A novel approach for denoising electrocardiogram signals to detect cardiovascular diseases using an efficient hybrid scheme.

Background: Electrocardiogram (ECG) signals are inevitably contaminated with various kinds of noises during acquisition and transmission. The presence of noises may produce the inappropriate information on cardiac health, thereby preventing specialists from making correct analysis. Methods: In this paper, an efficient strategy is proposed to denoise ECG signals, which employs a time-frequency framework based on S-transform (ST) and combines bi-dimensional empirical mode decomposition (BEMD) and non-local means (NLM). In the method, the ST maps an ECG signal into a subspace in the time frequency domain, then the BEMD decomposes the ST-based time-frequency representation (TFR) into a series of sub-TFRs at different scales, finally the NLM removes noise and restores ECG signal characteristics based on structural self-similarity. Results: The proposed method is validated using numerous ECG signals from the MIT-BIH arrhythmia database, and several different types of noises with varying signal-to-noise (SNR) are taken into account. The experimental results show that the proposed technique is superior to the existing wavelet based approach and NLM filtering, with the higher SNR and structure similarity index measure (SSIM), the lower root mean squared error (RMSE) and percent root mean square difference (PRD). Conclusions: The proposed method not only significantly suppresses the noise presented in ECG signals, but also preserves the characteristics of ECG signals better, thus, it is more suitable for ECG signals processing.

A unified Bayesian framework for bias adjustment in multiple comparisons from clinical trials.

In clinical trials, multiple comparisons arising from various treatments/doses, subgroups, or endpoints are common. Typically, trial teams focus on the comparison showing the largest observed treatment effect, often involving a specific treatment pair and endpoint within a subgroup. These findings frequently lead to follow-up pivotal studies, many of which do not confirm the initial positive results. Selection bias occurs when the most promising treatment, subgroup, or endpoint is chosen for further development, potentially skewing subsequent investigations. Such bias can be defined as the deviation in the observed treatment effects from the underlying truth. In this article, we propose a general and unified Bayesian framework to address selection bias in clinical trials with multiple comparisons. Our approach does not require a priori specification of a parametric distribution for the prior, offering a more flexible and generalized solution. The proposed method facilitates a more accurate interpretation of clinical trial results by adjusting for such selection bias. Through simulation studies, we compared several methods and demonstrated their superior performance over the normal shrinkage estimator. We recommended the use of Bayesian Model Averaging estimator averaging over Gaussian Mixture Models as the prior distribution based on its performance and flexibility. We applied the method to a multicenter, randomized, double-blind, placebo-controlled study investigating the cardiovascular effects of dulaglutide.

Research on predicting hematoma expansion in spontaneous intracerebral hemorrhage based on deep features of the VGG-19 network.

PURPOSE: To construct a clinical noncontrastive computed tomography (NCCT) deep learning joint model for predicting early hematoma expansion (HE) after cerebral hemorrhage (sICH) and evaluate its predictive performance. METHODS: All 254 patients with primary cerebral hemorrhage from January 2017 to December 2022 in the General Hospital of the Western Theater Command were included. According to the criteria of hematoma enlargement exceeding 33% or the volume exceeding 6 ml, the patients were divided into the HE group and the hematoma non-enlargement (NHE) group. Multiple models and the 10-fold cross-validation method were used to screen the most valuable features and model the probability of predicting HE. The area under the curve (AUC) was used to analyze the prediction efficiency of each model for HE. RESULTS: They were randomly divided into a training set of 204 cases in an 8:2 ratio and 50 cases of the test set. The clinical imaging deep feature joint model (22 features) predicted the area under the curve of HE as follows: clinical Navie Bayes model AUC 0.779, traditional radiology logistic regression (LR) model AUC 0.818, deep learning LR model AUC 0.873, and clinical NCCT deep learning multilayer perceptron model AUC 0.921. CONCLUSION: The combined clinical imaging deep learning model has a high predictive effect for early HE in sICH patients, which is helpful for clinical individualized assessment of the risk of early HE in sICH patients.

The Role of Emodin in the Treatment of Bladder Cancer based on Network Pharmacology and Experimental Verification.

