Zusammenfassung
Patienten mit einer strukturellen Herzerkrankung, die einen elektrischen Sturm erleiden, weisen besonders in den ersten 3 Monaten eine stark erhöhte rhythmogene und nichtrhythmogene ...Mortalität auf. Nach notfallmäßiger Terminierung der ventrikulären Arrhythmie müssen, abhängig vom Ergebnis einer Analyse der zugrunde liegenden Art und Ursache der Arrhythmie, verschiedene Therapiepfade eingeschlagen werden, um eine dauerhafte Rhythmusstabilisierung zu erreichen. Eckpfeiler der Therapie sind Triggerausschaltung, Sympathikusblockade (initial mittels β-Blocker und Sedierung), antiarrhythmische Therapie mit Amiodaron und Katheterablation, aber auch eine Behandlung der Herzinsuffizienz bzw. kreislaufunterstützende Maßnahmen. Der dargestellte Algorithmus kann helfen, auch invasive Maßnahmen, wie invasive Koronardiagnostik, Katheterablation oder invasive Kreislaufunterstützung rechtzeitig in die Therapiestrategie zu integrieren. Durch ein strukturiertes Vorgehen bei der Behandlung von Patienten mit elektrischem Sturm kann eine hohe Effektivität der Akuttherapie erreicht werden. Ob dies auch zu einer Verbesserung des Outcomes führt, muss im Weiteren evaluiert werden.
Catheter ablation has been shown to be an effective treatment for rhythm stabilization in patients with multiple ventricular arrhythmia episodes called electrical storm (ES). These procedures may be ...complex and are usually only performed in highly specialized and experienced centers. Still the optimum timing for catheter ablation in ES remains unclear.
Early access to perform acute ablation should be considered in patients who are not rhythm stabilized with antiarrhythmic medical treatment. Also patients with hemodynamic compromise (cardiogenic shock) are candidates for an early interventional strategy. In specialized centers it is consensus to perform catheter ablation in these patients as early as eligible especially when considering a high early and late mortality without interventional management. Establishing a structured protocol for treatment and admission to EP centers has helped to further reduce pre-ablation mortality and may optimize treatment of ES. Large scale networking to optimize and structure access to experienced electrophysiology centers is of importance to create a basis for optimizing treatment strategies.
This paper describes the Telemersive Toolkit hereafter referred to as TTkit, a system that enables artists and educators to set up complex low-latency multimedia streaming infrastructures between ...multiple computers connected via networks. TTkit addresses the challenge for non-technical personnel to create their own streaming environment that does not require reconfiguration of the local network infrastructure and allows computers to be connected across different network configurations and firewall setups. The TTkit provides an intuitive user interface called telemersive-gateway hereafter referred to as Gateway to set up the network and displays the current status of all streams – video, audio, motion tracking data, control data – exchanged within the network. Each Gateway on the network can monitor and configure the streaming setup of all other Gateways on the network, making it a very convenient tool for troubleshooting and helping artists, researchers as well as educators (e.g. to assist novice users) in setting up their individual machines. In order to evaluate TTkit, the Telematic Perfomance Format Research Group has used it for its three most recent project realisations in the form of telematic multimedia music and theater performances, one of which, called ’Osmosis’, is described in this paper to give a clearer understanding of the practical application of this system. Our findings suggest that TTkit is ready to be used by a wider community, and we believe that it will help artists and educators to create their own networked performance environments without spending too much time setting up the technical infrastructure, and thus focus more on the artistic freedom that the new system offers.
Modern software typically performs more than one functionality. These functionalities or features are not always organized in a way for modules representing these features to be used individually. ...Many software engineering approaches like programming language constructs, or product line visualization techniques have been proposed to organize projects as modules. Unfortunately, much legacy software suffer from years or decades of improper coding practices that leave the modules in the code almost undetectable. In such scenarios, a desirable requirement is to identify modules representing different features to be extracted. In this paper, we propose a novel approach that combines information retrieval and program analysis approaches to allow domain experts to identify slices of the program that represent modules using natural language search terms. We evaluate our approach by building a proof of concept tool in C, and extract modules from open source projects.
...cardiac regeneration over time might gradually substitute damaged cardiomyocytes after cardiac transplantation. Because Ki67-positive cardiomyocytes tend to be smaller than non-proliferating ...myocytes, they are thought to be young cells that might arise from stem cell differentiation (7). ...if newly formed cardiomyocytes were present in the biopsy samples obtained a few days after transplantation, they would be expected to express Ki67 rather than donor-derived cardiomyocytes, in which the probability to be terminally differentiated is much higher.
