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GigaOm’s Mobilize is live streaming right now (19,000 viewers), so if you can’t be there, tune in at http://www.livestream.com/gigaomtv.  If you can be there, drop by the Mission Bay Conference Center in San Francisco where close to 1000 industry execs are discussing the future of the mobile web. Great networking with Accenture, Adobe, Adaptive Path, AllThingsD.com, Ars Technica, Benchmark Capital, Business Week, CBS Market Watch, Cisco, CNET, Economist, Engadget, Finanical Times, Flixster, Forbes, Foundation Capital, French Maid TV, frog design, GameFly, GDGT.com, Geek Sugar, GetJar, Gizmodo, Google, Granite Ventures, Handango, HP, InfoWorld, Intel, InterWest Partners, Khosla Ventures,LG Mobile, Lightspeed Venture Partners, Mashable, Mayfield Fund, mig33, Mobile Monday, MEF, MobiTV, Moconews, MocoSpace, Motorola, Mozes, NATPE, NYT, Nielsen, Nokia, Opus Capital, Palm, PayPal, PC World, Qualcomm, Samsung, SF Chronicle, SJ Merc, Scobleizer, Sony Ericsson, SVB Capital, Sprint, Sun, TechCrunch, Thom Weisel, T-Mobile, USVP, Ubergizmo,  USA Today, Venrock, Venture Beat, Verizon, WSJ, WF, Wired, Y!, Zannel, ZDNet and others.

Om Malik opened the conference.  His research venture, GigaOM Pro, which provides subscribers research on-demand, reports that the US is on track to produce by end of 2009:  280mm wireless subscribers, $160B in service revenues, $45B of that in data revenues, 2.3T minutes of voice use and 1.7T text messages, translating to $160 per subscriber of data plan spending per year and 829 minutes per user.  A huge opportunity.

MONETIZING MOBILE APPS

Raven Zachary, Small Society
Considering Apple’s event yesterday it seemed fitting to have Raven lead with the first panel who advises companies like ZipCar and Whole Foods on their mobile strategies, and is known well to these parts as one of the pied pipers of iPhoneDevCamp – Seeing more carriers wanting to have their own app store, look at Verizon with VDC, it makes sense, they have the billing relationship with the end user.  Vodafone ramping up too.

Mark Curtis, Flirtomatic
There’s been a dramatic rise in popularity of the freemium model, free monetize with ad network although CPCs and CPMs have come way down in this economy, belive in time mobile ad marketplace will be massive.  See freemium as a walk in the park, every now and then you’ll want an ice cream, it’s nice to have the option.  At Flirtomatic, have had great success selling users greater visibility on site, they’re willing to pay if there profile will be seen by more women, experiencing 4x the CPMs from user-based ads.

Mark Jacobstein, iSkoot
There used to be enormous expenses associated with porting/QA of mobile games.  Focusing just on iPhone makes things easier, and yet for all it does so well (powerful SDK, screen real estate) there is so much that iPhone doesn’t do.  iPhone can’t multitask, apps don’t run in the background.  Few client based apps like time-wasting games.  Not going to make much selling a $2 app, money is in client/server services, free to end user like Skype (big applause from panel). MMS limitations, photos via SMS from a friend are sent with password and link – that’s a huge turnoff.  Mobile increases web engagement, those that access sites via phone are twice as engaged.  Developers now building in social context/gifting of virtual goods into game mechanics to take advantage of in-app commerce.

Dorrian Porter, Mozes
Most marketers not sure what to do with the mobile consumer, have yet to see mobile as a point of inspiration for impulse buy.  Most market with voice and SMS.  (Recently became a huge fan of SMS, now can text kids whenever he wants.) Mozes focuses on the browser-based experience.  There are SMS limitations to web-clipping

Adam Zbar, Zannel
ATT networks are slammed with data.  Will see services becoming more interoperable than islands.  Carriers for the longest time wanted to be entertainment companies and content creators, now some like Comcast are starting to see themselves more as a distribution platform – good for the developer community.

LOCATION:  CONTEXT IS MONEY
4000 LBS apps today, a small % but impressive considering 18 months ago there were only 5 LBS apps in the world.

KEYNOTE:  Innovation on Android – Introducing MotoBlur
Dr. Sanjay Jha, Co-CEO, Motorola
Number of mobile users doubled between 2008-9 from 10.8mm to 22mm devices accessing daily.  20% access web via mobile device.  Going from 1:1 SMS to 1:Many Social collaboration.  Ubiquitous availability of wireless broadband.  Rapid expansion.  Mobilizing the internet is the single biggest opportunity today.  Netbooks, eBooks, gaming devices, smartphones.  Smartphones being the backbone where mobilization will occur. Broadband definition – minimum 500kb data connectivity to mulitple users without regard of location.  What makes a smartphone – larger high-res display, anytime anywhere broadband connectivity, over the air updates (key), rich media, voice quality, coverage, multi-thread, multitasking operating system.  Android gives us a platform to mobilize the internet, enhance consumer experience, mulitple simultaneous transaction, competitive differentiation, Motorola supporting development of Android, have put meaningful resources behind the Android ecosystem, consumers overwhelmed by options.  Half of US mobile traffic is 180mm social networkers, will grow to 800mm (Gartner).   Aggregate media, music, address books, email addresses.  MotoBlur service allows your entire life to exist on a single stream, enables you to focus on being social, syncs contacts, posts, media, photos, FB, Twitter, Myspace, Gmail, Y!, corporate email customized on home screen and integrated deep into corners of device, so consumer can focus on being social not on how its sent.  Have it all one finger swipe away.  Widgets:  Social status, happenings (feeds, tweets, updates), messages, weather, Android marketplace and browser.  Create rich text email.  Easy to navigate streams, syncing push contacts into address book photos, birthdates. Integrates contact info through device, receive a call and caller’s profile info pops onscreen, get turn by turn direction to where they are, and it’s worry free – phone can be found by GPS in case its off on a cab ride without you – remote wipe – wipes device but keeps data in the cloud, set up once, good to go.  Phone as primary computer device, if it doesn’t fit in your pocket, the consumer won’t use it.  price points and memory costs are drivers to computing becoming mobile.  Regarding palm, it’s not a zero sum game, all boats float, with 300mm smartphones, its the biggest technology opportunity there is, MotoBlur will eventually evolve, this is just the starting point, the first step in a long journey.   Motorola is excited to integrate location, social graph and web info in an easily digestible way, Motorola does both sw and hw and can decide how to integrate, solve problems and deliver experience that simplifies life, health, fitness, media, build trust to share info, no rationale for 4G if its not for multimedia.

Cole Brodman, T-Mobile
Watch for Cliq with MotoBlur in time for the holidays, next chapter in Android innovation, open highly customizable platform, inviting 3P innovation to the network, first phone with social skills, always on connection, glance on the go, network can handle the traffic, T-Mobile has invested $9B in last 4y, has 200mm US customers with 3G coverage, T-Mobile customers text more than anyone in the world started with Sidekick, connected socializers 30-somethings like to stay in touch, have lead the smartphone adoption. T-Mobile will have product out in time for holidays with the best value, coverage, must have alwayson devices, Cliq in two colors white and titanium, with google browser, video capture.

