Advanced echocardiography and clinical surrogates to risk stratify and manage patients with structural heart disease

Part I focuses on the potential role of 3-dimensional echocardiography. At first a clinical risk score model for prediction of outcome in patients undergoing TAVI is presented (Chapter 2). Second the role of 3D-echocardiography is explored in depth in patients with mitral valve disease. Different non-invasive cardiac imaging modalities to evaluate mitral valve function and anatomy are described and the use of 3D-echocardiography is put into perspective (Chapter 3). We then evaluate the role of the latter to gain insights in patients with functional mitral regurgitation (Chapter 4), to select patients and guide procedures regarding percutaneous mitral valve repair using Mitra-Clip (Chapter 5) and to assess the effect of Mitra-Clip on the mitral valve (Chapter 6). In Part II we further elaborate the potential role of risk stratification by ECG and myocardial deformation imaging (strain), as surrogate markers of fibrosis. Surface ECG fragmentation in primary HCM is first evaluated (Chapter 7). The important future role of fibrosis imaging in valvular heart disease patients is then reviewed (Chapter 8). Finally the role of left atrial structure and function is evaluated in patients with mitral regurgitation (Chapter 9) and primary HCM (Chapter 10, 11).UBL - phd migration 201

Endovascular Treatment of a Right-Sided Ureteroiliac Fistula in a Patient with a Simultaneous Left-Sided Ureteroileal Fistula

We describe an 80-year-old female with a left ureteroileal fistula and simultaneously a right ureteroiliac fistula. Her history highlights the predisposing factors of radiation, major surgery in the region, and presence of bilateral double-J-stents. She was successfully treated with an endovascular approach after being initially misdiagnosed. There seems to be an increase in reporting ureteral fistulas, however this entity remains a rare clinical condition that can lead to life-threatening situations. A fast and accurate diagnosis of an ureteroarterial fistula remains a challenge

Prevalence, associated factors and management implications of left ventricular outflow tract obstruction in Takotsubo cardiomyopathy: a two-year, two-center experience

Background: Some patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction -there is, however, a paucity of data regarding this condition. Methods: Prevalence, associated factors and management implications of LVOT obstruction in TTC was explored, based on two-year data from two Belgian heart centres. Results: A total of 32 patients with TTC were identified out of 3,272 patients presenting with troponin-positive acute coronary syndrome. In six patients diagnosed with TTC (19%), a significant LVOT obstruction was detected by transthoracic echocardiography. Patients with LVOT obstruction were older and had more often septal bulging, and presented more frequently in cardiogenic shock as compared to those without LVOT obstruction (P < 0.05). Moreover, all patients with LVOT obstruction showed systolic anterior motion (SAM) of the anterior mitral valve leaflet, which was associated with a higher grade of mitral regurgitation (2.2 +/- 0.7 vs. 1.0 +/- 0.6, P< 0.001). Adequate therapeutic management including fluid resuscitation, cessation of inotropic therapy, intravenous beta-blocker, and the use of intra-aortic balloon pump resulted in non-inferior survival in TTC patients with LVOT obstruction as compared to those without LVOT obstruction. Conclusions: TTC is complicated by LVOT obstruction in approximately 20% of cases. Older age, septal bulging, SAM-induced mitral regurgitation and hemodynamic instability are associated with this condition. Timely and accurate diagnosis of LVOT obstruction by echocardiography is key to successful management of these TTC patients with LVOT obstruction and results in a non-inferior outcome as compared to those patients without LVOT obstruction

Il Nordest prima del Nordest

L'articolo introduce un volume monografico dedicato a casi di conflitto sociale (scioperi, occupazioni, vertenze sindacali, ma anche trasformazioni più lente) nel Veneto degli anni settanta, illustrando l'evoluzione del dibattito sul "decentramento produttivo" e sui distretti industriali e come questa prospettiva teorica abbia finito per negare il ruolo determinante svolto dai conflitti sociali (non sempre di classe e non sempre di fabbrica) nel consentire una evoluzione socialmente sostenibile di un modello produttivo inizialmente caratterizzato dal semplice abbassamento dei costi consentito dalla minore regolamentazione ambientale e sociale della piccola impresa e dell'artigianato

Clinical and Hemodynamic Effects of Percutaneous Edge-to-Edge Mitral Valve Repair in Atrial Versus Ventricular Functional Mitral Regurgitation.

