INTRODUÇÃO: A estenose aórtica, doença valvar de grande prevalência, tem na avaliação clínica e ecocardiográfica as principais ferramentas para avaliação dos pacientes. Ferramentas auxiliares de avaliação são desejáveis e neste contexto surgem os peptídeos natriuréticos. Os peptídeos natriuréticos BNP e NT-proBNP podem ser usados como marcadores diagnósticos e prognósticos em diversas situações clínicas. Postulamos que os peptídeos pudessem ter papel diagnóstico, mas principalmente valor prognóstico em pacientes com estenose aórtica grave. OBJETIVO: primariamente, definir o papel prognóstico de sobrevida dos peptídeos natriuréticos BNP e NT-proBNP no acompanhamento prospectivo de uma população de pacientes com estenose aórtica grave. Secundariamente, comparar os níveis séricos de BNP e NT-proBNP entre pacientes com EAo grave assintomáticos e sintomáticos. MÉTODOS: Foram incluídos de forma consecutiva 66 pacientes com estenose aórtica grave, definida pela presença de gradiente médio de pressão transvalvar aórtica maior que 40 mmHg. Os critérios de exclusão foram fibrilação atrial, outra valvopatia, cardiopatia associada, infecções ativas, neoplasias, doenças auto-imunes ou inflamatórias, insuficiência renal e obesidade. Dos 66 pacientes incluídos, 76% eram sintomáticos (50/66). Os sintomas foram definidos como dispnéia aos esforços, síncope ou angina. Na inclusão, todos os pacientes foram submetidos à avaliação clínica inicial, realização de ecocardiograma e dosagem de BNP e NT-proBNP. Os pacientes sintomáticos recebiam a indicação de tratamento cirúrgico e os pacientes assintomáticos eram conduzidos clinicamente. Os pacientes foram acompanhados prospectivamente. O desfecho clínico avaliado foi óbito cardiovascular, definido por morte súbita, morte por insuficiência cardíaca e óbito peri-operatório. RESULTADOS: Os pacientes foram acompanhados por 869 + 397 dias. Houve 11 óbitos durante o acompanhamento. Na inclusão, os níveis de BNP e NT-proBNP foram similares em assintomáticos e sintomáticos: BNP 72 (41-175) pg/mL versus 104 (46-270) pg/mL; p = 0,275 e NT-proBNP 676 (235-1356) pg/mL vs. 871 (310-2230) pg/mL; p = 0,226. Houve diferença entre os níveis de BNP e NT-proBNP e classe funcional (p < 0,001 e p < 0,001, respectivamente). Através da curva ROC foi determinado um valor de corte de BNP (105 pg/mL) e NT-proBNP (1500 pg/mL) capazes de predizer classe funcional III e IV (New York Heart Association), com área sob a curva de 0,806 e 0,786 respectivamente. BNP e NT-proBNP foram preditores de mortalidade (p=0,007 e p=0,001 respectivamente). BNP > 105 pg/mL aumentou o risco de óbito cardiovascular de forma independente [OR= 6,3 (IC95%: 1,36 - 29,25)]. NT-proBNP > 1500 pg/mL aumentou o risco de óbito cardiovascular de forma independente [OR = 6,5 (IC95%: 1,73 - 24,63)]. CONCLUSÃO: O BNP e o NTproBNP foram preditores independentes de mortalidade em pacientes com estenose aórtica grave em um acompanhamento de quatro anos. O BNP e o NT-proBNP foram preditores de classe funcional III e IV (New York Heart Association) em pacientes com estenose aórtica grave. O BNP e o NT-proBNP não permitiram diferenciar pacientes sintomáticos de assintomáticos / BACKGROUND: Aortic valve stenosis is a high prevalent cardiac valve disease, in which clinical and echocardiographic parameters are the most common approach of diagnosis and risk evaluation. Complementary methods are desirable and the natriuretic peptides BNP and NT-proBNP, both diagnostic and prognostic markers in multiple clinical situations, could improve patient assessment. We postulate that these peptides may have diagnostic purpose, but mainly a prognostic value in patients with severe aortic stenosis. OBJECTIVE: primarily, define the survival prognostic role of natriuretic peptides BNP and NT-proBNP in monitoring a population of patients with severe aortic stenosis prospectively. Secondarily, compare the serum levels of BNP and NT-proBNP among patients with symptomatic and asymptomatic severe aortic stenosis. METHODS: 66 consecutive patients with severe aortic stenosis, defined by the presence of gradient mean transvalvular aortic pressure greater than 40 mmHg were included. Exclusion criteria were concomitant atrial fibrillation, other valve disease, other myocardiopathies, active infections, autoimmunity diseases, inflammatory diseases, neoplasia, renal failure or obesity. 76% of patients were symptomatic (50/66), defined as dyspnea on exertion, syncope or angina. All patients underwent initial clinical evaluation, echocardiography and BNP and NT-proBNP measurement. Symptomatic patients were referred for surgical treatment and asymptomatic patients were clinically managed. (Patients were followed up prospectively). The clinical outcome was cardiovascular death, defined by sudden death, death from heart failure and peri-operative death. RESULTS: Patients were followed up for 869 + 397 days. There were 11 deaths during followup. On admission, levels of BNP and NT-proBNP were similar in asymptomatic and symptomatic individuals: BNP 72 (41-175) pg / mL vs. 104 (46-270) pg / mL, p = 0.275 and NT-proBNP 676 (235-1356) pg / mL vs. 871 (310-2230) pg / ml, p = 0.226. There were differences between the levels of BNP and NT-proBNP and functional class (p <0.001 p <0.001, respectively). ROC-curve analysis demonstrated a cut-off value of BNP (105 pg / mL) and NT-proBNP (1500 pg / mL) capable of predicting NYHA functional class III and IV, with an area under the curve of 0.806 and 0.786 respectively. BNP and NT-proBNP could predict mortality (p = 0.007 and p = 0.001 respectively). BNP > 105 pg/mL independently increased the risk of cardiovascular death [OR = 6.3 (95% CI: 1.36 to 29.25)]. NT-proBNP > 1500 pg/mL independently increased the risk of cardiovascular death [OR = 6.5 (95% CI: 1.73 to 24.63)]. CONCLUSION: BNP and NT-proBNP were independent predictors of mortality in patients with severe aortic stenosis after a follow up of 4 years. BNP and NT-proBNP were predictors of NYHA functional class III and IV in patients with severe aortic stenosis. BNP and NT-proBNP alone did not distinguish symptomatic from asymptomatic patients

