Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial

Background: Intraventricular haemorrhage is a subtype of intracerebral haemorrhage, with 50% mortality and serious disability for survivors. We aimed to test whether attempting to remove intraventricular haemorrhage with alteplase versus saline irrigation improved functional outcome. Methods: In this randomised, double-blinded, placebo-controlled, multiregional trial (CLEAR III), participants with a routinely placed extraventricular drain, in the intensive care unit with stable, non-traumatic intracerebral haemorrhage volume less than 30 mL, intraventricular haemorrhage obstructing the 3rd or 4th ventricles, and no underlying pathology were adaptively randomly assigned (1:1), via a web-based system to receive up to 12 doses, 8 h apart of 1 mg of alteplase or 0·9% saline via the extraventricular drain. The treating physician, clinical research staff, and participants were masked to treatment assignment. CT scans were obtained every 24 h throughout dosing. The primary efficacy outcome was good functional outcome, defined as a modified Rankin Scale score (mRS) of 3 or less at 180 days per central adjudication by blinded evaluators. This study is registered with ClinicalTrials.gov, NCT00784134. Findings: Between Sept 18, 2009, and Jan 13, 2015, 500 patients were randomised: 249 to the alteplase group and 251 to the saline group. 180-day follow-up data were available for analysis from 246 of 249 participants in the alteplase group and 245 of 251 participants in the placebo group. The primary efficacy outcome was similar in each group (good outcome in alteplase group 48% vs saline 45%; risk ratio [RR] 1·06 [95% CI 0·88–1·28; p=0·554]). A difference of 3·5% (RR 1·08 [95% CI 0·90–1·29], p=0·420) was found after adjustment for intraventricular haemorrhage size and thalamic intracerebral haemorrhage. At 180 days, the treatment group had lower case fatality (46 [18%] vs saline 73 [29%], hazard ratio 0·60 [95% CI 0·41–0·86], p=0·006), but a greater proportion with mRS 5 (42 [17%] vs 21 [9%]; RR 1·99 [95% CI 1·22–3·26], p=0·007). Ventriculitis (17 [7%] alteplase vs 31 [12%] saline; RR 0·55 [95% CI 0·31–0·97], p=0·048) and serious adverse events (114 [46%] alteplase vs 151 [60%] saline; RR 0·76 [95% CI 0·64–0·90], p=0·002) were less frequent with alteplase treatment. Symptomatic bleeding (six [2%] in the alteplase group vs five [2%] in the saline group; RR 1·21 [95% CI 0·37–3·91], p=0·771) was similar. Interpretation: In patients with intraventricular haemorrhage and a routine extraventricular drain, irrigation with alteplase did not substantially improve functional outcomes at the mRS 3 cutoff compared with irrigation with saline. Protocol-based use of alteplase with extraventricular drain seems safe. Future investigation is needed to determine whether a greater frequency of complete intraventricular haemorrhage removal via alteplase produces gains in functional status

SUPERCOMPUTER SIMULATION OF CRITICAL PHENOMENA IN COMPLEX SOCIAL SYSTEMS

The paper describes a problem of computer simulation of critical phenomena in complex social systems on a petascale computing systems in frames of complex networks approach. The three-layer system of nested models of complex networks is proposed including aggregated analytical model to identify critical phenomena, detailed model of individualized network dynamics and model to adjust a topological structure of a complex network. The scalable parallel algorithm covering all layers of complex networks simulation is proposed. Performance of the algorithm is studied on different supercomputing systems. The issues of software and information infrastructure of complex networks simulation are discussed including organization of distributed calculations, crawling the data in social networks and results visualization. The applications of developed methods and technologies are considered including simulation of criminal networks disruption, fast rumors spreading in social networks, evolution of financial networks and epidemics spreading

Mutations in HYAL2, Encoding Hyaluronidase 2, Cause a Syndrome of Orofacial Clefting and Cor Triatriatum Sinister in Humans and Mice.

Orofacial clefting is amongst the most common of birth defects, with both genetic and environmental components. Although numerous studies have been undertaken to investigate the complexities of the genetic etiology of this heterogeneous condition, this factor remains incompletely understood. Here, we describe mutations in the HYAL2 gene as a cause of syndromic orofacial clefting. HYAL2, encoding hyaluronidase 2, degrades extracellular hyaluronan, a critical component of the developing heart and palatal shelf matrix. Transfection assays demonstrated that the gene mutations destabilize the molecule, dramatically reducing HYAL2 protein levels. Consistent with the clinical presentation in affected individuals, investigations of Hyal2-/- mice revealed craniofacial abnormalities, including submucosal cleft palate. In addition, cor triatriatum sinister and hearing loss, identified in a proportion of Hyal2-/- mice, were also found as incompletely penetrant features in affected humans. Taken together our findings identify a new genetic cause of orofacial clefting in humans and mice, and define the first molecular cause of human cor triatriatum sinister, illustrating the fundamental importance of HYAL2 and hyaluronan turnover for normal human and mouse development

Adaptive optimistic simulation of multi-agent systems

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The study of the influence of obstacles on crowd dynamics

This paper presents the research on the influence of obstacles on crowd dynamics. We have performed experiments for four base scenarios of interaction in crowd: unidirectional flow, bidirectional flow, merging flows and intersection. Movement of pedestrians has been studied in simple shape areas: straight corridor, T-junction and intersection. The volumes and basic directions of pedestrian flows were determined for each of the areas. Layout of physical obstacles has been built from different combinations of columns and barriers. In order to acquire characteristics of the crowd dynamics a set of simulations was conducted using PULSE simulation environment. In the result, we have managed to obtain several dependences between layout of obstacles and crowd dynamics were obtained.Published versio

Quantitative comparison between crowd models for evacuation planning and evaluation

Crowd simulation is rapidly becoming a standard tool for evacuation planning and evaluation. However, the many crowd models in the literature are structurally different, and few have been rigorously calibrated against real-world egress data, especially in emergency situations. In this paper we describe a procedure to quantitatively compare different crowd models or between models and real-world data. We simulated three models: (1) the lattice gas model, (2) the social force model, and (3) the RVO2 model, and obtained the distributions of six observables: (1) evacuation time, (2) zoned evacuation time, (3) passage density, (4) total distance traveled, (5) inconvenience, and (6) flow rate. We then used the DISTATIS procedure to compute the compromise matrix of statistical distances between the three models. Projecting the three models onto the first two principal components of the compromise matrix, we find the lattice gas and RVO2 models are similar in terms of the evacuation time, passage density, and flow rates, whereas the social force and RVO2 models are similar in terms of the total distance traveled. Most importantly, we find that the zoned evacuation times of the three models to be very different from each other. Thus we propose to use this variable, if it can be measured, as the key test between different models, and also between models and the real world. Finally, we compared the model flow rates against the flow rate of an emergency evacuation during the May 2008 Sichuan earthquake, and found the social force model agrees best with this real data