BACKGROUND AND PURPOSE: Emodin, a compound derived from rhubarb and various traditional Chinese medicines, exhibits a range of pharmacological actions, including antiinflammatory, antiviral, and anticancer properties. Nevertheless, its pharmacological impact on bladder cancer (BLCA) and the underlying mechanism are still unclear. This research aimed to analyze the pharmacological mechanisms of Emodin against BLCA using network pharmacology analysis and experimental verification. METHODS: Initially, network pharmacology was employed to identify core targets and associated pathways affected by Emodin in bladder cancer. Subsequently, the expression of key targets in normal bladder tissues and BLCA tissues was assessed by searching the GEPIA and HPA databases. The binding energy between Emodin and key targets was predicted using molecular docking. Furthermore, in vitro experiments were carried out to confirm the predictions made with network pharmacology. RESULTS: Our analysis identified 148 common genes targeted by Emodin and BLCA, with the top ten target genes including TP53, HSP90AA1, EGFR, MYC, CASP3, CDK1, PTPN11, EGF, ESR1, and TNF. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses indicated a significant correlation between Emodin and the PI3KAKT pathway in the context of BLCA. Molecular docking investigations revealed a strong affinity between Emodin and critical target proteins. In vitro experiments demonstrated that Emodin inhibits T24 proliferation, migration, and invasion while inducing cell apoptosis. The findings also indicated that Emodin reduces both PI3K and AKT protein and mRNA expression, suggesting that Emodin may mitigate BLCA by modulating the PI3K-AKT signaling pathway. CONCLUSION: This study integrates network pharmacology with in vitro experimentation to elucidate the potential mechanisms underlying the action of Emodin against BLCA. The results of this research enhance our understanding of the pharmacological mechanisms by which Emodin may be employed in treating BLCA.

Electrochemical Performance and Microstructure Evolution of a Quasi-Solid-State Lithium Battery Prepared by Spark Plasma Sintering.

Solid-state lithium batteries are promising next-generation energy storage systems for electric vehicles due to their high energy density and high safety and require achieving and maintaining intimate solid-solid interfaces for lithium-ion and electron transport. However, the solid-solid interfaces may evolve over cycling, disrupting the ion and electron diffusion pathways and leading to rapid performance degradation. The development of solid-state lithium batteries has been hindered by the lack of fundamental understanding of the interfacial microstructure change over cycling and its relation to electrochemical properties. Herein, we prepared a quasi-solid-state lithium battery, 30%LiFePO4-55%Li1.5Al0.5Ge1.5(PO4)3-15%C| Li1.5Al0.5Ge1.5(PO4)3|Li, by spark plasma sintering, and employed it as a model system to reveal the microstructure evolution at the solid-solid interfaces with electrochemical performance of the batteries. The electrochemical assessment showed that the quasi-solid-state lithium battery exhibited a discharge specific capacity of about 150 mAh g-1 in the first 80 cycles and then experienced severe capacity attenuation afterward, accompanied by a gradual internal resistance increase. Scanning electron microscopy observation showed that more cracks were formed inside the solid-state electrolyte and at the solid-solid interfaces as the battery cycled from 10 to 67 and 157 cycles. Detailed microstructure and phase analysis by high-resolution transmission electron microscopy and selected area electron diffraction discovered that the crack formation and performance decay were mainly caused by (1) the volume change of the LiFePO4 composite cathode during cycling, (2) the grain expansion of the Li1.5Al0.5Ge1.5(PO4)3 solid-state electrolyte at its interface with lithium anode, and (3) the formation of a solid electrolyte interphase layer, comprising Li2CO3, LiF, and LiTFSI, at the cathode-solid-state electrolyte interface. These microstructure changes built up over repeated battery cycling, ultimately causing the structure collapse and battery failure. The microstructure evolution information is expected to guide the design of better structures and interfaces for solid-state lithium batteries.

Polarization of the third harmonic emission from the filamentation of femtosecond cylindrical vector beams.

We experimentally generate a third harmonic (TH) vector optical field in deep ultraviolet wavelength range using femtosecond vector laser beams. The generated TH beams are characterized by analyzing the Stokes parameters with different input laser energies. The results show that the TH predominantly preserves the vector polarization distribution of the fundamental frequency beam. Moreover, the intensity profile of the TH exhibits a multiple-ring structure. A hybrid polarization pattern is observed in the TH, where the ellipticity is influenced by the input laser energy. Our work provides an effective and straightforward method for producing TH vector optical fields, which may facilitate potential applications such as micro/nanofabrication and super-resolution microscopy.

