Abstract Aim Cardiac arrest centers have been associated with improved outcome for patients after cardiac arrest. Aim of this study was to investigate the effect on outcome depending on admission to ...high-, medium- or low volume centers. Methods Analysis from a prospective, multicenter registry for out of hospital cardiac arrest patients treated by the emergency medical service of Vienna, Austria. The frequency of cardiac arrest patients admitted per center/year (low <50; medium 50–100; high >100) was correlated to favorable outcome (30-day survival with cerebral performance category of 1 or 2). Results Out of 2238 patients (years 2013–2015) with emergency medical service resuscitation, 861 (32% female, age 64 (51;73) years) were admitted to 7 different centers. Favorable outcome was achieved in 267 patients (31%). Survivors were younger (58 vs. 66 years; p < 0.001), showed shockable initial heart rhythm more frequently (72 vs. 35%; p < 0.001), had shorter CPR durations (22 vs. 29 min; p < 0.001) and were more likely to be treated in a high frequency center (OR 1.6; CI: 1.2–2.1; p = 0.001). In multivariate analysis, age below 65 years (OR 15; CI: 3.3–271.4; p = 0.001), shockable initial heart rhythm (OR 10.1; CI: 2.4–42.6; p = 0.002), immediate bystander or emergency medical service CPR (OR 11.2; CI: 1.4–93.3; p = 0.025) and admission to a center with a frequency of >100 OHCA patients/year (OR 5.2; CI: 1.2–21.7; p = 0.025) was associated with favorable outcome. Conclusions High frequency of post-cardiac arrest treatment in a specialized center seems to be an independent predictor for favorable outcome in an unselected population of patients after out of hospital cardiac arrest.
Echocardiography is currently the noninvasive method of choice to screen patients with severe aortic valve stenosis (AS) for pulmonary hypertension (PH) by estimating systolic pulmonary artery ...pressure (sPAP). However, radiological options are also available by determining the main pulmonary artery (MPA) diameter in the setting of CT angiography. The aim of the present study was to compare cardiovascular biomarkers with the MPA diameter to allow other ways of detecting PH in patients with severe AS.
One hundred ninety-four patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) were included in this study and were divided into two groups based on the CT-angiographically determined MPA diameter. In accordance with ESC guidelines, a cut-off value of 29 mm was determined in this study, with the absence of PH defined by an MPA diameter <29 mm (N79/194) and the presence of PH defined by an MPA diameter ≥29 mm (115/194). Immediately before interventional aortic valve replacement, blood samples were drawn from the subjects and relevant cardiovascular biomarkers such as BNP, cTnI, GDF-15, H-FABP, IGF-BP2 and suPAR were assessed.
Patients with an MPA diameter ≥29 mm had significantly higher BNP (P=0.004), cTnI (P=0.039) and H-FABP (P=0.015) plasma levels, whereas GDF-15 (P=0.140), IGF-BP2 (P=0.088) and suPAR (P=0.140) showed no significant differences. In addition, cut-off values were calculated to predict an MPA diameter ≥29 mm. Significant results were shown with 1634.00 pg/mL for BNP (P=0.004), with 16.50 pg/mL for cTnI (P=0.039) and with 1.16 ng/mL for H-FABP (P=0.016). In a combined biomarker analysis, the 2-way combination of BNP and IGF-BP2 (AUC 0.671; 95%CI 0.538-0.805; P=0.023) and the 3-way combination of BNP, H-FABP and IGF-BP2 (AUC 0.685; 95%CI 0.551-0.818; P=0.015) showed the best results. Biomarker follow-up at 3 and 12 months after TAVR did not require additional information gain. Regarding 1-year survival, no significant difference could be detected between patients with an MPA diameter<29 mm compared to patients with ≥29 mm (log-rank test: P=0.262).
The MPA diameter remains a controversial parameter for the detection of PH in patients with severe AS. Standing on its own, this non-invasive parameter may not be precise enough to detect PH accurately. Combining this parameter with several biomarkers did not provide significant additional information.
