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Transthoracic, transesophageal, and intracardiac echocardiography are applicable imaging tools used for increasing the accuracy of tumor positioning during transvenous intracardiac tumor biopsy. However, incorporating echo-images in the extremely rare procedures is usually not easy. By using a contralateral catheter for simultaneous contrast injection and tip positioning, we demonstrated tumor biopsy safely and effectively in 4 cases without the guidance of echocardiography.

BackgroundLesion characteristics were shown to predict procedural success and outcomes in chronic total occlusion (CTO) recanalization. However, diverse techniques involved in these studies might cause potential heterogeneity.ObjectiveThe study aimed to test the impacts of lesion characteristics on CTO intervention with a pure antegrade wiring-based technique.Methods and ResultsWe studied consecutive 325 patients (64.5 ± 11.1 years, 285 men) with native CTO lesions intervened by a single operator with an antegrade-based technique between August 2014 and July 2020. Forty-seven patients with antegrade procedural failure (20 with pure antegrade wiring failure and 27 with back-up retrograde techniques) were compared to 278 patients with antegrade-only procedural success. With a median follow-up of 30.8 (16.1–48.6) months, 278 patients with procedural success were further assessed for target vessel failure (TVF: cardiac death, target vessel myocardial infarction [MI], and target lesion revascularization [TLR]). Patients with antegrade procedural success had a lower percentage of history with bypass graft (4 vs. 15%, p = 0.004) and lower Multicenter Chronic Total Occlusion Registry of Japan (J-CTO) score (2.1±1.3 vs. 3.4 ± 1.0, p < 0.001), when compared to those with antegrade failure. The J-CTO score was independently associated with procedural failure (odds ratio = 2.5, 95% CI = 1.8–3.4) in multivariate analysis. However, only clinical features, such as female gender (hazard ratio [HR] = 4.3, 95% CI = 1.4–13.1), estimated glomerular filtration rate 2 (HR = 3.2, 95% CI = 1.0–9.9), and old MI (HR = 4.5, 95% CI = 1.5–12.8), but not J-CTO score, could predict long-term TVF in multivariate Cox regression model.ConclusionThe feasibility of the antegrade guidewire-crossing technique for native CTO intervention was highly determined by lesion characteristics. With such a simpler technique, the prognostic impact of lesion complexity shown in studies with multiple recanalization techniques was negligible. This suggested antegrade true lumen tracking techniques deserved to be tried better even for CTO lesions with higher complexity.

This study presents the design, implementation, and characterization of 1D resonant type micro-electro-mechanical-systems (MEMS) piezoelectric scanning mirrors with different actuator designs to investigate their influences on the figure of merits (FoMs) for automotive light detection and ranging application. The MEMS scanning mirrors are driven by lead zirconate titanate (PZT) thin film in this study owing to its outstanding piezoelectric properties. Three different beam-type piezoelectric actuators are designed, including the reference meander straight-beam actuator design, and the proposed meander curved-beam and straight-curved tapered beam actuator designs. Simulations show the scan angle enhancement for two proposed designs, yet the resonant scanning frequency of meander curved-beam design dropped to below the 2 kHz requirement. To evaluate the designs, scanning mirrors with two proposed actuators are fabricated and tested. Measurements show that the resonant frequencies for the two proposed MEMS scanning mirrors are 1735 Hz and 2578 Hz, respectively. Two proposed designs respectively have the maximum optical angles of 48.1° and 50.6° at the 20 Vpp driving voltage. Due to the much higher stress on the beam structure induced by the misalignment of PZT film, the actuator could not reach the predicted scanning angle of near 80°. In comparison of the two proposed designs, the straight-curved tapered beam actuator design could enhance the FoM for about 56%. In summary, the performances of piezoelectric MEMS scanning mirror can be improved by varying the designs of length and shape of actuator, and the distribution of PZT film on the suspended actuator is also a critical design concern.