A rapid and sensitive CRISPR-Cas12a for the detection of Fusobacterium nucleatum.

Fusobacterium nucleatum (Fn), as a conditional pathogen, can cause a range of oral and gastrointestinal diseases. However, existing clinical detection methods require expensive equipment and complex procedures, which are inconvenient for large-scale screening in epidemiological research. The purpose of this study was to establish a reliable, rapid, and inexpensive detection method based on CRISPR/Cas12a technology for the detection of Fn. Specific recombinase polymerase amplification (RPA) primer sequences and crRNA sequences were designed based on the nusG gene of Fn. Subsequently, a fluorescence assay and a lateral flow immunoassay were established using the RPA and CRISPR-Cas12a system (RPA-CRISPR-Cas12a). Sensitivity validation revealed a limit of detection of 5 copies/µL. This method could distinguish Fn from other pathogens with excellent specificity. Furthermore, the RPA-CRISPR-Cas12a assay was highly consistent with the classical quantitative real-time PCR method when testing periodontal pocket samples. This makes it a promising method for the detection of Fn and has the potential to play an increasingly important role in infectious disease testing.IMPORTANCEFusobacterium nucleatum (Fn) naturally exists in the microbial communities of the oral and gastrointestinal tracts of healthy individuals and can cause inflammatory diseases in the oral and gastrointestinal tracts. Recent studies have shown that Fn is closely associated with the occurrence and development of gastrointestinal cancer. Therefore, the detection of Fn is very important. Unlike the existing clinical detection methods, this study established a fluorescence-based assay and lateral flow immunoassay based on the RPA and CRISPR-Cas12a system (RPA-CRISPR-Cas12a), which is fast, reliable, and inexpensive and can complete the detection within 30-40 minutes. This makes it a promising method for the detection of Fn and has the potential to play an increasingly important role in infectious disease testing.

Field recovery via simplified carrier-assisted differential detection with interleaved subcarrier loading scheme at low CSPR condition.

In this Letter, we propose a simplified carrier-assisted differential detection (CADD) receiver with interleaved subcarrier loading scheme to further reduce the system hardware complexity while preserving the capability of field recovery of double sideband (DSB) complex-valued signals at the low carrier to signal power ratio (CSPR) condition. The numerical results show that the simplified CADD receiver requires less gap subcarriers to achieve a bit-error-rate (BER) below the 7% hard-decision forward error correction (HD-FEC) limit of 3.8 × 10-3 as compared with a conventional CADD receiver. Despite the robustness to the time delay fluctuation decreases, which can be avoided using time-independent components in place of time delay line, more than a 3.2-dB optical signal-to-noise ratio (OSNR) gain can be obtained regardless of CSPR.

Analysis of a Binary Outcome Dichotomized from an Underlying Continuous Variable in Clinical Trials.

Binary-valued outcome is often seen in many clinical trials across therapeutic areas. It is not uncommon that such binary endpoints are derived from a continuous variable. For example, in diabetes clinical trials, the proportion of patients with HbA1c< 7% is often investigated as one of the key objectives, where HbA1c is a continuous-valued variable reflecting the averaged blood glucose value from the previous three months. Most of the time, if not all, the mean of those binary endpoints were estimated directly through the binary variable defined by the corresponding cutoff. Alternatively, by the nature of the derivation, that quantity could also be estimated by leveraging the density of the underlying continuous variable and computing the area under the density curve up to a threshold. This paper provides a few methods in relation to density estimation. Extensive simulation studies were conducted based on real clinical trial data to compare these estimation approaches against the direct estimation of the proportions. Simulation results showed that the density estimation approaches in general benefited from a smaller mean squared error in early phase studies where the sample size is limited. The density estimation approach is certainly expected to introduce bias, however, a favorable bias-variance trade-off may make these approaches attractive in early phase studies.

High-precision clock date recovery for optical wireless communications using orbital-angular-momentum-based mode division multiplexing.

In this Letter, we explore the potential of the application of clock data recovery for the implementation of real-time optical wireless communications (OWCs) employing orbital angular momentum (OAM)-based mode division multiplexing (MDM). We experimentally demonstrate a 3-mode multiplexed optical wireless link with a sum rate of 60 Gbps, in which the time synchronization of different channels is realized by the proposed modified digital feedback clock recovery based on the Gardner algorithm. The experimental results show that high-precision channel synchronization with a low timing error can be achieved, and the bit-error rate of all channels can drop below 7% of the hard-decision forward error correction (HD-FEC) limit of 3.8 × 10-3, which indicates that clock data recovery can potentially provide the implementation of real-time OWCs using OAM-based MDM.

