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Objectives The aim of this study was to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance among all comers undergoing second-generation drug-eluting stent (DES) implantation. Background The multicenter randomized ULTIMATE (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions) trial showed a lower incidence of 1-year TVF after IVUS-guided DES implantation among all comers compared with angiographic guidance. However, the 3-year clinical outcomes of the ULTIMATE trial remain unknown. Methods A total of 1,448 all comers undergoing DES implantation who were randomly assigned to either IVUS guidance or angiographic guidance in the ULTIMATE trial were followed for 3 years. The primary endpoint was the risk for TVF at 3 years. The safety endpoint was definite or probable stent thrombosis (ST). Results At 3 years, TVF occurred in 47 patients (6.6%) in the IVUS-guided group and in 76 patients (10.7%) in the angiography-guided group (p = 0.01), driven mainly by the decrease in clinically driven target vessel revascularization (4.5% vs. 6.9%; p = 0.05). The rate of definite or probable ST was 0.1% in the IVUS-guided group and 1.1% in the angiography-guided group (p = 0.02). Notably, the IVUS-defined optimal procedure was associated with a significant reduction in 3-year TVF relative to that with the suboptimal procedure. Conclusions IVUS-guided DES implantation was associated with significantly lower rates of TVF and ST during 3-year follow-up among all comers, particularly those who underwent the IVUS-defined optimal procedure compared with those with angiographic guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions; NCT02215915 )

Background Double kissing (DK) crush approach for patients with coronary bifurcation lesions, particularly localized at distal left main or lesions with increased complexity, is associated with significant reduction in clinical events when compared with provisional stenting. Recently, randomized clinical trial has demonstrated the net clinical benefits by intravascular ultrasound (IVUS)-guided implantation of drug-eluting stent in all-comers. However, the improvement in clinical outcome after DK crush treatment guided by IVUS over angiography guidance for patients with complex bifurcation lesions have never been studied in a randomized fashion. Trial design DKCRUSH VIII study is a prospective, multicenter, randomized controlled trial designed to assess superiority of IVUS-guided vs angiography-guided DK crush stenting in patients with complex bifurcation lesions according to DEFINITION criteria. A total of 556 patients with complex bifurcation lesions will be randomly (1:1 of ratio) assigned to IVUS-guided or angiography-guided DK crush stenting group. The primary end point is the rate of 12-month target vessel failure, including cardiac death, target vessel myocardial infarction, or clinically driven target vessel revascularization. The secondary end points consist of the individual component of primary end point, all-cause death, myocardial infarction, and in-stent restenosis. The safety end point is the incidence of definite or probable stent thrombosis. An angiographic follow-up will be performed for all patients at 13 months and clinical follow-up will be continued annually until 3 years after the index procedure. Conclusions DKCRUSH VIII trial is the first study designed to evaluate the differences in efficacy and safety between IVUS-guided and angiography-guided DK crush stenting in patients with complex true bifurcation lesions. This study will also provide IVUS-derived criteria to define optimal DK crush stenting for bifurcation lesions at higher complexity.

Aim The present study aimed to assess the benefits of two-stent techniques for patients with DEFINITION criteria-defined complex coronary bifurcation lesions. Methods and results In total, 653 patients with complex bifurcation lesions at 49 international centres were randomly assigned to undergo the systematic two-stent technique (two-stent group) or provisional stenting (provisional group). The primary endpoint was the composite of target lesion failure (TLF) at the 1-year follow-up, including cardiac death, target vessel myocardial infarction (TVMI), and clinically driven target lesion revascularization (TLR). The safety endpoint was definite or probable stent thrombosis. At the 1-year follow-up, TLF occurred in 37 (11.4%) and 20 (6.1%) patients in the provisional and two-stent groups, respectively [77.8%: double-kissing crush; hazard ratio (HR) 0.52, 95% confidence interval (CI) 0.30–0.90; P = 0.019], largely driven by increased TVMI (7.1%, HR 0.43, 95% CI 0.20–0.90; P = 0.025) and clinically driven TLR (5.5%, HR 0.43, 95% CI 0.19–1.00; P = 0.049) in the provisional group. At the 1 year after indexed procedures, the incidence of cardiac death was 2.5% in the provisional group, non-significant to 2.1% in the two-stent group (HR 0.86, 95% CI 0.31–2.37; P = 0.772). Conclusion For DEFINITION criteria-defined complex coronary bifurcation lesions, the systematic two-stent approach was associated with a significant improvement in clinical outcomes compared with the provisional stenting approach. Further study is urgently warranted to identify the mechanisms contributing to the increased rate of TVMI after provisional stenting. Study registration http://www.clinicaltrials.com; Identifier: NCT02284750.

Background Intravascular ultrasound (IVUS)-guided drug-eluting stent (DES) implantation is associated with fewer major adverse cardiovascular events compared with angiography guidance for patients with individual lesion subset. However, the beneficial effect on major adverse cardiovascular event outcome of IVUS guidance over angiography guidance in all-comers who undergo DES implantation still remains understudied. Objectives This study aimed to determine the benefits of IVUS guidance over angiography guidance during DES implantation in all-comer patients. Methods A total of 1,448 all-comer patients who required DES implantation were randomly assigned (1:1 ratio) to either an IVUS guidance or angiography guidance group. The primary endpoint was target-vessel failure (TVF) at 12 months, including cardiac death, target-vessel myocardial infarction, and clinically driven target-vessel revascularization (TVR). The procedure was defined as a success if all IVUS-defined optimal criteria were met. Results At 12 months follow-up, 60 TVFs (4.2%) occurred, with 21 (2.9%) in the IVUS group and 39 (5.4%) in the angiography group (hazard ratio [HR]: 0.530; 95% confidence interval [CI]: 0.312 to 0.901; p = 0.019). In the IVUS group, TVF was recorded in 1.6% of patients with successful procedures, compared with 4.4% in patients who failed to achieve all optimal criteria (HR: 0.349; 95% CI: 0.135 to 0.898; p = 0.029). The significant reduction of clinically driven target-lesion revascularization or definite stent thrombosis (HR: 0.407; 95% CI: 0.188 to 0.880; p = 0.018) based on lesion-level analysis by IVUS guidance was not achieved when the patient-level analysis was performed. Conclusions The present study demonstrates that IVUS-guided DES implantation significantly improved clinical outcome in all-comers, particularly for patients who had an IVUS-defined optimal procedure, compared with angiography guidance. (Intravascular Ultrasound Guided Drug Eluting Stents Implantation in “All-Comers” Coronary Lesions [ULTIMATE]; NCT02215915)

In the framework of Industry 4.0, collaborative manufacturing across different supply chains is one of the most important business models. In order to avoid the uneven distribution of service requirements among service providers (i.e., non-equalization phenomenon), a lot of service strategies with different characteristics can be taken as candidate solutions to adjust the matching between service providers and service consumers. Based on the background, how to identify the application conditions of various service strategies in complex environment has become a serious challenge in the field. To solve this problem, the computational experiment-based evaluation method is proposed in this paper, including customization of service strategy, construction of experiment system, and experiment analysis of service strategy. In this paper, three possible service strategies are built to deal with the non-equalization phenomenon, i.e., non-equalization strategy, equalization strategy, collaborative equalization strategy. Experiment results show that: collaborative equalization strategy can effectively enhance the service utilization rate and reduce the completion time in short supply environment; equalization strategy is the optimal one in oversupply market environment. This case study can show that the proposed method is feasible and the result is satisfactory.

