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Background: In patients treated for refractory cardiogenic shock (RCS) following acute myocardial infarction (AMI), predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA ECMO) has important implications for decision-making and prognosis. Methods: We performed a retrospective review of adult VA ECMO patients with RCS complicating AMI at our institution from 2010 to 2019. We evaluated use of peak troponin I as a predictor of successful decannulation. Results: Sixty-two patients were analyzed; mean age 61.1 ± 9.8 years, 73% males, 62% presented with STEMI. Forty-five patients were successfully weaned (group I). Seventeen patients did not wean (group II); seven patients received a durable LVAD, 10 died. Patients from group I had significantly lower peak troponin I (89 vs 434 ng/mL, p = 0.0001). Receiver operating characteristic curves showed a peak troponin I cutoff of 400 ng/mL correctly classified patients by weaning status 90% of the time, with associated sensitivity of 71% and specificity of 98%. With each 50 ng/mL increase in troponin I, the likelihood of weaning decreased by 33%. Conclusions: Peak troponin I above 400 ng/mL may be helpful in predicting unsuccessful weaning from VA ECMO support for refractory cardiogenic shock following myocardial infarction and facilitate triage decisions regarding need for advanced therapies.

Objectives: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) has been increasingly used in cardiopulmonary resuscitation (ECPR) in select patients. Few centers have published their experience or outcomes with ECPR. The aim of our study was to evaluate outcomes of adult patients in cardiac arrest placed on VA ECMO in the catheterization laboratory. Methods: We performed a retrospective analysis of adult patients in refractory cardiac arrest who underwent ECPR at the Minneapolis Heart Institute (MHI) at Abbott Northwestern Hospital from January 2012 to December 2017. Relevant data were obtained from electronic medical records, including arrest to ECMO flow time, total ECMO support time, and outcomes. Results: Twenty-six adult patients underwent ECPR at the study site during the defined time period. Seven patients (27%) sustained cardiac arrest out of hospital, 19 patients arrested in-hospital with eight of those occurring in the catheterization laboratory. Seventeen (65%) patients had initial rhythm of ventricular fibrillation or tachycardia (VF/VT). All patients underwent mechanical CPR with LUCAS device. Overall 30 day and 6 month survival was 69%. Median time from arrest to ECMO flow was 46 mins (21,68) vs 61 mins (36,71) in survivors and non-survivors, respectively. Sixteen of 18 survivors discharged with a CPC score of 1 or 2. Conclusions: We demonstrate that adult patients in cardiac arrest initiated on VA ECMO in the cardiac catheterization laboratory and cared for by a multidisciplinary shock team in the critical care unit have superior long-term survival and functionally favorable neurologic recovery when compared to current literature.

This study sought to compare the clinical characteristics and long-term outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with and without cardiogenic shock (CS) or cardiac arrest (CA) before percutaneous coronary intervention (PCI).Patients with STEMI complicated by CS or CA are underrepresented in STEMI registries.Consecutive patients with STEMI or new left bundle branch block within 24 h of symptom onset were included in a regional STEMI program comprising a PCI center (Minneapolis Heart Institute at Abbott Northwestern Hospital), 11 hospitals 60 miles from PCI center (zone 1), and 19 hospitals 60 to 210 miles from PCI center (zone 2). No patients were excluded. Patients were stratified based on the presence (+) or absence (-) of CS or CA before PCI. Patients with CA were further classified based on initial rhythm. Primary outcomes were in-hospital and 5-year mortality.Between March 2003 and December 2014, 4,511 STEMI patients were included in the regional program, including 398 (9%) with CS and 499 (11%) with CA. Hospital mortality was: CS+ and CA+, 44%; CS+ and CA-, 23%; CS- and CA+, 19%; and CS- and CA-, 2% (p 0.001). The 5-year survival probability for CS+ and CA+ patients was 0.69 (95% confidence interval: 0.61 to 0.76) and 0.89 (95% confidence interval: 0.84 to 0.93), respectively (p 0.01). Compared with patients with shockable rhythms, CA patients with nonshockable rhythms had significantly lower odds of survival at hospital discharge and at 5 years (both p 0.001).The combination of CS and CA significantly increases short-term mortality in patients with STEMI. After 5 years of follow-up, CS patients remained at high risk of fatal events, whereas the prognosis of CA patients was determined by initial rhythm at presentation.

