Incremental value of prognostic testing in patients with known or suspected ischemic heart disease: a basis for optimal utilization of exercise technetium-99m sestamibi myocardial perfusion single-photon emission computed tomography

OBJECTIVES: This study assessed the incremental prognostic implications of normal and equivocal exercise technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) and sought to determine its incremental prognostic value, impact on patient management and cost implications. BACKGROUND: The prognostic implications of Tc-99m sestamibi SPECT are not well defined, and risk stratification using this test has not been explored. METHODS: We studied 1,702 patients referred for exercise Tc-99m sestamibi SPECT who were followed up for a mean (+/- SD) of 20 +/- 5 months. Patients with previous percutaneous transluminal coronary angioplasty or coronary artery bypass surgery were excluded. The SPECT studies were assessed using semiquantitative visual analysis. Cardiac death and myocardial infarction were considered "hard" events, and coronary angioplasty and bypass surgery > 60 days after testing were considered "soft" events. RESULTS: Of the 1,702 patients studied, 1,131 had normal or equivocal scan results. A total of 10 events occurred in this group (1 cardiac death and 1 myocardial infarction [0.2% hard events]; 4 coronary angioplasty and 4 bypass surgery procedures [0.7% soft events]). The rates of hard events and referral to catheterization after SPECT were similarly low in patients with a low (< 0.15), intermediate (0.15 to 0.85) and high (> 0.85) post-exercise treadmill test (ETT) likelihood of coronary artery disease. With respect to scan type, patients with normal, probably normal or equivocal scan results had similarly low hard event rates. In the 571 patients with abnormal scan results, there were 43 hard events (7.5%) and 42 soft events (7.4%) (p < 0.001 vs. 1,131 patients with normal scan results for both). When the complete spectrum of scan responses was considered, SPECT provided incremental prognostic value in all patient subgroups analyzed. However, the nuclear scan was cost-effective only in patients with interpretable exercise ECG responses and an intermediate to high post-ETT likelihood of coronary artery disease and in those with uninterpretable exercise ECG responses and an intermediate to high pre-ETT likelihood of coronary artery disease. CONCLUSIONS: Normal or equivocal exercise Tc-99m sestamibi study results are associated with a benign prognosis, even in patients with a high likelihood of coronary artery disease. Although incremental prognostic value is added by nuclear testing in all patient subgroups, a testing strategy incorporating nuclear testing proved to be cost-effective only in the groups with an intermediate to high likelihood of coronary artery disease before scanning.     

考虑循环寿命折损的主动配电网仿射可调鲁棒优化方法

针对主动配电网在源荷储协同下的不确定性优化问题,提出了基于仿射可调鲁棒优化的主动配电网运行策略。首先,考虑分布式光伏的可控模型、循环寿命折损的电池储能模型和ZIP负荷模型,构建了主动配电网优化运行模型。然后,采用椭球集合来描述分布式光伏出力的不确定性,并结合仿射策略形成优化模型中决策变量与分布式光伏出力不确定性变量之间的线性决策机制。最后,通过对偶变换将主动配电网鲁棒优化模型转化为一个确定性的混合整数二阶锥规划模型进行求解。在改进的IEEE33节点算例系统中对比验证了所提出的仿射可调鲁棒优化方法的有效性和优点。     

考虑电池储能老化和需求侧响应的交直流混合配电网动态重构方法

现有的电池储能模型一方面认为电池的充放电功率和效率为固定不变的,另一方面有关电池储能的充放电过程对循环老化的影响缺少考虑,这与电池单元本体的非线性等效电路模型相违背。因此,考虑电池储能的循环老化成本、需求侧响应,提出了交直流混合配电网动态重构方法。通过对实际电池储能的充放电功率的运行区域进行采样,在凸包络的采样点集合中将非理想状态下的电池储能模型重构为线性模型。在此基础上,分别建立了基于累积吞吐电量和放电深度的循环老化成本模型,构建了综合成本最小化的交直流混合配电网动态重构模型。并采用混合整数二阶锥规划方法求解。在改进的33节点算例上仿真验证了所提基于放电深度的循环老化成本模型的经济性,分析了交直流混合配电网重构方法经济性的影响因素。     

Reduced brain serotonin transporter availability in major depression as measured by [123I]-2 beta-carbomethoxy-3 beta-(4-iodophenyl)tropane and single photon emission computed tomography

