The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP...The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.展开更多
叶面积的大小可以对树木的生长和生命活动产生深远的影响,进而关系到树木生物量的变化和森林生态的发展趋势,叶面积的研究可以对树木的相关分析起到较为关键的作用。基于黑龙江省48株红松人工林解析木数据和排水法测定的叶面积数据,建...叶面积的大小可以对树木的生长和生命活动产生深远的影响,进而关系到树木生物量的变化和森林生态的发展趋势,叶面积的研究可以对树木的相关分析起到较为关键的作用。基于黑龙江省48株红松人工林解析木数据和排水法测定的叶面积数据,建立基础线性回归模型,后引入随机效应参数构建混合效应回归模型以提高拟合效果和预估精度。在加入树木层次的随机效应时,最终得到的最优混合效应模型含有3个随机效应参数,分别为枝条基径的对数(lnBD)、枝条长度的对数(lnSL)、树高的对数(lnHT)。该模型的R_(a)^(2)=0.86,平均绝对偏差M_(AE)=0.3428,均方根误差R_(MSE)=0.4841,统计指标较仅包含固定效应的基础线性模型均有较好的提高。综合分析得出该模型可以较好地对红松枝条叶面积大小进行描述。基于该模型计算红松树冠叶面积并得到混合效应预估模型,混合模型的R a 2=0.83,R_(MSE)=0.4429。通过检验结果可知该模型可以较好地对红松树冠叶面积进行预估计算,为日后该地区人工红松的经营提供良好的指导方向。展开更多
文摘The deleterious effects of long-term right ventricular pacing necessitated the search for alternative pacing sites which could prevent or alleviate pacinginduced cardiomyopathy.Until recently,biventricular pacing(BiVP)was the only modality which could mitigate or prevent pacing induced dysfunction.Further,BiVP could resynchronize the baseline electromechanical dssynchrony in heart failure and improve outcomes.However,the high non-response rate of around 20%-30%remains a major limitation.This non-response has been largely attributable to the direct non-physiological stimulation of the left ventricular myocardium bypassing the conduction system.To overcome this limitation,the concept of conduction system pacing(CSP)came up.Despite initial success of the first CSP via His bundle pacing(HBP),certain drawbacks including lead instability and dislodgements,steep learning curve and rapid battery depletion on many occasions prevented its widespread use for cardiac resynchronization therapy(CRT).Subsequently,CSP via left bundle branch-area pacing(LBBP)was developed in 2018,which over the last few years has shown efficacy comparable to BiVP-CRT in small observational studies.Further,its safety has also been well established and is largely free of the pitfalls of the HBP-CRT.In the recent metanalysis by Yasmin et al,comprising of 6 studies with 389 participants,LBBPCRT was superior to BiVP-CRT in terms of QRS duration,left ventricular ejection fraction,cardiac chamber dimensions,lead thresholds,and functional status amongst heart failure patients with left bundle branch block.However,there are important limitations of the study including the small overall numbers,inclusion of only a single small randomized controlled trial(RCT)and a small follow-up duration.Further,the entire study population analyzed was from China which makes generalizability a concern.Despite the concerns,the meta-analysis adds to the growing body of evidence demonstrating the efficacy of LBBP-CRT.At this stage,one must acknowledge that the fact that still our opinions on this technique are largely based on observational data and there is a dire need for larger RCTs to ascertain the position of LBBPCRT in management of heart failure patients with left bundle branch block.
文摘叶面积的大小可以对树木的生长和生命活动产生深远的影响,进而关系到树木生物量的变化和森林生态的发展趋势,叶面积的研究可以对树木的相关分析起到较为关键的作用。基于黑龙江省48株红松人工林解析木数据和排水法测定的叶面积数据,建立基础线性回归模型,后引入随机效应参数构建混合效应回归模型以提高拟合效果和预估精度。在加入树木层次的随机效应时,最终得到的最优混合效应模型含有3个随机效应参数,分别为枝条基径的对数(lnBD)、枝条长度的对数(lnSL)、树高的对数(lnHT)。该模型的R_(a)^(2)=0.86,平均绝对偏差M_(AE)=0.3428,均方根误差R_(MSE)=0.4841,统计指标较仅包含固定效应的基础线性模型均有较好的提高。综合分析得出该模型可以较好地对红松枝条叶面积大小进行描述。基于该模型计算红松树冠叶面积并得到混合效应预估模型,混合模型的R a 2=0.83,R_(MSE)=0.4429。通过检验结果可知该模型可以较好地对红松树冠叶面积进行预估计算,为日后该地区人工红松的经营提供良好的指导方向。
