Levosimendan may improve survival in patients requiring mechanical assist devices for post-cardiotomy heart failure

INTRODUCTION: Most case series suggest that less than half of the patients receiving a mechanical cardiac assist device as a bridge to recovery due to severe post-cardiotomy heart failure survive to hospital discharge. Levosimendan is the only inotropic substance known to improve medium term survival in patients suffering from severe heart failure. METHODS: This retrospective analysis covers our single centre experience. Between July 2000 and December 2004, 41 consecutive patients were treated for this complication. Of these, 38 patients are included in this retrospective analysis as 3 patients died in the operating room. Levosimendan was added to the treatment protocol for the last nine patients. RESULTS: Of 29 patients treated without levosimendan, 20 could be weaned off the device, 9 survived to intensive care unit discharge, 7 left hospital alive and 3 survived 180 days. All 9 patients treated with levosimendan could be weaned, 8 were discharged alive from ICU and hospital, and 7 lived 180 days after surgery (p < 0.002 for 180 day survival). Plasma lactate after explantation of the device was significantly lower (p = 0.002), as were epinephrine doses. Time spent on renal replacement therapy was significantly shorter (p = 0.023). CONCLUSION: Levosimendan seems to improve medium term survival in patients failing to wean off cardiopulmonary bypass and requiring cardiac assist devices as a bridge to recovery. This retrospective analysis justifies prospective randomised investigations of levosimendan in this group of patients

Meta-Studie: Covid-19-Pandemie und betriebliche Anpassungsmaßnahmen: Begleitforschung zur Arbeitsweltberichterstattung im Auftrag des BMAS, Bd. 4

Die vorliegende Studie fasst den Stand der Erkenntnisse zu den Auswirkungen der Covid-19-Pandemie auf Betriebe und Beschäftigte sowie zu den betrieblichen Anpassungsmaßnahmen zusammen. Hierzu wurde eine Vielzahl von Studien und zugrundeliegenden Erhebungen erfasst und ausgewertet. Die einbezogenen Studien basieren auf Primärbefragungen bei Betrieben, Beschäftigten oder anderen Personen, die in Deutschland durchgeführt wurden. In einem weiteren Arbeitsschritt wird der Forschungsstand im Hinblick auf Vollständigkeit bzw. Forschungslücken bewertet.This study summarizes the current state of knowledge on the impact of the Covid 19 pandemic on companies and employees and on companies’ adaptation measures. For this purpose, a large number of studies and surveys were recorded and analyzed. The studies included are based on primary surveys of companies, employees or other persons conducted in Germany. In a further step, the current state of research is evaluated with regard to completeness and research gaps

A Coq Library of Undecidable Problems

International audienceWe propose a talk on our library of mechanised reductions to establish undecidability results in Coq. The library is a collaborative effort, growing constantly and we are seeking more outside contributors willing to work on undecidability results in Coq

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

A penalized time-frequency band feature selection and classification procedure for improved motor intention decoding in multichannel EEG

Objective. Motor imagery brain-computer interfaces (MI-BCIs) based on electroencephalography (EEG), a promising technology to provide assistance and support rehabilitation of neurological patients with sensorimotor impairments, require a reliable and adaptable subject-specific model to efficiently decode motor intention. The most popular EEG feature extraction algorithm for MI-BCIs is the common spatial patterns (CSP) method, but its performance strongly depends on the predefined frequency band and time segment length for analyzing the EEG signal. Approach. In this work, a novel method for efficiently decoding motor intention for EEG-based BCIs performing multiple frequency band analysis in multiple EEG segments is presented. This decoding algorithm uses raw multichannel EEG data which are decomposed into specific temporal and frequency bands. Features are extracted at each - band by using CSP. Feature selection and classification are simultaneously performed by means of a fast procedure, based on elastic-net regression, which allows for the inclusion of a priori discriminative information into the model. The effectiveness of the proposed method is tested off-line on two public EEG-based MI-BCI datasets and on a self-acquired dataset in two configurations: multiple temporal windows and single temporal window. Main results. The experimental results show that the proposed multiple time-frequency band method yields overall accuracy improvements of up to (average accuracy of 84.8%) as compared to the best current state-of-the-art methods based on filter bank analysis and CSP for MI detection. Also, classification variability is reduced, making the proposed method more robust to intra-subject EEG fluctuations. Significance. This paper presents a novel approach for improving motor intention detection by automatically selecting subject-specific spatio-temporal-spectral features, especially when MI has to be detected against rest condition. This technique contributes to the further advancement and application of EEG-based MI-BCIs for assistance and neurorehabilitation therapy.Fil: Peterson, Victoria. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Matemática Aplicada del Litoral. Universidad Nacional del Litoral. Instituto de Matemática Aplicada del Litoral; ArgentinaFil: Wyser, Dominik. Eth Zürich;Fil: Lambercy, Olivier. Eth Zürich;Fil: Spies, Ruben Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Santa Fe. Instituto de Matemática Aplicada del Litoral. Universidad Nacional del Litoral. Instituto de Matemática Aplicada del Litoral; ArgentinaFil: Gassert, Roger. Eth Zürich

Mobilization of CD34+-progenitor cells in patients with severe trauma.