Background Over the course of the COVID-19 pandemic, the care of patients with COVID-19 has changed and the use of extracorporeal membrane oxygenation (ECMO) has increased. We aimed to examine patient selection, treatments, outcomes, and ECMO centre characteristics over the course of the pandemic to date.Methods We retrospectively analysed the Extracorporeal Life Support Organization Registry and COVID-19 Addendum to compare three groups of ECMO-supported patients with COVID-19 (aged >= 16 years). At early-adopting centres-ie, those using ECMO support for COVID-19 throughout 2020-we compared patients who started ECMO on or before May 1, 2020 (group A1), and between May 2 and Dec 31, 2020 (group A2). Late-adopting centres were those that provided ECMO for COVID-19 only after May 1, 2020 (group B). The primary outcome was in-hospital mortality in a time-to-event analysis assessed 90 days after ECMO initiation. A Cox proportional hazards model was fit to compare the patient and centre-level adjusted relative risk of mortality among the groups.Findings In 2020, 4812 patients with COVID-19 received ECMO across 349 centres within 41 countries. For earlyadopting centres, the cumulative incidence of in-hospital mortality 90 days after ECMO initiation was 36.9% (95% CI 34.1-39.7) in patients who started ECMO on or before May 1 (group A1) versus 51.9% (50.0-53.8) after May 1 (group A2); at late-adopting centres (group B), it was 58.9% (55.4-62.3). Relative to patients in group A2, group A1 patients had a lower adjusted relative risk of in-hospital mortality 90 days after ECMO (hazard ratio 0.82 [0.70-0.96]), whereas group B patients had a higher adjusted relative risk (1.42 [1.17-1.73]).Interpretation Mortality after ECMO for patients with COVID-19 worsened during 2020. These findings inform the role of ECMO in COVID-19 for patients, clinicians, and policy makers. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

Iatrogenic coronary artery dissection is a feared complication of percutaneous coronary intervention as it can potentially lead to severe myocardial ischemia, arrhythmias, shock, and death. Bailout-stenting or less often, emergent coronary artery bypass graft surgery may be needed for restoring antegrade flow. We describe a case of inferior ST-segment elevation acute myocardial infarction with preserved antegrade coronary flow. Percutaneous coronary intervention was complicated by acute right coronary artery closure during guide catheter engagement. Attempts for re-entry into the right coronary artery true lumen failed. Attempts to obtain right femoral arterial access resulted in retroperitoneal hematoma. The patient developed refractory ventricular fibrillation and could not be defibrillated. Veno-arterial extracorporeal membrane oxygenation was started using surgical right femoral cutdown for the venous cannula and the left common femoral artery for the arterial cannula. A dissection strategy with a knuckled guidewire was used around previously placed stents followed by successful re-entry into the distal right coronary artery using the Stingray system. The venous cannula was changed to the internal jugular vein and the right common femoral artery and vein were surgically repaired. The patient was decannulated two days later and was eventually discharged from the hospital neurologically intact.

Changing look active galactic nuclei (CLAGNs) show complex nature in their X-ray spectral shape and line of sight column density variation. The physical mechanisms responsible for these variations are unclear. Here, we study the spectral properties of a CLAGN, NGC\,1365 using combined {\it XMM-Newton} and {\it NuSTAR} observations to understand the CL behavior. The model fitted mass accretion rate varied between $0.003\pm 0.001$ and $0.009\pm0.002$ $\dot M_{\rm Edd}$ and the dynamic corona changed from $28\pm 3$ to $10\pm1$ $r_g$. We found that the variable absorption column density correlates with the mass accretion rate and the geometry of the corona. The derived wind velocity was sufficiently low compared to the escape velocity to drive the wind away from the disc for the epochs when column densities were high. This suggests that the high and variable absorption can be due to failed winds from the disc. Our estimated ratio of mass outflow to inflow rate from the inner region of the disc lies between $0.019\pm0.006$ and $0.12\pm0.04$. From spectral fitting of the combined data, we found the mass of the central black hole to be constant $4.38\pm0.34 - 4.51\pm0.29 \times10^{6} M_\odot$, consistent with earlier findings. The confidence contours of $N_H$ with other model parameters show that the model fitted parameters are robust and non-degenerate. Our study construed that the changing accretion rate, which is a fundamental physical quantity and the geometry of the corona driving the CL phenomena in NGC\,1365. The physical picture considered in this work connects both variable continuum and variable absorbing medium scenarios., Comment: 8 pages, 7 figures, 1 table, accepted for publication in A&A, comments welcome