(Very cool demo – if only iPhone would push birthday reminders to home screen when turned on, and autoemailed birthday wishes)

Andy Rubin, Google
Smartphone is a communications device first and voice device second, data differentiates the smartphone but still need voice to carry it around with you at all time, interface with mobile internet, as powerful as a desktop PC from 15 years ago, internet is the destination, the window to the world, now cloud computing, network connected devices, we’re all personally participating in the ecosystem, what is good for the internet is good for Google, the bigger the base the better it is for Google’s primary ad business, the modern os brings the webto people’s pockets.  As for Palm and Symbian, let the best OS win.  Regarding which came first Android or iPhone OS – os developers have long history and have worked everywhere, who knows which came first, the important thing is that they came together to develop an open system.  Moving web forward as a platform, modern browsers more capable with HTML 5.

ULTRABAND:  Fast Platform for Innovation
How will we be at 100mbps or 1gbps wireless broadband by 2012.  In 1991 Xerox ParC stated its vision for pervasive computing.  18 years later still discussing what broadband is, what bandwidth is needed to be broadband, always there, omnipresent, delivering compelling user experiences at the speed of thought, a world in which the consumer knows that they desire it and suddenly it’s there.

Phil Asmundson, Deloitte
Exciting time for mobile, phones are our remote control to the world, look out 5-10y, fundamental changes to the marketplace, will find that apps that require ultraband eat up spectrum, as we watch video, primary entertainment devices for the millennials and gen xers, mobile mobile and fixed mobile still dont play with each other, two separate worlds, need to play together, cause of spectrum issues.  (Chetan Sharma:  The term smartphone will be an oxymoron in 5 years)  There is an innovation iceberg, the more broadband you provide, the more they’ll use, sw is driving the market, advances far faster than hw, then there are FCC challenges around spectrum, cells are going to be gone, need something more powerful than finite spectrum.  SW is driving force for mobile, need more partnerships, not one company can do it alone.  carriers rpus will increase, innovation cycle will advance, great new world coming sooner than you think.

Ken Denman, Openwave Systems
An all IP world is slave to consumer experience, beyond phones and smartphones there is a data tsunami coming, all things non-phones, all connected devices including things not mobile, appliances, cars , netbooks, wonderful soup coming up, exciting times, the key enabler is all IP environment, convergence will absolutely happen with mobile as the default.  Ethernet will appear to have more relevance.  There will be tiering of price around bundled services for a particular experience like Kindle.    As market evolves and consumers get snappy apps they may not have a problem with price tiering.  Offloading of multiple networks is key middleware solution, #1 RFP of CXOs.

Abhi Ingle, ATT
Increasing speeds and feeds with wireless broadband, 5y widely deployed LTE 100mbps, 10y fungibility of networks become more transparent switching the networks, evolve beyond cell tower, go way beyond phones to connected devices, internet of things, explosion of innovation, ATT Austin lab, connectivity extend to things never even imagined before, connected 30-somethings used to cloud computing environments, ATT has 38 data centers for cloud computing alone, powerful networks.  You need massive amounts of capital to achieve 1gbps, there is not enough spectrum to achieve those speeds, need capital, spectrum and transformation of network, unimaginable costs ($100B?).  One approach is to blend the networks, make it transparent to end user.

Rick Keith, Motorola
Underlying principle of delivery of apps (Twitter, FB), what is broadband relative to those apps, taking experience already familiar with moving to airwaves, to that thing previously known as cell phone, broadband is a marketing term, we’ve had wimax since 2007, for Pakistan and Brazil its the first connection ever had to home, what is broadband to them is not broadband to us.  Its an issue of latency, needs to be a subsecond from send to receive, must be snappy, cost doesn’t stop at capex, there is enormous operating expense as well. Hybrid networks need be transparent to user, right now if you have Boingo can use ATT wireless at airport, that doesn’t make sense.  Must be a bridge service.

THE NETBOOKS & ULTRAPORTABLE BOOM

Mark Spoonauer, LAPTOP Magazine
1 of 5 pcs sold are netbooks, not funny Apple yesterday showing pocket ripping from Dell Inspiron not fitting, netbooks outgrowing notebooks 2:1.  Cheap notebooks have existed before, small, easy to carry, low cost, voting with dollars due to economy, is there a cannibalization threat, netbook integrated broadband 3g attaching $60 fee to go unlimited data makes it not a low cost, carriers need to subsidize netbooks to take off

Noury Al-Khaledy, Intel

Price point needed for internet use, compact, companion, evolving of the mobile web, different form factors and uses, dependent on different devices for different needs, infrastructure to provide bandwidth is key, bill monthly per user or per device, majority shipping are wifi, open econsystem platform, battery life better and better CPU not draining battery, netbooks with 8hrs, sw ecosystem will grow,chrome runs best on pc, better battery life, integration, lower power, new processors handle full flash.

LOCATION, MEDIA & MONEY:  The Next Enablers

Len Lauer, Qualcomm
Qualcomm is starting with Smartbooks moving to broader consumer electronics category.  Problem with netbooks is that they don’t last all day.  Want a Smartbook that lasts all day, always on, email pushed, no need for fan to cool off, very sleek design.   (Three kids (18/16/13) and three netbooks not enough) Right now Smartbooks do not have full support of office environment, Microsoft not porting XP86 yet.  Adding connectivity to everything.  Amazon Kindle makes network connectivity invisible, built into price of book.  Opportunity of machine to machine.  Smart Grid technology, energy companies putting in mobile radio into thermostat in home, intelligence in smart cars where to recharge, digital cameras, navigation devices.  Lots of opportunities.  US/Europe carriers embracing machine to machine arpu higher, Verizon, ATT, Sprint, T-Mobile.  Start out with thin file apps without user involvement (not large PPT decks or media files) 4-5% royalty rate on CDMA for 3G (830mm of 4B are 3G, 3.25% royalty rate for 4G when LTE comes out.)  Interconnectivity multimode when not connected on 4G still get 3G, voice will run out on 3G til 2020.  Rate needs to come down from $60 for mass adoption, balance economics, higher cost of bandwidth costs.  Amount of data being consumed going up.  Qualcomm helping operators with network offload, Media FLO sits on its own network.  Data traffic up 400%, half from video streaming.  FLO is 1:Many, can push out top ten YouTube videos over broadcast/datacast network, or P2P if two are within a kilometer to have handsets talk to each other and send info to each other different spectrum band, low power and fast – new radio technology – going point to point via phones.  Longer R&D project.  Can also get it on to cable networks to offload but need to manage interference.  Media Flo $10-15/month subscription – 15 channels of linear feeds – Qualcomm pays for content from ESPN..  (CDN offload)  700mhz auction 10 years to get that spectrum out.  Think about lots of devices in your home being connected should be P2P, better to manage on a licensed spectrum basis.  Where its most populated is where its free – Korea, Japan, China – 45% devices watching tv.  Italy, Germany, US not hitting expectations, Qualcomm doesn’t have nationwide network yet, need to be on more devices, expand next year, platform capability not just restricted to mobile devices, should be on other consumer electronics like MP3, live tv in car (on fridge?).  Launching with AudioVox this month for cars, rear screen videos in cars will go live tv.  Watch for MP3 device with FLO coming out soon.

