Objective: Postinfarction ventricular septal defect (PIVSD) is a severe complication of acute myocardial infarction (AMI). Transcatheter closure (TCC) is an alternative option to surgical repair. This study was undertaken to examine the published literature to provide objective evidence for TCC using a meta-analysis. Methods:We searched for significant medical and publisher databases. Two reviewers checked the quality of the studies and extracted data. Eligible studies included single-arm studies and comparative studies. Weighted means, pooled event rates, efficacy outcomes and odds ratios (ORs) for immediate shunt reduction (ISR), presence of cardiogenic shock (CS), New York Heart Association (NYHA) class IV, time from AMI to ventricular septal defect (VSD), and time to VSD closure was estimated.Results: A total of 27 single-arm articles (462 patients) were included. The pooled event rate was 89.7% (95% confidence interval [CI]: 0.772-1.021) for successful device implantation, 80.9% (95% CI: 0.645-0.972) for ISR, 31.5% (95% CI: 0.149-0.482) for 30-day mortality, and 25.3% (95% CI: 0.072-0.434) for 30-day mortality of primary closure at the acute phase. CS (OR = 3.607, 95% CI: 2.301-5.653), NYHA class IV (OR = 6.491, 95% CI: 1.444-29.188) and time to VSD closure were risk predictors for TCC. There was no correlation between defect size (OR = 2.592, 95% CI: 0.380-17.661) and mortality. Conclusion:TCC should be a relatively safe and minimally invasive method for PIVSD, with an excellent successful device implantation rate and acceptable low 30-day mortality. The procedure appears promising, but its safety and efficacy could only be demonstrated by randomized controlled trials. Therefore, the mortality of data comparing surgery to TCC compels the need for future comparative trials.
Objective: Post-infarction ventricular septal defect (PIVSD) is a severe complication of acute myocardial infarction. Transcatheter closure (TCC) perform an alternative option to the surgical repair. This study was undertaken to examine the published literature to give the objective evidence of TCC using a meta-analysis. Methods: We searched for significant medical and publishers' databases. Two reviewers checked the quality of studies and extracted data. Eligible studies included single-arm studies and comparative studies. Weighted mean, pooled event rates, efficacy outcomes and odds ratios(OR) for immediate shunt reduction(ISR), presence of cardiogenic shock (CS), New York Heart Association ( NYHA) class IV, time from AMI to ventricular septal defect(VSD), time to VSD closure was estimated. Results: 27 single arm articles (462 patients) were included. The pooled event rate was 89.7% (95%CI: 0.772-1.021) for successful device implantation, 80.9% (95%CI: 0.645-0.972) for ISR, 31.5% (95%CI of 0.149-0.482) for 30-day mortality, 25.3% (95%CI: 0.072-0.434) for 30-day mortality of primary closure at acute phase. CS (OR=3.607, 95%CI: 2.301-5.653), NYHA class IV (OR=6.491, 95%CI: 1.444-29.188) and time to VSD closure are risk predictor for TCC. There is no correlation between the defect size (OR=2.592, 95%CI: 0.380-17.661) and mortality. Conclusion: TCC should be a relatively safe and low invasive method for PIVSD, with an excellent successful device implantation rate and acceptable low 30-day mortality. The procedure appears promising, but its safety and efficacy could only be demonstrated by randomized controlled trials. Therefore, they are needed more investigations to determine whether the acute phase or chronic phase to practice the procedure.
Left ventricular tissue Doppler imaging (TDI) velocities are used to monitor systolic and diastolic function, but it is not known how these may change in a hyperdynamic circulation, as often occurs in anesthesia and critical care medicine. Twenty-six healthy young volunteers were recruited and left ventricular systolic and diastolic tissue Doppler velocities measured at rest, light exercise, strenuous exercise, and recovery (10 minutes after exercise). At rest, TDI velocities significantly decreased from base to apex (P < .001). Within basal, mid, and apical sections, systolic and diastolic peak velocities differed between segments (P < .05), except for systolic middle (P = .094) and late diastolic apical velocities (P = .257). Basal septal velocities differed from basal lateral, for systolic (P = .041) but not diastolic peak values. Inferobasal radial values differed from basal lateral values for both systolic and diastolic velocities (P < .05). Both systolic and diastolic TDI velocities increased significantly in all segments in a proportionate manner with a hyperdynamic circulation.
With the wide application of deep learning object detection model, its internal security vulnerability is also highlighted. In this paper, a black box adversarial attack algorithm SAD-DE based on improved differential evolution is proposed to reveal the possible security risks of the object detection model. Taking full advantage of the high optimization efficiency and simple parameter setting of differential evolution algorithm, multi mutation strategy is adopted, and the mutation rate and crossover rate are adaptively improved to effectively improve the optimization efficiency. In this paper, two public data sets are randomly exampled as test sets to counter attacks on YOLOv3 and Fast R-CNN respectively. Experimental results show that this method achieves a high fooling rate while maintaining a low anti disturbance, and achieves a maximum improvement of 33% compared with other black box attack algorithms.
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