Highlights • Vietnam's EPI has caused sharp decreases in vaccine-preventable disease incidence. • EPI may have saved over 370,000 lives. • EPI represents good value for money.
We previously developed an automated approach based on pace mapping to localise early left ventricular (LV) activation origin. To avoid a singular system, we require pacing from at least 2 more known ...sites than the number of electrocardiography (ECG) leads used. Fewer leads used means fewer pacing sites required. We sought to identify an optimal minimal ECG lead set for the automated approach.
We used 1715 LV endocardial pacing sites to create derivation and testing data sets. The derivation data set, consisting of 1012 known pacing sites pooled from 38 patients, was used to identify an optimal 3-lead set by means of random forest regression (RFR), and a second 3-lead set by means of exhaustive search. The performance of these sets and the calculated Frank leads was compared within the testing data set with 703 pacing sites pooled from 25 patients.
The RFR yielded III, V1, and V4, whereas the exhaustive search identified leads II, V2 and V6. Comparison of these sets and the calculated Frank leads demonstrated similar performance when using 5 or more known pacing sites. Accuracy improved with additional pacing sites, achieving mean accuracy of < 5 mm, after including up to 9 pacing sites when they were focused on a suspected area of ventricular activation origin (radius < 10 mm).
The RFR identified the quasi-orthogonal leads set to localise the source of LV activation, minimizing the training set of pacing sites. Localization accuracy was high with the use of these leads and was not significantly different from using leads identified by exhaustive search or empiric use of Frank leads.
Nous avons développé une approche automatisée fondée sur la cartographie cardiaque pour repérer de manière précoce l’origine de l’activation du ventricule gauche (VG). Pour éviter un système unique, il faut cartographier au moins deux autres sites connus, outre les sites des dérivations d’électrocardiographie (ECG) utilisés. Un faible nombre de dérivations signifie que moins de sites de cartographie sont nécessaires. Nous avons cherché à déterminer un nombre minimal optimal de dérivations d’ECG pour l’approche automatisée.
Nous avons utilisé 1 715 sites de cartographie endocardique du VG pour créer des ensembles de données de dérivation et de test. L’ensemble de données pour la dérivation, qui contient 1 012 sites de cartographie connus collectés auprès de 38 patients, a été utilisé pour cibler un ensemble optimal de trois dérivations par régression par forêt aléatoire, et un autre ensemble de trois dérivations a été établi par recherche exhaustive. Le résultat donné par ces ensembles et le résultat des dérivations de Frank calculées ont été comparés dans l’ensemble de données de test comportant 703 sites de cartographie chez 25 patients.
La régression par forêt aléatoire a donné les dérivations III, V1 et V4, alors que la recherche exhaustive a donné les dérivations II, V2 et V6. Lors d’une comparaison, ces ensembles de données et les dérivations de Frank calculées ont offert des résultats similaires lorsqu’au moins cinq sites de cartographie connus étaient utilisés. L’exactitude s’est améliorée avec le nombre de sites de cartographie, pour atteindre une exactitude moyenne de < 5 mm, après l’inclusion de jusqu’à neuf sites de cartographies lorsqu’ils visaient une zone soupçonnée de l’origine de l’activation ventriculaire (rayon < 10 mm).
La régression par forêt aléatoire a permis de cerner un ensemble de dérivations quasi orthogonal permettant de cibler la source de l’activation du VG, en réduisant au minimum le nombre de sites de cartographie nécessaire. L’exactitude du positionnement était élevée avec l’utilisation de ces dérivations et n’était pas significativement différente des dérivations ciblées par recherche exhaustive ou de l’utilisation empirique des dérivations de Frank.
Endoscopic mucosal resection (EMR) with use of electrocautery (conventional EMR) has historically been used to remove large duodenal adenomas; however, use of electrocautery can predispose to adverse ...events including delayed bleeding and perforation. Cold snare EMR (cs-EMR) has been shown to be safe and effective for removal of colon polyps, but data regarding its use in the duodenum are limited. The aim of this study was to evaluate the efficacy and safety of cs-EMR for nonampullary duodenal adenomas ≥1 cm.
This was a multicenter retrospective study of patients with nonampullary duodenal adenomas ≥1 cm who underwent cs-EMR from October 2014 to May 2023. Patients who received any form of thermal therapy were excluded. Primary outcomes were technical success and rate of recurrent adenoma. Secondary outcomes were adverse events and predictors of recurrence.
A total of 125 patients underwent resection of 127 nonampullary duodenal adenomas with cs-EMR. Follow-up data were available in 89 cases (70.1%). The recurrent adenoma rate was 31.5% (n = 28). Adverse events occurred in 3.9% (n = 5), with 4 cases of immediate bleeding (3.1%) and 1 case of delayed bleeding (.8%). There were no cases of perforation. The presence of high-grade dysplasia was found to be an independent predictor of recurrence (odds ratio, 10.9 95% confidence interval, 1.1-102.1; P = .036).