In addition to the rapid development of global information and communications technology (ICT) and the Internet, recent rapid growth in cloud computing technology represents another important trend. Individual continuance intention towards information technology is a critical area in which information systems research can be performed. This study aims to develop an integrated model designed to explain and predict an individual’s continuance intention towards personal cloud services based on the concepts of technology readiness (TR) and the unified theory of acceptance and use of technology 2 (UTAUT2), moderated by gender, age, and experience of personal cloud services. The key results of the partial least square test largely support the proposed model’s validity and the significant impact of effort expectancy, social influence, hedonic motivation, price value, habit, and technology readiness on continuance intention towards personal cloud services. In addition to providing symmetric theoretical support with the proposed model and transforming the individual characteristics of TR into UTAUT2, this study could be used to enhance and analyze users’ adoption of personal cloud services and also increase the symmetry of the model’s explanation and prediction. The findings from this research contribute to providing practical implications and academic resources as well as improving our understanding of personal cloud service applications.

Patient Initials or Identifier Number Mr. L ### Relevant Clinical History and Physical Exam A 57-year-old male with a history of Hypertension, Type II Diabetes mellitus, Dyslipidemia and Coronary artery disease, triple vessel disease status post-percutaneous coronary intervention (PCI) with a

For promoting competitive advantages, many companies seek new ways to decrease costs in global markets. Information products contain more functionality, and their developments are continuous process to meet customer requirements. Developers have to manage and control a range of technology and increasing amount of product data. This research selects an old established enterprise named T-company in Taiwan as the subject. We found out 21 theoretical critical success factors (CSFs) from 6 case studies via three research and development departments of T-company. We pointed out 10 most important CSFs should be the critical point before and during the product data management implementation, which can be a reference model to executives of related electronic businesses.

After Taiwan becomes the 144th member of the World Trade Organization (WTO) on 2002, it also becomes a part of the global economic system. Therefore, when the financial tsunami influenced the global economy in 2007, it was inevitable that all transactions and professions in Taiwan could hardly survive, and the securities industry, of course, bore the brunt. Based on the exchange data of a Taiwan K-broker's orders, this research conducts an empirical case study by means of Data Mining. We adopt RFM (Recency, Frequency, and Monetary) modeling index to get the data, and then group the customers by Cluster Analysis of K-means and find out the transaction behaviors of indicative customers in each group around the financial tsunami. Finally, we summarize those users behavior of the hedging operations to be the reference models Taiwan stock market during the financial tsunami.

Background and Aims. The identification of possible pathogens for an infectious etiology of atherosclerotic coronary artery disease (CAD) is an expanding field. The present study was undertaken to explore the role of parvovirus B19, a potent infectious agent. Methods. A total of 565 patients were analyzed (90 patients with CAD, and 475 controls). Serologic analysis for human paravovirus B19 (B19) specific IgM and IgG was carried out in all patients. In addition, tissue specimens were obtained from five patients who received heart transplants. Direct in situ polymerase chain reaction (PCR) and immunocytochemistry were performed in the samples to localize B19 DNA. Results. Enzyme immunoassay showed that the seropositive rate of anti-B19 IgG in patients with CAD was 1.5- to 2.7-fold more frequent than in healthy controls. Clinical characteristics did not affect the prevalence of seropositivity for B19. However, anti-B19 IgM and B19-specific DNA were not detected in healthy or individuals with CAD. Furthermore, nonradioactive in situ PCR found that the majority of B19-specific DNA was located in the endothelial cells of the thickened intima. Conclusions. Our results first demonstrate a seroepidemiological and histopathological association between chronic B19 infection and CAD, suggesting that B19 infection may have a potential role in the pathogenesis of coronary atherosclerosis. 2009 IMSS. Published by Elsevier Inc.

This paper deals with civil infrastructures in general, sensor and smart structure technology, and smart steel structures in particular. Smart structures technology, an integrated engineering field comprising sensor technology, structural control, smart materials and structural health monitoring, could dramatically transform and revolutionize the design, construction and maintenance of civil engineering structures. The central core of this technology is sensor and sensor networks that provide the essential data input in real time for condition assessment and decision making. Sensors and robust monitoring algorithms that can reliably detect the occurrence, location, and severity of damages such as crack and corrosion in steel structures will lead to increased levels of safety for civil infrastructure, and may significantly cut maintenance or repair cost through early detection. The emphasis of this paper is on sensor technology with a potential use in steel structures.