Background Continuous flow left ventricular assist devices (CF -LVAD) improve survival in patients with advanced heart failure, but confer risk of bleeding complications. Serotonergic antidepressants (SA) are commonly used in heart failure patients receiving LVADs, but their inhibitory effect on platelet function may contribute to bleeding risk. Methods We performed a retrospective analysis of LVAD patients at our institution from 2016 –2019 comparing patients treated with SA after LVAD to those without SA. Demographic and clinical variables related to bleeding were collected on discharge from index hospitalization for CF-LVAD implantation and on admission for any bleeding event. The primary endpoint was incidence of bleeding requiring hospitalization after discharge . Secondary endpoints included overall number of admissions for bleeding, time to first hospitalization for a bleeding event, and incidence rate of hospitalizations for bleeding per patient year. Results 100 patients met inclusion criteria for the study. A total of 5 patients without a history of SA use and 31 patients who were prescribed SA after CF –LVAD implant were readmitted for a bleeding event after initial implant hospitalization (15% vs 46%, p = 0.004). Bleeding rate per person year (0.3 vs 0.61, p = 0.01) were significantly less in patients without SA use. Age-adjusted multivariable analysis found SA use to be associated with a hospitalization for bleeding (HR 2.3, 95% CI 0.99 –5.4). The higher incidence of hospitalization for bleeding was driven by non-gastrointestinal anatomical sites (6% vs 28%, p = 0.02) with a HR 7.7 (95% CI 0.96 –62). Conclusions SA treatment after CF-LVAD implantation was associated with an increased risk for bleeding complications requiring hospitalization, particularly non-gastrointestinal bleeding.

Sedatives and analgesics are frequently used in critically ill adult patients requiring mechanical ventilation in the intensive care unit, but optimal agent selection and dosing in patients supported with venoarterial extracorporeal membrane oxygenation remain poorly defined. This retrospective study evaluated whether sedative and analgesic agent selection and dosing had any impact on clinical outcomes after venoarterial extracorporeal membrane oxygenation decannulation. The primary endpoint of our study was the incidence of delirium within 48 h after venoarterial extracorporeal membrane oxygenation decannulation in patients who received an empiric ⩾50% sedation reduction of benzodiazepines (N = 22, group 2) compared to those who did not (N = 10, group 1) and those who required no sedatives within 24 h prior to venoarterial extracorporeal membrane oxygenation decannulation (N = 21, group 3). Secondary endpoints included time to extubation after decannulation, need for tracheostomy after decannulation, intensive care unit length of stay after decannulation, total hospital length of stay, and in-hospital mortality. Delirium within 48 h after decannulation was observed in 47% of all patients and did not differ between the three groups (50% vs 50% vs 43%, p = 0.9). No differences were observed in the secondary endpoints; though there was a trend toward shorter duration of mechanical ventilation and intensive care unit length of stay in patients who received an empiric ⩾50% sedation reduction. Our study suggests that we may need more than a 50% reduction in sedation but prospective studies with a larger sample size are warranted to evaluate how sedative/analgesic selection and dosing affect important clinical outcomes.

In 1981, the Be/X-ray binary (Be/XRB) A0538-66 showed outbursts characterized by high peak luminosities in the X-ray and optical bands. The optical outbursts were qualitatively explained as X-ray reprocessing in a gas cloud surrounding the binary system. Since then, further important information about A0538-66 have been obtained, and sophisticated photoionization codes have been developed to calculate the radiation emerging from a gas nebula illuminated by a central X-ray source. In the light of the new information and tools available, we studied again the enhanced optical emission displayed by A0538-66 to understand the mechanisms responsible for these unique events among the class of Be/XRBs. We performed about 10^5 simulations of a gas envelope photoionized by an X-ray source. We assumed for the shape of the gas cloud either a sphere or a circumstellar disc observed edge-on. We studied the effects of varying the main properties of the envelope and the influence of different input X-ray spectra on the optical/UV emission emerging from the photoionized cloud. We compared the computed spectra with the IUE spectrum and photometric UBV measurements obtained during the outburst of 29 April 1981. We also explored the role played by the X-ray heating of the surface of the donor star irradiated by the X-ray emission of the neutron star (NS). We found that reprocessing in a spherical cloud with a shallow radial density distribution can reproduce the optical/UV emission. To our knowledge, this configuration has never been observed either in A0538-66 during other epochs or in other Be/XRBs. We found, contrary to the case of most other Be/XRBs, that the optical/UV radiation produced by the X-ray heating of the surface of the donor star irradiated by the NS is non-negligible, due to the particular orbital parameters of this system that bring the NS very close to its companion., Accepted for publication in Astronomy & Astrophysics. Abstract abridged to meet arXiv requirements

