Le pronostic de l’arrêt cardiaque (AC) reste dramatique. Diagnostiquer sa cause rapidement et prédire précocement son pronostic ("pronostication") de manière fiable permettrait de mieux guider les traitements initiaux, en évitant de traiter futilement les patients avec faible probabilité d’évolution favorable ou à l’inverse de permettre d’intensifier le traitement de patients avec forte probabilité d’évolution favorable. Les biomarqueurs, dont l’utilité diagnostique et pronostique reste débattue, semblent actuellement insuffisamment sensibles et précis, surtout dans les 1ères heures après la reprise de l’activité circulatoire spontanée (RACS). Dans l’algorithme pronostique, seule la Neuron Specific Enolase (NSE) est validée après le 3ème jour post-AC et en 2ème intention. Notre première étude a montré que la valeur diagnostique des biomarqueurs "spécifiques" des lésions cérébrales en post-AC (protéine S100B : S100 et surtout NSE) était insuffisante, à l’admission en réanimation, pour étayer précisément le diagnostic de cause neurologique d’AC. Si la coronarographie précoce est l’outil diagnostique de référence de l’AC de probable cause cardiaque, les biomarqueurs ne peuvent remplacer le scanner cérébral pour diagnostiquer une cause neurologique d’AC. La deuxième étude a évalué, au 1er jour post-AC, S100 et NSE avec 2 témoins d’œdème cérébral proposés comme outils pronostiques : le diamètre de l’enveloppe du nerf optique (DENO) par échographie et le rapport de dédifférenciation substance grise / substance blanche (DSG/B) par scanner cérébral. Même si une relation directe ne peut être affirmée formellement entre ces paramètres, l’élargissement du DENO à J1 post-AC était corrélé aux lésions cérébrales, surtout l’œdème cérébral et les lésions neuronales suspectés sur l’élévation de la NSE (à l’admission et à J1) et la baisse de DSG/B. Si NSE, DSG/B et DENO à J1 étaient liés, S100, plus spécifique de la glie, n’était pas corrélée au DENO ni au DSG/B. NSE et S100 à l’admission, à J1 et J2 post-RACS et DENO à J1 étaient associées à la mortalité hospitalière. La troisième étude évaluait la valeur pronostique des biomarqueurs à la phase précoce de l’AC (NSE et S100 étant prélevées en médiane 220 min après la RASC). S100, réalisée en aveugle des cliniciens, était le biomarqueur le plus précis à l’admission en réanimation pour prédire correctement le pronostic défavorable à la sortie de l’hôpital et à 3 mois après AC, par rapport au lactate, pH et créatininémie, et surtout à la NSE. Les variations de S100 dans le temps permettaient d’affiner cette prédiction. S100 à l’admission était un facteur indépendant du pronostic défavorable à la sortie de l’hôpital, avec la durée sans massage cardiaque, le rythme initial non-choquable, le lactate initial et la présence de convulsion clinique. Selon les recommandations, la pronostication nécessite théoriquement d’être différée et multimodale, les biomarqueurs seuls n’étant pas recommandés, surtout précocement. Les biomarqueurs ne peuvent constituer une alternative, en comparaison à l’imagerie, pour l’aide diagnostique de la cause d’AC. A l’inverse, certains biomarqueurs comme la S100 après admission pourraient facilement et spécifiquement discriminer les AC ayant une certitude de pronostic défavorable. Associée à d’autres outils prédictifs clinico-radiologiques, la S100 pourrait être incorporée dans des algorithmes permettant de guider les thérapeutiques initiales. Une pronostication correcte précoce pourrait éviter des traitements invasifs inutiles, ou au contraire optimiser certaines thérapeutiques agressives. Le choix de méthodes recommandées et automatisées de contrôle ciblé de la température, très efficaces mais invasives et onéreuses, ou l’indication d’utiliser -ou pas- une assistance cardio-circulatoire extra-corporelle pourrait bénéficier d’une telle stratégie précoce de sélection des patients. / Outcome of cardiac arrest (CA) remains dramatic. To quickly diagnose the cause of CA and establish a reliable outcome prediction (prognostication) as early as possible could help to guide initial treatments. It could avoid futile treatments in patients with low chance of survival or of good neurological recovery, or conversely allow treatment optimization in patients expected to have a high likelihood of good neurological outcome. Usefulness of