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Background Compare-Acute trial showed a 1-year superior outcome of FFR-guided acute complete revascularization (FFR-CR) compared to culprit-lesion-only revascularization (CLO) in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease (MVD). Long-term outcome results are unknown. Purpose To evaluate if FFR-CR strategy is superior to CLO strategy in terms of outcome at 3 year follow-up. Methods Compare-Acute is a multicenter, investigator-initiated prospective randomized controlled trial that involved 24 sites. Patients with STEMI and MVD were randomized, after successful primary PCI towards FFR-CR or CLO treatment strategies with a 1:2 ratio (295 pts vs 590 pts). All stenosis ≥50% in the non-infarct artery were investigated by FFR in both arms. In the FFR-CR arm, all non-culprit (NC) lesions with a FFR ≤0.80 were treated by PCI. In the CLO arm pts underwent blinded FFR procedure of the NC lesions. Further treatment of these lesions was based on symptoms and/or ischemia testing during follow-up with an allowed treatment window of 45 days. The primary endpoint was defined as a composite of all-cause mortality, non-fatal myocardial infarction, any revascularization and cerebrovascular events (MACCE) at 12 months. The major secondary endpoint is MACCE from both strategies up to 3-year follow-up. Results 1-year clinical outcomes have already been presented and published. At 36 months the composite end-point of MACCE occurred in 46 patients in the FFR-CR group vs 178 patients in the CLO group (15.6% vs 30.2%; HR 0.46, 95% CI 0.29–0.59; p MACCE-free survival at 3 years Conclusion With this analysis of the Compare-Acute trial we confirm that the benefit of a FFR-guided complete revascularization strategy in patients with STEMI and MVD is maintained at 3 years of follow-up. This difference is mainly driven by increased revascularizations in the CLO arm, but also by increased incidence of MI in the CLO subgroup with FFR+ lesions that were left untreated.

This paper deals with investigating l1-loss and l2-loss l2-regularized Support Vector Machines implemented in PermonSVM – a part of our PERMON toolbox. The loss functions quantify error between predicted and correct classifications of samples in cases of non-perfectly linearly separable classifications. In numerical experiments, we study properties of Hessians related to performance score of models and analyze convergence rate on 4 public available datasets. The Modified Proportioning and Reduced Gradient Projection algorithm is used as a solver for the dual Quadratic Programming problem resulting from Support Vector Machines formulations.

Detections of material regions on CT-scans of solids are commonly treated manually by an expert. Although such manual detections have many advantages, some amount of human error is also incorporated. Moreover, expert opinions may vary significantly. We present an application of the k-means++ clustering as an alternative option to manual way of material area detections. k-means++ clustering is derived from k-means (the method of vector quantization, originally from signal processing), popular for cluster analysis in data mining and image processing communities. The algorithm s main advantages are its simple implementation and fast convergence to a local optimum of an objective function. We benchmark the suggested approach on transverse CT-scans of a fibre-reinforced concrete solid. Moreover, we introduce a technique for processing air distribution, such that the appropriate pixels detected as the pixels of air are converted into pixels representing concrete. The technique is based on the connected component algorithm. Benchmark and results of proposed method conclude the paper.

Bifurkacni leze jsou poměrně castým koronarografickým nalezem, jejichž řeseni je, navzdory pokrokům v instrumentariu i novým technikam, stale technicky a casově narocne. Je zaroveň spojeno s horsimi proceduralnimi i dlouhodobými klinickými výsledky. Dedikovane bifurkacni stenty byly vyvinuty s cilem zjednodusit intervencni lecbu bifurkacnich lezi a zlepsit jeji casne i dlouhodobe výsledky. V nasi kazuistice prezentujeme připad pacienta se subakutnim Q infarktem myokardu předni stěny s kritickou stenozou ve větveni kmene leve věncite tepny, který byl lecen primarni perkutanni koronarni intervenci (PCI) s použitim dedikovaneho bifurkacniho stentu Tryton Side Branch s velmi dobrým angiografickým a klinickým výsledkem.

We are focusing on the algorithms for solving the large-scale convex optimization problem in linear elasticity contact problems discretized by Finite Element method (FEM). The unknowns of the problem are the displacements of the FEM nodes, the corresponding objective function is defined as a convex quadratic function with symmetric positive definite stiffness matrix and additional non-linear term representing the friction in contact. The feasible set constraints the displacement subject to non-penetration conditions. The dual formulation of this optimization problem is well-known as a Quadratic Programming (QP) problem and can be considered as a most basic non-linear optimization problem. Understanding these problems and the development of efficient algorithms for solving them play the crucial role in the large-scale problems in practical applications. We shortly review the theory and examine the behavior and the efficiency of Spectral Projected Gradient method modified for QP problems (SPG-QP) on the solution of a toy example in MATLAB environment. Web of Science 12 20 art. no. 8674

BackgroundSuspicion of acute coronary syndrome (ACS) is one of the most common reasons for hospital admission. However, ACS is not confirmed in a high proportion of these patients during hospitalization. Very few details exist about these patients.AimTo evaluate the clinical characteristics and outcomes of hospitalized patients with a suspicion for ACS that has not been confirmed and compare these results with patients with confirmed ACS.Methods and resultsData were used from the CZECH-1 and CZECH-2 registries, collected in November 2005 and October–November 2012. Both registries contain data from all consecutive patients who have been hospitalized with an initial diagnosis of ACS. ACS was not confirmed during hospitalization in 578 of 1921 patients (30.1%) in the CZECH-1 registry and in 372 of 1221 (30.5%) in the CZECH-2 registry. In both registries, higher proportions of females (52 vs. 36%; p

The purpose of this paper is to describe the parallelization of PragTic - a fatigue damage simulator. There is a discussion about the former version inefficiency (caused by frequent I/O operations), parallel implementation and parallelized PragTic scalability testing. The parallelization is done at the node level where the nodes are defined in the context of the finite element mesh. We also ran a simple model example (hundreds of nodes), real world example (millions of nodes) and our approach is to test using numerical experiments where we achieve weak parallel scalability. At the end of the article, the results of numerical experiments are depicted in tables and graphs.

The paper deals with the solution of large multibody contact problems using massively parallel computers and domain decomposition methods. These methods can solve the problems discretized by billions of nodal variables at the cost nearly proportional to the number of variables using up to thousands cores before the communication costs start to dominate the computational costs. The paper describes the ingredients essential for efficient massively parallel implementation that increases the parallel scalability beyond the limit mentioned above. The improvements were enhanced into a new software package PERMON which is based on PETSc. The performance of the algorithm is demonstrated on the solution of an academic benchmark discretized by nearlybillion of nodal variables.

Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p0.0001). The RV-LS correlated with the scar extent (r = 0.83, p0.0001). RV-LS-15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS-20%), G2-RV stunning (baseline RV-LS-20%, 5th day RV-LS-20%) and G3-persistent RV dysfunction (unchanged RV-LS-20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

Uvod: Spektrum pacientů s akutnim koronarnim syndromem (AKS) se v důsledku postupneho starnuti obyvatelstva v průběhu poslednich dvou desetileti změnilo.Cil: Analyzovali jsme změny v epidemiologii a v lecebných strategiich ve dvou velkých registrech, ktere byly v letech 2005 a 2012 provedeny u přesně definovaných populaci Ceske republiky.Metody a výsledky: Do registrů CZECH-1 a CZECH-2 byli zařazovani vsichni po sobě jdouci hospitalizovani pacienti se vstupni diagnozou AKS v obdobi jednoho nebo dvou měsiců. Registrů CZECH-1 a CZECH-2 se zucastnilo 36, respektive 32 nemocnic. Do registru CZECH-1 bylo zařazeno celkem 1 921 pacientů a do registru CZECH-2 celkem 1 221 pacientů. Pacienti zařazeni do registru CZECH-2 byli starsi než pacienti v registru CZECH-1 (68 ± 12 vs. 66 ± 12 let; p 0,05) pacientů v registru CZECH-2. Urgentni angiografie u pacientů s infarktem myokardu s elevacemi useku ST (STEMI) byla provedena v 92 %, resp. 94 % připadů (p > 0,05); z tohoto poctu byla v 87 %, resp. 89 % připadů nasledně provedena primarni PCI. Mezi registry neexistovaly žadne rozdily v nemocnicni mortalitě (4,2 vs. 4,4 %; p = 0,805) ani v mortalitě pacientů s konecnou diagnozou Q-infarktu myokardu (Q-IM) (10,3 vs. 10,7 %; p = 0,870) nebo non-Q infarktu myokardu (non-Q-IM) (4,7 vs. 3,8 %; p = 0,497). Odhadovana incidence potvrzeneho AKS a STEMI v reprezentativnim populacnim vzorku z obou registrů byla 3 248 a 661 připadů/milion obyvatel/rok v registru CZECH-1 a 2 149 a 652 připadů/milion obyvatel/rok v registru CZECH-2. Pokles incidence AKS byl teměř výhradně důsledkem statisticky významneho poklesu incidence nestabilni anginy pectoris jako konecne diagnozy. Při propustěni byly pacientům s potvrzeným AKS v registrech CZECH-1, resp. CZECH-2 předepisovany nasledujici leky: kyselina acetylsalicylova (95 vs. 94 %; p > 0,05), clopidogrel (60 vs. 76,4 %; p 0,05), inhibitory enzymu konvertujiciho angiotensin (50 vs. 78 %; p ≤ 0,001) a statiny (75 vs. 90 %; p < 0,001).Zavěr: Mezi roky 2005 a 2012 se v Ceske republice zvýsil věk pacientů hospitalizovaných pro AKS. Invazivni reperfuzni strategie u pacientů se STEMI byla v obou registrech použita ve vysokem procentu připadů. Celkový osud pacientů s potvrzeným AKS se mezi roky 2005 a 2012 nezměnil. Odhadovana incidence AKS se snižila v důsledku poklesu poctu pacientů s nestabilni anginou pectoris. AbstractBackground: The clinical spectrum of acute coronary syndrome (ACS) has changed due to a progressively ageing population over the last two decades.Aim: We analysed the changes in the epidemiological and treatment strategies between two large registries that were performed in 2005 and 2012 in well-defined populations of the Czech Republic.Methods and results: The CZECH-1 and CZECH-2 registries enrolled all consecutive hospitalized patients with an initial diagnosis of ACS during a 1- or 2-month period, respectively. Thirty-six and 32 hospitals participated in the CZECH-1 and CZECH-2 registries, respectively. A total of 1 921 patients were enrolled in the CZECH-1 registry and 1 221 patients participated in the CZECH-2 registry. Patients enrolled in the CZECH-2 registry were older than those in CZECH-1 (68 ± 12 vs. 66 ± 12 years; p 0.05) of the patients in the CZECH-1 and CZECH-2 registries, respectively. Urgent angiography in patients with ST segment elevation myocardial infarction (STEMI) was performed in 92 and 94% of the patients (p > 0.05), respectively; of these, 87 and 89% subsequently underwent primary PCI. There were no significant differences in in-hospital (4.2 vs. 4.4%, p = 0.805) or in the mortality of patients with a final diagnosis of Q-myocardial (10.3 vs. 10.7%; p = 0.870) or non-Q-myocardial infarction (4.7 vs. 3.8%; p = 0.497) between the two registries. The estimated incidence of confirmed ACS and STEMI in a representative population from both registries was 3 248 and 661 cases/million individuals/year in the CZECH-1 registry and 2 149 and 652 cases/million individuals/year in the CZECH-2 registry. The fall in ACS incidence was almost exclusively due to a significant decrease in the incidence of unstable angina as the final diagnosis. At discharge, the patients with confirmed ACS were administered the following medications: aspirin (95 vs. 94%; p > 0.05), clopidogrel (60 vs. 76.4%; p 0.05), angiotensin-converting enzyme (ACE) inhibitors (50 vs. 78%; p ≤ 0.001) and statins (75 vs. 90%; p < 0.001) in the CZECH-1 and CZECH-2 registries, respectively.Conclusion: In the Czech Republic, the age of the patients hospitalized with ACS increased between 2005 and 2012. Invasive reperfusion strategy for patients with STEMI was very high in both registries. The overall outcome in patients with confirmed ACS did not change between 2005 and 2012. The estimated incidence of ACS decreased due to the fall in unstable angina pectoris.

Objectives This study sought to compare radial and femoral approaches in patients presenting with ST-segment elevation myocardial infarction (STEMI) and undergoing primary percutaneous coronary intervention (PCI) by high-volume operators experienced in both access sites. Background The exact clinical benefit of the radial compared to the femoral approach remains controversial. Methods STEMI-RADIAL (ST Elevation Myocardial Infarction treated by RADIAL or femoral approach) was a randomized, multicenter trial. A total of 707 patients referred for STEMI

The paper deals with the energy consumption evaluation of selected Sparse and Dense BLAS Level 1, 2 and 3 routines. Authors employed AXPY, Sparse Matrix-Vector, Sparse Matrix-Matrix, Dense Matrix-Vector, Dense Matrix-Matrix and Sparse Matrix-Dense Matrix multiplication routines from Intel Math Kernel Library (MKL). The measured characteristics illustrate the different energy consumption of BLAS routines, as some operations are memory-bounded and others are compute-bounded. Based on their recommendations one can explore dynamic frequency switching to achieve significant energy savings up to 23%.

