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Introduction Left ventricular assist devices (LVADs) play a fundamental role in treating end-stage heart failure. Outflow graft stenosis (OGS) represents a serious complication that can occur at a variable time point after the implantation, although typically of the order of months to years. Different types of OGS, both intrinsic and external, were described. Notwithstanding the etiology, this clinical scenario poses a life and health-threatening complication requiring timely and precise diagnosis followed by appropriate intervention. Case Report We present a case of a 72-years-old woman on LVAD HeartMate II (HM II) support. Three years after the index implantation, she presented with clinical symptoms of outflow graft stenosis. The patient was admitted to the hospital due to”low-flow“ alarms of HMII. The CT scan revealed distal outflow graft stenosis suggestive of kinking of the graft. Subsequent percutaneous transluminal stenting of the graft was performed. However, after the intervention, signs of hemodynamic compromise persisted. Both angiography and repeated CT scans verified peculiar pattern of the proximal shift of the stenotic segment relative to the implanted stent. Given this specific feature, a diagnosis was reclassified as a previously reported pattern of the outflow graft twist scenario, and surgical subxiphoid approach reexploration was indicated. On inspection, after disconnecting the bend relief from the pump body massive”gelly mass“ plasma transudate located in the interspace between the graft and the bend relief was observed. Immediately after removing compressing gelly mass, hemodynamic and pump parameters promptly resolved, and the bend relief was re-attached. Further patient follow-up remains uneventful to the date. Summary Our observation suggests that the diagnostic assessment of the outflow graft stenosis may be confusing and challenging. As plasma transudate likely develops over an extended period of time once a distal orifice of the bend relief already gets entrapped within the adjacent adhesion, the outflow graft may become contained within incompressible interspace while limited by tight connection to the pump body. That said, the graft constriction migration upon stenting can easily get misdiagnosed as a pattern suggestive of the intrinsic twist instead of correct”pseudotwist“ diagnosis associated with the external contained compartment compression.

Left ventricular assist devices (LVAD), currently used in treatment of terminal heart failure, are working on principle of rotary pump, which generates continuous blood flow. Non-pulsatile flow is supposed to expose endothelial cells to high stress and potential damage. Therefore, we investigated longitudinal changes in concentration of circulating endothelial microparticles (EMP) as a possible marker of endothelial damage before and after implantation of LVAD. Study population comprised 30 patients with end-stage heart failure indicated for implantation of the Heart Mate II LVAD. Concentrations of microparticles were measured as nanomoles per liter relative to phosphatidylserine before and 3 months after implantation. At 3 months after implantation we observed significant decrease in concentration of EMP [5.89 (95 % CI 4.31-8.03) vs. 3.69 (95 % CI 2.70-5.03), p=0.03] in the whole group; there was no difference observed between patients with ischemic etiology of heart failure (n=18) and with heart failure of non-ischemic etiology (n=12). In addition, heart failure etiology had no effect on the rate of EMP concentration decrease with time. These results indicate possibility that LVAD do not cause vascular damage 3 months after implantation. Whether these results suggest improvement of vascular wall function and of endothelium is to be proved in long-term studies.

This paper aims on a quality estimation of voice services in converged corporate networks. Besides the techno-centric Quality of Service (QoS) metrics a research area called Quality of Experience (QoE) provides metrics and methods for quality evaluation from the end-user's perspective. This contribution focuses on a QoE estimation of Voice over IP (VoIP) calls. Existing methods of voice quality estimation are compared on different voice codecs tested on a network topology suffering from distortions of real network. Finally, a regression analysis is employed to provide better understanding of impact of network conditions (delay, jitter, packet loss) on the VoIP service quality. The results can improve the voice quality monitoring systems in corporate networks.

In this paper, an overview of scheduling mechanisms constructed to enhance availability of services an embedded real-time system delivers is introduced along with the concept of a framework for comparison of the mechanisms. The framework expects that XML-based descriptions of the following parts of the system are available at its input: target device, operating system, application, scheduler and specification of experiments. On basis of the inputs, the framework is able to produce source-codes for a given platform and an operating system and after their compilation and programming by third-party tools, to perform and evaluate the experiments according to their specification. The applicability of the framework has been shown on selected component-of-the-shelf components such as a microcontroller, an operating system and on several sets of artificial as well as real-world applications running under limiting conditions such as insufficient amount of power and/or computational (re)sources. At the end of the paper, several mechanisms are evaluated on basis of the framework in order to show its practical applicability and kind of results achievable at its output.

We describe a very rare case of outflow cannula obstruction with fungal infectious thrombus formation. Discussion includes the etiology, diagnosis, and management of fungal infection complications related with long-term mechanical circulatory support. Left ventricular assist devices (LVADs) are increasingly used as bridge to transplant and permanent long-term therapy in the population with end-stage heart failure. Even though better clinical outcomes have been achieved with the newer-generation continuous-flow devices, infection complications are still a major risk for patients with continuous-flow LVAD implantation in long-term follow-up [Ann Thorac Surg 90:1270-1277, 2010]. Device-related infections can be categorized as driveline infections, pump-pocket infections, and LVAD-associated endocarditis [Expert Rev Med Devices 8: 627-634, 2011]. The microbiological profile is very heterogeneous; the most common pathogens are Staphylococcus, Pseudomonas, Streptococcus species, and Candida. Severe fungal infection may lead to dysfunction of the LVAD due to obstructive mass formation within the device. Due to the only anecdotal reports in the current literature, we present a very rare case of outflow fungal infectious thrombus formation leading to outflow cannula obstruction in patient with LVAD.

The Atacama Large Millimeter Array (ALMA) will, when it is completed in 2012, be the world's largest millimeter & sub-millimeter radio telescope. It will consist of 64 antennas, each one 12 meters in diameter, connected as an interferometer. The ALMA Test Interferometer Control System (TICS) was developed as a prototype for the ALMA control system. Its initial task was to provide sufficient functionality for the evaluation of the prototype antennas. The main antenna evaluation tasks include surface measurements via holography and pointing accuracy, measured at both optical and millimeter wavelengths. In this paper we will present the design of TICS, which is a distributed computing environment. In the test facility there are four computers: three real-time computers running VxWorks (one on each antenna and a central one) and a master computer running Linux. These computers communicate via Ethernet, and each of the real-time computers is connected to the hardware devices via an extension of the CAN bus. We will also discuss our experience with this system and outline changes we are making in light of our experiences.

a b s t r a c t Fulminant myocarditis (FM) is an inflammation of the myocardium characterized by progressive acute heart failure leading to cardiogenic shock that develops over several hours. In this article, we present a case of a female patient with acute fulminant lymphocytic myocarditis who was successfully treated with biventricular MCS.