Background: Patients with severe aortic valve stenosis (AS) frequently present with pulmonary hypertension (PH). The gold standard for detection of pulmonary hypertension is right heart ...catheterization, which is not routinely performed as a preoperative standard in cardiology centers today, neither before surgical valve replacement nor before transcatheter aortic valve replacement (TAVR) procedure. Echocardiographic determination of systolic pulmonary artery pressure (sPAP) provides an opportunity to assess the presence or absence of PH. The aim of the present study was to investigate the extent to which plasma levels of common cardiovascular biomarkers behave in patients with severe AS and an sPAP <40 mmHg in comparison to patients with an sPAP ≥40 mmHg. Methods: 179 patients with echocardiographic evidence of severe AS before TAVR procedure were divided into 2 groups based on sPAP. An sPAP of 40 mmHg was considered the cut-off value, with absence of PH defined by an sPAP <40 mmHg (n = 82) and presence of PH defined by an sPAP ≥40 mmHg (n = 97). Directly before TAVR, a blood sample was drawn from each patient, and plasma concentrations of the cardiovascular biomarkers Soluble Suppression of Tumorigenicity-2 (sST2), Growth/Differentiation of Factor-15 (GDF-15), Heart-Type Fatty-Acid Binding Protein (H-FABP), Insulin Like Growth Factor Binding Protein 2 (IGF-BP2), Soluble Urokinase-Type Plasminogen Activator Receptor (suPAR), Brain Natriuretic Peptide (BNP) and Cardiac Troponin I (cTnI) were determined. Results: Patients with an sPAP ≥40 mmHg had significantly higher sST2 (p = 0.010), GDF-15 (p = 0.005), IGF-BP2 (p = 0.029), suPAR (p = 0.018), BNP (p < 0.001) and cTnI (p = 0.039) plasma levels. Only for H-FABP (p = 0.069), no significant differences were discernible between the two groups. In addition, cut-off values were calculated to predict an sPAP ≥40 mmHg. Significant results were shown with 16045.84 pg/mL for sST2 (p = 0.010), with 1117.54 pg/mL for GDF-15 (p = 0.005), with 107028.43 pg/mL for IGF-BP2 (p = 0.029), with 3782.84 pg/mL for suPAR (p = 0.018), with 2248.00 pg/mL for BNP (p < 0.001) and with 20.50 pg/mL for cTnI (p = 0.002). Conclusions: sPAP as an echocardiographic parameter in combination with supplementary use of cardiovascular biomarkers presented here have the potential to provide more detailed information about the presence or absence of PH in a non-invasive way.
The integration of data, especially from heterogeneous sources, is a hard and widely studied problem. One particularly challenging issue is the integration of sources that are semantically equivalent ...but schematically heterogeneous. While two such data sources may represent the same information, one may store the information inside tuples (data) while the other may store it in attribute or relation names (schema). The SchemaSQL query language is a recent solution to this problem powerful enough to restructure such sources into each other without the loss of information. We propose the first incremental view maintenance strategy for such schema-restructuring views. Our strategy, based on an algebraic representation of the view query, correctly transforms a data update or a schema change to a source into sequences of schema and data updates to be applied to the view. We also introduce an optimization of incremental maintenance using batching. We present a proof of correctness of the propagation approach. We also describe the implementation of our SchemaSQL Query Processor and View Maintainer. Last, our experimental results demonstrate that, in many cases, incremental SchemaSQL view maintenance is significantly faster than complete view recomputation.
Views over distributed information sources, such as data warehouses, rely on the stability of the schemas of underlying databases. In the event of meta data changes in the sources, such as the ...deletion of a table or column, such views may become undefined. Using meta data about information redundancy, views can be evolved as necessary to remain well defined after source meta data changes. Previous work in view synchronization focused only on deletions of schema elements. We now offer an approach that makes use of additions also. Our algorithm returns view definitions to previous versions by using knowledge about the history of views and meta data. This technology enables us to adapt views to temporary meta data changes by canceling out opposite changes. It also allows undo/redo operations on meta data. Last, in many cases, the resulting evolved views even have an improved information quality. In this paper, we give a formal taxonomy of schema and constraint changes and a full description of the proposed history-driven view-synchronization algorithm for this taxonomy. We also prove the history-driven view-synchronization algorithm to be correct. Our approach falls in the global-as-view category of data integration solutions but, unlike prior solutions in this category, it now also deals with changes in the information space rather than requiring source schemas to remain constant over time. PUBLICATION ABSTRACT
Inclusion dependencies (INDs) between databases are assertions of subset-relationships between sets of attributes (dimensions) in two relations. Such dependencies are useful for a number of purposes ...related to information integration, such as database similarity discovery and foreign key discovery.
An exhaustive approach at discovering INDs between two relations suffers from the dimensionality curse, since the number of potential mappings between the attributes of two relations is exponential in the number of attributes. For this reason, levelwise (Apriori-like) approaches at discovery do not scale beyond relations with 8 to 10 attributes. Approaches modeling the similarity space as graphs or hypergraphs are promising, but also do not scale very well.
This paper discusses approaches to scale discovery algorithms for INDs and some other similarity patterns in databases. The major obstacle to scalability is the exponentially growing size of the data structure representing potential INDs. Therefore, the focus of our solution is on heuristic techniques that reduce the number of IND candidates considered by the algorithm. Despite the use of heuristics, the accuracy of the results is good for real-world data.
Experiments are presented assessing the quality of the discovery results versus the runtime savings. We conclude that the heuristic approach is useful and improves scalability significantly. It is particularly applicable for relations that have attributes with few distinct values.
Determining relationships such as functional or inclusion dependencies within and across databases is important for many applications in information integration. When such information is not ...available as explicit meta data, it is possible to discover potential dependencies from the source database extents. However, the complexity of such discovery problems is typically exponential in the number of attributes. We have developed an algorithm for the discovery of inclusion dependencies across high-dimensional relations in the order of 100 attributes. This algorithm is the first to efficiently solve the inclusion-dependency discovery problem. This is achieved by mapping it into a progressive series of clique-finding problems in k-uniform hypergraphs and solving those. Extensive experimental studies confirm the algorithm's efficiency on a variety of real-world data sets.
DyDa Chen, Jun; Zhang, Xin; Chen, Songting ...
International Conference on Management of Data: Proceedings of the 2001 ACM SIGMOD international conference on Management of data : Santa Barbara, California, United States; 21-24 May 2001,
05/2001
Conference Proceeding
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