Purpose Right heart failure (RHF) after left ventricular assist device implant is a common. The EUROMACS right-sided heart failure risk score is a novel and more simplified model for predicting early RHF after LVAD implantation. We sought to evaluate its accuracy after Off-pump left ventricular assist device implantation (OPLVADI). Methods This is a retrospective analysis of 82 patients (93% males) who underwent OPLVADI from 2011 to 2019. Forty eight patient were implanted with a HM2 (58%), 31 (38%) with HM3 and 3 (4%) with an HVAD. Using the EUROMACS 5-item scoring system (RA/PWCP >0.54 = 2 pts., Hgb 3 = 2.5 pts., severe RV dysfunction = 2pts) low RHF was defined as score 0-2, moderate >2-4 and severe > 4points. We compared the predicted with actual (post implant) RVF rate in our cohort. Results Based on EUROMACS RHF score pre implant RHF was predicted as low in 57% of patients, moderate in 27% and severein 10%. Actual RHF was mild in 76% of patients, moderate in 22% and severe in 2% of patients. Conclusion In patients who underwent off pump LVAD implantation, the EUROMACS RHF risk score system appears to underestimate the prevalence of mild RHF and overestimates moderate and severe RHF. Larger studies are needed to better characterize factors associated with RHF in this patient population.

We investigate a sample of quasars from the Sloan Digital Sky Survey. The $R_{FeII}$ is the ratio of the equivalent widths of Fe II to H$\beta$. FWHM H$\beta$ vs. this ratio is one of the correlations that is characteristic of the so-called Quasar Main Sequence. We select sources brighter than $m_{i} = 18^{mag}$ and $m_{r} = 18^{mag}$ at redshift lower than 0.7. We write a script to automate analysis of AGN optical spectra. We fit the spectra taking into account the starlight contamination, independent reddening of the starlight and of the disk continuum and consider several Fe II templates. We will compare our results to Shen & Ho (2014) diagram. Finally, we will compare the properties of strong Fe II emitters to the properties of the whole sample, with the aim to identify the key physical mechanism leading to efficient Fe II production. Work is in progress.

In this paper we describe our open source R package that will enable new modern research methodology for astronomers with data and algorithms deep analyses. It is using OpenCL accelerated column-oriented R environment. It will provide a basis to develop the computational project made of database and intelligent numerical algorithms searching for most extreme extragalactic objects and carrying out analyses of AGN. In this project self-learning numerical algorithms will be based on the newest methods of artificial intelligence and typical astronomical analyses approach, which will be first time programmed in R in such the big scope.

Extracorporeal membrane oxygenation (ECMO) has been used increasingly for both respiratory and cardiac failure in adult patients. Indications for ECMO use in cardiac failure include severe refractory cardiogenic shock, refractory ventricular arrhythmia, active cardiopulmonary resuscitation for cardiac arrest, and acute or decompensated right heart failure. Evidence is emerging to guide the use of this therapy for some of these indications, but there remains a need for additional evidence to guide best practices. As a result, the use of ECMO may vary widely across centers. The purpose of this document is to highlight key aspects of care delivery, with the goal of codifying the current use of this rapidly growing technology. A major challenge in this field is the need to emergently deploy ECMO for cardiac failure, often with limited time to assess the appropriateness of patients for the intervention. For this reason, we advocate for a multidisciplinary team of experts to guide institutional use of this therapy and the care of patients receiving it. Rigorous patient selection and careful attention to potential complications are key factors in optimizing patient outcomes. Seamless patient transport and clearly defined pathways for transition of care to centers capable of providing heart replacement therapies (e.g., durable ventricular assist device or heart transplantation) are essential to providing the highest level of care for those patients stabilized by ECMO but unable to be weaned from the device. Ultimately, concentration of the most complex care at high-volume centers with advanced cardiac capabilities may be a way to significantly improve the care of this patient population.

This paper describes the implementation of a system consisting of a mobile application and RESTful architecture server intended for the analysis and presentation of quasars' spectrum. It also depicts the quasar's characteristics and significance to the scientific community, the source for acquiring astronomical objects' spectral data, used software solutions as well as presents the aspect of Cloud Computing and various possible deployment configurations.

