第2次世界大戦の終結から現在に至る東欧の製造業における品質管理運動:ブルガリアの事例

要約のみTohoku University大滝精一課

Motivational factors for the adoption of ISO 9001 standards in Eastern Europe: the case of Bulgaria

Purpose: This study analyzes the motivational factors for ISO 9001 certification in Bulgaria from the internal/external motivations perspective, or the so-called dual model. Design/methodology/approach: This study is based on a mixed method research approach, which employed two interviews with experts in the field of quality management at the exploratory stage, and a survey involving 127 companies at the descriptive stage. Findings: This study claims that enhanced company image and competitiveness – an external motivation - is the leading motivational factor for ISO 9001 certification in Bulgaria. At the same time, our primary investigation reveals that Bulgarian firms are not predominantly externally driven, for internal motivations including process improvement and product quality improvement seem to be an important driver for ISO 9001 certification. Last but not least, this research asserts that enhanced company image and competitiveness has a stronger impact on the motivations for ISO 9001 certification than customer and supplier pressure, which is in line with previous research works on developing economy economies such as Bulgaria. Finally, our study indicates a moderate, yet positive correlation between motivations for and benefits of ISO 9001 certification. Social implications: This research work casts some light on the evolution of quality management in Bulgaria since the end of communism, which can serve as an important foundation for the better understanding of quality management in former communist economies in general and Eastern European states in particular. Originality/value: Derived from the acute gap between ISO studies in Western and former communist economies, this research work presents one of the first official, international studies in the field of ISO certification in Bulgaria, and more precisely, a paper describing the motives for ISO 9001 certification among Bulgarian businesses.Peer Reviewe

Percutaneous edge to edge mitraclip therapy in the management of mitral regurgitation

Mitral valve regurgitation (MR) is an important clinical issue as MR represents >30% of native valve diseases. Patients with symptomatic MR have a poor prognosis, with a 5% annual mortality rate in the absence of surgery. Optimal medical management can improve symptoms of heart failure but does not affect survival. Therefore, surgery is recommended by the current guidelines for patients with symptomatic severe MR or asymptomatic severe MR with evidence of left ventricular (LV) dysfunction or dilation. Despite  guidelines, a recent European survey established that one-half of the patients are not referred for surgery, mainly because of advanced age and the presence of comorbidity. Mitral valve (MV) repair is the preferred surgical strategy whenever feasible and is associated with lower morbidity and mortality and better preservation of LV function, compared with MV replacement . Reported in-hospital mortality rates range from 1% to 2% in low-risk patients, increasing up to 25% in high-risk or elderly patients. Therefore, new percutaneous techniques are developed to avoid surgery in high-risk patients

Interleukin response in cardiovascular diseases: an overview

Interleukins are important modulators of the immune response in the human body, which inevitably makes them participants in the intimate mechanisms of various diseases. Cardiovascular morbidity and mortality is high in the world as a whole, despite the ongoing primary and secondary prevention. Therefore their pathogenetic mechanisms are of significant research and clinical interest. A number of studies demonstrated changes in the interleukin status of patients with coronary heart disease, heart failure, some cardiomyopathies and rhythm conduction disorders. Significantly altered levels of basic for the immunity pro-inflammatory and anti-inflammatory cytokines were found. It was even proven, that some of them have predictive value for the manifestation of certain diseases. All this is a reason to allow interleukins to take part in the intimate mechanisms of cardiovascular diseases and consider the place of interleukin blockers in the treatment of these diseases

Tumor Necrosis Factor - alpha in Clinical Manifestation of Paroxysmal Atrial Fibrillation