Feature selection is of particular importance in the field of drug discovery. Many methods have been put forward for feature selection during recent decades. Among them, evolutionary computation has gained increasing attention owing to its superior global search ability. However, there still lacks a simple and efficient software for drug developers to take advantage of evolutionary computation for feature selection. To remedy this issue, in this paper, a user-friendly and standalone software, named ECoFFeS, is developed. ECoFFeS is expected to lower the entry barrier for drug developers to deal with feature selection problems at hand by using evolutionary algorithms. To the best of our knowledge, it is the first software integrating a set of evolutionary algorithms (including two modified evolutionary algorithms proposed by the authors) with various evaluation combinations for feature selection. Specifically, ECoFFeS considers both single-objective and multi-objective evolutionary algorithms, and both regression- and classification-based models to meet different requirements. Five data sets in drug discovery are collected in ECoFFeS. In addition, to reduce the total analysis time, the parallel execution technique is incorporated into ECoFFeS. The source code of ECoFFeS can be available from https://github.com/JiaweiHuang/ECoFFeS/ .

A challenging research topic in wireless sensor network is prolonging the network lifetime by optimizing the network energy expenditure. The paper explores an enhanced energy optimization routing protocol which uses double cluster heads in a clustering wireless sensor network. The double cluster heads which are determined by energy welfare function are referred to as main cluster head and assistant one, respectively. To balance nodes energy, a formula for the energy overhead is presented to make the sensor node join a temporary cluster with low energy consuming during cluster set-up stage. Then, during the routing selection, relay nodes communicate sensory information to the sink by using combining single-hop and multi-hop technology. The selection of relay nodes depends on the weight values involving information of residual energy, the number of nodes in the cluster, selected times as relay nodes, and a distance between two nodes. The improved protocol is evaluated via simulation experiments and compared with some existing protocols. The simulation results demonstrate that the proposed protocol outperforms the relevant protocols in energy utilization efficiency. Especially, the network lifetime is prolonged due to decreasing energy consuming of the cluster head.

Background: Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing...

Summary Background Cholangiocarcinoma (CCA) is a common biliary malignancy that results in high mortality and poor survival rates. The diagnostic capacity of miRNAs in CCA detection is still controversial. Current meta-analysis evaluate the evidence on the capacity of miRNAs for CCA diagnosis. Methods A systematic literature search for relevant articles in PubMed, Embase and Web of science database up to 10 April 2016 was conducted. The pooled sensitivity, specificity, positive and negative likelihood ratios (PLR and NLR, respectively), diagnostic odds ratio (DOR) and area under the curve (AUC) were pooled to assess the overall diagnostic value of miRNA. Subgroup analysis was further applied to explore the between-study heterogeneity. Publication bias was assessed with Deeks’ funnel plot. Statistical analysis was carried out using RevMan 5.2 and MetaDisc 1.4. Results A total of 501 patients and 248 controls from 14 studies in 8 articles were included in this meta-analysis. The pooled sensitivity and specialty were 0.83 (0.80–0.86) and 0.79 (0.75–0.83), respectively. The pooled PLR was 3.96 (2.64–5.94), NLR was 0.25 (0.19–0.34), DOR was 18.1 (9.79–33.5) and pooled AUC was 0.88 (0.85–0.90). Subgroup analyses indicated that the serum miRNA assays showed highly accurate CCA diagnosis. The diagnostic capacity was more accurate in Caucasians than in Asians. Conclusions The miRNA assays are promising diagnostic tools for CCA detection with moderate accuracy. However, further prospective studies were needed to confirm this results before clinical application.

Cloud manufacturing (CMfg) has become a brand-new service-oriented networked manufacturing. The key technology that achieves this manufacture mode is to aggregate all kinds of potential CMfg services to create value-added composite CMfg services, so as to satisfy various manufacturing requirements. As massive CMfg services with the same manufacturing functionalities and different quality of service (QoS) are emerging on the Internet, CMfg services dynamic composition becomes more and more complex. One challenge of this technology is how to efficiently solve the problem of multipath CMfg services dynamic composition. Another challenge is how to conquer the overconstrained problem occurred in the process of CMfg services dynamic composition. To tackle these two issues, this paper proposes an approach for multipath CMfg services dynamic composition based on improved QoS constraint hierarchies (CHs) model. First, a QoS constraints description model with new evaluation function is propounded based on the CHs theory to conquer the overconstrained problem; second, improved max–min ant system (MMAS) is put forward by introducing improved transfer rule, new global pheromone updating rule and mutation mechanism into MMAS, and then an optimization algorithm named culture genetic MMAS is constructed for multipath CMfg services dynamic composition. Finally, experimental results and performance comparison prove that the proposed method is both effective and efficient.

Background Provisional stenting (PS) is effective for great majority of patients with coronary bifurcation lesions. Double kissing (DK) crush approach demonstrated significant reduction of target lesion revascularization (TLR) for patients with more complex bifurcation lesion when compared with PS. Furthermore, DK crush technique was associated with lower rate of composite major adverse cardiac event (MACE), revascularization and stent thrombosis (ST) for patients with unprotected distal left main coronary artery bifurcation lesions (ULMb), compared to culotte stenting approach. The DKCRUSH V trial is designed to elucidate the benefits of DK crush over PS in patients with ULMb. Study design DKCRUSH V is a randomized, prospective, multinational clinical trial designed to evaluate the efficacy and safety of DK crush over PS for patients with ULMb. Subjects with Medina 1,1,1 or 0,1,1 ULMb will be randomized in a 1:1 fashion to PS or DK crush. The primary endpoint is target lesion failure (TLF) including target vessel myocardial infarction, cardiac death and TLR. Other endpoints address individual event of primary endpoint, and target vessel revascularization. The safety objective is the ST. Recruitment began in January 2012 and was completed in December 2015; 484 patients were randomized. The trial will continue until at least 56 adjudicated primary endpoints occur. Conclusions The DKCRUSH V study is investigating if DK crush approach versus PS will reduce the incidence of TLF in patients with symptomatic ULMb.

The present study aimed to analyze the incidence of SF and its correlation with clinical events after DES implantation and the outcome of re-intervention for symptomatic in-stent restenosis (ISR) induced by stent fracture (SF).SF is associated with a high rate of clinical events after the implantation of drug-eluting stents (DES). However, the chronological rate of SF and the effect of SF on clinical outcomes from a large patient population remain underreported.A total of 6,555 patients with 16482 DES in 10751 diseased vessels and surveillance angiography between November 2003 and January 2014 were prospectively studied. The primary endpoints included the incidence of SF, in-stent restenosis (ISR), target lesion revascularization (TLR), and definite stent thrombosis (ST) at the end of follow-up before and after propensity score matching. Clinical outcomes after TLR were also followed up.The SF rate was detected in 803 (12.3%) patients, 3,630 (22.0%) stents, and 1,852 (17.2%) diseased vessels. SF increased over time. SF was associated with higher unadjusted rates of ISR (42.1%), TLR (24.8%, n = 379), and definite ST (4.6%) compared with stents without fracture (10.7%, 6.6%, and 1.03%, all p 0.001), and the differences remained significant after propensity score matching (all p 0.05). There was no significant difference in any-cause or cardiac mortality between patients with and without SF. After 1,523 days of follow-up since the first surveillance angiography, repeat ISR was detected in 90 of 379 (23.8%) stents after reintervention, and 6 (7.5%) stents required repeat TLR.SF is more frequently observed after DES implantation. TLR was required in almost one-fourth of fractured stents. Increased events in the SF group did not translate into a difference in mortality compared with the non-SF group. Reintervention was associated with acceptable clinical results.