This retrospective multicenter study demonstrates that cs-EMR for nonampullary duodenal adenomas is safe and technically feasible with an acceptable recurrence rate. Future prospective studies are needed to directly compare outcomes of cs-EMR with conventional and underwater EMR.
Abstract
Increasing emphasis on the use of real-world evidence (RWE) to support clinical policy and regulatory decision-making has led to a proliferation of guidance, advice, and frameworks from ...regulatory agencies, academia, professional societies, and industry. A broad spectrum of studies use real-world data (RWD) to produce RWE, ranging from randomized trials with outcomes assessed using RWD to fully observational studies. Yet, many proposals for generating RWE lack sufficient detail, and many analyses of RWD suffer from implausible assumptions, other methodological flaws, or inappropriate interpretations. The
Causal Roadmap
is an explicit, itemized, iterative process that guides investigators to prespecify study design and analysis plans; it addresses a wide range of guidance within a single framework. By supporting the transparent evaluation of causal assumptions and facilitating objective comparisons of design and analysis choices based on prespecified criteria, the
Roadmap
can help investigators to evaluate the quality of evidence that a given study is likely to produce, specify a study to generate high-quality RWE, and communicate effectively with regulatory agencies and other stakeholders. This paper aims to disseminate and extend the
Causal Roadmap
framework for use by clinical and translational researchers; three companion papers demonstrate applications of the
Causal Roadmap
for specific use cases.
Three-dimensional (3D) integration using through-silicon vias (TSVs) and low-volume lead-free solder interconnects allows the formation of high signal bandwidth, fine pitch, and short-distance ...interconnections in stacked dies. There are several approaches for 3D chip stacking including chip to chip, chip to wafer, and wafer to wafer. Chip-to-chip integration and chip-to-wafer integration offer the ability to stack known good dies, which can lead to higher yields without integrated redundancy. In the future, with structure and process optimization, wafer-to-wafer integration may provide an ultimate solution for the highest manufacturing throughput assuming a high yield and minimal loss of good dies and wafers. In the near term, chip-to-chip and chip-to-wafer integration may offer high yield, high flexibility, and high performance with added time-to-market advantages. In this work, results are reported for 3D integration after using a chip-to-wafer assembly process using 3D chip-stacking technology and fine-pitch interconnects with lead-free solder. Stacks of up to six dies were assembled and characterized using lead-free solder interconnections that were less than 6 µm in height. The average resistance of the TSV including the lead-free solder interconnect was as low as 21 mΩ. PUBLICATION ABSTRACT
Abstract
Introduction
Alveolar macrophages (AMs) are lung-resident immune cells that phagocytose inhaled particles and pathogens, and help coordinate the lung’s immune response to infection. Little ...is known about the impact of chronic e-cigarette use (ie, vaping) on this important pulmonary cell type. Thus, we determined the effect of vaping on AM phenotype and gene expression.
Aims and Methods
We recruited never-smokers, smokers, and e-cigarette users (vapers) and performed research bronchoscopies to isolate AMs from bronchoalveolar lavage fluid samples and epithelial cells from bronchial brushings. We then performed morphological analyses and used the Nanostring platform to look for changes in gene expression.
Results
AMs obtained from smokers and vapers were phenotypically distinct from those obtained from nonsmokers, and from each other. Immunocytochemistry revealed that vapers AMs had significantly elevated inducible nitric oxide synthase (M1) expression and significantly reduced CD301a (M2) expression compared with nonsmokers or smokers. Vapers’ AMs and bronchial epithelia exhibited unique changes in gene expression compared with nonsmokers or smokers. Moreover, vapers’ AMs were the most affected of all groups and had 124 genes uniquely downregulated. Gene ontology analysis revealed that vapers and smokers had opposing changes in biological processes.
Conclusions
These data indicate that vaping causes unique changes to AMs and bronchial epithelia compared with nonsmokers and smokers which may impact pulmonary host defense.
Implications
These data indicate that normal “healthy” vapers have altered AMs and may be at risk of developing abnormal immune responses to inflammatory stimuli.
The original version of this Article contained errors in the author affiliations. Affiliation 2 incorrectly read 'Department of Neurology, The First Hospital of Jilin University, Changchun 130021 ...Jilin Province, China.'Affiliation 5 incorrectly read 'Department of Otolaryngology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061 Shanxi Province, China'Affiliation 9 incorrectly read 'State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China.'This has now been corrected in both the PDF and HTML versions of the Article.
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