INNOVATION THROUGH OBSERVATION & DESIGN

Denise Gershbein, frog design
Take products from strategy to market, brand, design, physical, digital.  Augmented reality has a lot to do with context that’s the moment when you move from looking down at a device toward holding up a lens to the world.  Likes Evernote.  Looks to Twitter for creative sources, inspiration, follows interesting people.  Envisioning LTE 4G, look at parallel and analogous paths make meaning out of cultural chaos so you can meet the market.  Arthur C Clark, Childhood’s End – getting into one universal consciusness.  What does it mean that you can be connected and have access to knowledge at the same time.

Jesse James Garrett, Adaptive Path
Observational research can be misused to dictate design and not room for innovation.  Design is a greater differentiator to stand out in crowded marketplace.  Integration of mobile platforms into larger universe as barriers to technologies and networks breakdown will start seeing new opportunities to be exploited for services to work across platforms.  Uncovering patterns in people’s behavior and psych, extend beyond how they interact with your product.  Be inspired by things beyond the technology space.

Crysta Metcalf, Motorola
Team tying different devices to each other, tying mobile device to tv.  Looking at how you would use mobile device in social tv experience.

Prashant Agarwal, Fjord
Noone has cracked mobile marketing yet.  Context is huge.  My phone knows my tweets, contacts..  Best experience is Amazon Kindle, get it, turn it on and there is nothing else to do except buy books.  Last time you bought a phone, just to get voice is not that simple.

Robin Boyar, thinktank research and strategy
Don’t always have a pencil but always have your phone.  Mobile device can monitor your health, use as tool to make life easier, better.  Young kids aren’t using smartphones, using the free feature phones.  Apps need to match 30y+ audience who own the smartphones.  How do you beat Apple at its game – recognize how to make user experience easier and cooler – build the brand experience – with Apple have extended relationship with them via iTunes, the store.  Used to head up research for gaming company, to get holistic view need all stakeholders in the focus group. If 7 year old and 70 year old gets it, you have a great product.

CARRIER PERSPECTIVE ON THE EVOLVING MOBILE ECOSYSTEM

Cole Brodman, T-Mobile
Social communications root of T-Mobile.  Largest per user text base than any other carriers in the world – 600 messages per user per month – more texting than calls.  Update FB status many times a week.  (Om asks if its possible we one day see voice as an add-on)  Android 10,000 apps, average T-Mobile user 40 apps per user in last 11 months.  Abundance use of apps.   Front home screen always on with context and location so info is relevant is very powerful, allows user to act quickly without logging in to web page.  Too many apps, over 60,000 apps, only a few make money.  Google working on how to make apps more discoverable as app store inventory grows.  T-Mobile to use retail footprint, 1700 stores, sales reps can aid discovery.  Paid and new apps, categorizing and merchandising stores need to be improved.  Once they discover an app make it easier to recommend to friends and family, word of mouth is key.  Not setting up T-Mobile app store, working with Android for an open marketplace but playing a role in discovery, and of course improve ways for app developers to leverage carrier billing, make it more frictionless, to pay with one click, next accelerant for app store consumption.  Phone company has to evolve from closed telco mindset to open web-based infrastructures to allow more rapid development to get things to market, allow application innovation.   T-Mobile is a communications company, it’s what occurs on the desktop, internet, devices we haven’t even thought of yet, need to breakdown the way we’ve traditionally gone to market.  Mobile internet 3-5y from today, starts with ubiquitous wireless broadband network $9B investment in 3G married with increasingly open operating systems, open APIs, increases in memory, battery life, processing power.   Front screen access mashed up with location and context, social graph, offer smarter network in the future, won’t have to keep re-entering data.  Likes Android as the first one to live up to expectations – open to carriers, manufacturing partners, developers to innovate.  Give consumers opportunity to personalize and customize, make it their own.  Apple viewpoint – everything is the same.  (Om – PCs guys don’t make that much money, Mac guys makes lots of money on same product) Consumers will have viable choices, different price points.  Customization without fragmentation.  That’s the work the ecosystem needs to do.  (Om – problem with iPhone is ATT network)  T-Mobile network will hold up, existing customers over-consume, set us up for increased capacity to handle increased consumption.  No announced plans for LTE in US, but its a natural migration, T-Mobile International leader in LTE early on. Thoughts on VOIP – not a threat, wireless pricing will continue to evolve, future consumption is moving away from voice, can only talk so much, first carrier to launch voice over wifi, concern so far has been quality, 3G not built for latency needed for VOIP.  Forgone conclusion, matter of timing, T-Mobile has embraced voice apps in Android market.  Front counter for services, thoughts on DRM – makes it easier if there is no DRM, important to share with others (limit time-sharing), leans toward a DRM-free world to allow sharing, subscription models naturally fit that way consumers want to consume media vs. transactional formats.

FACEBOOK PHONE AND SOCIAL MOBILE

Frank Meehan, INQ Mobile
GSM Wolrd Congress winner of best handsets designed around Skype and Facebook.  Carrier developed phone that aloowed you to make Skype calls.  Old voice and text handset manufacturers are stuck  - got to be fast, stay ahead, have to be able to put next FB on your phone quickly.  Brand naming has to be cool and catchy, need great distribution, retail, marketing – Apple does it very well, not many others.  Nokia is a very big company, they’ll fight their way back, what’s going to happen operators are keen to differentiate, each carrier has segmented behind a handset, INQ gives operator great customization.  Sony Ericcson and Nokia nder $200 feature phone market are competitors – boring, dull, most users don’t get data, INQ phones very easy.  INQ is now also moving into Android.  Android phones has struggled to compete on networks that carry iPhone.  User experience has to be better to get that iPhone out of user’s hand.  Need a hit handset every year.  Owner of INQ is investor in Spotify, Meehan sits on board of Spotify, huge in Europe.  (Om: $50 Peek email device, BB for everyone) Location not there yet but coming.  iPhone sells well to 35y+ who buys Macs.  But iPod market is under 35y, sell INQ phones to that market.