This paper proposes a two-stage method for reliable dynamic Web service composition and improves the reliability of dynamic Web service composition.In the first stage, the scale of candidate services is reduced and the service composition problem is transformed to local service selection problem.In the second stage, QoS of candidate services are predicted and used to select the optimal services for tasks in the service composition workflow.Culture Genetic Algorithm (CGA) is proposed to reduce candidate services and decompose the global QoS constraints into local QoS constraints.It proposes a Web service QoS dynamic prediction method based on improvedÂ?case-based reasoning (CBR). Web service composition is a key technology for creating value-added services by integrating available services. With the rapid development of Service Computing, Cloud Computing, Big Data, and the Internet of Things, mass services with the same functionalities and different quality of service (QoS) values are available on the Internet. Moreover, due to the uncertainties of services' application environment, a service's QoS is highly dynamic; these two factors cause reliable dynamic Web service composition to be a challenge. To address this issue, this paper proposes a two-stage approach for reliable dynamic Web service composition. In the first stage, the top K Web service composition schemes based on each service's historical QoS values are selected with the proposed algorithm named Culture Genetic Algorithm (CGA). Then, component services in the top K schemes are filtered out and employed as the candidate services for dynamic service composition. This operation can greatly reduce the number of available services and filter out better candidate services for dynamic service composition. Next, the global QoS constraints are decomposed into local QoS constraints with the CGA algorithm, and the global optimal problem of service composition is transformed into a local optimal service selection problem; this conversion increases the flexibility of dynamic service composition and provides a chance to predict QoS values of services before service selection. In the second stage, before selecting the best service for each task during the running of the service composition workflow, QoS values of each candidate service are predicted based on the improved case-based reasoning, and the best service is selected according to the predicted QoS values. Through QoS prediction, the reliability of the composite Web service can be greatly enhanced. Finally, experimental results show that the proposed method is feasible and effective.

To explore the association of platelet activation markers, vitamin D, and antiplatelet drugs resistance in ischemic stroke patients.A total of 230 patients with ischemic stroke were enrolled in this study. Platelet aggregation, platelet activation marker (CD62p), and vitamin D were measured after 7-14 days of dual antiplatelet treatment (aspirin + clopidogrel). All individuals were divided into a drug resistance group and a drug sensitive group according to the platelet maximum aggregation rate induced by antagonist adenosine diphosphate or arachidonic acid.In this study, the prevalence of aspirin resistance was low (1.2%), while the prevalence of clopidogrel resistance (CR) was 24.8%, so we focused on CR. The percentage of CD62p on activated platelet [(25.74 ± 4.61) versus (12.41 ± 3.93), P.001] and the prevalence of hypertension [93.0% (53) versus 79.8% (138), P = .021] in CR group were significantly higher than those in clopidogrel sensitive (CS) group, while the vitamin D concentration [(8.96 ± 4.41) versus (13.9 ± 4.84) ng/mL, P = .003] in CR group was significantly lower compared with the CS group. No significant difference was found in soluble P-selectin between these 2 groups [(56.2 ± 16.13) versus (54.2 ± 14.87) ng/mL, P = .258], neither in calcium [(2.29 ± .12) versus (2.33 ± .13) mmol/L, P = .821]. Logistic regression analysis showed that hypertension (odds ratio [OR] = 5.348, 95% confidence intervals [CI] 1.184-23.350, P = .026), expression of platelet CD62p (OR = 1.095, 95% CI 1.052-1.201, P = .018) and vitamin D level (OR = .832, 95% CI .763-.934, P = .005) were associated with CR in ischemic stroke patients.CR in ischemic stroke patients is associated with several independent predictors, including increased platelet activation marker CD62p, decreased vitamin D level, and hypertension.

Inspired by the evolution process of human intelligence and the social learning theory, a new swarm intelligence algorithm paradigm named the social learning optimization (SLO) algorithm is proposed. SLO consists of three co-evolution spaces: the bottom is the micro-space, where genetic evolution occurs; the middle layer is the learning space, where individuals enhance their intelligence through imitation learning and observational learning; knowledge is extracted from the middle layer and delivered to the top layer, which is called the belief space, where culture is established through knowledge accumulation and used to guide individuals' genetic evolution in the micro-space regularly. SLO is an optimization algorithm model for optimization problems, and a concrete algorithm could be generated by embodying SLO's three evolution spaces. Moreover, to demonstrate how to employ SLO and verify its superiority, this paper proposes the specific SLO (S-SLO) to solve the problem of QoS-aware cloud service composition. S-SLO is constructed by integrating the improved differential evolutionary (DE) algorithm and improved social cognitive optimization (SCO) into the micro-space and the learning space, respectively. Finally, experimental results and performance comparison show that the S-SLO is both effective and efficient. This work is expected to explore a novel swarm intelligence optimization model with better search capabilities and convergence rates, as well as to extend the theory of the swarm intelligence optimization algorithm.

Many molecular epidemiological studies have been performed to explore the association between MTHFR C677T polymorphism and cancer risk in diverse populations. However, the results were inconsistent. Hence, we performed a meta-analysis to investigate the association between cancer risk and MTHFR C677T (150,086 cases and 200,699 controls from 446 studies) polymorphism. Overall, significantly increased cancer risk was found when all eligible studies were pooled into the meta-analysis. In the further stratified and sensitivity analyses, significantly increased breast cancer risk was found in Asians and Indians, significantly decreased colon cancer risk was found, significantly decreased colorectal cancer risk was found in male population, significantly increased gastric cancer risk was found in Caucasians and Asians, significantly increased hepatocellular cancer risk was found in Asians, significantly decreased adult acute lymphoblastic leukemia (AALL) risk was found in Caucasians, significantly decreased childhood acute lymphoblastic leukemia (CALL) risk was found in Asians, and significantly increased multiple myeloma and NHL risk was found in Caucasians. In summary, this meta-analysis suggests that MTHFR C677T polymorphism is associated with increased breast cancer, gastric cancer, and hepatocellular cancer risk in Asians, is associated with increased gastric cancer, multiple myeloma, and NHL risk in Caucasians, is associated with decreased AALL risk in Caucasians, is associated with decreased CALL risk in Asians, is associated with increased breast cancer risk in Asians, is associated with decreased colon cancer risk, and is associated with decreased colorectal cancer risk in male population. Moreover, this meta-analysis also points out the importance of new studies, such as Asians of HNC, Asians of lung cancer, and Indians of breast cancer, because they had high heterogeneity in this meta-analysis (I(2) 75%).

Objectives This study sought to compare the outcomes of fractional flow reserve (FFR)–guided and angiography (Angio)–guided provisional side-branch (SB) stenting for true coronary bifurcation lesions. Background Angio-guided provisional SB stenting after stenting of the main vessel provides favorable outcomes for the majority of coronary bifurcation lesions. Whether an FFR-guided provisional stenting approach is superior has not been studied. Methods A total of 320 patients with single Medina 1,1,1 and 0,1,1 coronary bifurcation lesions undergoing stenting with a provisional SB approach were randomly assigned 1:1 to Angio-guided and FFR-guided groups. SB stenting was performed for Thrombolysis In Myocardial Infarction flow grade 70%, or greater than type A dissection after main vessel stenting in the Angio-guided group and for SB-FFR Results Comparing the Angio-guided and FFR-guided groups, treatment of the SB (balloon or stenting) was performed in 63.1% and 56.3% of lesions respectively (p = 0.07); stenting of the SB was attempted in 38.1% and 25.9%, respectively (p = 0.01); and, when attempted, stenting was successful in 83.6% and 73.3% of SBs, respectively (p = 0.01). The 1-year composite major adverse cardiac event rate was 18.1% in both groups (hazard ratio: 0.91, 95% confidence interval: 0.48 to 1.88; p = 1.00). The 1-year target vessel revascularization and stent thrombosis rates were 6.9% and 5.6% (p = 0.82) and 1.3% and 0.6% (p = 0.56) in the Angio-guided and FFR-guided groups, respectively. Conclusions In this multicenter, randomized trial, angiographic and FFR guidance of provisional SB stenting of true coronary bifurcation lesions provided similar 1-year clinical outcomes. (Randomized Study on DK Crush Technique Versus Provisional Stenting Technique for Coronary Artery Bifurcation Lesions; ChiCTR-TRC-07000015 )

By means of all kinds of collaboration mode, ‘cluster supply chain’ CSC can facilitate the realisation of the mass customised production. The collaboration between enterprises is enabled by the composition of manufacturing services MSs. To meet the specific demands of the mass customised production, two critical problems need to be solved in the process of manufacturing service composition MSC: 1 how to design the customised quality of service QoS evaluation model to depict a variety of customer requirements; 2 how to design the customised service composition method to deal with the fluctuated market requirement sequence. To address these issues, the customised QoS model designed for MSC is first constructed based on the characteristics of MS; second, the customised MSC method is proposed to make full use of the advantages of different methods under various market conditions; finally, based on the actual customised production condition in CSC, the simulation experiments are given to validate the effectiveness of the above solutions and the results are satisfactory.