Pharmacologically active compounds (e.g. from the groups of pharmaceutical drugs, cofactors or vitamins) often consist of two or more stereoisomers (enantiomers or diastereoisomers) which may differ ...in their pharmacodynamic/kinetic, toxicological and biological properties. A well-known example is vitamin E which is predominantly administered as two different forms, one derived from natural sources (mainly soybeans), and one from production by chemical total-synthesis. While vitamin E from natural sources occurs as a single stereoisomer (
RRR-
α-tocopherol), synthetic vitamin E (
all-rac-
α-tocopherol) is an equimolar mixture of eight stereoisomers. Based on a number of animal studies it has been suggested that the biological potency of natural-source vitamin E is 1.36 greater compared to its counterpart produced by chemical synthesis. In this study, we have used the Affymetrix GeneChip
® technology to evaluate the feasibility of a new bio-assay where the gene regulatory activities of
RRR-
α-tocopherol and
all-rac-
α-tocopherol were quantified and compared on the genome-wide level. For this purpose, HepG2 cells were supplemented with increasing amounts of
RRR- or
all-rac-
α-tocopherol for 7 days. Genes showing a dose-related induction/repression were identified by global gene expression profiling. Our findings show that
RRR- and
all-rac-
α-tocopherol share an identical transcriptional activity, i.e. induce/repress the expression of the same set of genes. Based on the transcriptional dose–response data, EC50 and IC50 values were determined for each of these genes. The feasibility of calculating a “transcriptional potency factor” of
RRR- vs.
all-rac-
α-tocopherol was evaluated by dividing the EC50/IC50 of
RRR-
α-tocopherol by the corresponding EC50/IC50 of
all-rac-
α-tocopherol for every of the vitamin E responsive genes. Using this approach we have calculated 215 single biopotency ratios. Subsequently, the mean of all potency ratios was found to be 1.05.
In the present work we propose a new assay for the analysis and comparison of the biological activity and potency of chiral compounds in vivo.
Ethnic and socioeconomic inequalities in obstetric outcomes are well established. However, the role of induction of labour (IOL) to reduce these inequalities is controversial, in part due to ...insufficient evidence. This national cohort study aimed to identify adverse perinatal outcomes associated with IOL with birth at 39 weeks of gestation ("IOL group") compared to expectant management ("expectant management group") according to maternal characteristics in women with low-risk pregnancies.
All English National Health Service (NHS) hospital births between January 2018 and March 2021 were examined. Using the Hospital Episode Statistics (HES) dataset, maternal and neonatal data (demographic, diagnoses, procedures, labour, and birth details) were linked, with neonatal mortality data from the Office for National Statistics (ONS). Women with a low-risk pregnancy were identified by excluding pregnancies with preexisting comorbidities, previous cesarean section, breech presentation, placenta previa, gestational diabetes, or a baby with congenital abnormalities. Women with premature rupture of membranes, placental abruption, hypertensive disorders of pregnancy, amniotic fluid abnormalities, or antepartum stillbirth were excluded only from the IOL group. Adverse perinatal outcome was defined as stillbirth, neonatal death, or neonatal morbidity, the latter identified using the English composite neonatal outcome indicator (E-NAOI). Binomial regression models estimated risk differences (with 95% confidence intervals (CIs)) between the IOL group and the expectant management group, adjusting for ethnicity, socioeconomic background, maternal age, parity, year of birth, and birthweight centile. Interaction tests examined risk differences according to ethnicity, socioeconomic background, and parity. Of the 1 567 004 women with singleton pregnancies, 501 072 women with low-risk pregnancies and with sufficient data quality were included in the analysis. Approximately 3.3% of births in the IOL group (1 555/47 352) and 3.6% in the expectant management group (16 525/453 720) had an adverse perinatal outcome. After adjustment, a lower risk of adverse perinatal outcomes was found in the IOL group (risk difference -0.28%; 95% CI -0.43%, -0.12%; p = 0.001). This risk difference varied according to socioeconomic background from 0.38% (-0.08%, 0.83%) in the least deprived to -0.48% (-0.76%, -0.20%) in the most deprived national quintile (p-value for interaction = 0.01) and by parity with risk difference of -0.54% (-0.80%, -0.27%) in nulliparous women and -0.15% (-0.35%, 0.04%) in multiparous women (p-value for interaction = 0.02). There was no statistically significant evidence that risk differences varied according to ethnicity (p = 0.19). Key limitations included absence of additional confounding factors such as smoking, BMI, and the indication for induction in the HES datasets, which may mean some higher risk pregnancies were included.
IOL with birth at 39 weeks was associated with a small reduction in the risk of adverse perinatal outcomes, with 360 inductions in low-risk pregnancies needed to avoid 1 adverse outcome. The risk reduction was mainly present in women from more socioeconomically deprived areas and in nulliparous women. There was no significant risk difference found by ethnicity. Increased uptake of IOL at 39 weeks, especially in women from more socioeconomically deprived areas, may help reduce inequalities in adverse perinatal outcomes.
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