Rationale and design of the AdaptResponse trial: a prospective randomized study of cardiac resynchronization therapy with preferential adaptive left ventricular‐only pacing

The AdaptResponse trial is designed to test the hypothesis that preferential adaptive left ventricular‐only pacing with the AdaptivCRT^® algorithm reduces the incidence of the combined endpoint of all‐cause mortality and intervention for heart failure (HF) decompensation, compared with conventional cardiac resynchronization therapy (CRT), among patients with a CRT indication, left bundle branch block (LBBB) and normal atrioventricular (AV) conduction. The AdaptResponse study is a prospective, randomized, controlled, single‐blinded, multicentre, clinical trial ( ClinicalTrials.gov Identifier: NCT02205359), conducted at up to 200 centres worldwide. Following enrolment and baseline assessment, eligible subjects will be implanted with a CRT system containing the AdaptivCRT algorithm, and randomized in a 1:1 fashion to either a treatment (‘AdaptivCRT’) or control (‘Conventional CRT’) group. The study is designed to observe a primary endpoint in 1100 patients (‘event‐driven’) and approximately 3000 patients will be randomized. The primary endpoint is the composite of all‐cause mortality and intervention for HF decompensation; secondary endpoints include all‐cause mortality, intervention for HF decompensation, clinical composite score (CCS) at 6 months, atrial fibrillation, quality of life measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ), health outcome measured by the EQ‐5D instrument, all‐cause readmission after a HF admission, and cost‐effectiveness. The AdaptResponse clinical trial is powered to assess clinical endpoints and is expected to provide definitive evidence on the incremental utility of AdaptivCRT‐enhanced CRT systems.     

冠状动脉搭桥术中移植管-宿主动脉直径比和缝合角的优化与分析

目的探索怎样的移植管-宿主动脉直径比和缝合角可以最大限度地提高冠状动脉搭桥术的成功率。方法借助ANSYS9.0对冠状动脉搭桥术进行模拟仿真,用响应面方法建立数学模型,利用优化理论寻找最优的移植管-宿主动脉直径比和缝合角,使影响手术成功率的主要因素-壁面切应力梯度最小。结果结果表明冠状动脉搭桥术中,大移植管-宿主动脉直径比和小缝合角的模型具有更好的血流动力特性。结论影响冠状动脉搭桥术成功率的因素很多,在现有条件下借助临床经验指导,选择尽可能大的移植管-宿主动脉直径比和尽可能小的缝合角的做法是可取的。     

Telematics-based online client–server/client collaborative environment for radiotherapy planning simulations

Customized cancer radiation treatment planning for each patient is very useful for both a patient and a doctor because it provides the ability to deliver higher doses to a more accurately defined tumor and at the same time lower doses to organs at risk and normal tissues. This can be realized by building an accurate planning simulation system to provide better treatment strategies based on each patient’s tomographic data such as CT, MRI, PET, or SPECT. In this study, we develop a real-time online client–server/client collaborative environment between the client (health care professionals or hospitals) and the server/client under a secure network using telematics (the integrated use of telecommunications and medical informatics). The implementation is based on a point-to-point communication scheme between client and server/client following the WYSIWIS (what you see is what I see) paradigm. After uploading the patient tomographic data, the client is able to collaborate with the server/client for treatment planning. Consequently, the level of health care services can be improved, specifically for small radiotherapy clinics in rural/remote-country areas that do not possess much experience or equipment such as a treatment planning simulator. The telematics service of the system can also be used to provide continued medical education in radiotherapy. Moreover, the system is easy to use. A client can use the system if s/he is familiar with the Windows^TM operating system because it is designed and built based on a user-friendly concept. This system does not require the client to continue hardware and software maintenance and updates. These are performed automatically by the server.     

实时逆转录-聚合酶链反应绝对定量实验优化的研究

目的　探讨优化实验反应条件 ,使实时逆转录 聚合酶链反应 (RT PCR)绝对定量能获得准确可靠的结果。方法　建立质粒标准品作为外参照 ;以管家基因GAPDH作为内参照 ,并对Mg2 、引物与探针比例、Buffer等进行优化。结果　优化条件后 ,RT PCR反应的扩增效率接近了理论最佳值 ,并可使靶基因与管家基因扩增效率保持一致 ,保证了方法的稳定性和可靠性。结论　为了获得可靠、重复性好的实时RT PCR绝对定量结果 ,应对实验方法进行优化。     

超声引导瘤内注射型卡铂-PLGA缓释微球制备工艺优化研究

目的探讨制备条件对微球粒径、表面形态和载药量的影响因素，确定制备超声引导瘤内注射型卡铂-PIGA缓释微球的最佳工艺条件。方法以O／O型乳化溶剂挥发法制备微球，采用单因素试验和拟水平均匀设计法优化制备工艺。结果制备微球的最佳条件是卡铂晶体粒径1～4μm，CBP／PIGA投料比为1：7，PLGA浓度为10％，内，外相体积比为1：8，span-80浓度为8％，搅拌速度为1400r/min，乳化和挥发时间分别是15min和4h；此条件所制备微球呈规则球形、表面光滑，粒径100—200μm的微球产出率达到65．4％，载药量为11．6％。结论优化卡铂-PLGA缓释微球的制备条件，可制备出符合瘤内注射要求的缓释微球。     

Dynamic programming in parallel boundary detection with application to ultrasound intima-media segmentation

Segmentation of carotid artery intima-media in longitudinal ultrasound images for measuring its thickness to predict cardiovascular diseases can be simplified as detecting two nearly parallel boundaries within a certain distance range, when plaque with irregular shapes is not considered. In this paper, we improve the implementation of two dynamic programming (DP) based approaches to parallel boundary detection, dual dynamic programming (DDP) and piecewise linear dual dynamic programming (PL-DDP). Then, a novel DP based approach, dual line detection (DLD), which translates the original 2-D curve position to a 4-D parameter space representing two line segments in a local image segment, is proposed to solve the problem while maintaining efficiency and rotation invariance. To apply the DLD to ultrasound intima-media segmentation, it is imbedded in a framework that employs an edge map obtained from multiplication of the responses of two edge detectors with different scales and a coupled snake model that simultaneously deforms the two contours for maintaining parallelism. The experimental results on synthetic images and carotid arteries of clinical ultrasound images indicate improved performance of the proposed DLD compared to DDP and PL-DDP, with respect to accuracy and efficiency.     

Gain in real-world cardiac resynchronization therapy efficacy with SyncAV dynamic optimization: Heart failure hospitalizations and costs

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FAME24/20中两步法ELISA试剂工作表的优化设计

[目的]为了缩短FAME24／20全自动酶联免疫分析仪的工作时间，提高工作效率。[方法]在FAME用户软件中编制好实验步骤，指定洗液的洗板单元和试剂的分配单元，改进酶标板进板方式和顺序，对ELISA两步法试剂的工作表进行优化。[结果]编制出2个能在53min内完成15个酶标板进板的工作表。[结论]优化设计两步法ELISA试剂的工作表，可以充分利用FAME24／20的仪器资源，并有效提高其使用效率。