In this paper, we discuss and present our progress toward a project, which is focused on fatigue life prediction under multiaxial loading in the domain of low-cycle fatigue, i.e. cases, where the plasticity cannot be neglected. First, the elastic-plastic solution in the finite element analysis is enhanced and verified on own experiments. Second, the method by Jiang describing the instantaneous damage increase by analyses of load time by time, is in implementation phase. In addition, simplified routines for conversion of elastic stresses-strains to elastic-plastic ones as proposed by Firat and Ye et.al. are evaluated on the basis of data gathered from external sources. In order to produce high quality complex analyses, which could be feasible in an acceptable time, and allow the period for next analyses of results to be expanded; the core of PragTic fatigue solver used for all fatigue computations are being re-implemented to get the fully parallelized scalable solution.

The paper deals with the energy consumption evaluation of the Finite Element Tearing and Interconnect (FETI) based solvers of linear systems, which is an established method for solving real-world engineering problems. Authors evaluated the effect of the CPU frequency on the energy consumption of the FETI solver using a linear elasticity 3D cube synthetic benchmark. In this problem, the effect of frequency tuning on the energy consumption of the essential processing kernels of the FETI method was evaluated. The paper provides results for two types of frequency tuning: (1) static tuning and (2) dynamic tuning. For static tuning experiments, the frequency is set before execution and kept constant during the runtime. For dynamic tuning, the frequency is changed during the program execution to adapt the system to the actual needs of the application. The paper shows that static tuning brings up 12% energy savings when compared to default CPU settings (the highest clock rate). The dynamic tuning improves this further by up to 3%.

Peak oxygen consumption (VO2peak), as measured by cardiopulmonary exercise testing (CPET), is a powerful independent predictor of cardiovascular disease (CVD) and all-cause mortality in a broad range of populations. We assessed the safety and feasibility of CPET in aging long-term hematopoietic cell transplantation (HCT) survivors, a population at high risk for premature onset of CVD. Next, we examined how organ-specific impairments (eg, cardiac, pulmonary, hematologic) impact VO2peak after HCT. Twenty consecutive HCT survivors underwent a comprehensive assessment of cardiopulmonary health that included CPET, echocardiography with strain, pulmonary function testing, 6-minute walk test, and timed up and go. Median age at assessment was 67.4 years (range, 42 to 75), and median time from HCT was 9.8 years (range, 3 to 20). No adverse events were observed during CPET procedures, and 95% of studies were considered to be at "peak" effort (respiratory exchange ratio ≥ 1.10). VO2peak was on average 22% less than predicted, and allogeneic HCT survivors had markedly lower VO2peak when compared with autologous HCT survivors (18.2 mL/kg/min versus 22.2 mL/kg/min; P = .05). Six participants (30%) had VO2peak ≤ 16 mL/kg/min, a threshold associated with a 9-foldrisk of death in patients undergoing HCT. Despite the presence of normal (>50%) resting left ventricular ejection fraction in all participants, 25% had markedly abnormal left ventricular longitudinal strain, an advanced echocardiographic measure of myocardial dysfunction. These findings highlight the role of stress-based measures and advanced myocardial imaging to characterize CVD risk in HCT survivors, setting the stage for tailored interventions to prevent CVD with its attendant morbidity and mortality.

Aims Thrombectomy during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) has been thought to be an effective therapy to prevent distal embolization and improve microvascular perfusion. The TOTAL trial ( N = 10 732), a randomized trial of routine manual thrombectomy vs. PCI alone in STEMI, showed no difference in the primary efficacy outcome. This angiographic sub-study was performed to determine if thrombectomy improved microvascular perfusion as measured by myocardial blush grade (MBG). Methods and results Of the 10 732 patients randomized, 1610 randomly selected angiograms were analysable by the angiographic core laboratory. Primary outcomes included MBG and post-PCI thrombolysis in myocardial infarction (TIMI) flow grade. Secondary outcomes included distal embolization, PPCI complications, and each component of the complications. The primary end point of final myocardial blush (221 [28%] 0/1 for thrombectomy vs. 246 {30%} 0/1 for PCI alone group, P = 0.38) and TIMI flow (712 [90%] TIMI 3 for thrombectomy vs. 733 [89.5%] TIMI 3 for PCI alone arm, P = 0.73) was similar in the two groups. Thrombectomy was associated with a significantly reduced incidence of distal embolization compared with PCI alone (56 [7.1%] vs. 87 [10.7%], P = 0.01). In multivariable analysis, distal embolization was an independent predictor of mortality (HR 3.00, 95% CI 1.19–7.58) while MBG was not (HR 2.73, 95% CI 0.94–5.3). Conclusions Routine thrombectomy during PPCI did not result in improved MBG or post-PCI TIMI flow grade but did reduce distal embolization compared with PCI alone. Distal embolization and not blush grade is independently associated with mortality.

We report the case of a patient with acute anterolateral myocardial infarction without ST segment elevations and incipient cardiogenic shock due to complex high grade left main (LM) stenosis and tight calcified ostial left anterior descending (LAD) artery stenosis. Rotablation followed by stent deployment achieved a successful angiographic outcome with no associated clinical complications. During 30 days follow-up, the patient remains stable. An acute interventional approach in unprotected LM coronary stenosis is associated with high procedural risk. Combining that procedure, i.e., rotational atherectomy, with stent placement enhanced procedural success and clinical outcome in this case.

Saňak D, Herzig R, Zapletalova J, Horak D, Kral M, Skoloudik D, Bartkova A, Veverka T, Heřman M, Kaňovský P. Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis. Acta Neurol Scand: 2011: 123: 339–344. © 2010 John Wiley & Sons A/S. Objectives – Intravenous thrombolysis (IVT) is considered an effective treatment for acute ischemic stroke (IS). However, not all treated patients may achieve good outcome. The aim was to evaluate whether the initial NIHSS and DWI infarct volume could be the predictors for good outcome after IVT. Patients and Methods – The set of 125 patients with consecutive hemispheric IS (78 men; mean age 66.0 ± 12.1 years) treated with IVT within 3 h was analyzed. DWI volume was measured on admission. Good outcome was defined as a score 0-2 in modified Rankin Scale. Results – Multivariate logistic regression analysis showed initial NIHSS as an independent predictor of good outcome (P = 0.001). ROC curves showed baseline NIHSS ≤13.5 points and DWI volume ≤13.7 ml as cut-offs related to good outcome. Conclusions – The initial NIHSS and DWI volume might be the predictors for good clinical outcome in acute stroke patients treated with IVT. The initial NIHSS score seems to be more accurate.