JUST A BROWSER OR FUTURE OF MOBILE OS

Jon von Tetzchner, Opera Software
Browser has potential to be a unifying force to deploy across wide range of mobile devices without having to create a whole bunch of native apps.  80% of phones not running OS, thus web is natural choice for these phones, HTML 5 local storage and drag and drop, deliver rich app experience.  Browser started as a document viewer, then added Java, developers moving faster than that, now running applications.  Scalable vector graphics is coming in the browser.  Microsoft held the browser market back for years.  If doing it web-based, it will run everywhere.  Widget is a web app running in a separate window, can run everywhere, PC, Wii, TVs, media players. Webkit vs Opera mini.  Opera Unite service – there is just one web, see all devices working together.  People haven’t really taken to MMS, hard to get photos over to PC, bluetooth is a hurdle.Opera 10 downloaded 10mm times in the first week.  More than 700ees in 10 countries.  Still focus on the end-user, make peoples lives easier, FF, rewind, speed dial..people expect that, now 40mm active users.  In some countries, #1.  Touch based gestures, mouse gestures very popular.  Take pride on running on 10 year old PCs.  Core of the browser hasn’t changed.  Apps will be web-based, more power to play with.

INVESTMENT OUTLOOK:  THE VC PANEL

Lawrence Aragon, Venture Capital Journal
Panel raised $2B need to invest.  Seed and Series A not looking good for 2009.

Mitch Lasky, Benchmark Capital
Infatuated by iPhone comes out of being burnt.  App store has been great for developers and Apple but not venture, opportunity to aggregate market share hasn’t materialized, will soon be back in multi-platform world, will need to be on more than just iPhone.  Would invest in a company contingent on partnering with carrier.  Did 200,000 store keeping units serving global wireless market.  Now 27,000 games on iPhone, noone can make money.  Don’t mind high-friction environment. ARPU has been flat at $50 for years.  Will see higher RPUs when virtual goods comes to iphone apps.  ATT $18B to built out network to support data consumption.  Network build out is a significant issue.

Dixon Doll, DCM
Portfolio includes mig 33.  Series B in mig33 last mobile investment, in the midst of a Series A not announced.  Can’t justify monetization on advertising – wont get VCs excited.  Must look beyond US, US carriers at best are 3rd best in the world, lots of innovation in China and Japan.  Cynical about business model where carrier determines outcome of business, better to create competitive environment, e.g. MLB.com doing well with its subscription on multiplatforms, competitive dynamic is useful.  Economist talks about innovative mobile apps:  augmented reality.  DC does not understand job creation role of the VCs.  Primitive emerging market nations live off their mobile phones, creating microeconomies, money transfer payments exciting new applications.

Rob Coneybeer, Shasta Ventures
Portfolio includes Eye-Fi.  Prefer companies that don’t require carrier relationship, then can focus on value of partnership instead of imbalance of power.  When both parties have alternatives, its best.  People get hung up on ARPUs, want revenues higher than cost, voice down, data up, wave of growth around the corner, some new business models of advertising and promotion enabled by location and intent, can be explosive, developers can write to a platform without talking to carriers to see if it will go on a deck.  New features (accelerometers, touch screens) to get to a multibillion dollar industry.  Seek to build a portfolio of 25 exciting companies.  Plays Foursquare, gaming + location drives explosive adoption.

Bob Borchers, Opus Capital
(Fmr Apple iPhone exec) Portfolio includes Eye-Fi.  Mobile startups don’t require as much capital as before.  Can easily get fulfillment on your own, may need capital for awareness.  Venture community is so burned by the 500 feature phones they tried, soured on the space.  Many have great proof of concept. iPhone 2+ years old and App Store 1 year old.  Traditional carrier-focused metrics voice RPU, data RPU may be $50, other ecosystems $80 ARPUs on iPhone apps.  All do seed deal, have to have money to add people, need capital to keep company going.

John Balen, Canaan Partners
Last Series A India mobile company.  Series A is down because the whole market is down.  Seeing now an upswing in deals.  Activity level will rise in 2010.  Coming out of recession.  Every web app has to have mobile window because browser is so prevalent.  Not everything is showing up as mobile, might be categorized as web app.  Change is happening.  Need leverage with carrier.  Carriers operate differently abroad.  iPhone best over the top payment system and the outsourcing of cell phone business.  Watch the unbundling of what a cell phone company is.  Disaggregation of cell phones towers.  Win-win for consumer.  Happened in India even with low RPUs.  Augmented reality is next.  New ventures around location, cameras..

The term cardiomyopathy generally denotes a  progressive disease  in clinical cardiology.There was a time   diagnosis  of dilated cardiomyopathy (DCM )  was synonymous with a  delayed death sentence !  Of course , the situation has vastly improved over the years  with the availability of  new medical , interventional and surgical management. Still ,  there is no denying the  fact  ,  DCM continues to  have a grave outcome  especially when it occurs without any identifiable cause .

While we have  variety of aggressive DCMs , we also  have  patients with relatively benign forms of   dilated and dysfunctional hearts  which recover totally .

This reversible forms of DCM is observed in  the following  situations.

Hypertensive dilated cardiomyopathy . The left ventricle  in  some of the  patients with severe SHT  respond to the stress (Increased  after load) by dilatation rather than hypertrophy. This is especially common after an episode of LVF.  If we do an acute echocardiogram the LV function is severely impaired and the LV may  also be dilated. With good control of BP and fluid management the ventricle promptly return  to it’s baseline dimension. The recovery is complete in many .

* Note in the past these entities were not called as  cardiomyopathy .

Peri partum cardiomyopathy.

This is a serious disorder of cardiac muscles that occur during pregnancy  few months before  or few months after delivery  . There is correlation between PIH and this entity. Prognosis varies between very bad to excellent. Very few cardiac entities  have a  natural history like this one disease of women.Most of the pregnant women regain their original cardiac status within  year or so. It should be recalled there is high chances of recurrence in next pregnancy.

Alcoholic cardiomyopathy.

The toxic response to alcohol or the additive cobalt can result in DCM .There is overlap  between holiday heart syndrome and alcoholic DCM , where atrial fibrillation is the major problem. Wet Beri beri is the advamced form of clinical DCM that respond to vitamin B therapy.

Tachycardic cardiomyopathy.

This is also a common entity that occur during persistent sinus tachycardia or AF , thyrotoxicosis.Beta blockers are  of great use here.  Recovery is usual if the primary cause is correctable.

Miscellaneous conditions

Diabetes and chronic kidney disorders are known to have a reversible form of cardiomyopathy

Some rare toxins  , scorpion envenomation , selenium deficiency can result in reversible DCM

**Ischemic DCM are partially  correctable in many , still  we don’t include it as cause for reversible DCM

*** Many episodes of acute myocarditis can have transient or short term LV dialtation and  dysfunction.they are classified as myocarditis .But there is little  difference (Except acadmeic . . .)  between chronic myocarditis with LV dysfucntion  and cardiomyopathy.

Enjoy our cut away scenes from the platform.

We are not taking the train to New York tomorrow for the 11th Annual DEL CLOSE MARATHON (Twitter Hashtag: #DCM11). We are flying airplanes, not flying, taking them, although some of our North Carolina compatriots would say we’re taking a handbasket, all the way to HELL. Why? Because in this MrD clip Jesus says, “Fuck.”

