the transesophageal echocardiography tube can remain in place throughout (5). The Amplatzer occluder is particularly suitable for this new method because it is easily viewed in transesophageal echocardiographic imaging, rotationally symmetrical and easily positioned. 2. Closure of Morphologically Complex Atrial Septal Defects Multiple perforations of the atrial septum can also be successfully closed by intervention. If the defects are close together, one occluder can be used to cover all the defects; if they are further apart, the simultaneous implantation of two occluders is indicated. Two occluders are more likely to achieve occlusion without residual shunt (7). Multiple defects are often associated with an atrial septal aneurysm. With regard to the interventional possibilities these anomalies can be divided into four groups: aneurysm with PFO (type A), with ASD (type B), with several defects situated close together (type C) and large aneurysms with a number of irregularly distributed perforations (type D). The first three types may be closed by intervention, which mostly achieves partial stabilization of the aneurysms (8). 3. Atrial Septal Defects and Restrictive Left Ventricle We showed that, in particular in older patients with ASD, left ventricular restriction may be concealed. In these patients interventional ASD closure can lead to acute cardiac decompensation (9). A sign of disruption of left ventricular compliance was a marked rise in the left atrial pressure and disturbance of the mitral valve inflow during temporary occlusion of the defect (10). Following prophylactic 'conditioning' of the left ventricle by drugs that reduce the preload and increase inotropism (diuretics, phosphodiesterase inhibitors, catecholamines), interventional ASD closure succeeded in almost all patients with good adaptation of the ventricle and without cardiac decompensation occurring (11). Conclusion The work reported here addresses complex questions and frontier areas of the interventional closure of ASDs and PFO and presents new interventional strategies. It enables less X-ray exposure and less X-ray contrast medium to be used in clinical practice. Morphologically complex defects can be treated by standard procedures and with a small risk, even in patients with advanced age and left ventricular restrictive dysfunction
Der interzelluläre Transport Lipid-geladener Lysosomen aus Makrophagen in glatte Gefäßmuskelzellen führt zur phänotypischen Veränderung der Gefäßmuskelzellen in einen schaumzellartigen Phänotyp
No full textAIMS: Macrophages (MPs) and vascular smooth muscle cells (VSMCs) closely interact within the growing atherosclerotic plaque. An in vitro co-culture model was established to study how MPs modulate VSMC behaviour.
METHODS AND RESULTS: MPs were exposed to fluorescence-labelled-acetylated LDL (FL-acLDL) prior to co-culture with VSMCs. Fluorescence microscopy visualized first transport of FL-acLDL within 6 h after co-culture implementation. When MPs had been fed with FL-acLDL in complex with fluorescence-labelled cholesterol (FL-Chol), these complexes were also transferred during co-culture and resulted in cholesterol positive lipid droplet formation in VSMCs. When infected with a virus coding for a fusion protein of Rab5a and fluorescent protein reporter (FP) to mark early endosomes, no co-localization between Rab5a-FP and the transported FL-acLDL within VSMCs was detected implying a mechanism independent of phagocytosis. Next, expression of lysosome-associated membrane glycoprotein 1 (LAMP1)-FP, marking all lysosomes in VSMCs, revealed that the FL-acLDL was located in non-acidic lysosomes. MPs infected with virus encoding for LAMP1-FP prior to co-culture demonstrated that intact fluorescence-marked lysosomes were transported into the VSMC, instead. Xenogenic cell composition (rat VSMC, human MP) and subsequent quantitative RT-PCR with rat-specific primers rendered induction of genes typical for MPs and down-regulation of the cholesterol sensitive HMG-CoA reductase.
CONCLUSION: Our results demonstrate that acLDL/cholesterol-loaded lysosomes are transported from MPs into VSMCs in vitro. Lysosomal transfer results in a phenotypic alteration of the VSMC towards a foam cell-like cell. This way VSMCs may lose their plaque stabilizing properties and rather contribute to plaque destabilization and rupture
Métricas de autor Ruth Alejandra Patiño Jacinto
No full textInforme de las métricas de autor de la Dra. Ruth Alejandra Patiño Jacinto de las publicaciones indexadas en Google Académico cuyo objetivo es entregar un insumo para el fortalecimiento de las capacidades y potencialidades de los autores de la Universidad Santo Tomás en el posicionamiento y visibilidad de sus publicacionesReport of the author metrics of Ruth Alejandra Patiño Jacinto of the publications indexed in Google Scholar whose objective is to provide an input for the strengthening of the capacities and potentialities of the authors of the Santo Tomás University in the positioning and visibility of their publicationshttp://unidadinvestigacion.usta.edu.c
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