Recent trials in multivessel STEMI patients show that a strategy of complete revascularization in the acute or sub-acute phase guided by angiography (PRAMI, CvLPRIT) or FFR (PRIMULTI, COMPARE-ACUTE) improves the composite endpoint of MACE in comparison to an infarct related artery (IRA) only

Atrial fibrillation (AF) is considered a predictor for severe stroke and poor outcome. The aim was to evaluate whether AF is associated with poor outcome in acute ischemic stroke (IS) patients treated with intravenous thrombolysis (IVT). In a retrospective study, 157 consecutive IS patients (98 males, mean age 67.3 +/- 10.2 years), treated with IVT within 3 hours from stroke onset, were divided into two groups according to presence/absence of AF. Neurological deficit was evaluated using the NIHSS on admission, 24 hours, and 7 days later, while the 90-day clinical outcome was assessed using the modified Rankin Scale (mRS). A total of 66 patients (38 males) presented with AF. The baseline NIHSS was 13.3 +/- 5.4 in AF and 11.0 +/- 5.1 points in non-AF patients (P = 0.006). AF patients had arterial occlusions more frequently in the baseline MRA (54.5% in AF versus 25.3% in non-AF, P = 0.0002). No differences were found between groups in clinical improvement after 24 hours and 7 days or in rate of achieved recanalizations. AF patients had significantly poorer 90-day clinical outcome than non-AF patients (median mRS 2.5 vs. 1.0). Patients with AF had significantly worse 90-day clinical outcome after IVT compared to those without AF, probably due to more severe baseline neurological deficits and the greater number of arterial occlusions in the MRA before IVT.

Purpose: To evaluate the efficacy and safety of 0.1 mmol/kg gadodiamide administration for contrast-enhanced magnetic resonance angiography (MRA) in detecting hemodynamically relevant renal artery stenosis (RAS) when compared with intraarterial digital subtraction angiography (IA-DSA) as the gold standard. Materials and Methods: In a multicenter, controlled study, 395 patients with suspected or known RAS were included. Three independent readers evaluated the MRA images. Two readers evaluated the IA-DSA images and subsequently achieved consensus. The sensitivities and specificities of gadodiamide-enhanced MRA were analyzed at the per-patient and per-vessel levels (exact 1-sided binomial test at α = 0.025 with 95% confidence interval). Results: A total of 335 patients who had available standard of truth and MRA tests were included in the all-subjects efficacy population: 55.5% (186/335) men and 44.5% women with a mean age of 63 ± 13 years (range 17–85 years). The sensitivities and specificities ranged from 81% to 86% for all independent readers at the per-patient analysis based on subjects with the diagnostic images. Similar results were achieved with per-vessel level analysis. Fewer than 1% of patients had adverse event associated with gadodiamide administration. There were no cases of nephrogenic systemic fibrosis (NSF) reported. Conclusion: Gadodiamide administration at the labeled dose of 0.1 mmol/kg for contrast-enhanced MRA achieved equivalent results compared to IA-DSA in evaluation of RAS and was well tolerated. J. Magn. Reson. Imaging 2010; 31: 390–397. © 2010 Wiley-Liss, Inc.

Ovarian hyperstimulation syndrome (OHSS) is the most serious complication of sterility treatment. It is characterised by ovarian enlargement, ascites, electrolyte disturbance, hypovolaemia and haemoconcentration. A case of ischaemic stroke due to right middle cerebral artery (MCA) occlusion in a young female with OHSS after pharmacological treatment of sterility is reported. Left central hemiparesis occurred suddenly within a few days after the embryo transfer. Magnetic resonance imaging diffusion-weighted images showed infarction in the right basal ganglia and magnetic resonance angiography (MRA) revealed the occlusion of the M1 segment of the right MCA. The haemodilution and the anticoagulation therapy were effective. Twenty-four hours after the stroke onset, MRA showed MCA recanalisation. The neurological deficit resolved completely within 3 months. The patient delivered 2 healthy infants at term. This case emphasises that the recent advent of ovulation induction and reproductive techniques is a newly recognised cause of cerebral stroke in otherwise healthy females.

We report an original method of transcatheter closure of an arteriovenous fistula using the combination of an Amplatzer PDA occluder and a carotid stent. The fistula was between the left carotid artery and the brachiocephalic vein. The patient had significant left-to-right shunt and was highly symptomatic. Due to the large orifice and pseudoaneurysmatic enlargement of the fistula, we had to use a large Amplatzer PDA occluder and the protruding part of the PDA device disk had to be covered with a carotid stent. The fistula was completely closed. The patient stopped having symptoms and, 2 years after the procedure, the effect persists.

Summary Background Two large trials have reported contradictory results at 1 year after thrombus aspiration in ST elevation myocardial infarction (STEMI). In a 1-year follow-up of the largest randomised trial of thrombus aspiration, we aimed to clarify the longer-term benefits, to help guide clinical practice. Methods The trial of routine aspiration ThrOmbecTomy with PCI versus PCI ALone in Patients with STEMI (TOTAL) was a prospective, randomised, investigator-initiated trial of routine manual thrombectomy versus percutaneous coronary intervention (PCI) alone in 10 732 patients with STEMI. Eligible adult patients (aged ≥18 years) from 87 hospitals in 20 countries were enrolled and randomly assigned (1:1) within 12 h of symptom onset to receive routine manual thrombectomy with PCI or PCI alone. Permuted block randomisation (with variable block size) was done by a 24 h computerised central system, and was stratified by centre. Participants and investigators were not masked to treatment assignment. The trial did not show a difference at 180 days in the primary outcome of cardiovascular death, myocardial infarction, cardiogenic shock, or heart failure. However, the results showed improvements in the surrogate outcomes of ST segment resolution and distal embolisation, but whether or not this finding would translate into a longer term benefit remained unclear. In this longer-term follow-up of the TOTAL study, we report the results on the primary outcome (cardiovascular death, myocardial infarction, cardiogenic shock, or heart failure) and secondary outcomes at 1 year. Analyses of the primary outcome were by modified intention to treat and only included patients who underwent index PCI. This trial is registered with ClinicalTrials.gov, number NCT01149044. Findings Between Aug 5, 2010, and July 25, 2014, 10 732 eligible patients were enrolled and randomly assigned to thrombectomy followed by PCI (n=5372) or to PCI alone (n=5360). After exclusions of patients who did not undergo PCI in each group (337 in the PCI and thrombectomy group and 331 in the PCI alone group), the final study population comprised 10 064 patients (5035 thrombectomy and 5029 PCI alone). The primary outcome at 1 year occurred in 395 (8%) of 5035 patients in the thrombectomy group compared with 394 (8%) of 5029 in the PCI alone group (hazard ratio [HR] 1·00 [95% CI 0·87–1·15], p=0·99). Cardiovascular death within 1 year occurred in 179 (4%) of the thrombectomy group and in 192 (4%) of 5029 in the PCI alone group (HR 0·93 [95% CI 0·76–1·14], p=0·48). The key safety outcome, stroke within 1 year, occurred in 60 patients (1·2%) in the thrombectomy group compared with 36 (0·7%) in the PCI alone group (HR 1·66 [95% CI 1·10–2·51], p=0·015). Interpretation Routine thrombus aspiration during PCI for STEMI did not reduce longer-term clinical outcomes and might be associated with an increase in stroke. As a result, thrombus aspiration can no longer be recommended as a routine strategy in STEMI. Funding Canadian Institutes of Health Research, Canadian Network and Centre for Trials Internationally, and Medtronic Inc.