Insulin-like growth factor 2 (IGF-2) mRNA-binding protein 3 (IMP3) is overexpressed in pancreatic cancer, while remaining undetectable in the normal pancreas, indicating its important role in pancreatic cancer pathogenesis. The role of IMP3 in pancreatic carcinogenesis has not been fully understood. The main goal of this study was to probe the expression profile of IMP3 in different stages of pancreatic ductal adenocarcinoma (PDAC) development, and evaluate their prognostic significance in PDAC patients. We used quantitative real-time RT-PCR combined manual microdissection to precisely detect IMP3 expression in 97 microdissected foci from 50 patients with PDAC. Nonparametric test, Log-rank test and Cox regression analysis were used to evaluate the clinical significance of DNMTs expression. Expression of IMP3 increased from normal duct to pancreatic intraductal neoplasia and to PDAC. IMP3 mRNA expression statistically correlated with TNM staging. Univariate analysis showed that high level of IMP3 expression, tumor differentiation, TNM staging and alcohol consumption were statistically significant risk factors. Multivariate analysis showed that high level of IMP3 expression and tumor differentiation were statistically significant independent poor prognostic factors. These results suggested that pancreatic carcinogenesis involves an increased IMP3 mRNA expression, and it may become valuable diagnostic and prognostic markers as well as potential therapeutic targets for pancreatic cancer.

Web service dynamic composition is a key technology for creating value-added services by composing available services and applications. With the rapid development of web service, cloud computing, big data and internet of things, more and more services with identical functionality and different Quality of Service (QoS) are available; moreover, QoS of Web services are highly dynamic, so, how to create composite Web services reliably and efficiently is still an open issue. For this problem, this paper proposes a reliable Web service composition method based on global QoS constraints decomposition and QoS dynamic prediction. The approach includes two critical phases: firstly, before service composition, global QoS constraints are decomposed into local constraints, and the problem of Web service dynamic composition is transformed to a local optimization problem; secondly, during the running time, optimal Web service is selected for the current abstract service based on predicted QoS values. Experiment results show that our approach can greatly enhance the reliability of composite Web service.

In coal mine industry, the context-aware intelligent service system can be used to provide the most appropriate information services to miners according to their real-time situation. As a result, the information resources can be taken full advantage of so as to help miners to improve their safety condition, which are not just accessible to the management staff. However, there is not a detailed discussion or an in-depth research on the implementation of service system at present. In order to bridge the gap between the theory and the practice in the field, three critical problems need to be solved: (1) How to model the served miners' context? (2) How to provide the information services to meet miners' customized demands? (3) How to verify the availability of service invocation? According to the characteristics and practical needs of coal mine, this paper first proposes the Coal Mine Semantic Sensor Network Ontology (CMSSN) to build miner's context model, which can facilitate reusing the context resources in different coal mines. Then, the configuration model connecting context information and business services is constructed to realize the customized service invocation. Thirdly, the method of computational experiment is proposed to verify the availability and validity of service system, i.e. whether the service system can provide the suitable service on time in various virtual accident experiments. A case study is given to explain how to implement the computational experiment on a virtual coal mine simulation platform. Finally, the potential problems in realizing the system are discussed, which will be our research focus in future. PACS: 75.40.-s; 71.20.LP

The current study aimed at determining the best cutoff value of angiographic and intravascular ultrasound (IVUS) parameters for defining fractional flow reserve (FFR)0.8 in patients with single coronary artery lesion.The correlation between angiographic or IVUS variables and FFR in patients with single coronary artery lesions has not been studied yet.Quantitative coronary analysis and IVUS and FFR measurements were used in 323 patients with a single lesion. The best angiographic and IVUS cutoff values and their predictive value for FFR0.8 were compared using area under the receiver-operator characteristic curve (AUC).FFR0.8 was in 54.2%. Minimal lumen area (MLA), plaque burden (PB), lesion length (LL) and lesion at left anterior descending artery (LAD) were four predictors of FFR0.8. LL had less value in predicting FFR0.8. The cutoff values of PB and MLA for FFR0.8 were 72.7% and 2.97 mm(2). MLA and PB had similar high diagnostic value for vessel size ≥ 3 mm (cutoff values: 3.02 mm(2) and 80.7%), proximal LAD lesion (cutoff values: 3.04 mm(2) and 76.5%) and unstable angina (2.82 mm(2) and 71.9%). Combination of MLA (2.82 mm(2)) and PB (80.6%) had increased diagnostic value for distal LAD lesion. Only PB (71%) had higher diagnostic value for diabetic patients. MLA and PB could not predict FFR0.8 for vessel size3mm, and non-LAD lesion.Best cutoff value of MLA and PB for FFR0.8 in patients with a single lesion is patient-, vessel size- and lesion location-oriented. PB has strengthened diagnostic accuracy for diabetic patients.

Virtual enterprise is a temporary network of independent companies or enterprises that can quickly bring together to fulfill a value-added task. With the development of Web service technologies, the enterprise business systems can be encapsulated as Web services. Establishing a virtual enterprise is actually a process of Web service composition. As more and more Web services with the same functionalities and different Quality of Service (QoS) are available, QoS-aware Web service dynamic composition becomes an active research issue. Although several solutions have been provided for this issue, most of these methods based on global optimization, their poor performance render them inappropriate for applications with dynamic and real-time requirements. Moreover, these methods do not consider the commercial agreements and historical contact information between Web services with combination relationship. In this paper, we propose an approach for Web service dynamic composition based on global QoS constraints decomposition. The proposed method consists of three steps: Firstly, global QoS constraints are decomposed into local constraints optimally by a new algorithm named Culture Genetic Algorithm. Secondly, QoS values determination rules are designed to determine QoS values of candidate services. Thirdly, best Web services that can satisfy the local constraints are selected for each task during the running time. Experimental results show that our approach has better performance in solving the problem of QoS-aware Web service dynamic composition.

Type 2 diabetes correlates with clinical events after the implantation of a second-generation drug-eluting stent (DES). The rate and prognostic value of stent fracture (SF) in patients with diabetes who underwent DES implantation remain unknown. A total of 1160 patients with- and 2251 without- diabetes, who underwent surveillance angiography at 1 year after DES implantation between June 2004 and August 2014, were prospectively studied. The primary endpoints included the incidence of SF and a composite major adverse cardiac event [MACE, including myocardial infarction (MI), cardiac death, and target-vessel revascularization (TVR)] at 1-year follow-up and at the end of follow-up for overall patients, and target lesion failure [TLF, including cardiac death, target vessel myocardial infarction (TVMI) and target lesion revascularization (TLR)] at the end of study for SF patients. In general, diabetes was associated with a higher rate of MACE at 1-year (18.4 vs. 12.9%) and end of follow-up (24.0 vs. 18.6%, all p 0.001), compared with those in patients who did not have diabetes. The 1-year SF rate was comparable among patients with diabetes (n = 153, 13.2%) and non-diabetic patients (n = 273, 12.1%, p 0.05). Diabetic patients with SF had a 2.6-fold increase of SF-related cardiac death at the end of study and threefold increase of re-repeat TLR when compared with non-diabetic patients with SF (5.9 vs. 2.2%, p = 0.040; 6.5 vs. 2.2%, p = 0.032), respectively. Given the fact that diabetes is correlated with increased MACE rate, SF in diabetic patients translates into differences in mortality and re-repeat TLR compared with the non-diabetic group.