Background— In hypertrophic cardiomyopathy (HCM), heart transplant has been predominantly confined to patients with systolic dysfunction. An underappreciated HCM subset comprises patients with preserved left ventricular (LV) systolic function who may also require consideration for transplantation. Therefore, we sought to define the clinical profile and occurrence of advanced heart failure among patients with nonobstructive HCM and preserved systolic function. Methods and Results— Databases from 2 referral centers comprising 2100 HCM patients were interrogated. Forty-six nonobstructive HCM patients (2.2%) either received or were listed for heart transplant, including 20 with normal systolic function (ejection fraction ≥50%). At transplant listing, these 20 patients were 42±13 years old, each in New York Heart Association functional class III/IV with ejection fraction of 62±7%. LV was hypertrophied with maximum wall thickness of 22±4 mm and nondilated (end-diastolic dimension, 39±7 mm). Cardiovascular magnetic resonance in 10 (of 15) patients showed no or minimal fibrosis (≤5% LV mass). Elevated LV end-diastolic or pulmonary capillary wedge pressure, consistent with diastolic dysfunction, was present in 15 patients (75%). LV filling was impaired by echocardiographic measures in all patients, including a restrictive inflow pattern in 8 (40%). In 2 patients, traditional criteria for transplant were absent, including peak V O 2 >14 mL/kg/min. Heart transplantation was performed in 12 patients with each alive and without cardiovascular symptoms, 2.3±1.7 years later. Conclusions— A previously under-recognized segment of the broad HCM clinical spectrum consists of nonobstructive patients with advanced heart failure, in the presence of preserved systolic function, for whom heart transplant is the sole definitive therapeutic option.

Purpose Serotonergic antidepressants (SA) are commonly used for a variety of indications in patients supported with durable left ventricular assist devices (LVAD). Reduced serotonin reuptake with SAs leads to platelet dysfunction and is associated with an increased risk of bleeding across diverse populations. There is limited data on the bleeding risk with SAs in the LVAD population prone to hemorrhagic complications due to other mechanisms. Methods We performed a retrospective analysis of LVAD patients (pts) managed at our institution from January 2016 to August 2018. Pertinent demographics and clinical variables related to bleeding were collected at the time of discharge from LVAD implantation and on admission for a bleeding event. Pts were divided into those prescribed an SA at discharge from LVAD implantation or admitted for a bleeding event with documented SA use prior to admission (Group 1) and those without SA exposure after implant (Group 2). Primary and secondary endpoints included incidence of bleeding requiring hospitalization, time from implant to first hospitalization for a bleeding event, and incidence rate of hospitalizations for bleeding per patient years. Results A preliminary analysis of 20 randomly selected pts out of 95 total implants performed. Ten pts were prescribed an SA (Group 1) and 10 were not (Group 2). Baseline demographics and bleeding risk factors were similar between the (two) 2 groups. Trazodone and sertraline were the most commonly prescribed SAs (35% each) and multiple SA use was common (50%). Acid suppressive therapy was used in all pts at discharge. In Group 1, 50% of the pts were hospitalized for a bleeding event compared to 10% of pts in Group 2 (p=0.1). At 1 year, 60% of pts remained free from hospitalization for a bleeding event in Group 1 compared to 100% in Group 2 (p=0.16). The number of bleeds per patient-year in Group 1 vs. those in Group 2 was 0.79 vs 0.4, respectively (p=0.26). Gastrointestinal (6 vs. 3 events) and intracranial (2 vs. 0 events) bleeding was more common in Group 1. Conclusion A preliminary analysis of patients with an LVAD treated with SA therapy demonstrated a trend towards an increased rate of hospitalization due to bleeding and a shorter time to first hospitalization compared to those who were not treated with an SA. Our final analysis will expand to all 95 patients to determine the significance of these findings.

Institutional Affiliations Co-chairs Feldman D: Minneapolis Heart Institute, Minneapolis, Minnesota, Georgia Institute of Technology and Morehouse School of Medicine; Pamboukian SV: University of Alabama at Birmingham, Birmingham, Alabama; Teuteberg JJ: University of Pittsburgh, Pittsburgh, Pennsylvania Task force chairs Birks E: University of Louisville, Louisville, Kentucky; Lietz K: Loyola University, Chicago, Maywood, Illinois; Moore SA: Massachusetts General Hospital, Boston, Massachusetts; Morgan JA: Henry Ford Hospital, Detroit, Michigan Contributing writers Arabia F: Mayo Clinic Arizona, Phoenix, Arizona; Bauman ME: University of Alberta, Alberta, Canada; Buchholz HW: University of Alberta, Stollery Children’s Hospital and Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada; Deng M: University of California at Los Angeles, Los Angeles, California; Dickstein ML: Columbia University, New York, New York; El-Banayosy A: Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Elliot T: Inova Fairfax, Falls Church, Virginia; Goldstein DJ: Montefiore Medical Center, New York, New York; Grady KL: Northwestern University, Chicago, Illinois; Jones K: Alfred Hospital, Melbourne, Australia; Hryniewicz K: Minneapolis Heart Institute, Minneapolis, Minnesota; John R: University of Minnesota, Minneapolis, Minnesota; Kaan A: St. Paul’s Hospital, Vancouver, British Columbia, Canada; Kusne S: Mayo Clinic Arizona, Phoenix, Arizona; Loebe M: Methodist Hospital, Houston, Texas; Massicotte P: University of Alberta, Stollery Children’s Hospital, Edmonton, Alberta, Canada; Moazami N: Minneapolis Heart Institute, Minneapolis, Minnesota; Mohacsi P: University Hospital, Bern, Switzerland; Mooney M: Sentara Norfolk, Virginia Beach, Virginia; Nelson T: Mayo Clinic Arizona, Phoenix, Arizona; Pagani F: University of Michigan, Ann Arbor, Michigan; Perry W: Integris Baptist Health Care, Oklahoma City, Oklahoma; Potapov EV: Deutsches Herzzentrum Berlin, Berlin, Germany; Rame JE: University of Pennsylvania, Philadelphia, Pennsylvania; Russell SD: Johns Hopkins, Baltimore, Maryland; Sorensen EN: University of Maryland, Baltimore, Maryland; Sun B: Minneapolis Heart Institute, Minneapolis, Minnesota; Strueber M: Hannover Medical School, Hanover, Germany Independent reviewers Mangi AA: Yale University School of Medicine, New Haven, Connecticut; Petty MG: University of Minnesota Medical Center, Fairview, Minneapolis, Minnesota; Rogers J: Duke University Medical Center, Durham, North Carolina