PERMON toolbox makes use of theoretical results in discretization techniques, quadratic programming algorithms, and domain decomposition methods. It is built on top of the PETSc framework for numerical computations. This paper describes its packages, and shows case of their application for a contact problem of linear elasticity decomposed by TFETI non-overlapping domain decomposition method. We end with the inequality constrained quadratic programming problems that can be solved by our PermonQP package with the PermonIneq extension.

The energy consumption of supercomputers is one of the critical problems for the upcoming Exascale supercomputing era. The awareness of power an energy consumption is required on both software and hardware side. This poster deals with the energy consumption evaluation of the Total-Finite Element Tearing and Interconnect (TFETI) based solvers [2] of linear systems implemented in PERMON toolbox [1], which is an established method for solving real-world engineering problems, and with the energy consumption evaluation of the BLAS routines. The experiments performed in the poster deal with CPU frequency. This work is performed in the scope of the READEX project (Runtime Exploitation of Application Dynamism for Energy-efficient eXascale computing) [6]. The measurements were performed on the Intel Xeon E5-2680 (Intel Haswell micro-architecture) based Taurus system installed at TU Dresden. The system contains over 1400 nodes that have an FPGA-based power instrumentation called HDEEM (High Definition Energy Efficiency Monitoring), that allows for fine-grained and more accurate power and energy measurements. The measurements can be accessed through the HDEEM library, allowing developers to take energy measurements before and after the region of interest. We have evaluated the effect of the CPU frequency on the energy consumption of the TFETI solver for a linear elasticity 3D cube synthetic benchmark. On the dualized problem MPFX=MPd, we have evaluated the effect of frequency tuning on the energy consumption of the essential processing kernels of the TFETI method. There are two main phases in TFETI — preprocessing and solve. In preprocessing it is necessary to regularize the stiffness matrix K and factorize it and to assemble the G and GGT matrices and the second one to factorize. Both operations belong to the most time and also energy consuming operations. The solve employs the Preconditioned Conjugate Gradient (PCG) algorithm, which consists of sparse matrix-vector multiplications (by F, P, M L , M D matrices) and vector dot products and AXPY functions. In each iteration, we need to apply the direct solver twice, i.e., for forward and backward solves for the pseudoinverse K+ action and for the coarse problem solution, the (GGT)−1 action. The multiplication by the dense Schur complement matrix adds an additional operator with different computational characteristics, potentially increasing the exploitable dynamism. The poster provides results for two types of frequency tuning: (1) static tuning and (2) dynamic tuning. For static tuning experiments, the frequency is set before execution and kept constant during the runtime. For dynamic tuning, the frequency is changed during the program execution to adapt the system to the actual needs of the application. The poster shows that static tuning brings up 11.84% energy savings when compared to default CPU settings (the highest clock rate). The dynamic tuning improves this further by up to 2.68%. In total, the approach presented in this paper shows the potential to save up to 14.52% of energy for TFETI based solvers, see Table1. Another energy consumption evaluations were done with selected Sparse and Dense BLAS Level 1, 2 and 3 routines. For benchmarking we have used a set of matrices from University Florida collection [4]. We have employed AXPY, Sparse Matrix-Vector, Sparse MatrixMatrix, Dense Matrix-Vector, Dense Matrix-Matrix and Sparse Matrix-Dense Matrix multiplication routines from Intel Math Kernel Library (MKL) [3]. The measured characteristics illustrate the different energy consumption of BLAS routines, as some operations are memory-bounded and others are compute-bounded. Based on our recommendations one can explore dynamic frequency switching to achieve significant energy savings up to 23%, for more details see Table 2.

Purpose This study was undertaken to determine the magnitude of pulmonary dysfunction in childhood cancer survivors when compared with healthy controls and the extent (and predictors) of decline over time. Patients and Methods Survivors underwent baseline (t1) pulmonary function tests, followed by a second comprehensive evaluation (t2) after a median of 5 years (range, 1.0 to 10.3 years). Survivors were also compared with age- and sex-matched healthy controls at t2. Results Median age at cancer diagnosis was 16.5 years (range, 0.2 to 21.9 years), and time from diagnosis to t2 was 17.1 years (range, 6.3 to 40.1 years). Compared with odds for healthy controls, the odds of restrictive defects were increased 6.5-fold (odds ratio [OR], 6.5; 95% CI, 1.5 to 28.4; P < .01), and the odds of diffusion abnormalities were increased 5.2-fold (OR, 5.2; 95% CI, 1.8 to 15.5; P < .01). Among survivors, age younger than 16 years at diagnosis (OR, 3.0; 95% CI, 1.2 to 7.8; P = .02) and exposure to more than 20 Gy chest radiation (OR, 5.6; 95% CI, 1.5 to 21.0; P = .02, referent, no chest radiation) were associated with restrictive defects. Female sex (OR, 3.9; 95% CI, 1.7 to 9.5; P < .01) and chest radiation dose (referent: no chest radiation; ≤ 20 Gy: OR, 6.4; 95% CI, 1.7 to 24.4; P < .01; > 20 Gy: OR, 11.3; 95% CI, 2.6 to 49.5; P < .01) were associated with diffusion abnormalities. Among survivors with normal pulmonary function tests at t1, females and survivors treated with more than 20 Gy chest radiation demonstrated decline in diffusion function over time. Conclusion Childhood cancer survivors exposed to pulmonary-toxic therapy are significantly more likely to have restrictive and diffusion defects when compared with healthy controls. Diffusion capacity declines with time after exposure to pulmonary-toxic therapy, particularly among females and survivors treated with high-dose chest radiation. These individuals could benefit from subsequent monitoring.

