INTRODUCTION: Use of the mechanically expandable transcatheter aortic valve (MEV) has been recently linked to increased risks of valve dysfunction and cardiovascular mortality. The risk of developing conduction disturbance with the MEV valve is well known, and the negative prognostic impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation is another consideration. AIM: This study aimed to compare the mid-term survival of patients with MEV and self-expandable valves (SEV), and to examine survival of both groups according to the presence or absence of PPI. METHODS: This single-centre, retrospective, observational study examined data from MEV and SEV groups comprising 92 and 373 patients, respectively. The mean clinical follow-up was 2.5±1.7 years. Mortality information was obtained from the National Institutes of Health Information and Statistics. RESULTS: Baseline characteristics were comparable between the groups. The log-rank test showed higher cardiovascular mortality in the MEV group (p=0.042; the relative risk (RR) 1.594 (95% CI 1.013 to 2.508)). The Cox proportional hazards model identified MEV implantation as an independent predictor of cardiovascular mortality. The rate of PPI was twice as high in the MEV vs SEV group (33.7% vs 16.1%; p<0.001). We compared the survival of both groups according to the presence or absence of PPI and found higher mortality in the MEV group without PPI versus the SEV group without PPI (p=0.007; RR 2.156 (95% CI 1.213 to 3.831)). Survival did not differ in the groups with PPI. CONCLUSIONS: A higher mid-term cardiovascular mortality rate was observed with MEV versus SEV implants. Comparing both groups according to the presence or absence of PPI, we observed a higher mortality risk in patients with MEV without PPI than in SEV without PPI. In contrast, mortality did not differ between the groups when PPI was implanted.
- MeSH
- aortální chlopeň diagnostické zobrazování chirurgie MeSH
- aortální stenóza * diagnostické zobrazování chirurgie MeSH
- kardiostimulátor * MeSH
- lidé MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
Introduction: Long-term data on the Lotus® (Boston Scientific, USA) valve are lacking. Aim: To evaluate mid-term outcomes of aortic stenosis patients treated with either Lotus or Evolut R® valves (Medtronic, USA). Material and methods: Our study sample comprised 190 patients (71 Lotus and 119 Evolut valves). The mean clinical follow-up was 2.0 ±0.9 years. Information on mortality was obtained from the National Institutes of Health Information and Statistics. Results: No significant differences existed in baseline characteristics between the groups. The rate of procedural complications was low and without significant differences between groups. The log rank test showed higher mortality in the Lotus group for cardiovascular mortality (p = 0.02; RR = 2.4, 95% CI: 1.123-5.075). Multivariable analysis revealed that the Lotus valve was independently associated with cardiovascular mortality (p = 0.03). At the end of echocardiography follow-up (4.1 ±0.9 years), we found a significantly higher mean aortic valve gradient (AVGm) in the Lotus group than in the Evolut group (17.9 ±9.5 vs. 10.2 ±3.5 mm Hg; p = 0.0006), and 3 (10%) patients from the Lotus group suffered from symptomatic re-stenosis requiering re-intervention. Conclusions: The results of our study suggest that higher cardiovascular mortality rates during mid-term follow-up were associated with Lotus compared with Evolut valves. Higher AVGm in the Lotus valves suggests the possibility of accelerated prosthesis degeneration.
- Publikační typ
- časopisecké články MeSH
Automated sentiment analysis is becoming increasingly recognized due to the growing importance of social media and e-commerce platform review websites. Deep neural networks outperform traditional lexicon-based and machine learning methods by effectively exploiting contextual word embeddings to generate dense document representation. However, this representation model is not fully adequate to capture topical semantics and the sentiment polarity of words. To overcome these problems, a novel sentiment analysis model is proposed that utilizes richer document representations of word-emotion associations and topic models, which is the main computational novelty of this study. The sentiment analysis model integrates word embeddings with lexicon-based sentiment and emotion indicators, including negations and emoticons, and to further improve its performance, a topic modeling component is utilized together with a bag-of-words model based on a supervised term weighting scheme. The effectiveness of the proposed model is evaluated using large datasets of Amazon product reviews and hotel reviews. Experimental results prove that the proposed document representation is valid for the sentiment analysis of product and hotel reviews, irrespective of their class imbalance. The results also show that the proposed model improves on existing machine learning methods.