Syftet med denna studie är att studera hur hälsa och utbildning påverkar det ekonomiska välståndet i och utanför ekonomisk jämvikt i Europa. Studien omfattar 43 europeiska länder och ekonomiskt välstånd mäts i BNP per capita. Två modeller estimeras där den första är en variant av en utökad MRW-modell och den andra utgår ifrån en klassisk Cobb-Douglas produktionsfunktion. Skattningar av MRW-modellen baseras på paneldata för perioden 1995-2013 och Cobb-Douglas-specifikationen skattas med paneldata för perioden 1991-2013. Parametrarna skattas med minstakvadrat-estimatorn och i båda specifikationerna används fixa effekter. Det sammantagna resultatet från de båda modellerna är tvetydligt och det är svårt att ge en entydig slutsats. Investeringar i hälsa och utbildning har en svagt negativ effekt på BNP per capita medan förväntad livslängd vid födseln och utbildningsdeltagande på gymnasienivå har positiva effekter. De tvetydliga resultatet kan bero på omvänd kausalitet, modellspecifikation och/eller snedvridning orsakad av utelämnade variabler.

Herzinsuffizienz ist eine sehr häufige Erkrankung vor allem des höheren Lebensalters. Biomarker wie NT-proBNP, BNP, hsCRP haben neben ihrer Bedeutung für die Diagnose einer akuten Herzinsuffizienz einen großen Stellenwert in der Abschätzung der Prognose eines Patienten. Die prognostische Relevanz dieser Marker konnte auch bei nicht herzinsuffizienten, anderweitig kranken Patienten gezeigt werden. Unklar und wenig erforscht ist die Aussagekraft von Biomarkern in einem Kollektiv nicht akut dekompensierter Patienten, welche sich ambulant bei ihrem Hausarzt vorstellen. Die Handheld-BNP-Studie untersuchte im primärärztlichen Bereich das diagnostische Potential von BNP und der miniaturisierten Echokardiographie. Die vorliegende Follow-up-Studie untersucht die prognostische Relevanz von BNP sowie vergleichend den prognostischen Wert von NT-proBNP und der Kardiologendiagnose. Auch die prognostische Aussagekraft der inflammatorischen Marker hsCRP und TNF-ɑ, ebenso wie die Frage, ob durch eine Kombination der Marker die prognostische Abschätzung weiter gesteigerter werden kann, ist Gegenstand dieser Arbeit. Zuletzt wurde eine multivariate Regressionsanalyse durchgeführt, um den unabhängigen prognostischen Wert der Biomarker zu untersuchen. Es konnte gezeigt werden, dass bei diagnostisch naiven Patienten mit dem klinisch-anamnestischen Verdacht auf das Vorliegen einer Herzinsuffizienz das kardiale wie auch das nicht-kardiale Mortalitätsrisiko sowie die Rate an Hospitalisierungen gegenüber der Allgemeinbevölkerung gleichen Alters erhöht sind, unabhängig vom Vorliegen einer Herzinsuffizienz. Eine Bestimmung der Biomarker BNP, NT-proBNP, hsCRP und TNF-ɑ erwies sich in diesem Kollektiv als hilfreich, diejenigen mit erhöhtem Risiko zu erkennen. / Heart failure is a very common disease especially among old people. In addition to their importance for the diagnosis of acute heart failure, biomarkers such as NT-proBNP, BNP, hsCRP and TNF-ɑ play a major role in the assessment of patients prognosis. The prognostic relevance of these markers could even be demonstrated on ill patients with a diagnosis other than heart failure. The significance of biomarkers in a group of not acutely decompensated patients, who consult their general practitioner, is unclear and little explored. The Handheld-BNP-study examined the diagnostic potential of BNP an the miniaturized echokardiography in a primary care setting. The follow-up-study at hand investigates the prognostic relevance of BNP and compares the prognostic value of NT-proBNP and the cardiologist diagnosis. The prognostic value of the inflammatory markers hsCRP and TNF-ɑ, as well as the question of wether the prognostic assessment can further be enhanced by a combination af these markers, are subject of this thesis. At last, a multivariate regression analysis was performed to investigate the independent prognostic value of biomarkers. The thesis shows that the cardiac and non-cardiac mortality risk and the hospitalization rate in diagnostically naive patients with diffuse symptoms who are potentially indicative of heart failure is high, compared to other people of similar age, irrespective of the presence of heart failure. A determination of the biomarkers BNP, NT-proBNP, hsCRP and TNF-ɑ in this cohort proved to be helpful to identify those at increased risk.