Mortality due to refractory cardiogenic shock (RCS) exceeds 50%. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has become an accepted therapy for RCS. The aim of our study was to evaluate outcomes of patients with RCS treated with percutaneous VA-ECMO (pVA-ECMO). Retrospective review of patients supported with VA-ECMO at our institution in 2012-2013. Clinical characteristics, bleeding, vascular complications, and outcomes including survival were assessed. A total of 37 patients were supported with VA-ECMO for RCS. The majority of VA-ECMO (76%) was placed in the catheterization laboratory. Nearly half (49%) of the patients presented with acute myocardial infarction. Seven patients (19%) underwent insertion of pVA-ECMO in the setting of cardiopulmonary resuscitation with mechanical chest compression device. Median duration of support was 5 days. Index hospitalization, 30-day, and 1-year survival were 65%, 65%, and 57%, respectively. Survival rate for discharged patients was 87.5% with a median follow-up of 450 days. Refractory cardiogenic shock supported with pVA-ECMO is associated with an improved survival in patients with a traditionally poor prognosis.

Mechanical circulatory support (MCS) is, as the name implies, the use of electro-mechanical devices to support the circulatory system. This support may be uni-ventricular, bi-ventricular, pulmonary, percutaneous, central, or any combination of these, depending on the clinical scenario. A large component of MCS use is in a more permanent fashion in the bridge-to-transplant (BTT) or destination therapy (DT) patient. The other scenario where MCS is used is in the acute setting as a means of supporting the patient as a bridge-to-recovery or a bridge-to-decision about long-term MCS.

Obtaining interesting celestial objects from tens of thousands or even millions of recorded optical-ultraviolet spectra depends not only on the data quality but also on the accuracy of spectra decomposition. Additionally rapidly growing data volumes demands higher computing power and/or more efficient algorithms implementations. In this paper we speed up the process of substracting iron transitions and fitting Gaussian functions to emission peaks utilising C++ and OpenCL methods together with the NOSQL database. In this paper we implemented typical astronomical methods of detecting peaks in comparison to our previous hybrid methods implemented with CUDA.

Cardiovascular care has witnessed a paradigm shift toward widespread use of mechanical circulatory support (MCS). In this context, the 2015 SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care is a timely and welcome addition to the literature. This consensus statement is an important summary of the state of the field and a valuable method for all who participate in cardiovascular care to ensure up-to-date understanding of the treatment options available.

We propose a very simple physical mechanism responsible for the formation of the Low Ionization Line part of the Broad Line Region in Active Galactic Nuclei. It explains the scaling of the Broad Line Region size with the monochromatic luminosity, including the exact slope and the proportionality constant, seen in the reverberation studies of nearby sources. The scaling is independent from the mass and accretion rate of an active nucleus. The mechanism predicts the formation of a dust-driven wind in the disk region where the local effective temperature of a non-illuminated accretion disk drops below 1000 K and allows for dust formation. We explore now the predictive power of the model with the aim to differentiate between this model and the previously proposed mechanisms of the formation of the Broad Line Region. We discuss the expected departures from the universal scaling at long wavelength, and the role of the inclination angle of the accretion disk in the source. We compare the expected line profiles with Mg II line profiles in the quasars observed by us with the SALT telescope. We also discuss the tests based on the presence or absence of the broad emission lines in low luminosity active galaxies. Finally, we discuss the future tests of the model to be done with expected ground-based observations and satellite missions., Based the talk presented during the COSPAR 2014 meeting, Advances in Space Research (in press)

