Dynamic optimization of CRT pacing using a novel algorithm improves survival in a real-world cohort of patients

Background The AdaptivCRT (aCRT) algorithm continuously adjusts cardiac resynchronization therapy (CRT) according to intrinsic atrioventricular (AV) conduction status, providing synchronized left-ventricular pacing in patients (pts) with a normal PR interval and adaptive biventricular (BiV) pacing in pts with a prolonged PR interval. Prior secondary analyses of prospective trials demonstrated a reduction in mortality and atrial fibrillation incidence with aCRT. Objective To compare mortality in a large real-world population of pts with and without aCRT using electronic health record (EHR) data. Methods An Optum® de-identified EHR dataset and Medtronic CareLink device data were linked to identify pts (age>18 years) with a CRT implanted between 2014–2018 who survived ≥35 days post implant and with a documented baseline left ventricular ejection fraction (LVEF). Pts were grouped with aCRT set to either Adaptive BiV+LV (aCRT group) or standard CRT (control group). Two pt subgroups were identified: (i) pts with left bundle branch block (LBBB) and no AV block, (ii) pts with either no LBBB or with AV block. Kaplan-Meier curves and log-rank were used to estimate and compare survival between treatment and control groups in both the full cohort and subgroups. Multivariate Cox regression was used to estimate the aCRT treatment effect while controlling for baseline characteristics. Results Among 8624 patients implanted with a CRT device with EHR data available for a median of 23.5 months post implant [IQR: 12.6, 37.3], 3994 patients had the aCRT feature activated. Pts in the aCRT group were younger (median 69 [IQR:60, 76] vs 73 [IQR: 65, 79] years), more frequently female (35% vs 26%), and more frequently had LBBB (72% vs 51%); p's<0.001. Median QRS duration was 150ms (IQR: 133, 164) for the aCRT group and 152ms (IQR: 134, 172) for the control group (p<0.001). Median LVEF was 22% (IQR: 18, 30) for the aCRT group and 25% (IQR: 20, 30) for the control group (p<0.001). Through 60 months post implant, the overall mortality rate was 23.6% (95% CI: 20.7%-26.3%) for the aCRT group and 37.6% for the control group (95% CI: 34.9%-40.1%), p<0.001. Subgroup analysis demonstrated a significant reduction in mortality with aCRT in both pts with LBBB without AV block (Figure, left panel) and pts without LBBB and with AV block (Figure, right panel). After accounting for baseline differences, the reduction in mortality remained significant in the LBBB/no AV block group (HR: 0.54, 95% CI: 0.39–0.76, p<0.001) and trended toward significance in the no LBBB/with AV block group (HR: 0.89, 95% CI: 0.79–1.01; p=0.08). Conclusion In a large, real-world population of pts implanted with CRT devices, the AdaptivCRT algorithm was associated with significantly reduced mortality, with a greater reduction observed among pts with LBBB and without AV block. These results are being tested prospectively in the ongoing AdaptResponse multi-national, randomized clinical trial. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Medtronic, Inc. Cumulative probability of death by group

Joint Watermarking for Image Reliability Control in Encrypted and Compressed Domains

Sharing medical images can enormously help doctor in their day by day practice by permitting them to arrive at a symptomatic all the more rapidly. However, such images are sensitive and should be ensured. In this paper, propose the principal joint watermarking-encryption pressure conspire for the insurance of medical images. Its inventiveness is twofold. In a first time, it permits the admittance to watermarking-based security administrations from the scrambled and the compacted bitstreams without parsing them even part of the way. It gets conceivable to follow images and control their dependability from both the encoded and compacted spaces. In a second, it remains on the blend of spot replacement watermarking, JPEG-LS and the AES block figure in its CBC mode to make our plan. Tests directed on various medical images modalities (radiographic and retina pictures) show the ability of our framework to safely make accessible a message in both scrambled and compacted areas while limiting the contortion of the images.