BACKGROUND: Prior research has suggested reductions in the density of serotonin transporter (SERT) binding sites in blood platelets and post-mortem brain tissue of depressed patients. We sought to determine whether patients with unipolar major depression have diminished SERT availability as assessed by both brainstem [123I] beta-CIT SPECT and platelet [3H]paroxetine binding. METHODS: Drug-free depressed and healthy subjects were injected with 211 +/- 22 MBq [123I] beta-CIT and imaged 24 +/- 2 h later under equilibrium conditions. A ratio of specific to nonspecific brain uptake (V3" = (brainstem-occipital)/occipital), a measure proportional to the binding potential (Bmax/Kd), was used for all comparisons. RESULTS: Results showed a statistically significant reduction in brainstem V3" values in depressed as compared to healthy subjects (3.1 +/- .9 vs. 3.8 +/- .8, p = .02). Platelet [3H]paroxetine binding was not altered (Bmax = 2389 +/- 484 vs. 2415 +/- 538 fmol/mg protein, p = .91) and was not significantly correlated with brainstem [123I] beta-CIT binding (r = -0.14, p = .48). CONCLUSIONS: These data are the first to suggest reductions in the density of brain SERT binding sites in living depressed patients. These findings provide further support for a preeminent role for alterations in serotonergic neurons in the pathophysiology of depression.     

CD57+/CD28- T cells in untreated hemato-oncological patients are expanded and display a Th1-type cytokine secretion profile, ex vivo cytolytic activity and enhanced tendency to apoptosis

Protopolystoma (Monogenea, Polystomatidae) is strictly specific to the anuran amphibian genus Xenopus. The host group is characterised by a polyploid series in which chromosome numbers reflect diploid, tetraploid, octoploid and dodecaploid constitutions; the series is considered to have evolved through interspecies hybridisation and genome duplication. This study correlates information on host evolutionary relationships with patterns of parasite speciation and host specificity. Protopolystoma is restricted to one subgenus (Xenopus) with multiples of 36 chromosomes, and is absent from the subgenus Silurana (with multiples of 20 chromosomes). Molecular, biochemical and karyotype evidence distinguishes three subgroups within Xenopus. Representative species from each subgroup, Xenopus muelleri, Xenopus fraseri and Xenopus laevis, have been examined for polystomatid infection. Two species of Protopolystoma occur in each of these host species. In X. muelleri, the two Protopolystoma species reflect parasite co-speciation corresponding with the divergence of two sibling host species. Xenopus fraseri and X. laevis (both with 2n = 36 chromosomes) are implicated in the hybrid origin of two octoploid species, Xenopus wittei and Xenopus vestitus (both 2n = 72). The relationships of the Protopolystoma species in these Xenopus taxa reflect this presumed ancestry. Xenopus wittei carries two species of Protopolystoma, one shared with X. fraseri and the other shared with X. laevis. Xenopus vestitus carries a single species of Protopolystoma which is shared with X. laevis but there is no "heirloom" which reflects its hybrid origin involving X. fraseri. In addition to these shared parasite species which may reflect shared host genes, X. fraseri and X. laevis each carry separate species-specific Protopolystoma which do not occur in other Xenopus species even where there is evidence of common genetic information (as in the allopolyploid wittei and vestitus). This case study may be interpreted as indicating a powerful influence of host genetic factors on susceptibility to infection, host-specificity, and parasite speciation.     

氡及其子体运移仿真系统开发

基于.net开发平台,借助C讨论了仿真系统的软件实现过程,简述了系统的功能模块及关键技术实现.实现了氡及其子体运移机制研究的计算机化.     

面向自治系统间IP前缀劫持的一种无证书安全防范机制

自治系统间的IP前缀劫持是互联网安全的重大威胁.目前基于非对称密码学的前缀劫持防范机制都无可避免地面临复杂的公钥证书存储管理问题或者密钥托管问题,并且在前缀源自治系统在线验证时计算量太大,难以在实际中布署实施.本文提出的这种防范机制,采用公钥自证明签名方案进行前缀源自治系统的验证,无需公钥证书和密钥托管,可从多方面提高防范机制的性能,有望促进IP前缀劫持防范机制的实际布署实施.     

Optimal search path for service in the presence of disruptions

We consider the following basic search path problem: a customer residing at a node of a network needs to obtain service from one of the facilities; facility locations are known and fixed. Facilities may become inoperational with certain probability; the state of the facility only becomes known when the facility is visited. Customer travel stops when the first operational facility is found. The objective is to minimize the expected total travel distance.     

Consistent Sets of Secondary Structures in Proteins

Ab initio predictions of secondary structures in proteins have to combine local predictions, based on short fragments of the protein sequence, with consistency restrictions, as not all locally plausible predictions may be simultaneously true. We use the fact that secondary structures are patterns of hydrogen bonds and that a single residue can participate in hydrogen bonds of at most one secondary structure. Consistency of fixed-sized pieces of secondary structures is the easiest to approximate and we formalize it as 1-2 matching problem. Consistency of entire secondary structures is a version of set packing. We also investigate how to form a simple problem if we add the requirement that the secondary structure and the loops that connect them fit together in a metric space. Every problem that we investigated is MAX-SNP hard and it has a constant factor approximation. Computational experience suggests that in biological instances, we can find nearly optimal solutions using heuristics.