Circulating CD34+ progenitor cells () gained importance in the field of regenerative medicine due to their potential to home in on injury sites and differentiate into cells of both endothelial and osteogenic lineages. In this study, we analyzed the mobilization kinetics and the numbers of CD34+, CD31+, CD45+, and CD133+ cells in twenty polytrauma patients (n = 13 male, n = 7 female, mean age 46.5±17.2 years, mean injury severity score (ISS) 35.8±12.5 points). In addition, the endothelial differentiation capacity of enriched CD34+cells was assessed by analyzing DiI-ac-LDL/lectin uptake, the expression of endothelial markers, and the morphological characteristics of these cells in Matrigel and spheroid cultures. We found that on days 1, 3, and 7 after a major trauma, the number of CD34+cells increased from 6- up to 12-fold (p<0.0001) over the number of CD34+cells from a control population of healthy, age-matched volunteers. The numbers of CD31+ cells were consistently higher on days 1 (1.4-fold, p<0.01) and 7 (1.3-fold, p<0.01), whereas the numbers of CD133+ cell did not change during the time course of investigation. Expression of endothelial marker molecules in CD34+cells was significantly induced in the polytrauma patients. In addition, we show that the CD34+ cell levels in severely injured patients were not correlated with clinical parameters, such as the ISS score, the acute physiology and chronic health evaluation II score (APACHE II), as well as the sequential organ failure assessment score (SOFA-2). Our results clearly indicate that pro-angiogenic cells are systemically mobilized after polytrauma and that their numbers are sufficient for the development of novel therapeutic models in regenerative medicine

Mobilization of CD34+-progenitor cells in patients with severe trauma.

Circulating CD34+ progenitor cells () gained importance in the field of regenerative medicine due to their potential to home in on injury sites and differentiate into cells of both endothelial and osteogenic lineages. In this study, we analyzed the mobilization kinetics and the numbers of CD34+, CD31+, CD45+, and CD133+ cells in twenty polytrauma patients (n = 13 male, n = 7 female, mean age 46.5±17.2 years, mean injury severity score (ISS) 35.8±12.5 points). In addition, the endothelial differentiation capacity of enriched CD34+cells was assessed by analyzing DiI-ac-LDL/lectin uptake, the expression of endothelial markers, and the morphological characteristics of these cells in Matrigel and spheroid cultures. We found that on days 1, 3, and 7 after a major trauma, the number of CD34+cells increased from 6- up to 12-fold (p<0.0001) over the number of CD34+cells from a control population of healthy, age-matched volunteers. The numbers of CD31+ cells were consistently higher on days 1 (1.4-fold, p<0.01) and 7 (1.3-fold, p<0.01), whereas the numbers of CD133+ cell did not change during the time course of investigation. Expression of endothelial marker molecules in CD34+cells was significantly induced in the polytrauma patients. In addition, we show that the CD34+ cell levels in severely injured patients were not correlated with clinical parameters, such as the ISS score, the acute physiology and chronic health evaluation II score (APACHE II), as well as the sequential organ failure assessment score (SOFA-2). Our results clearly indicate that pro-angiogenic cells are systemically mobilized after polytrauma and that their numbers are sufficient for the development of novel therapeutic models in regenerative medicine

Mobilization of CD34+-progenitor cells in patients with severe trauma

Circulating CD34+ progenitor cells () gained importance in the field of regenerative medicine due to their potential to home in on injury sites and differentiate into cells of both endothelial and osteogenic lineages. In this study, we analyzed the mobilization kinetics and the numbers of CD34+, CD31+, CD45+, and CD133+ cells in twenty polytrauma patients (n = 13 male, n = 7 female, mean age 46.5±17.2 years, mean injury severity score (ISS) 35.8±12.5 points). In addition, the endothelial differentiation capacity of enriched CD34+cells was assessed by analyzing DiI-ac-LDL/lectin uptake, the expression of endothelial markers, and the morphological characteristics of these cells in Matrigel and spheroid cultures. We found that on days 1, 3, and 7 after a major trauma, the number of CD34+cells increased from 6- up to 12-fold (p<0.0001) over the number of CD34+cells from a control population of healthy, age-matched volunteers. The numbers of CD31+ cells were consistently higher on days 1 (1.4-fold, p<0.01) and 7 (1.3-fold, p<0.01), whereas the numbers of CD133+ cell did not change during the time course of investigation. Expression of endothelial marker molecules in CD34+cells was significantly induced in the polytrauma patients. In addition, we show that the CD34+ cell levels in severely injured patients were not correlated with clinical parameters, such as the ISS score, the acute physiology and chronic health evaluation II score (APACHE II), as well as the sequential organ failure assessment score (SOFA-2). Our results clearly indicate that pro-angiogenic cells are systemically mobilized after polytrauma and that their numbers are sufficient for the development of novel therapeutic models in regenerative medicine