Bovine Neonatal Pancytopenia (BNP) is a disease of calves, characterised by peripheral blood and bone marrow depletion, which emerged in Europe in 2007. A strong epidemiological association between BNP and the administration of a particular inactivated Bovine Viral Diarrhoea (BVD) vaccine (Pregsure BVD, Pfizer Animal Health) to the dams of affected calves has been reported. Early studies suggested that BNP is mediated by the transfer of alloantibodies in colostrum and that these alloantibodies recognise major histocompatibility complex (MHC) class I molecules. This led to the hypothesis that Pregsure contains bovine MHC I molecules, originating from the MDBK line cell used in vaccine production, and that this is responsible for the generation of alloantibodies in particular cows injected with the vaccine. This project aimed to investigate the mechanisms by which BNP arises and develops. In particular to gain an understanding of the molecular basis of the syndrome and how this influences the number of cows and calves affected and the specificity of the pathology for the haematopoietic system. Haematological analysis of clinically normal calves born on a BNP-affected farm demonstrated that 15% of calves had profoundly abnormal haematology and could be described as affected by subclinical BNP. BNP was reproduced experimentally by feeding pooled colostrum to neonatal calves, confirming the role of colostrum in mediating the condition. Detailed analysis of serial haematology and bone marrow pathology from these calves demonstrated variable alloantibody damages to different haematopoietic lineages. In vitro cellular assays using a panel of MHC I-defined bovine leukocyte cell lines and mouse cells individually transfected with the MDBK-MHC I alleles demonstrated that Pregsure vaccinated cows have significantly higher titres of functionally active MHC I alloantibodies than BVDV unvaccinated cows or cows vaccinated with alternative BVDV vaccines. The alloantibody response was found to be heterogeneous in individual Pregsure vaccinated cows. MHC I expression levels on peripheral blood and bone marrow cells, assessed by flow cytometry, was shown to correlate with levels of in vitro and in vivo alloantibody damage. Overall, the results of this project demonstrate that the pathogenesis of BNP is mediated by the transfer of MHC I-specific alloantibodies via colostrum that cause rapid destruction of peripheral blood and bone marrow cells, and which is dependent on the titre of alloantibody produced by an individual cow, its specificity for the MHC I alleles present, and density of MHC I expression on the specific cells.

Tänk dig att du plockar upp en tidning på vägen hem, tidningen har slående rubriker vilka tilltalar dig och du väljer att fördjupa dig och eventuellt ta till dig det som lyfts fram i artikeln. Det som den här i studien uppmärksammar är att konjunkturer spelar roll, och synen på konjunkturernas inverkan på samhället och individen lyfts fram i tidningsartiklarna. Det är en bild av en orolig framtid som lyfts fram i media och framtiden kan till och med uppfattas som hotfull genom exemplet lågkonjunktur. Lågkonjunkturen för med sig en samhällsförändring som uppmärksammas av media och genom att belysa denna samhällsförändring via diskursanalys och utvalda teoretiska utgångspunkter om risksamhället och om samhället som socialt konstruerat vilka lyfter fram föreställningarna kring lågkonjunkturen i relation till samhällets utveckling.