Health status and clinical outcomes in older adults with chronic coronary disease: the ISCHEMIA trial

BACKGROUND: Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown. OBJECTIVES: The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. METHODS: One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure. RESULTS: Among 4,617 participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged ≥75 years. Baseline SAQ summary scores were lower in participants aged <65 years. Fully adjusted differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI: 3.56-6.24) at age 55 years, 3.48 (95% CI: 2.40-4.57) at age 65 years, and 2.13 (95% CI: 0.75-3.51) at age 75 years (Pinteraction = 0.008). Improvement in SAQ Angina Frequency was less dependent on age (Pinteraction = 0.08). There were no age differences between invasive vs conservative management on the composite clinical outcome (Pinteraction = 0.29). CONCLUSIONS: Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).

Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease: The ISCHEMIA Trial.

BACKGROUND: Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown. OBJECTIVES: The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. METHODS: One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure. RESULTS: Among 4,617 participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged ≥75 years. Baseline SAQ summary scores were lower in participants aged <65 years. Fully adjusted differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI: 3.56-6.24) at age 55 years, 3.48 (95% CI: 2.40-4.57) at age 65 years, and 2.13 (95% CI: 0.75-3.51) at age 75 years (Pinteraction = 0.008). Improvement in SAQ Angina Frequency was less dependent on age (Pinteraction = 0.08). There were no age differences between invasive vs conservative management on the composite clinical outcome (Pinteraction = 0.29). CONCLUSIONS: Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; NCT01471522).

An Improved Matching Practice for Augmenting a Randomized Clinical Trial with External Control.

The use of information from real world to assess the effectiveness of medical products is becoming increasingly popular and more acceptable by regulatory agencies. According to a strategic real-world evidence framework published by U.S. Food and Drug Administration, a hybrid randomized controlled trial that augments internal control arm with real-world data is a pragmatic approach worth more attention. In this paper, we aim to improve on existing matching designs for such a hybrid randomized controlled trial. In particular, we propose to match the entire concurrent randomized clinical trial (RCT) such that (1) the matched external control subjects used to augment the internal control arm are as comparable as possible to the RCT population, (2) every active treatment arm in an RCT with multiple treatments is compared with the same control group, and (3) matching can be conducted and the matched set locked before treatment unblinding to better maintain the data integrity and increase the credibility of the analysis. Besides a weighted estimator, we also introduce a bootstrap method to obtain its variance estimation. The finite sample performance of the proposed method is evaluated by simulations based on data from a real clinical trial.

Investigation on repetition-coding and space-time-block-coding for indoor optical wireless communications employing beam shaping based on orbital angular momentum modes.

In this paper, we propose a novel beam shaping technique based on orbital angular momentum (OAM) modes for indoor optical wireless communications (OWC). Furthermore, we investigate two spatial diversity techniques, namely repetition-coding (RC) and Alamouti-type orthogonal space-time-block-coding (STBC) for indoor OWC employing the new beam shaping technique. The performance of both diversity schemes is systematically analyzed and compared under different beam shaping techniques using different OAM modes with different power ratios of the modes. It is shown that both RC and STBC can improve the system performance and effective coverage and RC outperforms STBC in all the beam shaping techniques regardless of the power ratios of the different modes. In addition, to further understand the performance of RC and STBC schemes against the signal delays induced during OAM mode conversion, the system tolerance of the two schemes to the delay interval is investigated with different OAM mode-based beam shaping techniques. Numerical results show that higher resistance to the delay interval can be achieved in STBC scheme. The advantage is more obvious when employing OAM0 and OAM1 based beam shaping technique.

Spatial characteristics of VOCs and their ozone and secondary organic aerosol formation potentials in autumn and winter in the Guanzhong Plain, China.