biomarkers to guide clinicians in finding the CA diagnosis and helping prognostication is debated. Biomarkers are considered as not sensitive and accurate enough, especially within the first hours after return of spontaneous circulation (ROSC). Their use is only recommended in prognostication for Neuron Specific Enolase (NSE) as a second line tool and after the third day from CA. Our first study confirmed that biomarkers “specific” of brain injury (S100B protein: S100 and moreover NSE) cannot sufficiently discriminate the neurological cause of CA on ICU admission. If early coronary angiogram is the standard for diagnosing a probable cardiac cause of CA, biomarkers cannot replace brain computed-tomography (CT) in CA from a neurological cause. The second study evaluated, during the 1st day after ROSC, the link between biomarkers (S100 and NSE) and 2 surrogates of brain oedema recently proposed as outcome predictors: echography of the optic nerve sheath diameter (ONSD), and grey to white matter attenuation ratio (GWR) on brain CT-scan. Even though we cannot conclude on a definitive relationship between these parameters, ONSD enlargement at day 1 was associated with specific brain damage after CA, such as brain oedema and mostly axonal injuries, as reflected by increases in NSE (on admission and at day 1) and low GWR measurements. Whereas NSE, GWR and ONSD at day 1 were correlated, S100, which is more specific of glial injuries, did not reach significance. NSE and S100 on admission, at days 1 and 2 after ROSC, as well as ONSD at day 1, were associated with survival at hospital discharge. The third study evaluated the prognostic value of several biomarkers in the early phase after CA (NSE and S100 being sampled at median 220 min after ROSC). S100, blinded to physicians, was the biomarker with the best accuracy after ICU admission to correctly predict unfavourable outcome at hospital discharge and at 3 months after CA, compared with all other biomarkers such as lactate, pH, creatinine, and especially NSE. S100 variations during the first day after admission refined prognostication. Initial S100 was an early independent predictive factor associated with unfavourable outcome at hospital discharge, with the no-flow duration, initial lactate value, initial non-shockable rhythm, and the presence of clinical seizure. According to guidelines, prognostication theoretically needs to be delayed and multimodal, biomarkers alone not being recommended especially in the early phase after CA. Biomarkers cannot seem to be an alternative option compared to imaging to precisely diagnose the CA cause. By contrast, some biomarkers, such as S100 after admission, could easily and specifically discriminate CA patients with certainty of unfavourable outcome. Associated with other predictive tools (clinical or using imaging), biomarkers could interestingly be incorporated in early decisional algorithms to optimally guide initial therapies. This correct patient classification could help to avoid unuseful treatments versus to maximize aggressive therapies. The choice of recommended servo-controlled targeted temperature management devices, very efficient but invasive and expensive, or the indication -or not- of a cardio-circulatory assist device implementation should be guided in the early stage after ROSC using this simple strategy of patient selection.

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23068号 / 医博第4695号 / 新制||医||1049(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 石見 拓, 教授 大鶴 繁, 教授 福田 和彦 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Diploma thesis mainly deals with temperature management and calculation of temperature profile in oven by using SMD packages (PLCC, 1206) of different thermal capacitance on testing PCB. Above all shows theoretical consecution of temperature profile calculation in oven by using known mathematical method like the lumped capacitance method or finite difference method. Theoretical solution and measured values are compared. Diploma thesis also deals with fixation methods of thermocouples K type on assembly, comparison methods based on known and subexperiment, determines the deficiencies of methods. This thesis can perform as theoretical as well as experimental resource to prediction of temperature profiles of PCB´s with different assembly density.

