Real-time multiprocessing of slit scan chromosome profiles

The multiprocessor NERV and its application to slit scan flow cytometry is described. Up to 320 processors and 640 MBytes of RAM may be used in one VME crate, providing a computing power of ≤ 1300 MIPS. The multiprocessor is controlled by a host computer that provides a friendly user interface and comfortable program development tools. All hardware and software has been tested on a prototype NERV system with 5 processors. For a real-time classification/detection of normal and aberrant chromosomes, the centromeric index or the number of centromeres are computed or specifically labeled DNA sequences are detected. The program is partitioned into 60 tasks that can be executed concurrently. A total analysis time of < 600 μs including system overhead will be achieved according to timing measurements which have been done for all individual tasks.     

What kind of noise increases with age?

It was hypothesized that internal representations of visually presented stimuli are noisier because of higher random neural activity or less precise relations among neuronal units in the central nervous systems (CNSs) of older persons than in younger persons. The rationale for and results from manipulations designed to examine predictions derived from this hypothesis are discussed. Age-related differences in an incomplete picture-identification task were found to be similar to those resulting from the addition of random background noise in stimulus displays of young adults.     

Bestimmung des Harnammoniaks in der Destillationsapparatur nach K. Lang

Zusammenfassung Es wird gezeigt, wie der Ammoniakgehalt von wäßrigen Flüssigkeiten nach Adsorption an Permutit in der vonLang angegebenen einfachen Destillationsapparatur bestimmt werden kann.     

Kommentar zu den Leitlinien (2017) der ESC/EACTS zum Management von Herzklappenerkrankungen

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie - Seit der letzten Herausgabe der Leitlinien zur Behandlung von Klappenfehlern durch die European Society of Cardiology (ESC) und die...     

Admission plasma vasopressin levels in children with meningococcal septic shock

Objective Vasopressin (AVP) response has been reported to be inappropriately low in adult established septic shock. We studied admission AVP levels in children with meningococcal septic shock (MSS).Patients and methods All children with meningococcal infection admitted to our PICU between May 2001 and August 2002 were classified as MSS (persistent hypotension despite fluid therapy, with perfusion abnormalities and the need for vasoactive drug infusion for at least 24 h or until death), or meningococal infection without shock (fever and purpura, with or without meningitis). Blood samples were collected at admission and AVP levels were subsequently determined using Nichols Institute Diagnostics vasopressin assay. Eighteen of 19 children with MSS (7 deaths) and 15 without shock (no death) were included.Results In children with MSS median admission AVP level was 41.6 pg/ml (1.4–498.9) and in those without 3.3 pg/ml (1.6–63.8). In children with MSS the AVP level was not correlated with duration of shock and fluid expansion prior to AVP sampling, or with age-adjusted blood pressure and natremia at the time of blood sampling. AVP levels were higher in nonsurvivors, but not significantly so. Only one nonsurvivor had an admission AVP level below 30 pg/ml.Conclusions In our children with established MSS who died the admission AVP level were not inappropriately low. Further studies including serial AVP level assessments are needed before concluding that AVP administration is of little interest in children with MSS.     

Complications of endoscopic retrograde cholangiopancreatography during live endoscopy workshop demonstrations

BACKGROUND AND STUDY AIMS: Endoscopy workshops are thought to be associated with larger numbers of complications than routine clinical treatment. In this study, patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) during live demonstrations were compared with matched patients treated in an ERCP unit. PATIENTS AND METHODS: Patients who underwent ERCP during workshops over a 12-year period were reviewed. The control for each patient was the next patient admitted to the same ERCP unit with similar indications. Possible delays before treatment, ERCP indications, the use of general anesthesia, standard endoscopic and special treatments, success and complication rates for ERCP, prolonged hospitalization periods, and financial benefits for patients were assessed. RESULTS: A total of 168 workshop patients and 168 control patients were compared. ERCP was delayed in 18 patients to allow treatment during the workshops. General anesthesia was used in 87.5 % of the workshop patients, in comparison with 44 % of the control patients (P < 0.001). The duration of the endoscopies and radiation exposure did not differ, and the endoscopic treatments carried out also did not differ significantly, with the exception of cholangiopancreatoscopy (7 % in the workshop group versus 0 %; P < 0.01). The success and complication rates were similar in the workshop and control patients, as was the duration of hospitalization. Among the patients treated during workshops, 45 % benefited financially, as they were not charged for stents or other devices. CONCLUSIONS: These results suggest that, in this setting, ERCP performed during live demonstrations is safe and raises no major ethical problems.     