And it was funny.

Last year, Mister Andy Lavender predicted the potential DCM Schedule fallout with a challenge: Can you survive the 49 and 1/2 hour Improv Gauntlet? For 2009, the marathon got longer by 4 and 1/2 hours! And Diplomat got scheduled on Friday 8/14 (a SWEET Midnight slot on the Hudson Guild stage) so you don’t have a Half-way marker, but you can start the Marathon off right.

See you in New York.

- Mister Zach Ward

Sodele auf geht’s zum dritten Teil der AnimagiC Saga … oO’

Ich, bzw. wir hatten uns fest vorgenommen noch mehr Fotos zu machen. Man kann ja schlecht mit so wenigen Cosplay-Fotos wieder nach Hause kommen. Und das als Anime-Fan, Hobbyfotograf und Blogger!
Glücklicherweise lief uns, bzw. vielmehr liefen wir in ein meiner Meinung nach sehr gelungens Cosplay von Revy aus Black Lagoon.
Vielen Dank für’s Posen falls Du das hier lesen solltest
Leider hat in dem Fall der Kameramann den Fokus vermasselt, aber das ändert ja nichts an Cosplay ^^’

Damit war meine Seele für’s erste beruhigt. Nun ging es aber gleich wie immer mit unserem Im-deformierten-Kreis-herumlaufen-bis-man-wen/was-Interessantes-findet weiter.

Link *duck nicht hauen* – Gleichberechtigung, immer nur muss der arme Zelda unter Namensverwechselungen leiden! … oO’

Und das letzte mal, dass ich DEN mal in nicht-Cosplay-Form gesehen habe ist schon Ewigkeiten her!

Natürlich darf auch Hotaru nicht fehlen – zumahl meine Freundin unheimlicher Fan von selbiger ist.

Ebenfalls besten Dank für’s Posieren

Gegen 14 Uhr begaben wir uns erneut in den Festsaal, wo der neunte und damit letzte regionale Vorentscheid der DCM ( Deutsche Cosplay Meisterschaft) seinen Platz auf der Bühne einnahm. So weit so gut.
Wie bei jedem Wettbewerb gab es auch hier die DO NOT WANTs und die ganz klarer Favoriten.
DO NOT WANT – war zum Beispiel Sonic … ich hätte zumindestens den Bauch eingezogen und hätte luckystar nachgetanzt, aber gefühlte 2 Stunden nichts tun ist nicht lustig, nicht interessant und auch nicht rührend… oO’
Sehr gut gemacht fand’ ich hingegen Kratos Aurion aus Tales of Symphonia( yay ein Game was ich mal hab!). Das Kostüm war gut und der Auftritt war meiner Ansicht nach besser als der der meisten Anderen.

Die Teilnehmer wurden in männlich und weiblich unterteilt, wobei hier eine Pause beim wechseln gemacht wurde. Diese zögerte sich jedoch durch ein zu groß geratenes Cosplay heraus, welches nicht so recht durch die Tür passen wollte. Während eben dieses “Ding” auseinander und wieder zusammen gebastelt wurde, bekam ein gewisses Moderatording, das etwas dagegen hatte süß genannt zu werden (ich kann ihn verstehen ~.~) eine etwas ungeduldige Haltung. Ehrlich gesagt versaute das ein bischen die Stimmung, aber die Technik hat ihn geärgert, sodass man zumindestens etwas zu Lachen hatte. Super war der Moment in dem die Technik anfing mit dem “Technoblitlichtzeffekteding” den Moderator zu ärgern. Welcher dann sich beschwerte, was er vielleicht hätte nicht tun sollen, da in dem Moment auchnoch Fotoaperate mit Blitzlicht aus dem Publikum zum Vorschein kamen. Nunja nach einigen Minuten ging es dann ja auch weiter und nachdem alle Teilnehmer einmal die Bühne blockiert hatten verliessen wir ebenfalls den Saal um noch draussen ein paar Fotos zu machen.

Dabei stiessen wir noch auf …err wenn ich mich nicht täusche Lightning und Noctis Lucis Caelum aus Final Fantasy

Zu sehen war im übrigen auch der Fernseher aus Ring !

Nach einer weiteren hundertsten Runde kehrten wir zurück in den Festsaal. Dort gaben sich gerade Ongaku no kara die Ehre und spielten einige sehr interessanet Stücke. Darunter war auch eine (meiner Meinung nach sehr gelungene) Umdichtung des Stücks “Ich gehör nur mir” aus dem Musical “Elisabeth” in “Ich bin ein Vampir”.
Das Stück war wohl auch als Parodie auf Twilight ausgelegt, auffallende Anspielung “und glitzern im Sonnenschein”. Ich fand’s genial – sowohl vom Text als auch vom Video im Hintergrund ( ok keine geniale grafische qualität, aber der Sinn dahinter war wohl eher ausschlaggebend…). Der Text wa stellenweise echt zum wegrollen.

Anschließend bot Yamiku diverse Songs aus Anime und Jrock/Jpop Kultur. Dabei waren sogar auch ältere Schinken wie ein Soundtrack von Mila Superstar und Bubblegumm Crisis. Natürlich mit Tänzen und Video dazu was auch sonst. ^^

Nun kommt es schon fast zum Abschied mit der AnimagiC – 18Uhr begann “Das große Finale”!
Es liefen zuerst noch einmal, unter kräftigem Applaus, die Ehrengäste der Convention auf die Bühne. Jeder japanische Gast versucht sein Bestes mit ein paar Dankes- und Abschiedssätzen auf Deutsch.
Und man stellte erneut fest: Masahiko Minami liebt deutsches Bier
Nach noch mehr Applaus und Geklatsche für alle Ehrengäste wurden die Gewinner des DCM-Vorentscheides bekannt gegeben.

bei den Männern:
1. Sascha Shinjiku Z. Bahamut ( Final Fantasy X)
2. Benjamin Gestoert K. Hakoda ( Avatar)

bei den Frauen:
1. Beate sakura_b K. Sailor Cosmos ( Sailor Moon)
2. Stefanie Yamane R. Kratos Aurion ( Tales of Symphonia)

Der Gewinner des letzten Jahres wurde ebenfalls noch einmal auf die Bühne gebeten – die Gewinnerin, war nicht (mehr) anwesend.