Esta tese apresenta soluções para o gerenciamento e otimização de temperatura para sistemas de codificação de vídeo baseados nas características da aplicação e no conteúdo dos vídeos digitais. Diferente dos trabalhos estado-da-arte, as soluções propostas nesta tese focam em técnicas de gerenciamento de temperatura no nível da aplicação e características da aplicação codificação de vídeo e as propriedades dos vídeos digitais são explorados para desenvolver soluções termais para a codificação de vídeo com baixas perdas na qualidade de serviço das aplicações. Diversas análises são realizadas considerando a aplicação de codificação de vídeo para entender o comportamento da temperatura durante o processo de codificação para diferentes sequências de vídeo. Com base nos resultados das análises, soluções com diferentes abordagens são propostas para atenuar os efeitos da temperatura nos sistemas de codificação de vídeo. Gerenciamento de temperatura baseado nas características da aplicação para o padrão de codificação HEVC usa uma técnica de seleção de configuração em tempo de execução para manter a temperatura abaixo dos limites seguros de operação com bons resultados de qualidade de vídeo. Otimização de temperatura baseado em computação imprecisa usa aproximações baseadas em conteúdo para reduzir a temperatura de chips executando o HEVC. Um escalonador de tarefas que usa características da aplicação para guiar o escalonamento de threads focando na redução dos gradientes espaciais de temperatura que são resultantes do desbalanceamento natural de cargas entre as threads da aplicação. As soluções propostas são capazes de reduzir em até 10 ºC a temperatura do chip com perdas insignificantes na eficiência de compressão. Os resultados de qualidade objetiva (medida usando PSNR) são de 12 dBs até 20 dBs maiores quando comparados com trabalhos da literatura. Além disso, o escalonador de tarefas proposto é capaz de eliminar os gradientes espaciais de temperatura maiores que 5 ºC para arquitetura multi-cores. Como principal conclusão, esta tese demonstra que as técnicas de gerenciamento de temperatura que usam o conhecimento da aplicação de maneira conjunta com as propriedades dos vídeos digitais tem um alto potencial para melhorar os resultados de temperatura de sistemas de codificação de vídeo mantendo bons resultados de qualidade visual dos vídeos codificados. / This thesis presents application-driven temperature-aware solutions for next generation video coding systems, such as the High Efficiency Video Coding (HEVC). Different from state-of-the-art works, the proposed solutions raise the abstraction of temperature management to the application-level, where video coding characteristics and video content properties are used to leverage thermal-aware solutions for video coding with low QoS (Quality of Service) degradation. Several video coding and temperature analyses are performed to understand the behavior of temperature when encoding different video sequences. Based on the analyses results, different approaches are proposed to mitigate the temperature effects on video coding systems. Application-driven temperature management for HEVC uses run-time encoder configuration selection to keep temperature under safe operational state while providing good visual quality results. Temperature optimization using approximate computing uses content-driven approximations to reduce the on-chip temperature of HEVC encoding. Application-driven temperature-aware scheduler leverages application-specific knowledge to guide a scheduling technique targeting reducing the spatial temperature gradients that are resulted from the unbalance workload nature of multi-threaded video coding application. The proposed solutions are able to provide up to 10 °C of chip temperature reduction with negligible compression efficiency loss. Besides, when compared with previous works the resulted objective video quality (PSNR) is from 12 dB up to 20 dB higher. Moreover, the proposed scheduler eliminates spatial temperature gradients greater than 5 ºC of multi-core architectures. As conclusion, this thesis demonstrates that leveraging application-specific knowledge and video content properties has a significant potential to improve temperature profiles of video coding systems while still keeping good quality results.

Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.