Magnetic resonance imaging (MRI) may help identify acute stroke patients with a higher potential benefit from thrombolytic therapy. The aim of our study was to assess the correlation between initial cerebral infarct (CI) volume (quantified on diffusion-weighted MRI) and the resulting clinical outcome in acute stroke patients with middle cerebral artery (MCA) (M(1-2) segment) occlusion detected on MRI angiography treated by intravenous/intraarterial thrombolysis.Initial infarct volume (V(DWI-I) ) was retrospectively compared with neurological deficit evaluated using the NIH stroke scale on admission and 24 h later, and with the 90-day clinical outcome assessed using the modified Rankin scale in a series of 25 consecutive CI patients. The relationship between infarct volume and neurological deficit severity was assessed and, following the establishment of the maximum V(DWI-I) still associated with a good clinical outcome, the patients were divided into two groups (V(DWI-I)or =70 ml and70 ml).V(DWI-I) ranged from 0.7 to 321 ml. The 24-h clinical outcome improved significantly (P=0.0001) in 87% of patients with a V(DWI-I)or =70 ml (group 1) and deteriorated significantly (P=0.0018) in all patients with a V(DWI-I)70 ml (group 2). The 90-day mortality was 0% in group 1 and 71.5% in group 2. The 90-day clinical outcome was significantly better in group 1 than in group 2 (P=0.026).Clinical outcome could be predicted from initial infarct volume quantified by MRI-DWI in acute CI patients with MCA occlusion treated by intravenous/intraarterial thrombolysis. Patients with a V(DWI-I)or =70 ml had a significantly better outcome.

A new variant of the FETI method for numerical solution of elliptic PDE is presented. The basic idea is to simplify inversion of the stiffness matrices of subdomains by using Lagrange multipliers not only for gluing the subdomains along the auxiliary interfaces, but also for implementation of the Dirichlet boundary conditions. Results of numerical experiments are presented which indicate that the new method may be even more efficient then the original FETI.

We develop an optimal algorithm for the numerical solution of coercive variational inequalities, by combining FETI algorithms of dual-primal type with recent results for bound constrained quadratic programming problems. The discretized version of the model problem, obtained by using the FETI-DP methodology, is reduced by the duality theory of convex optimization to a quadratic programming problem with bound constraints. The resulting problem is solved by a new algorithm with a known rate of convergence given in terms of the spectral condition number of the quadratic problem. We present convergence bounds that guarantee the scalability of the algorithm. These results are confirmed by numerical experiments.

Theoretical and experimental results concerning FETI based algorithms for contact problems of elasticity are reviewed. A discretized model problem is first reduced by the duality theory of convex optimization to the quadratic programming problem with bound and equality constraints. The latter is then optionally modified by means of orthogonal projectors to the natural coarse space introduced by Farhat and Roux in the framework of their FETI method. The resulting problem is then solved either by special algorithms for bound constrained quadratic programming problems combined with penalty that imposes the equality constraints, or by an augmented Lagrangian type algorithm with the inner loop for the solution of bound constrained quadratic programming problems. Recent theoretical results are reported that guarantee certain optimality and scalability of both algorithms. The results are confirmed by numerical experiments. The performance of the algorithm in solution of more realistic engineering problems by basic algorithm is demonstrated on the solution of 3D problems with large displacements or Coulomb friction.

To develop and validate a model for probability of hospital mortality for cancer patients at 72 h of intensive care unit (ICU) management.This is an inception cohort study performed at four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 827 patients and then validated on an additional 415 patients. Multiple logistic regression modeling was used to develop the models, which were subsequently evaluated for discrimination and calibration. The main outcome measure is in-hospital death.A probability of mortality model, which incorporates ten discrete categorical variables, was developed and validated. All variables were collected at 72 h of ICU care. Variables included evidence of disease progression, performance status before hospitalization, heart rate100 beats/min, Glasgow coma score/=5, mechanical ventilation, arterial oxygen pressure/fractional inspiratory oxygen ( PaO(2)/FiO(2)) ratio250, platelets100 k/ micro l, serum bicarbonate (HCO(3))20 mEq/l, blood urea nitrogen (BUN)40 mg/dl, and a urine output of150 ml for any 8 h in the previous 24 h. The p values for the fit of the preliminary and validation models were 0.535 and 0.354 respectively, and the areas under the receiver operating characteristic (ROC) curves were 0.809 and 0.820.We report a multivariable logistic regression model to estimate the probability of hospital mortality in critically ill cancer patients at 72 h of ICU care. The model is comprised of ten unambiguous and readily available variables. When used in conjunction with clinical judgment, this model should improve discussions about goals of care of these patients. Additional validation in a community hospital setting is warranted.

In this paper we present an algorithm for the parallel solution of the rate-independent elasto-plastic problems with kinematic hardening. We assume the von Mises plastic criterion and the associated plastic flow rule. The time discretization is based on the implicit Euler method. The corresponding one-time-step problem is formulated in the incremental form with respect to the unknown displacement and discretized spatially by the finite element method. We use an ‘external’ algorithm based on a linearization of the elasto-plastic stress–strain relation by the corresponding tangential operator and we parallelize the arising linearized problem by the Total-FETI method. The numerical experiments were carried out using our novel C/C++ library FLLOP (FETI Light Layer On top of PETSc) at HECToR supercomputer located at EPCC, UK. Web of Science 84 54 48

Aims TOTAL ( N = 10 732), a randomized trial of routine manual thrombectomy vs. percutaneous coronary intervention alone in ST elevation myocardial infarction, showed no difference in the primary efficacy outcome but a significant increase in stroke. We sought to understand these findings. Methods and results A detailed analysis of stroke timing, stroke severity, and stroke subtype was performed. Strokes were adjudicated by neurologists blinded to treatment assignment. Stroke within 30 days, the primary safety outcome, was increased [33 (0.7%) vs. 16 (0.3%), hazard ratio (HR) 2.06; 95% confidence interval (CI) 1.13–3.75]. The difference in stroke was apparent within 48 h [15 (0.3%) vs. 5 (0.1%), HR 3.00; 95% CI 1.09–8.25]. There was an increase in strokes within 180 days with minor or no disability (Rankin 0–2) [18 (0.4%) vs. 13 (0.3%) HR 1.38; 95% CI 0.68–2.82] and in strokes with major disability or fatal (Rankin 3–6) [35 (0.7%) vs. 13 (0.3%), HR 2.69; 95% CI 1.42–5.08]. Most of the absolute difference was due to an increase in ischaemic strokes within 180 days [37 (0.7%) vs. 21 (0.4%), HR 1.71; 95% CI 1.03–3.00], but there was also an increase in haemorrhagic strokes [10 (0.2%) vs. 2 (0.04%), HR 4.98; 95% CI 1.09–22.7]. Patients that had a stroke had a mortality of 30.8% within 180 days vs. 3.4% without a stroke ( P < 0.001). A meta-analysis of randomized trials ( N = 21 173) showed an increase in risk of stroke (odds ratio 1.59; 95% CI 1.11–2.27) but a trend towards reduction in mortality odds ratio (odds ratio 0.87; 95% CI 0.76–1.00). Conclusion Thrombectomy was associated with a significant increase in stroke. Based on these findings, future trials must carefully collect stroke to determine safety in addition to efficacy.