The Mg II line is of extreme importance in intermediate redshift quasars since it allows us to measure the black hole mass in these sources and to use these sources as probes of the distribution of dark energy in the Universe, as a complementary tool to SN Ia. Reliable use of Mg II requires a good understanding of all the systematic effects involved in the measurement of the line properties, including the contamination by Fe II UV emission. We performed three spectroscopic observations of a quasar LBQS 2113-4538 (z = 0.956) with the SALT telescope separated in time by several months and we analyze in detail the mean spectrum and the variability in the spectral shape. We show that even in our good-quality spectra the Mg II doublet is well fit by a single Lorentzian shape. We tested several models of the Fe II pseudo-continuum and showed that one of them well represents all the data. The amplitudes of both components vary in time, but the shapes do not change significantly. The measured line width of LBQS 2113-4538 identifies this object as a class A quasar. The upper limit of $3\%$ for the contribution of the Narrow Line Region (NLR) to Mg II may suggest that the separation of the Broad Line Region (BLR) and NLR disappears in this class of objects., 10 pages, 8 figures, accepted to A&A

We present photoionisation modelling of the intrinsic absorber in the bright quasar HS 1603+3820. We construct spectral energy distribution using optical/UV/X-ray observations as an input to photoionisation calculations. Spectra from Keck telescope show extremely high ratio of CIV to HI, for the first absorber in system A, named A1. This value, together with high column density of CIV ion, puts strong constraints on photoionisation model. We use photoionisation modeling to derive hydrogen number density at the cloud illuminated surface. Estimating bolometric luminosity of HS 1603+3820, from typical formula for quasars, we calculate the distance to A1. The derived location is as close as 0.1 pc, and situates an absorber even closer to the nucleus than the possible location of the Broad Line Region in this object, Comment: 15 pages, 9 figures, submitted to New Astronomy

High redshift quasars can be used to deduce the distribution of dark energy in the Universe, as a complementary tool to SN Ia. The method is based on determination of the size of the Broad Line Region from the emission line delay, determination of the absolute monochromatic luminosity either from the observed statistical relation or from a model of the formation of the Broad Line Region, and determination of the observed monochromatic flux from photometry. This allows to obtain the luminosity distance to a quasar independently from its redshift. The accuracy of the measurements is however, a key issue. We model the expected accuracy of the measurements by creating artificial quasar monochromatic lightcurves and responses from the Broad Line Region under various assumptions about the variability of a quasar, Broad Line Region extension, distribution of the measurements in time, accuracy of the measurements and the intrinsic line variability. We show that the five year monitoring based on Mg II line should give the accuracy of 0.06 - 0.32 magnitude in the distance modulus which allows to put interesting constraints on the cosmological models. Monitoring of higher redshift quasars based on CIV lines is problematic due to much higher level of the intrinsic variability of CIV in comparison with Mg II., Comment: accepted to Astronomy & Astrophysics

Finding interesting celestial objects among tens of thousands or even millions of recorded raw data is not an easy task to implement. In this paper we speed up this process with high level nvidia cuda C++ template library called Thrust, which makes our database with R interface much more efficient.

Although recent years bring massive astronomical surveys which have been extensivly searched, there are still many mysteries burried in the data. We attempt to extract objects with untypical emission lines. Especialy those with with weak and absent emission but without significant absorption. For that purpose we created database which contains quasars spectra for a quick access and peaks detection code in R environment what we describe in this article.

Weak emission line quasars are a rare and puzzling group of objects. In this paper we present one more object of this class found in the Sloan Digital Sky Survey (SDSS). The quasar SDSS J094533.99+100950.1, lying at z = 1.66, has practically no C IV emission line, a red continuum very similar to the second steepest of the quasar composite spectra of Richards et al., is not strongly affected by absorption and the Mg II line, although relatively weak, is strong enough to measure the black hole mass. The Eddington ratio in this object is about 0.45, and the line properties are not consistent with the trends expected at high accretion rates. We propose that the most probable explanation of the line properties in this object, and perhaps in all weak emission line quasars, is that the quasar activity has just started. A disk wind is freshly launched so the low ionization lines which form close to the disk surface are already observed but the wind has not yet reached the regions where high ionization lines or narrow line components are formed. The relatively high occurrence of such a phenomenon may additionally indicate that the quasar active phase consists of several sub-phases, each starting with a fresh build-up of the Broad Line Region., Comment: 10 pages, 3 figures, 5 tables; accepted for publication in MNRAS