Background The association of platelet reactivity and clinical outcomes, especially stent thrombosis, was not so clear. We sought to investigate whether high platelet reactivity affects clinical outcomes of patients with drug eluting stents (DESs) implantation. Methods All enrolled individuals treated with DESs implantation were evaluated by PL-11, using sequentially platelet counting method. The primary end point was the occurrence of definite and probable stent thrombosis at 2 years. The secondary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), including all cause death, spontaneous myocardial infarction (MI), target vessel revascularization (TVR), and ischemic stroke. Results A total of 1331consecutive patients were enrolled at our center. There were 91 patients (6.8 %) identified with high platelet reactivity (HPR) on aspirin, and 437 patients (32.9 %) with HPR on clopidogrel. At 2-year follow-up, the incidence of stent thrombosis was significantly higher in patients with HPR on aspirin (9.9 % vs. 0.4 %, p

sis. Compared to the angiography-guided group, the IVUS-guided group had a significantly lower overall unadjusted ST rate (1.2% vs. 6.9%, P < 0.001), definite ST (0.6% vs. 5.3%, P < 0.001), late ST (0.6% vs. 4.3%, P 5 0.003), MI (4.6% vs. 8.9%, P 5 0.038) and cardiac death (0.9% vs. 3.3%, P 5 0.049). By propensity score matching, 123 paired patients were matched. The late ST at 12-months follow-up was 0% in the IVUS-guided group versus 4.9% in the angiography-guided group (P 5 0.029), resulting in significant differences in ST-elevation MI between the two groups (2.4% vs. 9.8%, P 5 0.030). Conclusions: The IVUS-guided two-stent technique was associated with significantly reduced late stent thrombosis, with a resultant reduction in ST-elevation MI. V C 2012 Wiley

The present study aimed to compare the long-term (five-year) safety and efficacy between the one-stent, two-stent and double-kissing (DK) crush strategies, utilising drug-eluting stents, for unprotected left main coronary artery (ULMCA) bifurcation lesions.Between March 2004 and April 2007, 633 consecutive patients with ULMCA bifurcation lesions (232 in the one-stent group and 401 in the two-stent group) were prospectively enrolled. The primary endpoint was the occurrence of major adverse cardiac events (MACE), a composite of cardiac death, myocardial infarction (MI), and target vessel revascularisation (TVR), at five-year follow-up. Patients in the the two-stent group were classified as DK crush (n=155) and other two-stent techniques (culotte, T-stenting, kissing stenting and classical crush, n=246). Forty-seven (16.8%) patients in the one-stent group crossed over to the two-stent group. The one-stent group was associated with an increased incidence of MI compared to the two-stent approach (10.5% vs. 5.5%, p=0.025). The crude rate of MACE at five years was 28.0% in the one-stent group and 28.4% in the two-stent group (p=0.927). DK crush was associated with a significantly decreased five-year MACE compared to the other two-stent approaches or the one-stent approach (DK crush: 14.8% vs. other two-stent approaches: 37.0%, one-stent approach: 28.0%, p0.001). The main benefit of DK crush primarily appeared to be secondary to a reduction in TVR (7.7% vs. 30.5% vs. 18.1%, p0.001). By Cox regression analyses, the non-DK crush two-stent technique, a high SYNTAX Score (≥33) or New Risk Stratification (NERS) score (20), and incomplete revascularisation were shown to be independent predictors of MACE at five-year follow-up.With distal left main true bifurcations, the two-stent technique (excluding DK crush) is an independent predictor of long-term MACE. DK crush is associated with more favourable long-term clinical outcomes. Confirmation of these findings is required from randomised controlled trials.

To solve the inverse kinematics problem of a robot manipulator without closed form solutions, one-dimensional iterative method is very useful. However, for a 5-DOF robot manipulator, because of the uncontrolable and uncertain orientation vectors, it's difficult to analytically express all joint variables by one of them, therefore one-dimensional iterative method can not be directedly used. By adding an appropriate virtual joint to it, a 5-DOF manipulator can be changed into a 6-DOF one so that the uncertain orientation vectors can be pre-given, and the difficulty is solved. To illustrate this virtual joint method a 5-DOF serial robot manipulator with prismatic arm joint and offset wrist is discussed in this paper as an example.

Background: Compared with the classical crush, double kissing (DK) crush improved outcomes in patients with coronary bifurcation lesions. However, there is no serial intravascular ultrasound (IVUS) comparisons between these two techniques. Objectives: This study aimed to analyze the mechanisms of the two crush stenting techniques using serial IVUS imaging. Methods: A total of 54 patients with IVUS images at baseline, post-stenting and eight-month follow-up were classified into classical (n = 16) and DK (n = 38) groups. All patients underwent final kissing balloon inflation (FKBI). Unsatisfactory kissing (KUS) was defined as the presence of wrist or >20% stenosis during FKBI at the side branch (SB) ostium. The vessels at bifurcation lesions were divided into the proximal main vessel (MV) stent, the crushed segment, the distal MV stent, the SB ostium and the SB stent body. Results: KUS and incomplete crushing were commonly observed in the classical group (62.5%, 81.3%), compared with DK group (18.0%, 39.5%, P < 0.001 and P = 0.004). The post-stenting stent symmetry in the classical group was 71.85 ± 7.69% relative to 85.93 ± 6.09% in DK group (P = 0.022), resulting in significant differences in neointimal hyperplasia (NIH, 1.60 ± 0.21 mm2 vs. 0.85 ± 0.23 mm2, P = 0.005), late lumen loss (1.31 ± 0.81 mm2 vs. 0.55 ± 0.70 mm2, P = 0.013), and minimal lumen area (MLA, 3.57 ± 1.52 mm2 vs. 4.52 ± 1.40 mm2,P = 0.042) at the SB ostium between two groups. KUS was positively correlated with the incomplete crush and was the only predictor of in-stent-restenosis (ISR) at the SB ostium. Conclusion: DK crush was associated with improved quality of the FKBI and larger MLA. KUS predicted the occurrence of ISR. © 2011 Wiley Periodicals, Inc.

SUMMARY Objective: This study aimed to compare the acute effects of nicardipine and esmolol on hemodynamic and endothelial shear stress (ESS) in patients with unstable angina (UA) and moderate coronary stenosis (MCS). Background: Nicardipine and esmolol exhibit cardioprotection via different mechanisms. However, their acute effects on hemodynamic and ESS are still unknown. Methods: One-hundred sixteen patients with UA and MSC were randomly divided into nicardipine (n = 59) and esmolol (n = 57) groups. Drugs were injected as a bolus followed by continuous infusion to achieve the steady states defined as the mean blood pressure (MBP) reduced by ≥10% or a heart-rate change by ≥15 bpm, lasting for at least 10 min. The aortic pressure (AP), EKG, blood velocity, right atrial pressure, distal coronary pressure (DCP), systolic time (ST), isovolumetric diastolic time (IVDT), speed filling time (SFT), and ESS were simultaneously calculated at baseline and steady states. Results: Both drugs significantly reduced blood pressure and rate-pressure load. Infusion of nicardipine was associated with negative remodeling of the distal segment (P = 0.005). Esmolol, rather than nicardipine, increased minimal lumen diameter (P = 0.040), prolonged SFT (0.34 ± 0.03 s vs. 0.41 ± 0.03 s, P < 0.001), reduced DCP (P < 0.001) and increased blood velocity (33.65 ± 1.07 cm/s vs. 43.36 ± 1.25 cm/s, P < 0.001) at SFT stages, with increased blood-flow (P < 0.001). Both drugs increased downstream ESS. Esmolol significantly reversed abnormally increased ESS (P < 0.001) and increased upstream ESS compared with nicardipine (P < 0.001). Conclusion: Beyond a similar reduction of AP, patients with UA and MCS could benefit more from the reduction of heart rate induced by esmolol (ChiCTR-TRC-10000964).

The water mist is an economical and environmental agent for gas explosion suppression. It can be applied in the commonly gas concentration zones and the gas accumulation zones which is difficult to reduce the concentration of methane gas. By numerical analysis, this paper studies the effect of the direction and the number of the nozzles, and the distance form the nozzles to the wall at X direction in upper corner in coal mine. For gas explosion suppression in upper corner, it can use one nozzle which direction is same as the wind and the distance is 2m.