Въведение: Предсърдното мъждене (ПМ) е най-честата аритмия в клиничната практика. Все повече данни се натрупват за участието на цитокините в патогенезата на аритмията, като обект на изследване до момента са преди персистиращата и перманентната форма на ритъмното нарушение.Цел: Да се потърсят промени в плазмените концентрации на TNF-α, свързани с изявата на пароксизмалното предсърдно мъждене (ППМ).Материал и методи: Плазмените концентрации на TNF-α бяха измерени трикратно при 51 пациенти (26 мъже и 25 жени; средна възраст 59.84 1.60 г) с ППМ, a именно: незабавно след хоспитализацията им (т.е. по време на ритъмното нарушение), 24 часа и 28 дни след възстановяване на синусов ритъм. Показателят беше измерен еднократно при 52 контроли (26 мъже и 26 жени; средна възраст 59.50 1.46 г.) без анамнестични или електрокардиографски данни за ПМ до момента. Плазмените концентрации на TNF-α бяха определени с ELISA кит (Elabscience Biotechnology Co., Ltd, China). Синусов ритъм бе възстановен медикаментозно с propafenone.Резултати: При постъпване на пациентите в отделението концентрациите на TNF-α бяха повишени спрямо тези на контролите (15.06 0.81 vs 8.20 0.29 pg/mL, p<0.001). Двадесет и четири часа след възстановяване на синусов ритъм промените персистираха (13.09 0.70 vs 8.20 0.29 pg/mL, p<0.001). На двадесет и осмия ден липсваше значима разлика (9.21 0.54 vs 8.20 0.29 pg/mL, p=0.10).Заключение: При ППМ се наблюдават динамични промени в плазмените концентрации на TNF-α. Те са значимо повишени по време на клиничната изява на ритъмното нарушение. След възстановяване на синусов ритъм те се нормализират бавно във времето. Специфичният характер на установените отклонения дават сериозно основание да се приеме клиничната им значимост за изявата на заболяването.Introduction: Atrial fibrillation is the most common arrhythmia in clinical practice. There has been a growing body of evidence in recent years of the role of inflammatory cytokines in the pathogenesis of the rhythm disorder, although the studies have been predominantly in the field of persistent and permanent atrial fibrillation. Aim: To find changes in plasma concentrations of TNF-α, concerning the clinical manifestation of paroxysmal atrial fibrillation. Materials and Methods: Plasma concentrations of IL-6 were measured three times in 51 patients (26 men and 25 women; mean age 59.84 1.60 yrs) with paroxysmal atrial fibrillation: once immediately after hospitalization of these patients (that is, during the rhythm disorder episode at baseline), then at 24 hours and finally 28 days after restoration of sinus rhythm. The plasma concentration was measured only once in the control group of 52 control subjects (26 men, 26 women; mean age 59.50 1.46 yrs). We used ELISA kit to determine the IL-6 concentrations. The sinus rhythm was restored with propafenone for all patients. Results: Baseline plasma concentrations of IL-6 were higher than those of controls (15.06.38 0.81 vs 8.20 0.29 pg/mL, p<0.001). The difference was retained for 24 hours after sinus rhythm restoration of (13.09 0.70 vs 8.20 0.29 pg/mL, p<0.001). At 28 days there was no statistically significant difference between patients and controls (9.21 0.54 vs 8.20 0.29 pg/mL, p=0.10). Conclusion: Dynamic changes of TNF-α plasma concentrations were established in paroxysmal atrial fibrillation. The cytokine levels were significantly elevated during the clinical manifestation of the arrhythmia. They decreased slowly after restoration of sinus rhythm. The changes we found provide a strong rationale to suggest that they are most likely relevant to the clinical manifestaton of paroxysmal atrial fibrillation

Newly-detected glucose disturbances in patients undergoing coronary angiography for known or suspected coronary artery disease

PURPOSES: Glucose disturbances are common in patients with coronary artery disease (CAD), however, usually, they remain undiagnosed. The aim of this study was to estimate the newly-diagnosed glucose abnormalities in patients undergoing coronary angiography for known or suspected CAD.MATERIAL AND METHODS: A routine oral glucose tolerance test (OGTT) was applied in 96 consecutive patients without previous history of type 2 diabetes mellitus (T2DM) undergoing coronary angiography. Glucose tolerance was defined according to WHO-2006 criteria by OGTT performed within a week after hospital discharge.RESULTS: Glucose disturbances prevailed over normoglycemia as 64.58% of the patients demonstrated hyperglycemia while 35.42% presented with normal glucose tolerance (NGT). Overall, 120 min-hyperglycemia (≥7.8 mmol/L) was found out in 52.08% of the participants and only 12.5% of the cases had isolated fasting hyperglycemia (fasting plasma glucose, FPG e6.1 mmol/L and postchallenge glucose <7.8 mmol/L). Based on plasma glucose values such as FPG and 2-hour post-OGTT glucose, the proportion of patients with newly diagnosed T2DM, impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) was 26.04%, 28.12% and 10.42 %, respectively. Some 20% of the newly-diagnosed T2DM patients reached a diagnostic FPG value only, 32% reached 120 min.-plasma glucose (PG) value only while 48% met combined criteria.CONCLUSION: Glucose abnormalities identified by OGTT are more common than normoglycemia - in 64.58% versus 35.42% of the patients undergoing coronary angiography for known or suspected CAD. This finding strongly suggests that OGTT is the most valuable tool for the early detection of disturbed glucose regulation and should be performed routinely in the patients with known or suspected CAD.Scripta Scientifica Medica 2013; 45(3): 69-73