The present study aims to assess the clinical and hemodynamic impact of percutaneous edge-to-edge mitral valve repair with MitraClip in patients with atrial functional mitral regurgitation (A-FMR) compared with ventricular functional mitral regurgitation (V-FMR). Mitral regurgitation (MR) grade, functional status (New York Heart Association class), and major adverse cardiac events (MACE; all-cause mortality or hospitalization for heart failure) were evaluated in 52 patients with A-FMR and in 307 patients with V-FMR. In 56 patients, hemodynamic assessment during exercise echocardiography was performed before and 6 months after intervention. MR reduction after MitraClip implantation was noninferior in A-FMR compared with V-FMR (MR grade ≤2 at 6 months in 94% vs 82%, respectively, p <0.001 for noninferiority) and was associated with improvement of functional status (New York Heart Association class ≤2 at 6 months in 90% vs 80%, respectively, p = 0.2). Hemodynamic assessment revealed that cardiac output at 6 months was higher in A-FMR at rest (5.1 ± 1.5 L/min vs 3.8 ± 1.5 L/min, p = 0.002) and during peak exercise (7.9 ± 2.4 L/min vs 6.1 ± 2.1 L/min, p = 0.02). In addition, the reduction in systolic pulmonary artery pressure at rest was more pronounced in A-FMR: Δ SPAP -13.1 ± 15.1 mm Hg versus -2.2 ± 13.3 mm Hg (p = 0.03). MACE rate at follow-up was significantly lower in A-FMR versus V-FMR, with an adjusted odds ratio of 0.46 (95% confidence interval 0.24 to 0.88), which was caused by a reduction in hospitalization for heart failure. In conclusion, percutaneous edge-to-edge mitral valve repair with MitraClip is at least as effective in A-FMR as in V-FMR in reducing MR. However, the hemodynamic improvement and reduction of MACE were significantly better in A-FMR

Les leçons de la sagesse sur les défauts des hommes : premiere partie ...

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Les leçons de la sagesse sur les defants des hommes : premiere partie ...

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Voke Swimwear : impacto de um novo segmento numa marca de vestuário, um caso prático

Mestrado em Ciências EmpresariaisA presente tese de final de mestrado pretende analisar a viabilidade do negócio da marca de vestuário de praia feminino VOKE Swimwear, que irá incluir um novo segmento (lingerie) e reforçar o seu negócio online, de forma a combater a sazonalidade do negócio. O estudo é composto por duas fases - uma primeira teórica e uma segunda fase prática. Através de uma abordagem teórica composta, em que se pretende aprofundar conceitos de empreendedorismo, negócio online e plano de negócio, cria-se uma base literária para a componente prática do presente estudo. Procurou-se estudar diversos autores conceituados nas suas áreas de atividade de forma a garantir validade teórica para os conceitos apresentados. A segunda fase do presente estudo é composta por um plano de negócios que traduz não só as atuais operações e características do negócio, mas também a possibilidade de integração do novo segmento de vestuário na oferta atual da marca. Em suma, tendo como suporte um inquérito realizado junto de uma amostra com caraterísticas semelhantes ao atual público-alvo da VOKE Swimwear e os resultados derivados de uma análise financeira, prova-se que existem condições para integrar o novo segmento, lingerie, aproveitando todas as sinergias inerentes ao atual negócio.This master thesis aims to study the business?s viability of a women's swimwear brand - VOKE Swimwear -which will include a new segment (lingerie) and strengthen online business in order to combat the seasonality. The study is composed of two phases - a first theoretical and a second practical phase. Through a theoretical approach which aimes to deepen concepts of entrepreneurship, online business and business plans, a literary base for the practical component of the present study is created. It was study several authors in their areas of activity so as to guarantee theoretical validity for the presented concepts. The second phase of the present study is composed of a business plan that translates not only the current operations and characteristics of the business, but also the whole process of integrating the new segment into the current brand offering. It is also possible to understand how this segment attenuates the current sales pattern, marked by the high seasonality that a swimwear brand naturally has. In short, based on a survey carried out on a sample population with similar characteristics to the current target public of the brand and results derived from a financial analysis, it is proved that there are conditions to integrate the new segment in the brand taking advantage of all the synergies inherent to the business.info:eu-repo/semantics/publishedVersio