Virtual enterprise is a temporary network of independent companies or enterprises that can quickly bring together to fulfill a value-added task. With the development of Web service technologies, the enterprise business systems can be encapsulated as Web services. Establishing a virtual enterprise is actually a process of Web services composition. As more and more Web services are available, many Web services with different quality of service (QoS) can be found for tasks of the composite Web service. Thus, a significant research problem in Web service composition is how to select the correct Web services for tasks such that the composite Web service gives the best overall quality. In this paper, we propose an approach to achieve Web services selection efficiently with excellent comprehensive quality. Firstly, a comprehensive evaluation model based on generic QoS (GQoS) and domain QoS (DQoS) of composite Web service is established. Secondly, a novel optimization algorithm named culture max–min ant system (C-MMAS) is constructed to solve the problem of Web service selection based on DGQoS. Simulations show that when used in Web service selection, C-MMAS is better than ant colony optimization algorithm and MMAS in efficiency.

Background Data on the relevance of the location of coronary bifurcation lesions treated by crush stenting with outcomes were limited. Hypothesis We hypothesized that the location of the bifurcation lesion correlated with clinical outcome. Method A total of 212 patients with 230 true bifurcation lesions treated by crush stenting with drug-eluting stents (DES) were assessed prospectively. Surveillance quantitative angiographies were indexed at 8 months after procedure. Primary endpoint was major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, and target lesion revascularization (TLR). Results Patients in the distal right coronary artery (RCAd) group were characterized by higher proportions of prior myocardial infarction and very tortuous lesions. However, lesions in the RCAd group, compared to those of other groups, had the lowest late lumen loss, with resultant lowest incidence of MACE at a mean follow-up of 268±35 days. Independent predictors of MACE included unsatisfied kissing (KUS; hazard ratio [HR]: 12.14, 95% confidence interval [CI]: 4.01–12.10, P = .001) and non-RCA lesion (HR: 20.69, 95% CI: 5.05–22.38, P = .001), while those of TLR were KUS (HR: 10.21, 95% CI: 0.01–0.34, P = .002), bifurcation angle (HR: 4.728, 95% CI: 2.541–4.109, P = .001), and non-RCA lesion (HR: 16.05, 95%CI: 1.01–4.83, P = .001). Conclusions Classical crush stenting with drug-eluting stents is associated with significantly better outcomes in RCAd. Quality of kissing inflation is mandatory to improve outcome. Copyright © 2009 Wiley Periodicals, Inc.

Background: Wall shear stress (SS) plays an important role in the initiation and proliferation of coronary atherosclerosis, especially for bifurcations. Stenting in the coronary artery will cause many different changes in velocity, flow, cross-sectional area, and especially the wall SS. However, it is still unknown how much wall SS distribution varies with stenting in coronary bifurcation. Objective: The purpose of this study was to investigate the magnitude and distribution of wall SS after the classical crush stenting for bifurcation lesions. Methods: Eleven patients with true coronary bifurcation stenting by the classical crush technique were included. We studied the difference of wall SS between restenosis and nonrestenosis groups in these patients. The differences in SS between preprocedure and postprocedure, as well as between immediately postprocedure and after an 8-month follow-up, were also analyzed. Diameter stenosis or minimal lumen diameter were measured by quantitative coronary analysis. The commercial CD STAR-CCM+ was used to calculate the SS. Results: At baseline, the SS in all the segments of all patients was high. The baseline SS of the restenosis group was 50% lower than the nonrestenosis group. Immediately after percutaneous coronary intervention (PCI), the SS in both areas decreased; however, the SS of the nonrestenosis group decreased to its lowest level possible while the SS of the restenosis group decreased moderately. Eight months later, the SS of all the segments of the nonrestenosis group remained persistently low at the same level of right after PCI. In contrary, the SS in the restenosis group returned to near its baseline level. Conclusion: From our study, after a 2-stent crush technique using drug-eluting stents (DES), the degree of SS reduction appears to predict in-stent restenosis (ISR). A SS decrease to its lowest level and remaining homogenously low is a prime condition to prevent ISR. A baseline low SS, which decreases minimally after PCI and recovers to around its baseline level, appears to be the setting for restenosis. These conditions can be evaluated as predictors of lesions that may need surveillance angiography and proper IVUS evaluation to prevent future in-stent restenosis. (J Interven Cardiol 2010;23:330–340)

Background: While many studies confirmed the importance of fractional flow reserve (FFR) in guiding complex percutaneous coronary interventions (PCI), data regarding the significance of FFR for bifurcation lesions are still lacking. Methods: Between October 2008 and October 2009, 51 patients with true bifurcation lesions were consecutively enrolled and randomized into double kissing (DK) crush (n = 25), and provisional 1-stent (n = 26) groups. FFR measurements at baseline and hyperemia were measured at pre-PCI, post-PCI, and at 8-month follow-up. Results: Clinical follow-ups were available in 100% of patients while only 33% of patients underwent angiographic follow-up. Baseline clinical and angiographic characteristics were matched between the 2 groups. Pre-PCI FFR of the main branch (MB) in the DK group was 0.76 ± 0.15, which was significantly lower than in the provisional 1-stent group (0.83 ± 0.10, P = 0.029). This difference disappeared after the PCI procedure (0.92 ± 0.04 vs. 0.92 ± 0.05, P = 0.58). There were no significant differences in terms of baseline, angiographic, procedural indexes, and FFR of side branch (SB) between the 2 treatment arms. However, immediately after PCI, the patient with DK crush had higher FFR in the SB as compared to the provisional 1-stent group (0.94 ± 0.03 vs. 0.90 ± 0.08, P = 0.028, respectively) and also they had lower diameter stenosis (8.59 ± 6.41% vs. 15.62 ± 11.69%, P = 0.015, respectively). Conclusion: In the acute phase, immediately after PCI for bifurcation lesion, DK crush stenting was associated with higher FFR and lower residual diameter stenosis in the SB, as compared with the provisional 1-stent group. (J Interven Cardiol 2010;23:341–345)

Background: Endothelial shear stress is one of the local hemodynamic factors suspected in the development of coronary atherosclerosis in bifurcation lesions. In patients with provisional stenting, the endothelial shear stress (SS) distribution is unknown. Objective: The aim of this study was to investigate the magnitude and distribution of the SS of coronary bifurcation lesions stenting by the provisional approach. Methods: Ten consecutive patients were included in this study. Quantitative coronary analysis, flow study, and three-dimensional computational analysis with the aid of the commercial software CD STAR-CCM+ were done before and after the provisional stenting procedure and also 8 months later. Results: Clinical and angiographic follow-up were available in all patients. No patient had a side branch (SB) stent. At the 8-month follow-up, no major adverse cardiac event (MACE) occurred. There was also no clinical and angiographic restenosis. Before PCI, the distal main vessel (MV)-lateral, and the SB-lateral subsegments had relative nonsignificant lower SS value (4.08 ± 2.78 Pa and 4.35 ± 5.04 Pa, respectively) when compared to other segments. After 8-month follow-up, sustained decreased SS value was shown in the distal MV-lateral segment (4.08 ± 2.78–1.68 ± 1.65 Pa), when compared with significantly increased SS value in the SB-lateral subsegment 4.35 ± 5.04–16.50 ± 40.45 Pa). The explanation is that after stenting in the MV, the flow was redistributed immediately after percutaneous coronary intervention (PCI) and reversed back to its original 8 months later. However, the growth of the fibrous tissue causing in-stent restenosis (ISR) is prohibited by sirolimus on the stent struts. In contrast, in a branch opened up by plain old balloon angioplasty (POBA), the flow did not change much, the flow could even be worse because it is shifted to the MV after the cross-sectional area of the MV improved by stenting. However, thanks to POBA, there is increased fibrous tissue formation, enough to increase the SS and prevent further accumulation of cell and cholesterol needed for more restenosis. Conclusion: In the provisional approach, low endothelial SS correlated with no restenosis for patients who underwent stenting of the MV, while a contradictory combination of high SS and no restenosis was seen in the SB after only POBA. The mechanism of prevention of restenosis in the SB is by increasing the SS while in the MV, the mechanism of prevention of ISR is secondary to sirolimus on the stents struts. (J Interven Cardiol 2010;23:319–329)