Cytomegalovirus reactivation and mortality in patients with acute respiratory distress syndrome

Purpose

Cytomegalovirus (CMV) reactivation occurs frequently in patients with the acute respiratory distress syndrome (ARDS) and has been associated with increased mortality. However, it remains unknown whether this association represents an independent risk for poor outcome. We aimed to estimate the attributable effect of CMV reactivation on mortality in immunocompetent ARDS patients.

Methods

We prospectively studied immunocompetent ARDS patients who tested seropositive for CMV and remained mechanically ventilated beyond day 4 in two tertiary intensive care units in the Netherlands from 2011 to 2013. CMV loads were determined in plasma weekly. Competing risks Cox regression was used with CMV reactivation status as a time-dependent exposure variable. Subsequently, in sensitivity analyses we adjusted for the evolution of disease severity until onset of reactivation using marginal structural modeling.

Results

Of 399 ARDS patients, 271 (68 %) were CMV seropositive and reactivation occurred in 74 (27 %) of them. After adjustment for confounding and competing risks, CMV reactivation was associated with overall increased ICU mortality (adjusted subdistribution hazard ratio (SHR) 2.74, 95 % CI 1.51–4.97), which resulted from the joint action of trends toward an increased mortality rate (direct effect; cause specific hazard ratio (HR) 1.58, 95 % CI 0.86–2.90) and a reduced successful weaning rate (indirect effect; cause specific HR 0.83, 95 % CI 0.58–1.18). These associations remained in sensitivity analyses. The population-attributable fraction of ICU mortality was 23 % (95 % CI 6–41) by day 30 (risk difference 4.4, 95 % CI 1.1–7.9).

Conclusion

CMV reactivation is independently associated with increased case fatality in immunocompetent ARDS patients who are CMV seropositive.

     

Biliary stent occlusion--a problem solved with self-expanding metal stents? European Wallstent Study Group.

The main limitation in the endoscopic palliation of malignant biliary obstruction is due to stent blockage. One of the factors thought to be of importance is the diameter of the endoprosthesis. In this paper, we report the results of a multicenter European study with a one cm diameter self-expanding metal stent (Wallstent) in 103 patients with malignant biliary obstruction. Insertion of the stent following guidewire positioning was successful in 97.1% of the patients without any cases of de novo cholangitis developing after the endoscopic procedure. The median follow-up for the entire group was 145 days. In all but 3 patients, the stent expanded to more than 80% of its maximum diameter. Two patients had ongoing cholangitis after stent insertion. Long-term complications manifested by late cholangitis, were seen in 18% of the cases after a median interval of 125 days. The occlusion rate by biliary sludge was 5% after a median time period of 175 days which is substantially less than the 21% occlusion rate reported for polyethylene stents. In conclusion, our results show that the Wallstent can be easily placed in distal and mid-CBD strictures after guidewire passage, with most of the patients having a- good drainage effect. The occlusion rate by biliary sludge is significantly less than for conventional polyethylene stents, but the occlusion by tumor ingrowth is substantial. A disadvantage is the high cost of the Wallstent. Further randomized trials will be required to determine the cost-benefit ratio for the use of this stent.     

Die Bedeutung der SYNTAX-Studie für die moderne Koronarchirurgie

Coronary artery bypass graft surgery (CABG) is still considered to be the standard of care for patients with a prognostically relevant pattern of coronary artery disease. New stent designs, including drug-eluting stents (DES) and improvements in percutaneous coronary intervention (PCI) technologies during recent years, challenge CABG in the treatment of coronary three-vessel disease and/or left main stem stenosis. To date, randomized trials have demonstrated significantly higher repeat revascularization rates in PCI patients but comparable results regarding procedural and mid-term survival as well as adverse events like myocardial infarction. In contrast, real world registry data demonstrated a survival benefit of CABG over PCI as the primary treatment option. Recently, 2-year results of the largest comparative randomized trial to date, the SYNTAX trial, were made available. These data demonstrated the superiority of CABG over PCI regarding the combined endpoint of death and major adverse cardiac and cerebrovascular events, including repeat revascularization. There were comparable results in patients with less complex coronary artery disease between PCI and CABG, while patients with more complex coronary pathologies had significantly better results after surgical intervention. These results have led to controversies in all major medical societies and have resulted in intensive and ongoing guideline discussions.