- MeSH
- algoritmy * MeSH
- emoce MeSH
- lidé MeSH
- neuronové sítě * MeSH
- sémantika MeSH
- strojové učení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
55 stran : ilustrace ; 19 x 26 cm
Brožura se zaměřuje na projekt návrhu stavby bydlení pro seniory, zejména na použité materiály a na konstrukci. Určeno odborné veřejnosti.
- MeSH
- domovy pro seniory MeSH
- dřevo MeSH
- konstrukční materiály MeSH
- projektování a výstavba zařízení metody MeSH
- zdravotní služby pro seniory MeSH
- železo MeSH
- Publikační typ
- práce podpořená grantem MeSH
- Geografické názvy
- Česká republika MeSH
- Konspekt
- Architektura
- NLK Obory
- technika
- geriatrie
- NLK Publikační typ
- brožury
PURPOSE OF THE STUDY Transposition of tibialis posterior muscle ranks among the methods of dorsiflexion restoration in patients with peroneal nerve palsy. Even though this method is commonly used, anatomical variations are still encountered which make us modify the established procedures. The purpose of this study is to evaluate the functional outcomes of operated patients and based on the clinical experience to define by cadaver preparation the anatomical causes preventing the use of the standard transposition technique. MATERIAL AND METHODS The clinical group includes 21 patients (15 men, 6 women) with the mean age of 34.2 years and with common peroneal nerve palsy confirmed by EMG. In 20 patients, transposition of the tendon of the tibialis posterior muscle (MTP) through the interosseous membrane of the leg was performed. In one patient the tendon was transposed ventrally to the distal end of the tibia and fixed in the lateral cuneiform bone due to an extremely narrow space of the interosseous membrane of the leg distally between the lower limb bones. In 18 patients the tendon was fixed by osteosuture to the base of 3rd metatarsal bone, in three patients to the lateral cuneiform bone. The outcomes were evaluated at 6 months after the surgery, when active ankle dorsiflexion (DF) range of motion greater than 5° was considered an excellent outcome, active position at 90° up to DF less than 5° a satisfactory outcome, and any plantigrade position as a poor outcome. The anatomical study included 20 extremities fixed by formalin (10 cadavers, 5 men and 5 women with the mean age of 71.3 years). The length of the individual parts of tibialis posterior muscle was measured and the variations of the muscle attachment were evaluated. The measurement was concluded by a simulation of surgical procedure. RESULTS When evaluating the clinical group, an excellent outcome was reported in 12 patients (57%), a satisfactory outcome in 8 patients (38%) and a poor outcome in one patient (5%). When evaluating the anatomical group, a division of the attaching part of the tendon into three main strips was observed. The thickest middle strip attached to the tuberosity of navicular bone and medial cuneiform bone was reported in all the specimens. The thinner lateral strip (originating from the tendon in 90% of specimens) was attached to the intermediate and lateral cuneiform bone, the cuboid bone, metatarsal bones II-V, and moreover it grows into the origin of the flexor hallucis brevis muscle. The third strip of the tendon attached to the sustentaculum tali, plantar calcaneonavicular ligament and fibrocartilago navicularis was missing in one specimen (5%). When the passing the tendon through the interosseous space between the lower limb bones was simulated in order for the tendon to go in the direction of the planned traction, in two specimens (10%) the pulling through was impossible due to the tendon being thicker than the interosseous space. In two specimens (10%) it was not the tendon, but already the muscular belly which passed through the given space. DISCUSSION In our group, 95% of the functional outcomes were excellent or satisfactory. A poor result was reported in one patient, in whom the EMG examination was not performed as a standard procedure and in whom the muscular strength was insufficient to achieve full dorsiflexion of the ankle. The anatomical study indicates that the narrow space between the lower limb bones can prevent the pulling through of the tendon, which can be addressed intraoperatively by the transposition of the tendon ventrally to tibia. The study reveals that the tendon necessary for transposition can be elongated by the strips of the tendon attached to the sole of the foot. CONCLUSIONS The knowledge of the anatomical conditions may help us better manage potential complications intraoperatively. Key words: tibialis posterior muscle, peroneal nerve palsy, transposition of tibialis posterior muscle, anatomy of tibialis posterior muscle, common fibular nerve palsy.