As critical precursors of tropospheric ozone (O3) and secondary organic aerosol (SOA), volatile organic compounds (VOCs) largely influence air quality in urban environments. In this study, measurements of 102 VOCs at all five major cities in the Guanzhong Plain (GZP) were conducted during Sep.09-Oct. 13, 2017 (autumn) and Nov. 14, 2017-Jan. 19, 2018 (winter) to investigate the characteristics of VOCs and their roles in O3 and SOA formation. The average concentrations of total VOCs (TVOCs) at Xi'an (XA), Weinan (WN), Xianyang (XY), Tongchuan (TC), and Baoji (BJ) sites were in the range of 55.2-110.2 ppbv in autumn and 42.4-74.3 ppbv in winter. TVOCs concentrations were reduced by 22.4%-43.5% from autumn to winter at XA, WN and BJ. Comparatively low concentrations of TVOCs were observed in XY and TC, ranging from 53.5 to 62.7 ppbv across the sampling period. Alkanes were the major components at all sites, accounting for 26.4%-48.9% of the TVOCs during the sampling campaign, followed by aromatics (4.2%-26.4%). The average concentration of acetylene increased by a factor of up to 4.8 from autumn to winter, indicating the fuel combustion in winter heating period significantly impacted on VOCs composition in the GZP. The OH radical loss rate and maximum incremental reactivity method were employed to determine photochemical reactivities and ozone formation potentials (OFPs) of VOCs, respectively. The VOCs in XA and WN exhibited the highest reactivities in O3 formation, with the OFP of 168-273 ppbv and the OH loss rates of 19.3-40.8 s-1. Alkenes and aromatics primarily related to on-road and industrial emissions contributed 57.8%-76.3% to the total OFP. The contribution of aromatics to the SOA formation at all sites reached 94.1%-98.6%. Considering the potential source-area of VOCs, regional transport of VOCs occurred within the GZP cities.

[Characteristics of VOCs and Formation Potentials of O3 and SOA in Autumn and Winter in Tongchuan, China].

Volatile organic compounds (VOCs) are the main precursors of tropospheric O3 and secondary organic aerosol (SOA), which can enhance atmospheric oxidation, promote the formation of secondary pollutants, and affect regional air quality and human health. In order to gain insights on VOCs characteristics and their potentials for O3 and SOA formation, the volume fraction of 102 VOCs in autumn and winter in the urban area of Tongchuan were monitored using the TH-300B online monitoring system. The maximum incremental reactivity (MIR) coefficient and the fractional aerosol coefficient (FAC) were used to estimate the ozone formation potential (OFP) and SOA formation potential (SOAFP), respectively. The φ(TVOC, total VOCs) were (50.52±16.81)×10-9 in autumn and (63.21±35.24)×10-9 in winter. The OFPs were 138.43×10-9 in autumn and 137.123×10-9 in winter, and the SOAFPs were 3.098 µg·m-3 and 0.612 µg·m-3, respectively. Alkanes (26.19%) and aromatics (26.04%) were the most abundant species in autumn, and alkanes (48.88%) were the most abundant species in winter. Trans-2-pentene, toluene, and m/p-xylene were the most reactive species in terms of OFPs in autumn, and ethylene, acetylene, and propylene were the top three species contributing to the total OFPs in winter. Toluene, m/p-xylene, and ethylbenzene contributed the most to the total SOAFPs in both of autumn and winter. Traffic emissions were considered as the major source of VOCs in both seasons. VOCs from biomass/coal combustion emissions showed seasonal differences, which were more prominent in winter. The results can provide references for the "one city, one policy" to mitigate regional VOCs pollution and improve ambient air quality.

Sample size calculation for clustered survival data under subunit randomization.

Each cluster consists of multiple subunits from which outcome data are collected. In a subunit randomization trial, subunits are randomized into different intervention arms. Observations from subunits within each cluster tend to be positively correlated due to the shared common frailties, so that the outcome data from a subunit randomization trial have dependency between arms as well as within each arm. For subunit randomization trials with a survival endpoint, few methods have been proposed for sample size calculation showing the clear relationship between the joint survival distribution between subunits and the sample size, especially when the number of subunits from each cluster is variable. In this paper, we propose a closed form sample size formula for weighted rank test to compare the marginal survival distributions between intervention arms under subunit randomization, possibly with variable number of subunits among clusters. We conduct extensive simulations to evaluate the performance of our formula under various design settings, and demonstrate our sample size calculation method with some real clinical trials.

Effects of initial invasive vs. initial conservative treatment strategies on recurrent and total cardiovascular events in the ISCHEMIA trial.