Esta tese apresenta soluções para o gerenciamento e otimização de temperatura para sistemas de codificação de vídeo baseados nas características da aplicação e no conteúdo dos vídeos digitais. Diferente dos trabalhos estado-da-arte, as soluções propostas nesta tese focam em técnicas de gerenciamento de temperatura no nível da aplicação e características da aplicação codificação de vídeo e as propriedades dos vídeos digitais são explorados para desenvolver soluções termais para a codificação de vídeo com baixas perdas na qualidade de serviço das aplicações. Diversas análises são realizadas considerando a aplicação de codificação de vídeo para entender o comportamento da temperatura durante o processo de codificação para diferentes sequências de vídeo. Com base nos resultados das análises, soluções com diferentes abordagens são propostas para atenuar os efeitos da temperatura nos sistemas de codificação de vídeo. Gerenciamento de temperatura baseado nas características da aplicação para o padrão de codificação HEVC usa uma técnica de seleção de configuração em tempo de execução para manter a temperatura abaixo dos limites seguros de operação com bons resultados de qualidade de vídeo. Otimização de temperatura baseado em computação imprecisa usa aproximações baseadas em conteúdo para reduzir a temperatura de chips executando o HEVC. Um escalonador de tarefas que usa características da aplicação para guiar o escalonamento de threads focando na redução dos gradientes espaciais de temperatura que são resultantes do desbalanceamento natural de cargas entre as threads da aplicação. As soluções propostas são capazes de reduzir em até 10 ºC a temperatura do chip com perdas insignificantes na eficiência de compressão. Os resultados de qualidade objetiva (medida usando PSNR) são de 12 dBs até 20 dBs maiores quando comparados com trabalhos da literatura. Além disso, o escalonador de tarefas proposto é capaz de eliminar os gradientes espaciais de temperatura maiores que 5 ºC para arquitetura multi-cores. Como principal conclusão, esta tese demonstra que as técnicas de gerenciamento de temperatura que usam o conhecimento da aplicação de maneira conjunta com as propriedades dos vídeos digitais tem um alto potencial para melhorar os resultados de temperatura de sistemas de codificação de vídeo mantendo bons resultados de qualidade visual dos vídeos codificados. / This thesis presents application-driven temperature-aware solutions for next generation video coding systems, such as the High Efficiency Video Coding (HEVC). Different from state-of-the-art works, the proposed solutions raise the abstraction of temperature management to the application-level, where video coding characteristics and video content properties are used to leverage thermal-aware solutions for video coding with low QoS (Quality of Service) degradation. Several video coding and temperature analyses are performed to understand the behavior of temperature when encoding different video sequences. Based on the analyses results, different approaches are proposed to mitigate the temperature effects on video coding systems. Application-driven temperature management for HEVC uses run-time encoder configuration selection to keep temperature under safe operational state while providing good visual quality results. Temperature optimization using approximate computing uses content-driven approximations to reduce the on-chip temperature of HEVC encoding. Application-driven temperature-aware scheduler leverages application-specific knowledge to guide a scheduling technique targeting reducing the spatial temperature gradients that are resulted from the unbalance workload nature of multi-threaded video coding application. The proposed solutions are able to provide up to 10 °C of chip temperature reduction with negligible compression efficiency loss. Besides, when compared with previous works the resulted objective video quality (PSNR) is from 12 dB up to 20 dB higher. Moreover, the proposed scheduler eliminates spatial temperature gradients greater than 5 ºC of multi-core architectures. As conclusion, this thesis demonstrates that leveraging application-specific knowledge and video content properties has a significant potential to improve temperature profiles of video coding systems while still keeping good quality results.

