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Scholz K.H.,St Bernward Hospital | Maier S.K.G.,Julius Maximilians University Wrzburg | Jung J.,Klinikum Worms | Fleischmann C.,Klinikum Wolfsburg | And 9 more authors.
JACC: Cardiovascular Interventions | Year: 2012

Objectives This study sought to evaluate the effect of systematic data analysis and standardized feedback on treatment times and outcome in a prospective multicenter trial. Background Formalized data feedback may reduce treatment times in ST-segment elevation myocardial infarction (STEMI). Methods Over a 15-month period, 1,183 patients presenting with STEMI were enrolled. Six primary percutaneous coronary intervention hospitals in Germany and 29 associated nonpercutaneous coronary intervention hospitals participated. Data from patient contact to balloon inflation were collected and analyzed. Pre-defined quality indicators, including the percentage of patients with pre-announced STEMI, direct handoff in the catheterization laboratory, contact-to-balloon time <90 min, door-to-balloon time <60 min, and door-to-balloon time <30 min were discussed with staff on a quarterly basis. Results Median door-to-balloon time decreased from 71 to 58 min and contact-to-balloon time from 129 to 103 min between the first and the fifth quarter (p < 0.05 for both). Contributing were shorter stays in the emergency department, more direct handoffs from ambulances to the catheterization laboratory (from 22% to 38%, p < 0.05), and a slight increase in the number of patients transported directly to the percutaneous coronary intervention facility (primary transport). One-year mortality was reduced in the total group of patients and in the subgroup of patients with primary transport (p < 0.05). The sharpest fall in mortality was observed in patients with primary transport and TIMI (Thrombolysis In Myocardial Infarction) risk score <3 (n = 521) with a decrease in 30-day mortality from 23.1% to 13.3% (p < 0.05) and in 1-year mortality from 25.6% to 16.7% (p < 0.05). Conclusions Formalized data feedback is associated with a reduction in treatment times for STEMI and with an improved prognosis, which is most pronounced in high-risk patients. (Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction [FITT-STEMI]; NCT00794001) © 2012 American College of Cardiology Foundation.

Okhotin A.,University of Turku | Reitwiessner C.,Julius Maximilians University Wrzburg | Reitwiessner C.,Federico Santa María Technical University
Theoretical Computer Science | Year: 2012

Consider context-free grammars generating strings over a one-letter alphabet. For the membership problem for such grammars, stated as "Given a grammar G and a string an, determine whether an is generated by G", only a nave O(|G|·n2)-time algorithm is known. This paper develops a new algorithm solving this problem, which is based upon fast multiplication of integers, works in time |G|·nlog3n·2O(log*n), and is applicable to context-free grammars augmented with Boolean operations, known as Boolean grammars. For unambiguous grammars, the running time of the algorithm is reduced to |G|·nlog2n·2O(log*n). The algorithm is based upon (a simplification of) the online integer multiplication algorithm by Fischer and Stockmeyer [M.J. Fischer, L.J. Stockmeyer, Fast on-line integer multiplication, Journal of Computer and System Sciences 9 (3) (1974) 317331]. © 2012 Elsevier B.V. All rights reserved.

Groneberg D.,Julius Maximilians University Wrzburg | Konig P.,University of Lübeck | Koesling D.,Ruhr University Bochum | Friebe A.,Julius Maximilians University Wrzburg
Gastroenterology | Year: 2011

Background & Aims: The nitric oxideguanosine 3',5'-cyclic monophosphate (cGMP) signaling pathway has an important role in the control of smooth muscle tone. NO is produced by NO synthases and acts as a major inhibitory neurotransmitter in the gastrointestinal (GI) tract. The main target, NO-sensitive guanylyl cyclase (NO-GC), is stimulated by NO to produce the intracellular messenger cGMP. We investigated the role of NO-GC in nitrergic relaxation and GI motility. Methods: We tested relaxation of GI smooth muscle in mice that do not express NO-GC or mice with disruption of NO-GC specifically in smooth muscle cells. Different segments of the GI tract (fundus, lower esophageal sphincter, pyloric sphincter, and duodenum) were used in isometric force studies. NO donors and electrical field stimulation were used to assess nitrergic signaling. Whole-gut transit time was measured as an indicator of GI motility. Results: Mice that lack NO-GC do not have NO-induced relaxation of GI smooth muscle. Gut transit time was increased, resulting in GI dysfunction. Surprisingly, in mice that lack NO-GC specifically in smooth muscle, NO-induced relaxation was reduced only slightly, and whole-gut transit time was unchanged compared with wild-type mice. Conclusions: Lack of NO-GC in smooth muscle cells does not impair NO-induced relaxation of GI tissues or GI motility. The NO receptor guanylyl cyclase in GI smooth muscle is therefore dispensable for nitrergic signaling in mice. © 2011 AGA Institute.

Glasser C.,Julius Maximilians University Wrzburg | Reitwiessner C.,Julius Maximilians University Wrzburg | Selivanov V.,Russian Academy of Sciences
Theoretical Computer Science | Year: 2011

We study the shrinking and separation properties (two notions well-known in descriptive set theory) for NP and coNP and show that under reasonable complexity-theoretic assumptions, both properties do not hold for NP and the shrinking property does not hold for coNP. In particular we obtain the following results. NP and coNP do not have the shrinking property unless PH is finite. In general, ΣnP and ΠnP do not have the shrinking property unless PH is finite. This solves an open question posed by Selivanov (1994) [33].The separation property does not hold for NP unless UP⊆coNP.The shrinking property does not hold for NP unless there exist NP-hard disjoint NP-pairs (existence of such pairs would contradict a conjecture of Even et al. (1984) [6]).The shrinking property does not hold for NP unless there exist complete disjoint NP-pairs. Moreover, we prove that the assumption NP≠coNP is too weak to refute the shrinking property for NP in a relativizable way. For this we construct an oracle relative to which P=NP∩coNP, NP≠coNP, and NP has the shrinking property. This solves an open question posed by Blass and Gurevich (1984) [3] who explicitly ask for such an oracle.© 2010 Elsevier B.V. All rights reserved.

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