IntroductionProvisional stenting (PS) for simple coronary bifurcation lesions is the mainstay of treatment. A systematic two-stent approach is widely used for complex bifurcation lesions (CBLs). However, a randomised comparison of PS and two-stent techniques for CBLs has never been studied. Accordingly, the present study is designed to elucidate the benefits of two-stent treatment over PS in patients with CBLs.Methods and analysisThis DEFINITION II study is a prospective, multinational, randomised, endpoint-driven trial to compare the benefits of the two-stent technique with PS for CBLs. A total of 660 patients with CBLs will be randomised in a 1:1 fashion to receive either PS or the two-stent technique. The primary endpoint is the rate of 12-month target lesion failure defined as the composite of cardiac death, target vessel myocardial infarction (MI) and clinically driven target lesion revascularisation. The major secondary endpoints include all causes of death, MI, target vessel revascularisation, in-stent restenosis, stroke and each individual component of the primary endpoints. The safety endpoint is the occurrence of definite or probable stent thrombosis.Ethics and disseminationThe study protocol and informed consent have been approved by the Institutional Review Board of Nanjing First Hospital, and accepted by each participating centre. Written informed consent was obtained from all enrolled patients. Findings of the study will be published in a peer-reviewed journal and disseminated at conferences.Trial registration numberNCT02284750; Pre-results.

AIMS This study sought to compare angiographic endpoints at one-year follow-up after a drug-eluting stent implantation guided by either intravascular ultrasound (IVUS) or angiography in patients with chronic total occlusion (CTO) lesions. METHODS AND RESULTS Patients with at least one CTO lesion recanalised successfully were randomly assigned to the IVUS-guided or the angiography-guided group. The use of IVUS for penetration of the true lumen and optimisation of stent expansion was only done in the IVUS-guided group. The primary endpoint was in-stent late lumen loss (LLL) at one-year follow-up. A total of 230 patients with CTO lesions after successful recanalisation were enrolled and followed with office visits or telephone contact up to 24 months. In-stent LLL in the IVUS-guided group was significantly lower compared to the angiography-guided group at one-year follow-up (0.28±0.48 mm vs. 0.46±0.68 mm, p=0.025), with a significant difference in restenosis of the "in-true-lumen" stent between the two groups (3.9% vs.13.7%, p=0.021). The minimal lumen diameter and minimal stent cross-section area significantly and negatively correlated with LLL (all p

In order to accurately predict the Web service Qos in a highly dynamic environment,we put forward a Qos dynamic prediction method based on Semi-Markov Processes(SMP) and Case-based Reasoning(CBR).This method firstly uses semi-Markov process to predict business state of web service in the future, and then applies the technology of CBR to predict Web service QoS, for example,when the service deals with a specific task. Experimental results show that this prediction method can improve the accuracy of Web service QoS greatly. The results provides a reliable basis for the objective evaluation and successful Web service composition. entatio� grxS��#�segmentation algorithm based on iterative segmentation and maximum variance between clusters of traffic signs is studied. Secondly, with feature extraction of traffic signs based on SIFT studied, the codebook is generated by these feature clustering and images are described by histograms using Bag of Words (BOW) model. Finally, multi-class classifier based on SVM is designed to classify traffic signs. The experimental results demonstrate the effectiveness and practicality of the BOW model classification algorithm based on the traffic sign images collected in the natural environment.

Objectives: We investigated the clinical outcome of stenting of unprotected left main coronary artery (LMCA). Methods: We studied 164 patients with nonbifurcated LMCA lesions (group A) and 96 patients with distal bifurcated lesions (group B). Results: Clinical follow-up was available in 100%. Angiographic follow-up was 87.3% in group A and 86% in group B (p = 0.922). There were significant differences in major adverse cardiac events at 1 (p = 0.014) and 2 years (p = 0.002) between group B (19.8%, 25.0%) and group A (9.1%, 10.4%), mainly due to increased target-vessel revascularization (16.7, 21.9% in group B vs. 6.1, 7.3% in group A, p = 0.006 and 0.001, respectively). The double-stent technique was associated with worse outcomes at 1 year in group B compared to group A. Bifurcation lesions (HR 3.42, 95% CI 1.34–5.61, p = 0.001), diabetes (HR 2.68, 95% CI 2.01–12.11, p = 0.015), three-vessel disease (HR 0.83, 95% CI 0.27–0.96, p = 0.001), incomplete revascularization (HR 0.15, 95% CI 0.11–0.35, p = 0.001) and stent diameter (HR 5.05, 95% CI 2.71–10.01, p = 0.03) were the independent factors of major adverse cardiac events in the whole patient cohort. Conclusion: Stenting unprotected distal bifurcated LMCA was associated with unfavorable results when compared to stenting other LMCA lesions.

Two hundred forty-six patients with 252 bifurcation lesions were enrolled into a prospective, nonrandomized study to use paclitaxel-eluting or sirolimus-eluting stent for crush stenting in the treatment of coronary bifurcation lesions. Compared with the sirolimus-eluting stent group, the paclitaxel-eluting stent group had significantly higher mean late lumen and binary angiographic restenosis rates. Sirolimus-eluting stent versus paclitaxel-eluting stent recipients had significantly lower in-segment restenosis in the entire main vessel (15.7% vs 3.1%, P = .004), and simultaneous side branch and main vessel restenoses were solely detected in the paclitaxel-eluting stent group (11.9% vs 0%, P = .03). Target-lesion vessel revascularization and cumulative major adverse cardiac events rates were significantly higher in the paclitaxel-eluting versus the sirolimus-eluting stent group (17.99% vs 8.41%, P = .01; 19.4 vs 9.3%, P = .01; 23.6 vs 11.2%, P = .03). In this study with crush stenting, use of sirolimus-eluting stent, compared with paclitaxel-eluting stent, yielded significantly lower late lumen loss, restenosis, and revascularization rates, with comparable safety by 8-month follow-up.

BACKGROUND Because no data regarding the comparison of crush stenting with paclitaxel (PES) or sirolimus eluting stents (SES) for coronary bifurcate lesions have been reported, we compared the clinical outcomes of these two types of stents. METHODS Two hundred and thirty patients with 242 bifurcate lesions were enrolled in a prospective, nonrandomized trial. Primary endpoints included myocardial infarction, cardiac death and target vessel revascularization at 8 months. RESULTS All patients were followed up clinically and 82% angiographically at 8 months. Final kissing balloon inflation was performed in 72% in the PES and 75% in the SES groups (P>0.05). Compared to the SES group, PES group had a higher late loss and incidence of restenosis (P=0.04) in the prebifurcation vessel segment. The postbifurcation vessel segment in the PES group had a greater late loss ((0.7+/-0.6) mm vs (0.3+/-0.4) mm, P

The potential role of hydration in prevention of contrast-induced nephropathy (CIN) still remains to be unclear.Nine-hundred and thirty-six patients scheduled for percutaneous coronary intervention (PCI) were enrolled into the present study, and divided into normal (serum creatinine1.5 mg/dl) and abnormal (serum creatineor =1.5 mg/dl) groups according to their baseline serum concentration of creatinine. Each group was further randomly divided into two subgroups: hydration and nonhydration. All patients in abnormal group took twice orally loading dose of 1200 mg acetylcysteine (ATLS) at 12 h before scheduled time for coronary angiogram and immediately after procedure. Creatinine concentration was remeasured at the time of admission (just before catheterization), every day for the following three days. The primary end point during 6-month follow-up included clinical driven revascularization (either PCI or CABG), death from all causes, and requiring emergency renal-replacement therapy.The incidence of CIN was more commonly in abnormal group that in normal group (6.52% vs. 37.68%, p0.001). Hydration had potentials in prevention of CIN only in patients with elevated baseline concentration of creatinine. Multivariate analysis demonstrated that the following variables remained to be significant factors correlating with CIN: ageor =70 years (odds ration [OR] 5.27, 95% confidence interval [CI] 1.94 to 13.07, p=0.0007), contrast volumeor =320 ml (OR 3.26, 95% CL 2.14 to 7.58, p=0.01), diabetes mellitus (OR 9.86, 95% CL 5.38 to 31.67, p0.0001), and peripheral arterial disease (OR 11.25, 95% CL 5.12 to 43.19, p0.0001). Patients with CIN in abnormal group had worse clinical outcomes, compared to patients with CIN in normal group.Patients with CIN and preexisting renal insufficiency had worse clinical outcomes. Hydration with 0.45% sodium chloride alone had no potential effect on the occurrence of CIN in patients with normal renal function. Combination of hydration with ATLS could reduce the incidence of CIN in patients at high risk.