- MeSH
- dospělí MeSH
- kosterní svaly transplantace MeSH
- lidé MeSH
- mrtvola MeSH
- neuropatie nervus peroneus chirurgie MeSH
- obnova funkce MeSH
- přenos šlachy metody MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Regional innovation performance is an important indicator for decision-making regarding the implementation of policies intended to support innovation. However, patterns in regional innovation structures are becoming increasingly diverse, complex and nonlinear. To address these issues, this study aims to develop a model based on a multi-output neural network. Both intra- and inter-regional determinants of innovation performance are empirically investigated using data from the 4th and 5th Community Innovation Surveys of NUTS 2 (Nomenclature of Territorial Units for Statistics) regions. The results suggest that specific innovation strategies must be developed based on the current state of input attributes in the region. Thus, it is possible to develop appropriate strategies and targeted interventions to improve regional innovation performance. We demonstrate that support of entrepreneurship is an effective instrument of innovation policy. We also provide empirical support that both business and government R&D activity have a sigmoidal effect, implying that the most effective R&D support should be directed to regions with below-average and average R&D activity. We further show that the multi-output neural network outperforms traditional statistical and machine learning regression models. In general, therefore, it seems that the proposed model can effectively reflect both the multiple-output nature of innovation performance and the interdependency of the output attributes.
- MeSH
- organizační inovace * MeSH
- rozhodování MeSH
- společenská třída MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
Současné výsledky metaanalýz a randomizovaných studií neposkytují důkazy pro nadřazenost perkutánní koronární intervence či optimální farmakoterapie ve smyslu redukce mortality či rizika vzniku infarktu myokardu při léčbě chronické stabilní oligosymptomatické ischemické choroby srdeční. Při rozhodování o způsobu léčby je nezbytné zvážit další kritéria, kterými mohou být individuální klinická prezentace, rozsah ischemie či aterosklerotického postižení. Stanovení individuálního rizika léze, a tedy i pacienta pomocí moderních invazivních zobrazovacích metod a užití biodegradabilních technologií mohou v blízké budoucnosti sehrát na tomto poli významnou úlohu. Úloha intervenčního kardiologa současnosti v léčbě chronické stabilní ischemické choroby srdeční je při absenci definitivních randomizovaných dat zcela nezastupitelná a spočívá v uvážlivém a odpovědném výběru přiměřeného diagnostického a terapeutického postupu s nejlepším poměrem riziko vs prospěch pro pacienta.
Current results of meta‑analyses and randomized trials have not brought any proof of superiority of PCI or medical therapy in reduction of nonfatal MI or all‑cause or cardiovascular mortality in patients with chronic stable oligosymptomatic coronary artery disease. Therefore, it is necessary to consider several sources of information in the therapeutic decision‑making process, such as individual clinical presentation, extent of ischemia or atherosclerosis. The evaluation of individual lesion or patient risk using modern invasive imaging methods and introduction of bioresorbable technologies may play a significant role in this field in the near future. The role of an interventional cardiologist in situations where randomized data are lacking is critical and is based on a responsible choice of appropriate diagnostic and therapeutic strategy considering the best risk/benefit ratio for the patient.
- Klíčová slova
- vulnerabilní plát, biodegradabilní stenty,
- MeSH
- aterosklerotický plát diagnóza patofyziologie MeSH
- ateroskleróza patofyziologie MeSH
- biokompatibilní materiály MeSH
- blízká infračervená spektroskopie MeSH
- chronická nemoc MeSH
- infarkt myokardu prevence a kontrola MeSH
- ischemická choroba srdeční * diagnóza terapie MeSH
- koronární angioplastika * MeSH
- lidé MeSH
- stenty uvolňující léky * MeSH
- tkáňové podpůrné struktury MeSH
- vstřebatelné implantáty MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