16 Background: Advance Care Planning (ACP) is central to patient-centered care and helps assure treatment aligns with a patient’s goals, values, and priorities. ACP is often poorly incorporated into the hematopoietic stem cell transplantation (HSCT) population, with reported advance directive (AD) rates of 23-50%. At City of Hope National Medical Center (COH), concerted efforts to improve the overall number of ADs in HSCT was undertaken and evaluated. Methods: The Department of Supportive Care Medicine at COH, in collaboration with medical faculty and administrative support, created a patient-centered ACP program. The first two years (2013/2014) broadly focused on all new COH patients. The last two years (2015/2016) included a specific focus on patients undergoing HSCT. The primary goal was a completed AD in the electronic medical record before day 0 of transplant. In addition to provider and transplant team engagement, major time points for supportive care integration to facilitate AD completion were identified including: 1) registration, 2) new patient orientation, 3) the clinical visit when transplant was decided, 4) pre-transplant education class, 5) clinical social work psychosocial assessment visit, and 6) the pre-transplant hospital days. AD completion rates were calculated with Odds Ratio and Mantel-Haenszel Chi-Square using Epi Info StatCalc. Results: Between 2012 and 2016 at COH, 1784 transplants were performed. For HSCT patients in 2012, baseline AD capture rate before day 0 of transplant was 28.6%. With the institutional AD program, the AD capture rate before day 0 of transplant was 31.6% for 2014, compared with 2012 [odds ratio, 1.17(95% CI, 0.85-1.60); p = .33]. With both institutional and hematology specific programs, AD capture rate before day 0 was 69.5% for 2016, compared to 2014[odds ratio, 4.30 (95% CI, 3.14-5.91); p < .001]. Conclusions: Compared to 2012, the institutional AD program in 2014 insignificantly impacted HSCT AD completion rates. Improving the rate of AD completion from 28.6% to 69.5% in HSCT patients required both institutional AD efforts and a targeted program. Nevertheless, more work is needed to improve AD completion rates before transplant to 100%.

FLLOP (FETI Light Layer On top of PETSc) is a novel solver for linear systems and more general quadratic programming problems. It connects quadratic programming algorithms with FETI domain decomposition methods that bring high parallel scalability and at the same time high accuracy and robustness needed in engineering applications. According to its name, FLLOP forms an extension of the renowned PETSc software framework for parallel numerical solution of partial differential equations. It can be thus adopted by PETSc users with relative ease. The above-mentioned facts makes FLLOP a unique project. It now forms a solver part of our emerging PERMON toolbox for Parallel, Efficient, Robust, Modular, Object-oriented, Numerical simulations. We introduce one more PERMON tool, Permon Cube, which serves as a benchmark generation tool for FLLOP in massively parallel environment.

Although the beginnings of bone marrow transplantation (BMT) date back to 1939 with a case report of intravenous infusion of 18 cm3 of bone marrow from a sibling into a patient with aplastic anemia, 4, 12 modern BMT was pioneered by the Nobel Prize winner E. Donnell Thomas and his fellow investigators who performed the first successful allogeneic BMTs in the late 1960s and early 1970s. Since the last review of critical care complications of BMT in the January, 1988, issue of Critical Care Clinics by Joel Brochstein, MD, 10 significant strides have been made in basic research and clinical trials, with exponential growth in the numbers of BMTs performed in the 1980s and 1990s.39 Bone marrow is no longer the sole source of allogeneic and autologous hematopoietic cells; peripheral blood stem cell collections and umbilical cord blood are used increasingly, so the preferred term used in the literature is hematopoietic stem cell transplantation (HCT). Worldwide, an estimated 40, 000 transplantations are performed annually. The list of potential disease states amemable to HCT, displayed in the box, continues to expand.39 MalignanciesNonmalignant DiseasesLeukemia/preleukemiaSevere aplastic anemia Chronic myeloid leukemiaParoxysmal nocturnal hemoglobinuria Acute myeloid leukemia Acute lymphoblastic leukemiaHemoglobinopathies Juvenile chronic myeloid leukemiaThalassemia majorSickle cell disease Myelodysplastic syndromesCongenital disorders of hematopoiesis Therapy-related myelodysplasia/leukemiaFanconi's anemia Chronic lymphocytic leukemiaDiamond-Blackfan syndromeNon-Hodgkin's and Hodgkin's lymphomaKostmann's agranulocytosisFamilial erythrophagocytic histiocytosisMultiple myelomaSolid tumorsDyskeratosis congenita Breast cancerShwachman-Diamond syndrome Testicular cancerSevere combined immunodeficiency and related disorders Ovarian cancer Small cell lung cancerWiskott-Aldrich syndrome NeuroblastomaInborn errors of metabolism As the number of HCT patients has increased, so has the need for intensive care of the life-threatening complications associated with this high-risk procedure. The ICU use rates in HCT are estimated to range from 7% to 40%, depending on the type of transplant and risk factors such as age, conditioning regimen, and underlying disease.20 At the City of Hope National Medical Center (COHNMC), HCT patients with critical care complications are transferred to a 12-bed combined medical/surgical ICU, whereas at other institutions critically ill patients are managed on the transplantation ward.74 The COHNMC uses a multidisciplinary team approach to management of the critically ill HCT patient, with team leadership provided by the primary hematologist/oncologist and the adult or pediatric pulmonary intensivist and with input from a variety of other medical and surgical subspecialists as appropriate, including gastroenterologists, nephrologists, infectious diseases specialists, transfusion medicine specialists, psychiatrists, general surgeons, thoracic surgeons, neurosurgeons, and otolaryngologists. Bedside rounds are made daily in the ICU with input by physicians and nursing, respiratory therapy, dietary, pharmacy, social services, pastoral care, and physical therapy personnel. Several studies have suggested that transitioning from an open to a closed ICU with stricter administrative and triage control by an intensivist leads to more efficient use, shorter length of stay, decreased number of days of mechanical ventilation, lower costs, and improved outcome.29, 63, 70 At COHNMC and at many cancer centers, however, the team approach has proved to be most effective in the complex management of critically ill HCT patients. Many critical care complications in HCT patients are the same as those that occur in other immunocompromised patients, including sepsis, systemic inflammatory response syndrome (SIRS), multiorgan dysfunction syndrome (MODS), opportunistic infection, drug toxicity, hemorrhage, and so forth. This article focuses on the critical care problems occurring more specifically in the HCT patient, including infection, specific-organ toxicities, graft-versus-host disease (GvHD), and regimen-related toxicity (RRT). Previous reviewers have pointed out that complications following HCT tend to follow a fairly predictable timetable related to the evolution of immunologic changes attributable to the chemoradiation conditioning regimen, with an interval of pancytopenia preceding engraftment.15, 20, 50, 99, 107 This timetable, as shown in the box, is sometimes useful in narrowing the differential diagnosis, especially in pulmonary complications occurring after HCT.109a Traditionally, complications are grouped as early (occurring within 100 days after HCT) or late (occurring more than 100 days after HCT). Most early complications are related to the chemoradiation myeloablative therapy (regimen-related toxicity, or RRT) and to bacterial, fungal, and herpes simplex virus (HSV) infections. Once engraftment occurs and the white blood cell count starts to rise (approximately day 15 to 20 after HCT, the middle period), the incidence of bacterial infection begins to decrease and the risk for Aspergillus (with a second peak occurring between days 60 and 80 after HCT), and Cytomegalovirus (CMV) interstitial pneumonitis increases. Because of significant overlap of complications occurring in the early, middle and late periods, more specific diagnostic testing almost always is required to determine specific diagnosis and appropriate therapy. Technologic advancements during the past decade in imaging, hemodynamic assessment, and more sensitive culture techniques have facilitated the diagnosis of pulmonary complications, although the precise cause of many complications often remains obscure, and treatment is often empiric and supportive. Early(>30 days) InfectiousMiddle(30 to 100 days) Interstitial pneumonitisLate(>100 days) InfectiousBacterialCytomegalovirusBacteriaFungal (Candida, Aspergillus)Human herpes virus 6Filamentous fungi (Aspergillus and others)Viruses (non-Cytomegalovirus)Idiopathic pneumonia syndromeNocardiaAspirationVirusesMycobacteriaPneumocystis carinii pneumonia Pulmonary edemaInfectiousGvHD-associated phenomenaCardiac dysfunctionPneumocystis carinii pneumoniaObstructive airways diseaseHypervolemiaAtypical bacteriaBronchiolitis obliteransCapillary leakAspergillusVeno-occlusive disease Idiopathic pneumonia syndromeIdiopathic pneumonia syndromeRelapsed disease Diffuse alveolar hemorrhageDiffuse alveolar hemorrhageGvHD=graft-versus-host disease