Als Abrundung der Ganze Sache, traten noch einmal einige Gruppen auf und brachten das Publikum zum Lachen und Mitsingen. Die improvisierte a capella-Version von “Zankoku na Tenshi no Tēze” – auch bekannt als “Cruel Angel Thesis” dem Opening von Neon Genesis Evangelion – brachte noch mehr Stimmung in den Saal. Das Schlusslicht bildete die AnimagiC Crew. Der Autritt von selbiger war mehr als nur lustig
Man sah nur eine Dame schreiend über die Bühne rennen – mit ein paar Sekunden verspätung folgte, sich der wie Zombies bewegende Rest der Crew. Vielen Dank hier, noch ein großes Danke dort. Zum Abschied gab’s zu einem AMV noch eine sich-bewegende-Menschenschlange. Drei der Crew liessen es sich nicht nehmen zwei Lieder zum Abschlussgag anzustimmen. Ich bin zwar kein Fan von “Alle meine Entchen techno” aber alle hatten ihren Spaß, also passte es

Der Saal leerte sich und jeder ging wieder seinen Weg. Nanashi und ich machten uns auf den Heimweg, gabelten dabei noch einen Kollegen von ihm auf und waren ein paar Stunden später wieder zu Hause. Vielmehr wurden erstmal fleissig die Bilder kopiert, bevor Nanashi dann nach Hause fuhr.

Hiermit möchte ich mich noch einmal bei allen Cosplayern/ Cosplayerinnen bedanken, die es mir/uns erlaubt haben Fotos zu machen. Die Wahrscheinlichkeit ist zwar gering, jedoch könnt Ihr auch gerne die Bilder in Original-Auflösung von mir haben – falls ihr sie wollt
Bedanken möchte ich mich ebenfalls bei Nanashi der mich überhaupt erst dazu gebracht hat überhaupt (mit ihm) auf die AnimagiC zu gehen. Ich hoffe er wird die Tage auch mal mit seinem Bericht fertig ^.^

doumo arigatou gozaimasu

La Musica 006 – 23.07.09 @ Houseradio.pl

Tracklist:

1.Filin Brake, Greg Dorban, Eman – Change The World (Spoken DJ Tool) //Reelgroove
2.Child – Japan (Reprise Mix) //Tribal Vision Records
3.Definition Of Soul – Definition Of Soul (Questionmarq Deep Remix) //Gotta Keep Faith
4.Amit Shoham – White Chocolate //Tarantic
5.Carlos Gibbs – Where Are You (Alland Byallo Remix) //Trenton Records
6.Zweikland – Sanctuary In House Music (Jackie & Szato Szatewicz Deep Mix) //Coffee Bar Music
7.David Harness & Roland Clark – The Deejay’s an Alien Part II (Rocco Spoken Mix) //Foliage Records
8.Raw Artistic Soul – Domingos Ride (Sosue Soulkomplex Remix) //Raw Artistic
9.Anton Pieete – I Do Not Want (Orginal Mix) //Intacto
10.Clemens Rumpf and David A. Tobin – This Old House (Story Teller Mix) //Reelgroove
11.Spooky – Eypes Mouth (Lyme Bay Version) //Platipus
12.DCM – Gyre 3 (Orginal Mix) //Phatt Sounds
13.Yass ft. LT Brown – No Lies (Alternative Mix) //Defected
14.Shik Stylko – Majiko //Stylo Recordings

Download: La Musica 006 – download

Stream: La Musica 006 – stream

Best Regards,
Backlash

How will you refer to a ventricle which is not dilated but still has severe global contractile dysfunction ?

Traditionally cardiomyopathy is classified as

• Dilated (DCM)
• Hypertrophic(HCM)
• Restrictive (RCM)

But there is large group of pateints who do not show any of the above features and still have global hypokinesia  contractile dysfunction. this group has been largely ignored .It could constitute up to 25%of all cardiomyopathy.there can be some overlap between non dialted cardiomyopathy and RCM.

We report our experience here with

non dilated cardiomyopathy click to download PPT

By Sim Kwang Yang

The public political conversation in Sarawak can only be described as primitive at best.  How I know it!  I was engaged in frontline politics for nearly 20 years in Bandar Kuching, trying to elevate the level of political narrative in my home state.  It was near impossible, because the media was all closed, and the weight of the Internet had yet to be felt.

Thanks to the Internet, I can read the Borneo Post online everyday these days.  Living in Cheras on the edge of Kuala Lumpur as I do, it is my way of touching base with my home state, so to speak.

On June 5, in a story headlined Pakatan Rakyat cannot bring progress, this is what I read about what George Chan has to say.

“Sarawakians should not disappoint themselves by believing that the so-called Pakatan Rakyat (PR) government, which has been pre-occupied with internal squabbles, can bring about progress to the nation.

“In giving this advice yesterday, Sarawak United People’s Party (SUPP) president Datuk Patinggi Tan Sri Dr George Chan stressed that the state needed stability and a peaceful environment for development and progress.

“It is evident that in Peninsular Malaysia, we have seen many incidents where Pakatan Rakyat is too occupied with its political gimmicks and demonstrations to gain political mileage.’

This is the sort of mindless mind-numbing monologic harangue from Sarawak top politicians one reads on the Borneo Post daily.  The sad thing is that there are actually mindless voters who believe in this sort of inane rhetoric.

Sarawak has been ruled by the BN since 1963.  We are the state with the richest natural resources, in land, minerals, timber, oil and gas.  We have great political stability in that the state government has never changed hands and the opposition is still weak 46 years after independence.

But the last time I checked, Sarawak is still one of the poorest states in Malaysia, ranked 12^th I think, ahead of Kelantan in terms of per capita income.  Meanwhile, we know how rich the political top dogs in Sarawak are.  What is the value of that kind of political stability in our state?

In contrast, the per capita income in Selangor is in the region of RM50,000 per annum.  In Penang, the Chief Minister Lim Guan Eng has just announced that poverty has been completely eradicated in the state; he just gave monthly government assistance to the last few hundred Penang residents who live below the poverty line.

I live in the state of Selangor.  Nothing much has changed since the Pakatan Rakyat took over the government in 2008.  It has barely been one year, and the new state government is still learning the art of governance.  But the water bill in my Cheras home has been slashed to about RM5 a month.

Already, the people of Selangor are seeing unprecedented change.  The income of each State Executive Councilors has been made public.  Under a committee headed by Eli Wong, they are now preparing a Freedom of Information Bill.

I would like to see a declaration of the personal wealth of our Sarawak top politicians, including that of George Chan.  I would like to see the enactment of Freedom of Information in the Sarawak DUN, so that I can have a list of all the timber concessionaires in the state.

As for the PR component parties caught in internal squabbles, we see BN parties washing dirty linens in public, both in East and West Malaysia, especially within SUPP.

I think what George Chan is trying to say is this,”Look at Perak.  The PR state government there is so caught in a political crisis that they cannot provide the stability to rule the state.  Likewise, all PKR state governments including a future Sarawak PR state government cannot rule the state.

What are the facts?  In Selangor, Penang, Kedah, and Kelantan, they enjoy political stability and economic development under their PR state governments.  The problem in Perak is the product of the scheming, machination, sabotage, and dirty politics of UMNO, specifically that of the prime Minister Najib Tun Razak.  It is BN that is the source of the constitutional and political crisis in Perak.

The only way out is for a state general election to be held now in Perak.  That is what BN will not allow to happen, because BN will lose big.  Even Dr. M has said so!