China´s ongoing transformation into a consumer-driven economy, could this influence the Swedish society in more ways than just the economic? The purpose of this study is to contribute with qualitative research examples for further research in order to shed some light on, or give significant insights into how contemporary and emerging relations between China and Sweden might influence Swedish society and culture. This study seeks to find a understanding if there is a connection between household consumption expenditure growth and the rise of the middle class in China which might be related to the structural transition to a modern consumer economy, and if this in turn can impact Swedish society in more ways than just the economic in a globalization perspective. The methodology choice for this study is a Sociological exploratory approach with qualitative semi-structured expert interviews. The study shows that the Swedish society could be affected in more unprecedented ways than just the economic.

It has been known that anthracycline-based chemotherapy has the potential to cause cardiac dysfunction in breast cancer patients; however, recently evidence has shown that the addition of trastuzumab increases this risk. The study objective was to compare the cost-effectiveness of monitoring for cardiotoxicity with B-type natriuretic peptide (BNP), multi-gated acquisition scanning (MUGA), echocardiography (ECHO) or no monitoring from a payer’s prospective. Cost-effectiveness was compared between alternatives using an incremental cost-effectiveness ratio with outcomes of 1) quality-adjusted life-years and 2) percentage of patients diagnosed with each monitoring strategy. Costs estimates (in 2010 U.S. Dollars) of each strategy (obtained from the Center for Medicare and Medicaid Services website [www.cms.gov]) included the cost of the test, cost of treating heart failure once discovered (which includes medications, routine office visits, medication management) and the cost of potential acute care (which includes emergency department visits and hospitalizations). Estimates for the probabilities of heart failure development, disease progression, need for acute care, and mortality, as well as utility estimates for all disease stages were obtained from published literature. A 15-year time-frame was used with a 3% discount rate for both costs and QALYs. In the base-case analysis, the average costs and QALYs for monitoring patients were $10,062/ 6.92 QALY, $13,627/4.22 QALY, $14,739/ 6.61 QALY and $15,656/ 6.49 QALY for BNP, No Monitoring, ECHO and MUGA respectively. When comparing all alternatives to BNP, the ICER values were negative, indicating that BNP was the dominant monitoring strategy. Percent detection was similar between the three monitoring methods [21-22 % for HER-2(-) and 30-31% for HER-2(+) patients]. Again BNP was dominant over the other monitoring strategies. Sensitivity analyses were robust to changes in discount rate, probability of patients testing HER-2 (+), probability of patients being diagnosed in an asymptomatic stage, incidence of cardiac dysfunction in patients receiving anthracycline therapy ± trastuzumab and estimate of disutility associated with additional testing. A probabilistic sensitivity analysis conducted via Monte Carlo simulation led to the same conclusion as the base-case analysis; BNP was the dominant strategy over all monitoring alternatives. / text

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Syftet med uppsatsen är att undersöka arbetslöshetens påverkan av konjunktursvängningar, där studiens teoretiska utgångspunkt är Okuns lag. Arbetet är avgränsat till fyra länder: Sverige, Australien, Japan och USA. De valda länderna representerar varsin världsdel, är medlemmar i OECD, är av en hög utvecklingsgrad och innehar mycket data på de valda undersökta faktorerna. En förväntan finns att det uppstår en variation på sambandet då de valda länderna har olika uppbyggnader i till exempel arbetsmarknaden. Tidigare studier i ämnet Okuns lag ger en inblick i hur det kan ha skett en förändring över tid och mellan länder. Frågeställningen undersöks och besvaras med hjälp av en empirisk undersökning med årlig data för de fyra länderna utförd under en tidsperiod på 44 år, som är uppdelad i två perioder hämtad från OECDs databas. Regressionsanalysen bekräftar att det finns ett negativt samband mellan variationen i kortsiktig tillväxt och arbetslöshet för samtliga länder. Däremot gav samtliga länder ett resultat som inte var signifikant på granskningen om en förändring skett mellan de två undersökta perioderna. Detta leder till ett antagande att det inte skett en förändring över tid rent resultatmässigt. Den här studien tar upp troliga förklaringar till variationen i sambandet som finns mellan länderna, detta för att kunna ge exempel på möjliga bakomliggande faktorer till sambandet.