AIMS: The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial prespecified an analysis to determine whether accounting for recurrent cardiovascular events in addition to first events modified understanding of the treatment effects. METHODS AND RESULTS: Patients with stable coronary artery disease (CAD) and moderate or severe ischaemia on stress testing were randomized to either initial invasive (INV) or initial conservative (CON) management. The primary outcome was a composite of cardiovascular death, myocardial infarction (MI), and hospitalization for unstable angina, heart failure, or cardiac arrest. The Ghosh-Lin method was used to estimate mean cumulative incidence of total events with death as a competing risk. The 5179 ISCHEMIA patients experienced 670 index events (318 INV, 352 CON) and 203 recurrent events (102 INV, 101 CON). A single primary event was observed in 9.8% of INV and 10.8% of CON patients while ≥2 primary events were observed in 2.5% and 2.8%, respectively. Patients with recurrent events were older; had more frequent hypertension, diabetes, prior MI, or cerebrovascular disease; and had more multivessel CAD. The average number of primary endpoint events per 100 patients over 4 years was 18.2 in INV [95% confidence interval (CI) 15.8-20.9] and 19.7 in CON (95% CI 17.5-22.2), difference -1.5 (95% CI -5.0 to 2.0, P = 0.398). Comparable results were obtained when all-cause death was substituted for cardiovascular death and when stroke was added as an event. CONCLUSIONS: In stable CAD patients with moderate or severe myocardial ischaemia enrolled in ISCHEMIA, an initial INV treatment strategy did not prevent either net recurrent events or net total events more effectively than an initial CON strategy. CLINICAL TRIAL REGISTRATION: ISCHEMIA ClinicalTrials.gov number, NCT01471522, https://clinicaltrials.gov/ct2/show/NCT01471522.

VOCs characteristics and their ozone and SOA formation potentials in autumn and winter at Weinan, China.

Frequent ozone and fine particulate matter (PM2.5) pollution have been occurring in the Guanzhong Plain in China. To effectively control the tropospheric ozone and PM2.5 pollution, this study performed measurements of 102 VOCs species from Sep.19-25 (autumn) and Nov.27-Dec. 8, 2017 (winter) at Weinan in the central Guanzhong Plain. The total volatile organic compounds (TVOCs) concentrations were 95.8 ± 30.6 ppbv in autumn and 74.4 ± 37.1 ppbv in winter. Alkanes were the most abundant group in both of autumn and winter, accounting for 33.5% and 39.6% of TVOCs concentrations, respectively. The levels of aromatics and oxygenated VOCs were higher in autumn than in winter, mainly due to changes in industrial activities and combustion strength. Photochemical reactivities and ozone formation potentials (OFPs) of VOCs were calculated by applying the OH radical loss rate (LOH) and maximum incremental reactivity (MIR) method, respectively. Results showed that Alkenes and aromatics were the key VOCs in term ozone formation in Weinan, which together contributed 59.6% ̶ 65.3% to the total LOH and OFP. Secondary organic aerosol formation potentials (SOAFP) of the measured VOCs were investigated by employing the fractional aerosol coefficient (FAC) method. Aromatics contributed 94.9% and 96.2% to the total SOAFP in autumn and winter, respectively. The regional transport effects on VOCs and ozone formation were investigated by using trajectory analysis and potential source contribution function (PSCF). Results showed that regional anthropogenic sources from industrial cities (Tongchuan, Xi'an city) and biogenic sources from Qinling Mountain influenced VOCs levels and OFP at Weinan. Future studies need to emphasize on meteorological factors and sources that impact on VOCs concentrations in Weinan.

Group sequential testing for cluster randomized trials with time-to-event endpoint.

We propose group sequential methods for cluster randomized trials (CRTs) with time-to-event endpoint. The alpha spending function approach is used for sequential data monitoring. The key to this approach is determining the joint distribution of test statistics and the information fraction at the time of interim analysis. We prove that the sequentially computed log-rank statistics in CRTs do not have independent increment property. We also propose an information fraction for group sequential trials with clustered survival data and a corresponding sample size determination approach. Extensive simulation studies are conducted to evaluate the performance of our proposed testing procedure using some existing alpha spending functions in terms of expected sample size and maximal sample size. Real study examples are taken to demonstrate our method.