Quasars can be used as a complementary tool to SN Ia to probe the distribution of dark energy in the Universe by measuring the time delay of the emission line with respect to the continuum. The understanding of the Mg II emission line structure is important for cosmological application and for the black hole mass measurements of intermediate redshift quasars. The knowledge of the shape of Mg II line and its variability allows to determine which part of the line should be used to measure the time delay and the black hole mass. We thus aim at determination of the structure and the variability of the Mg II line as well as of the underlying Fe II pseudo-continuum. We performed five spectroscopic observations of a quasar CTS C30.10 (z = 0.9000) with the SALT telescope between December 2012 and March 2014, and we studied the variations of the spectral shape in the 2700 - 2900 A rest frame. We showed that the Mg II line in this source consists of two kinematic components, which makes the source representative of type B quasars. Both components were well modeled with a Lorentzian shape. Both components vary in a similar way. The Fe II contribution seems to be related only to the first (blue) Mg II component}. Broad band spectral fitting rather favor the use of the whole line profile. The contribution of the Narrow Line Region to Mg II is very low, below 2%. The Mg II variability is lower than the variability of the continuum, which is consistent with the simple reprocessing scenario. The variability level of CTS C30.10 and the measurement accuracy of the line and continuum is high enough to expect that further monitoring will allow to measure the time delay between the Mg II line and continuum., Comment: accepted to Astronomy & Astrophysics; no language corrections

SDSS J094533.99+100950.1 is a weak line quasar (WLQ) characterised by a low equivalent widths of the high-ionization emission lines such as CIV or HeII, typical iron emission, radio quiescence and X-ray weakness. In our work we tried to answer the question if it is possible that observed emission is intrinsically weak and come from not fully developed broad emission-line region (BELR). We also analyse the observed continuum to check if it is able to ionize a BELR gas and reproduce a weakness of emission-lines or this spectral feature can be simply explained by an intrinsic absorption. Our conclusion is that the minimal active galactic nuclei (AGN) engine consisting of an unobscured accretion disk with a partially ionized gas just expanding from the disk atmosphere is enough to explain observed features of SDSS J094533.99+100950.1.

Purpose: Development of aortic insufficiency (AI) in patients (pts) during continuous flow LVAD support is a well known phenomenon that can lead to ineffective LVAD output. Current literature reports an average AI progression by 0.7 grade at 6 months (mo). We hypothesized that optimal medical therapy (MT) together with lowering the LVAD speed to allow aortic valve (AV) opening delays development of significant AI. Methods and Materials: Charts and echocardiograms (echos) of 40 LVAD pts were reviewed for demographics and medications. Medications were uptitrated to MAP of 60-80mmHg. VAD speed (RPM) was reduced according to our outpatient VAD protocol and collected at 1 and 6 mo. Echos were reviewed at baseline (pre LVAD), 1 and 6 mo for left ventricular end diastolic dimensions (LVEDD)(cm), AV opening, presence/ absence of AI. AI was graded: O-none, 0.5-trace,1-mild,1.5-mild-moderate, 2-moderate, 2.5-moderate-severe, 3-severe. Results: Forty pts, mean age 58, were included in the study. At 6 mo 38/40 (93%) pts were receiving beta blocker (BB), 30/40 (73%) ACE-I/ARB, 27/40 (66%) aldosterone receptor blocker (ALDOBL). Fifty six percent of pts achieved half of maximal daily dose of ACE-I/ARB, 45% BB and 53% ALDOBL. Twenty nine out of 40 (71%) pts were on furosemide, mean dose 32 mg. At baseline mean LVEDD was 6.8, AI present in 12/40 pts (30%), mean grade 0.3. At 1 mo LVEDD decreased to a mean 5, AI present in 6/22 (27%) pts, mean grade 0.27. At 6 mo LVEDD was the same, mean 5.1, AI present in 8/19 (42%) pts. Mean grade increased from 0.27 to 0.4 (p 0.3). Mean LVAD speed at 1 mo was 9190 and decreased to 8840 at 6 mo (p 0.001). At 1 mo AV opened with every beat in 33% pts, partially opened in 8%, did not open in 54%. At 6 mo AV opened with every beat in 36% pts, partially opened in 21%, did not open in 43%. Conclusions: Our results suggest slower progression in the AI grade at 6 mo in LVAD pts, than reported to date. An early strategy of decreasing VAD speed combined with optimization of MT may account for this difference and possibly improve long term survival.

Transformation and rosette formation of peripheral blood lymphocytes were studied. We have observed decrease in lymphocyte response to the mitogen as well as in spontaneous ability to the transformation. The percent of B-rosettes was diminished, while T-rosettes were in normal ranges. Lower index of completely transformed ones in men indulged to freely in alcohol may be consequence of altered cell membrane fluidity of shifts in T lymphocyte subpopulations.