Supplemental Material: Reappraisal of the Mesozoic tectonic transition from the Paleo-Tethyan to Paleo-Pacific domains in South China

Synthesis of the formation ages of the Triassic and Jurassic mafic rocks, shoshonitic rocks and granitoids in the Southeastern South China Block; Table S2: Major oxide (wt%) and trace element (ppm) compositions for the Triassic and Jurassic mafic rocks, shoshonitic rocks and high-Mg andesite and granitoids in the Southeastern South China Block; Table S3: Sr-Nd isotope compositions for the Triassic and Jurassic mafic rocks, shoshonitic rocks and high-Mg andesite and granitoids in the Southeastern South China Block; Table S4: Zircon Hf isotope compositions for the Triassic and Jurassic mafic and shoshonitic rocks and granitoids in the Southeastern South China Block; Figure S1: (A) Ta/Yb-Ce/Yb diagram for the Triassic and Jurassic shoshonitic rocks and (B) SiO2-MgO diagram for the Jurassic high-Mg andesite in the Southeastern South China Block; Figure S2: The variations of high field strength elements (HFSE) with loss on ignition (LOI) for the Jurassic mafic rocks in the Southeastern South China Block.<br>

Supplemental Material: Reappraisal of the Mesozoic tectonic transition from the Paleo-Tethyan to Paleo-Pacific domains in South China

Synthesis of the formation ages of the Triassic and Jurassic mafic rocks, shoshonitic rocks and granitoids in the Southeastern South China Block; Table S2: Major oxide (wt%) and trace element (ppm) compositions for the Triassic and Jurassic mafic rocks, shoshonitic rocks and high-Mg andesite and granitoids in the Southeastern South China Block; Table S3: Sr-Nd isotope compositions for the Triassic and Jurassic mafic rocks, shoshonitic rocks and high-Mg andesite and granitoids in the Southeastern South China Block; Table S4: Zircon Hf isotope compositions for the Triassic and Jurassic mafic and shoshonitic rocks and granitoids in the Southeastern South China Block; Figure S1: (A) Ta/Yb-Ce/Yb diagram for the Triassic and Jurassic shoshonitic rocks and (B) SiO2-MgO diagram for the Jurassic high-Mg andesite in the Southeastern South China Block; Figure S2: The variations of high field strength elements (HFSE) with loss on ignition (LOI) for the Jurassic mafic rocks in the Southeastern South China Block.<br>

Supplemental Material: Reappraisal of the Mesozoic tectonic transition from the Paleo-Tethyan to Paleo-Pacific domains in South China

Synthesis of the formation ages of the Triassic and Jurassic mafic rocks, shoshonitic rocks and granitoids in the Southeastern South China Block; Table S2: Major oxide (wt%) and trace element (ppm) compositions for the Triassic and Jurassic mafic rocks, shoshonitic rocks and high-Mg andesite and granitoids in the Southeastern South China Block; Table S3: Sr-Nd isotope compositions for the Triassic and Jurassic mafic rocks, shoshonitic rocks and high-Mg andesite and granitoids in the Southeastern South China Block; Table S4: Zircon Hf isotope compositions for the Triassic and Jurassic mafic and shoshonitic rocks and granitoids in the Southeastern South China Block; Figure S1: (A) Ta/Yb-Ce/Yb diagram for the Triassic and Jurassic shoshonitic rocks and (B) SiO2-MgO diagram for the Jurassic high-Mg andesite in the Southeastern South China Block; Figure S2: The variations of high field strength elements (HFSE) with loss on ignition (LOI) for the Jurassic mafic rocks in the Southeastern South China Block.<br>

Ancestral Caddo Ceramic Sherds from 2016 Investigations at 41MR211, Marion County, Texas

Renewed archaeological investigations in 2016 by the Texas Historical Commission at the early 19th century Caddo site 41MR211 recovered a small number of ancestral Caddo ceramic vessel sherds from a variety of contexts in Locus 3 (Table 1), which is located just east of the main 1999 excavation block (Figure 1). The sherds are from grog-tempered (70 percent) and shell-tempered (30 percent) vessels. In the larger vessel sherd assemblage (n=368) reported by Parsons et al. (2002a, 2002b) from 41MR211, 36.8 percent of the sherds are from shell-tempered vessels and 59.4 percent are from vessels made with grog temper.