AIM: To evaluate the change of growth characteristics and radiosensitivity of irradiated primary cultured human hepatocarcinoma cells. METHODS: All tumor tissue samples were obtained from 39 hepatocarcinoma patients with a mean age of 49.6 years (range 22-76 years). We divided the samples into irradiated group and non-irradiated group and measured their plating efficiency (PE), population doubling time (PDT), radiosensitivity index SF2 and cell cycle. RESULTS: The PDT of primary culture of hepatocarcinoma cells was 91.0±6.6 h, PE was 12.0±1.4%, SF2 was 0.41±0.05%. The PDT of their irradiated progeny was 124.8±5.8 h, PE was 5.0±0.7%, SF2 was 0.65±0.09%. The primary cultured human hepatocarcinoma cells showed significant S reduction and G2 arrest in a dose-dependent manner. The progeny of irradiated primary cultured hepatocarcinoma cells grew more slowly and its radiosensitivity increased. CONCLUSION: The progeny of irradiated primary cultured human hepatocarcinoma cells grows more slowly and its radiosensitivity increases.

The outcome differences between Chinese male and female patients within one-year follow-up after percutaneous coronary intervention (PCI) with stent remain unclear. The present study was aimed to compare clinical outcomes in such two populations. From May 1999 to December 2009, 4,334 patients with acute myocardial infarction (MI), unstable angina, stable angina, or silent ischemia, who underwent PCI, were registered at our centers. Among these, 3,089 were men and 1,245 were women. We compared these groups with respect to the primary outcomes of MI and secondary outcomes including a composite of major adverse cardiac events (MACE) including cardiac death, MI, target lesion revascularization, target vessel revascularization (TVR), stent thrombosis (ST), definite ST and probable ST at one-year follow-up. Chinese male patients had a higher MACE rate (13% vs. 10.7%, P = 0.039), mainly led by TVR (9.09% vs. 6.98%, P = 0.024) at one year, which was significantly different than female patients. Chinese male and female patients showed a significant difference on MACEs. However, there was no significant difference with respect to MI between these groups.

Rajiv Shrestha,1 Sandeep Gami,1 Jing Xu,2 Du-Jiang Xie,2 Zhi-Zhong Liu,2 Tian Xu,1 Fei Ye,2 Shi-Qing Din,3 Xue-Song Qian,4 Song Yang,5 Yue-Qiang Liu,6 Feng Li,7 Ai-Ping Zhang,8 Shao-Liang Chen2 1Nanjing Medical University, Nanjing, 2Nanjing First Hospital, Nanjing Medical University, Nanjing, 3Huainan Xinhua Hospital, Huainan, 4Zhangjiagang People's Hospital, Zhangjiagang, 5Yixin People's Hospital, Yixin, 6Jintan People's Hospital, Jintan, 7Huainan Oriental General Hospital, Huainan, 8Huainan People's Hospital, Huainan, People's Republic of China Background: Previous studies have reported a discrepancy in baseline characteristics and outcomes after percutaneous coronary intervention between men and women. However, this finding has never been verified in the Chinese population. The present study analyzed two-year clinical outcomes after placement of coronary drug-eluting stents in Chinese men and women. Methods: From January 2005 to December 2010, a total of 3804 Chinese patients (2776 men, 1028 women) who underwent drug-eluting stent implantation were studied prospectively. The primary endpoint was the composite major adverse cardiac event (MACE) rate, including myocardial infarction, cardiac death, and target vessel revascularization at two years. Stent thrombosis served as the safety endpoint. Propensity score matching was used to compare the adjusted MACE rate between the two groups. Results: At two-year follow-up, unadjusted rates of myocardial infarction, non-ST segment elevation myocardial infarction, target vessel revascularization, and MACE were significantly different between men (6.84%, 4.6%, 13.1%, and 21.7%, respectively) and women (3.8% [P = 0.001], 2.0% [P < 0.001] 10.3% [P = 0.025], and 16.3% [P < 0.001], respectively). After propensity score matching, there were no significant differences in composite MACE and individual endpoints at two years between the genders. Conclusion: Despite all the unfavorable risk factor clustering in women and complex coronary disease in men, the two-year clinical outcomes after coronary stent placement were comparable between Chinese women and men. Keywords: drug-eluting stent, major adverse cardiac event, gender difference, clinical follow-up

⁎ Corresponding author. E-mail address: chmengx@126.com (S.L. Chen). We thank Dr. Iyisoy et al. for their interest in our paper [1]. They summarized several articles in a remarkable way. There aremany preventive measures that can reduce the risk of CIN, including: different hydration regimens which included NS, 1/2 NS or NaCO3 solutions. In terms of Acetycysteine, the authors reviewed all the literature and the conclusion is to administer Acetycysteine to high risk patients. However, the dosage indicated in the literature was not consistent. The authors concluded that there is no consistent therapy for CIN and that prevention is the best method. The hypothesis that Acetycysteine might contribute to the reduction of contrastinduced nephropathy (CIN) was fully reported in their paper [2]. We completely agree with the authors' conclusion. As a matter of fact, in our prospective, multicenter, randomized study, we enrolled 936 patients after percutaneous coronary intervention (PCI) with normal and abnormal creatinine. We found that, 1. there are significant differences in incidence of CIN in normal and abnormal groups (43 vs. 104), 2. patients with CIN and pre-existing renal insufficiency experienced worse clinical outcomes, compared to patients with CIN in the normal group which usually follows a benign course, 3. there is no positive effect of hydration with 0.45NS on the prevention of CIN in normal renal function, and 4. combination of hydration andNAC has the potential to reduce the incidence of CIN for patients with renal group. Our study did not address the issue of dosage of Acetycysteine but we decided to give Acetycysteine in combination with hydration to patients with abnormal renal function and as a result, we observed a reduction of CIN of 37%. This magnitude of reduction could suggest that the combination of Acetycysteine and hydration is a good method of preventive therapy in patients with renal insufficiency undergoing percutaneous coronary intervention.

To establish the cell survival curve for primary hepatic carcinoma cells and to study the relationship between SF(2) of primary hepatic carcinoma cells and radiosensitivity.Hepatic carcinoma cells were cultured in vitro using 39 samples of hepatic carcinoma at stages II-IV. Twenty-nine samples were cultured successfully in the fifth generation cells. After these cells were radiated with different dosages, the cell survival ratio and SF(2) were calculated by clonogenic assay and SF(2) model respectively. The relationship between SF(2) and the clinical pathological feature was analyzed.Twenty-nine of thirty-nine samples were successfully cultured. After X-ray radiation of the fifth generation cells with 0, 2, 4, 6, 8 Gy, the cell survival rate was 41%, 36.5%, 31.0%, 26.8%, and 19%, respectively. There was a negative correlation between cell survival and irradiation dosage (r = -0.973, P0.05). SF(2) ranged 0.28-0.78 and correlated with the clinical stage and pathological grade of hepatic carcinoma (P0.05). There was a positive correlation between SF(2) and D0.5 (r = 0.773, P0.05).SF(2) correlates with the clinical stage and pathological grade of hepatic carcinoma and is a marker for predicting the radiosensitivity of hepatic carcinomas.