In another BP story headlined PKR’s act demeaning for Sarawakians, the reporters Raymond Mering and Lim How Ping wrote these three leading paragraphs:

“Parti Keadilan Rakyat (PKR) is sending all the wrong signals with its decision to appoint Perak-born Mustaffa Kamil Ayub to lead the party in Sarawak.

“PKR is probably the first peninsula-based party to actually appoint a Peninsular Malaysian to directly head its branch in Sarawak and it has become a questionable precedence.

“Sarawak’s Barisan Nasional (BN) senior leaders found it all somewhat demeaning for Sarawakians.”

The first two paragraphs are instances of bad journalism, because the two reporters have confused opinions with facts.  They put down their own opinions or the opinions of other people without quoting the identity of the sources to make the statement sound as if it is a fact.

This is the cardinal sin of journalism, but it has gone on for as long as I can remember in Sarawak.  Perhaps some Sarawakians have come to accept this bad practice as standard and good!

Again, the PKR appointment in Sarawak has been described by George Chan as “crazy”

Then again, we have to recall that in West Malaysia at least, it is common for component parties of Barisan national to appoint a national leader from out of the state to be the head of the party of any state.

Datuk Seri Najib Tun Razak is a Pahang UMNO man, and yet he has appointed himself Perak UMNO chief.  So George Chan has just called Najib “crazy”, demeaning the people of Perak!

At the end of the day, George Chan’s public statements on those two occasions have nothing to do with the welfare of the people of Sarawak.  They were illogical, ill thought out, and plainly simplistic.  His purpose was just to use his monopoly in the Sarawak newspapers to put down and demonise his political opponents, without regard for the Truth.  It is called sophistry.

The SUPP used to be a great political party, very close to the grass-root in these hey days in the early 1960s, when I was growing up as a primary school student at the KMC flats at Jalan Ban Hock.  They used to draw huge crowds at the Song Keng Hai grounds with Mr. Chan Siaw Hee as their firebrand speaker.  They really enjoyed the support of the working people.

Then they joined the Sarawak Alliance government in 1970 under the leadership of Tun Rahman Yakub.  They sang a different tune.  In 1978, I joined the DAP to fight them.  It was a tough fight, partly because of the charismatic leadership of Dr. Wong Soon Kai who gave the SUPP a kind of Renaissance.

Now SUPP is under the questionable leadership of George Chan and fast becoming the party of tycoon towkays.  He had offered to step down after disastrous defeats at the hands of unknown young upstart candidates from the DAP in Kuching in 2006.  Then he changed his mind.  What good fortune for the DAP in future elections indeed!

(SKY can be reached at kenyalang578@hotmail.com )

HONNEUR AUX FUSILLIERS MONT-ROYAL EN NORMANDIE

Les Fusilliers Mont-Royal, le plus ancien bataillon francophone montréalais encore en existence, auront droit à un honneur particulier, dimanche, en France, dans le cadre des commémorations de la Bataille de Normandie. Le forum Le Monde en guerre, qui regroupe 2000 passionnés d’histoire, tiendra une cérémonie au cours de laquelle sera dévoilée une stèle de marbre noir en hommage aux 400 soldats canadiens tombés sur les fermes de Troteval et de Beauvoir, dans la commune de Saint-Martin-de-Fontenay, près de Caen, entre le 20 et le 23 juillet 1944. La cérémonie de dimanche aura lieu sur la ferme de Troteval. Le nouveau commandant des Fusiliers, le lieutenant-colonel Francis Roy, a pris l’avion vendredi pour assister à l’inauguration de la stèle. Il aurait aimé pouvoir amener quelques survivants de l’opération des Fusiliers, mais leur état de santé ne le permettait pas.

Le 6 juin 1944, plus de 14.000 jeunes hommes de la 3ème Division d’infanterie canadienne ont pris d’assaut la plage de “Juno“. 340 d’entre eux sont morts ce matin-là sous les tirs ennemis. Des régiments de carabiniers de Toronto, de Winnipeg, de Régina et du Nouveau-Brunswick sont arrivés sur la plage peu de temps après et ont été rejoints par le régiment de La Chaudière. Après un sanglant corps à corps, ils ont pu se frayer un chemin dans les communes de Bernières, Courseulles-sur-Mer et Saint-Aubin. Le gouvernement Harper a promis jeudi 2,6 millions de dollars au «Projet mémoire», qui vise à constituer des archives complètes de la participation du Canada à la Deuxième Guerre mondiale.

Via la cyberlettre de Radio-Canada International

Quelqu’un à ne pas oublier:

Léo Major, DCM (1921 – 2008)

«Durant les première heures de l’assaut, il est grièvement blessé à un œil  mais refuse d’être évacué. Bien au contraire, il se lance dans la bataille et à la fin de la première journée du jour J, il capture avec ses hommes un blindé allemand (un hanomag Sd.Kfz 251). Mais la légende grandit et s’étoffe lorsque, après la bataille de Scheldt (durant laquelle il fait prisonnier 93 soldats allemands), Léo Major refuse d’être décoré. Non par principe, mais parce que celui qui doit lui remettre sa décoration est le célèbre Général Montgomery que Léo Major considère comme étant militairement incompétent ! …»

La suite de l’histoire (avec liens externes):

Léo Major – Wikipedia english

Léo Major – Wikipédia français

In a world that is becoming more multilingual, bilingual aphasia is a clinical problem with a major clinical impact. However, at present we lack causal explanations of the many features of recovery patterns and there is no consensus about the language in which the patient should receive speech therapy. Further advance requires an understanding of the dynamics of recovery. In a novel longitudinal, single-case study, we combine fMRI and dynamic causal modeling to examine the effects of specific language treatment for picture naming on the representation and control of language areas during the course of recovery. Improved performance in the treated language was associated with increased activation in language areas. Consistent with theoretical expectations, causal modeling indicated increased connectedness of the control and language networks for the treated language. This functional approach holds great promise for investigating recovery patterns and the effects of specific language treatment in bilingual aphasic patients.

from Brain and Language

Dieses Dicom Format ( .dcm) scheint ja wohl der digitale Bild-Standard in der Medizin zu sein. Man bekommt dann immer (zumindestens wenn man danach fragt) seine Röntgenaufnahmen auf so tollen CDs. Mit der Freunde über die schönen Bilder ist es meistes schnell vorbei, wenn man versucht sich das ganze am Mac anzusehen. Auf den CDs sind meistens nur die .dcm Dateien und je nach Arzt/Klinik ein komischer Windows Viewer dafür. 

Wenn man Glück hat, ist vieleicht noch eine aufs übelste runtergerechnete JPEG Datei irgendwo auf der CD zu finden. (Wahrscheinlich ist die dann auch nur irgendwo zur Vorschau).

Wer im Besitz eine Photoshops ist, kann DICOM ohne Probleme öffnen und bekommst sogar die Meta-Daten zu sehen und eine schicke Umrechnung der DICOM-Layer in Photoshop Ebenen.