Cil: Porovnat pocet pacientů indikovaných k implantaci ICD v primarni prevenci nahle srdecni smrti podle starých (2005) a nových (2009) doporuceni Ceske kardiologicke spolecnosti (CKS) u pacientů po prodělanem infarktu myokardu s elevacemi useku ST.Metodika a výsledky: Vysetřili jsme 205 konsekutivnich pacientů 12-29 měsiců po prodělanem infarktu myokardu s elevacemi useku ST. Odebrali jsme anamnezu a provedli echokardiograficke a EKG vysetřeni, neprovaděli jsme elektrofyziologicke vysetřeni. Na zakladě výsledků těchto vysetřeni jsme hodnotili indikaci k implantaci implantabilniho kardioverteru-defibrilatoru (ICD) v primarni prevenci nahle srdecni smrti podle starých a nových doporuceni CKS. V obdobi od prosince 2006 do prosince 2007 bylo na nasem pracovisti hospitalizovano celkem 310 pacientů pro infarkt myokardu s elevacemi useku ST. Nemocnicni mortalita dosahovala 5,2 %, po propustěni z nemocnice a před planovaným vysetřenim zemřelo 2,7 % pacientů. Ostatni pacienti byli pozvani k vysetřeni, 81 z nich se vsak nedostavilo. Z vysetřených nemocných byli ctyři indikovani k implantaci ICD podle starých doporuceni a 25 bylo indikovano podle nových doporuceni. Když jsme vzali v uvahu vsechny pacienty přijate pro infarkt myokardu s elevacemi useku ST (STEMI), zjistili jsme, že 1,3-1,8 %, resp. 8,1-11,3 % je indikovano k implantaci ICD v primarni prevenci.Zavěr: V populaci pacientů s ICHS po prodělanem STEMI jsme s implementaci nových doporuceni (2009) CKS zjistili sestinasobný narůst indikaci k implantaci ICD v primarni prevenci nahle srdecni smrti.

Thyroid abscess is a rare condition with a dramatic clinical course. Most commonly, thyroid abscess develops in a multinodular goiter. Rarely, the infection is iatrogenic. This report describes an abscess developing after fine-needle aspiration biopsy. The infectious agent was Escherichia c

PURPOSE To develop prospectively and validate a model for probability of hospital survival at admission to the intensive care unit (ICU) of patients with malignancy. PATIENTS AND METHODS This was an inception cohort study in the setting of four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 1,483 patients and then validated on an additional 230 patients. Multiple logistic regression modeling was used to develop the models and subsequently evaluated by goodness-of-fit and receiver operating characteristic (ROC) analysis. The main outcome measure was hospital survival after ICU admission. RESULTS The observed hospital mortality rate was 42%. Continuous variables used in the ICU admission model are PaO2/FiO2 ratio, platelet count, respiratory rate, systolic blood pressure, and days of hospitalization pre-ICU. Categorical entries include presence of intracranial mass effect, allogeneic bone marrow transplantation, recurrent or progressive cancer, albumin less than 2.5 g/dL, bilirubin > or = 2 mg/dL, Glasgow Coma Score less than 6, prothrombin time greater than 15 seconds, blood urea nitrogen (BUN) greater than 50 mg/dL, intubation, performance status before hospitalization, and cardiopulmonary resuscitation (CPR). The P values for the fit of the preliminary and validation models are .939 and .314, respectively, and the areas under the ROC curves are .812 and .802. CONCLUSION We report a disease-specific multivariable logistic regression model to estimate the probability of hospital mortality in a cohort of critically ill cancer patients admitted to the ICU. The model consists of 16 unambiguous and readily available variables. This model should move the discussion regarding appropriate use of ICU resources forward. Additional validation in a community hospital setting is warranted.

The FETI (Finite Element Tearing and Interconnecting) method turned out to be one of the most successful methods for the parallel solution of elliptic partial differential equations. Total-FETI (TFETI) by Dostal et al. simplifes the inversion of stiffness matrices of subdomains by using Lagrange multipliers not only for gluing the subdomains along the auxiliary interfaces, but also to enforce the Dirichlet boundary conditions. Thus, bases of kernels of all subdomain stiffness matrices are known a priori and can be assembled directly from mesh data.Although usual applications of TFETI method lie in the field of material sciences and structural mechanics, we demonstrate its applicability to the problem of the image registration of computer tomography imaging data using elastic registration method.