Esta tese apresenta soluções para o gerenciamento e otimização de temperatura para sistemas de codificação de vídeo baseados nas características da aplicação e no conteúdo dos vídeos digitais. Diferente dos trabalhos estado-da-arte, as soluções propostas nesta tese focam em técnicas de gerenciamento de temperatura no nível da aplicação e características da aplicação codificação de vídeo e as propriedades dos vídeos digitais são explorados para desenvolver soluções termais para a codificação de vídeo com baixas perdas na qualidade de serviço das aplicações. Diversas análises são realizadas considerando a aplicação de codificação de vídeo para entender o comportamento da temperatura durante o processo de codificação para diferentes sequências de vídeo. Com base nos resultados das análises, soluções com diferentes abordagens são propostas para atenuar os efeitos da temperatura nos sistemas de codificação de vídeo. Gerenciamento de temperatura baseado nas características da aplicação para o padrão de codificação HEVC usa uma técnica de seleção de configuração em tempo de execução para manter a temperatura abaixo dos limites seguros de operação com bons resultados de qualidade de vídeo. Otimização de temperatura baseado em computação imprecisa usa aproximações baseadas em conteúdo para reduzir a temperatura de chips executando o HEVC. Um escalonador de tarefas que usa características da aplicação para guiar o escalonamento de threads focando na redução dos gradientes espaciais de temperatura que são resultantes do desbalanceamento natural de cargas entre as threads da aplicação. As soluções propostas são capazes de reduzir em até 10 ºC a temperatura do chip com perdas insignificantes na eficiência de compressão. Os resultados de qualidade objetiva (medida usando PSNR) são de 12 dBs até 20 dBs maiores quando comparados com trabalhos da literatura. Além disso, o escalonador de tarefas proposto é capaz de eliminar os gradientes espaciais de temperatura maiores que 5 ºC para arquitetura multi-cores. Como principal conclusão, esta tese demonstra que as técnicas de gerenciamento de temperatura que usam o conhecimento da aplicação de maneira conjunta com as propriedades dos vídeos digitais tem um alto potencial para melhorar os resultados de temperatura de sistemas de codificação de vídeo mantendo bons resultados de qualidade visual dos vídeos codificados. / This thesis presents application-driven temperature-aware solutions for next generation video coding systems, such as the High Efficiency Video Coding (HEVC). Different from state-of-the-art works, the proposed solutions raise the abstraction of temperature management to the application-level, where video coding characteristics and video content properties are used to leverage thermal-aware solutions for video coding with low QoS (Quality of Service) degradation. Several video coding and temperature analyses are performed to understand the behavior of temperature when encoding different video sequences. Based on the analyses results, different approaches are proposed to mitigate the temperature effects on video coding systems. Application-driven temperature management for HEVC uses run-time encoder configuration selection to keep temperature under safe operational state while providing good visual quality results. Temperature optimization using approximate computing uses content-driven approximations to reduce the on-chip temperature of HEVC encoding. Application-driven temperature-aware scheduler leverages application-specific knowledge to guide a scheduling technique targeting reducing the spatial temperature gradients that are resulted from the unbalance workload nature of multi-threaded video coding application. The proposed solutions are able to provide up to 10 °C of chip temperature reduction with negligible compression efficiency loss. Besides, when compared with previous works the resulted objective video quality (PSNR) is from 12 dB up to 20 dB higher. Moreover, the proposed scheduler eliminates spatial temperature gradients greater than 5 ºC of multi-core architectures. As conclusion, this thesis demonstrates that leveraging application-specific knowledge and video content properties has a significant potential to improve temperature profiles of video coding systems while still keeping good quality results.

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This diploma thesis summarizes basic findings about issues of making development samples of PCB. The emphasis is especially on required quality which complies with mentioned norms. The theoretical section includes methodology for evaluating quality dismounted boards, assembling and soldering, parameters of components under different environmental circumstances. The practical part is carried out in cooperation with the department EEG in R&D Automotive Lighting Jihlava. It is dedicated to the design and the preparation of development samples where the quality is assessed according to given methodology from the theoretical part. PCB are analyzed by an X-ray, metallographic grinding and other methods. Recommendations are given and based on results for improvements.

Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p < 0.12). Conclusions Temperature control in surgically treated patients with space-occupying MCA infarction using a pre-specified protocol excluding temperature management systems resulted in mild hyperthermia between 36.8 °C and 37.2 °C and a low overall temperature load. Future prospective studies on larger cohorts comparing different strategies for normothermia treatment including temperature management devices are needed.