Für den Alltagseinsatz fehlt uns jetzt noch die Formatintegration ins Betriebsystem – sprich: Spotlight,  Quicklook, usw.

Das erledigt das Quick Dicom Toolkit für uns. Der mitgelieferte Viewer ist zwar Schrott, aber die sonstige Integration ist soweit ich das bisher sagen kann, absolut zufriedenstellend.

Chapter 6 “Discovering a new continent” documents the first stage of IT growth in India – “focus on computer hardware”. The notable contribution of the book is the due credit given to the original pioneers and their extreme frustrations – Vinay Bharat Ram meeting SONY CEO Akio Morito, he agreeing to permit DCM to assemble SONY calculators in India and the Indian government refusing to convert their own LOI (Letter of Intent) into a manufacturing license! The DCM Data products story is captured well. The story of HCL starts with the crafty Shiv Nadar who started HCL as a joint sector to capitalize on “Hindustan” and quietly getting out of the “joint” sector; the early successes of HCL are documented well

·       HCL Micro computer 8C

·       HCL PC,

·       HCL Singapore operation (HCL Far East)

·       HCL selling Apollo workstations in India, and,

·       and HCL America

Interestingly, the unknown hero in HCL’s success – designer Raman – has been given his due credit. The rise of PSI (of Deshpande and Raveendran fame) and their contributions are given due credit. The growth of Wipro and its evolution into many facets of hardware manufacturing are well documented. This decade gave an opportunity for India to see the direct benefits of competition – prices falling by 25-50% in a year and business volume growing year after year at a similar rate.

(My Book Review will be posted over the next 10 days (starting March 28, 2009) – a chapter a day for each of the ten chapters!)

Book Review

Sharma Dinesh, “The Long Revolution”, The birth and growth of India’s IT industry”, Harper Collins (Dec 2008)

An interview from Bloomberg with Dixon Doll, co-founder and general partner of DCM and Chairman of the National Venture Capital Association, talking about the challenges that Venture Capital is facing:

The Upright Citizens Brigade Theatre has announced that the 11th annual Del Close Marathon will run from August 14-16, with over 150 shows playing across three venues.

The event was created in celebration of the late Del Close, a pioneer in the art of improvisation and an inspiration to generations of students:

“Del Close was the driving force behind improvisational comedy in Chicago for over 30 years influencing Bill Murray, Tina Fey, Mike Myers, John Belushi, Chris Farley and the Upright Citizens Brigade to name a few. After Del’s passing in 1999, the UCB started the Del Close Marathon to celebrate their mentor and keep alive his name and teachings for future generations.”

DEL CLOSE

DCM is currently accepting submissions for shows. In particular they’re interested in out-of-town groups submitting late-night shows. The submission deadline is May 4th.

Drama Queen

Lythan from the Daring Cardmakers wants to see 3 different patterned papers on our card and this is what I came up with.

Supplies: Paper: ProvoCraft and Funky Hand; Stamp: Stamping Bella

Lythan von den Daring Cardmakers will diese Woche 3 verschiedene gemusterte Papiere auf unseren Kreationen sehen und dies ist meine Karte dazu.

Material: Papier: ProvoCraft und Funky Hand; Stempel: Stamping Bella

I am still waiting that our baby will come the next few days (due this Friday….) and until then nothing is better than creating some cards. I tried to combine two challenges in one. The Daring Cardmakers have this week’s theme “Give it some heart” and the Papertake Weekly Challenge has another wonderful sketch from Dawny which I will use to create more cards because I loved it so much. I hope my hubby will be pleased with the Valentin’s card.

Supplies: Paper: ProvoCraft and Artoz; Embellishments: Varia

Ich bin immer noch am Warten bis unser Baby zur Welt kommt (Termin diesen Freitag) und bis dahin ist nichts besser als einige Karten zu gestalten. Ich hab versucht zwei Herausforderungen in einer zu Kombinieren. Die Daring Cardmakers haben das dieswöchige Thema auf  “Give it some heart” gesetzt und bei den Papertake Weekly Challenge stellt Dawny wieder eine wunderbare Sketchvorlage zur Verfügung. Ich hoffe,mein Mann wird von dieser Valentins Karte begeistert sein.

Material: Papier: ProvoCraft und Artoz;  Kleinzeug: Diverses

                                    Competence of mitral valve is vital  for proper hemodynamics of  heart .A trivial mitral regurgitation ,is observed in nearly 10-20% of normal population detected by doppler echocardiograpgy .This is other wise clinically insignificant. In fact , it is expected  , the sonographers do not report this,  as it might increase the patient anxiety.

Can a mildly incompetent mitral valve be a hemodynamic advantage ?

Left ventricle , physiologically can have only one exit, namely LVOT and aortic valve.If there is normal  impedance , at this level (LV after load )  it  is refered to as  physiological .In disease states , as in cardiac failure there is raised after load or LV wall stress.this makes the LV struggle to pump blood into aorta.The more the dilatation the more the wall stress (Laplace law). more the wall stress more the after load.

 The  main principle of management of cardiac failure  for decades  has been promoting  LV inotropism .Now we have realised this is fundamentally a wrong concept, (Except in acute heart failure). Hence the main option available now is to reduce the after load , ACEI do that most effectively and proven to improve survival.

What is the effect of  trivial or mild MR on LV after load  ?

It is a hemodynamic fact for MR  to increase LV contractility  and Dp/Dt  due to a relative reduction of after load.

In patients with cardiac failure , even a mild improvement in LV contractility can give a  symptomatic improvement .

Can mitral valve act as controlled safety valve allowing only a trivial or mild MR ?

This may be difficult . But it happens naturally in many of our patents in cardiac failure .

Probably , these are same  patients who come under the 20% incidence of physiological  doppler  MR .Other group could  form the  functional MR*

We have found, patients with  DCM  with mild mitral regurgitation tolerate excercise better than patients who have very competent and rigid mitral valve.It is presumed a mitral valve which gives in a little bit , decompresses the LV with a symptomatic benefit.But if the MR , is occurs in an eccentric path or it results in significant volume burden the potential advantage becomes a liability.

Related issues

*Functional mitral regurgitation. Functional MR is said to occur , when patients with cardiac failure, and resultant dilatation of mitral annular ring, and lack of opposition of leaflets

While milder forms of MR are well tolerarted  , when it occurs  acutely ( even if it is mild) ,  it can be dangerous and result in sudden pulmonary edema  .This usually happens in acute MI or infective endocarditis etc.

 Final message

• Minimal or mild  mitral regurgitation without any significant volume overloding  in some of the patients with dilated cardiomyopathy  could bring  a hemodynamic advantage .
• So one may not unduly worry about , a mild MR (central jet) in patients with DCM.It could be after all a safety exit for overstrained LV

We will report the results of the ongoing study about the impact of presence /absence    of  mild MR on the 6 minute walk test in patients with dilated cardiomyopathy.