Rapid advances have been made in recent years in the development of sensor-based technologies, which greatly expand the range and effectiveness of this application to civil, mechanical, and aerospace engineering systems. This paper attempts to overview the research conducted in recent years and the state-of-the-art. Key research topics are presented, and future strategic directions are suggested. Emerging needs for engineering application in civil infrastructure and mechatronics systems, and natural and artificial disaster mitigation are described. A review of NSF's sponsored research program activities in dynamic systems, modeling, sensing and control is also given. Strategic issues in advancing sensors and smart structural technologies and their applications are discussed. Copyright © 2005 John Wiley & Sons, Ltd.

Considerable research on telomerase on human neoplastic and normal long-lived proliferative tissues has emerged. We explored the expression of telomerase in atherosclerotic human epicardial coronary arteries.Forty discrete human coronary arterial segments obtained from 19 heart transplant recipients were classified into nonatherosclerotic and atherosclerotic groups based on coronary angiography and histological examination. PCR-ELISA-based telomeric repeat amplification protocol (TRAP), and immunohistochemical analyses were conducted to determine the functional activity and cell-specific expression of telomerase.Seventy percent of atherosclerotic coronary arteries exhibited positive telomerase activity, and the reactivation incidence reached fourfold higher than that of controls (P=.007). The telomerase catalytic protein, human telomerase reverse transcriptase (hTERT), was expressed in 88% of atherosclerotic tissues, a fivefold higher frequency compared with that of the controls. There was also a correlation of hTERT expression with the level of telomerase bioactivity (P=.017) and with the severity of atherosclerotic grade (P.001). In comparison with the immunostaining of mitotic antigen, Ki-67, we found an association of hTERT expression with actively cycling cells in early lesions but with quiescent cells in late advanced atherosclerotic stages.The up-regulation of telomerase and its catalytic hTERT protein during stages of atherosclerotic evolution may implicate a role of telomerase in vascular remodeling underlying atherogenesis.

Flies orientate themselves quickly in an unstructured environment through motion information computed from their low-resolution compound eyes. The fly visual system is an example of a robust motion system that works in a natural environment. In this paper, the author describes a low-power analog very large scale integration (aVLSI) chip that models motion computation in the fly. The architecture of this motion chip closely follows the anatomical layout of of the fly visual layers. The output of the chip corresponds to the responses of the wide-field direction-selective cells in the final layer of the visual system. The silicon chip has a one-dimensional array of 37 elementary motion detectors (EMDs) each of which provides local motion information. The EMD outputs are aggregated in a nonlinear way to produce a motion output that is independent of the stimulus size and contrast. The author employed various circuit techniques to ensure robust motion computation in each processing stage. Results from the circuit fabricated in a 1.2 /spl mu/m CMOS technology are compared with the responses of the direction-selective cells.

This study extends the Technology Acceptance Model (TAM) by incorporating relationship quality as a mediator to construct a comprehensive framework for understanding the influence on continuance intention in the hospital e-appointment system. A survey of 334 Taiwanese citizens who were contacted via phone or the Internet and Structural Equation Modeling (SEM) is used for path analysis and hypothesis tests. The study shows that perceived ease of use (PEOU) and perceived usefulness (PU) have significant influence on continuance intention through the mediation of relationship quality, consisting of satisfaction and trust. The direct impact of relationship quality on continuance intention is also significant. The analytical results reveal that the relationship between the hospital, patients and e-appointment users can be improved via enhancing the continued usage of e-appointment. This paper also proposes a general model to synthesize the essence of PEOU, PU, and relationship quality for explaining users' continuous intention of e-appointment.

We proposed the design and implementation of the laser diode driver (LDD) circuitry with large driving current capability and high speed. The novel LDD circuitry with SFM (Source Follower Mode) architecture has been developed and carefully simulated. Besides, we also compared previous SFM architecture with the proposed novel SFM architecture. It can be shown that the novel SFM LDD faster speed performance than that of previous architecture. And novel SFM LDD is better than previous including Slew-Rate, reaction time, overshoot /Undershoot and corner case. The novel LDD is designed and implemented in TSMC 0.35-μm 5V CMOS process.

Objectives: The purpose of this study was to evaluate the value of a hand-carried portable ultrasound device in the emergency department for patients with cardiomegaly and evaluate its impact on diagnosis and treatment. We compared the results of the portable ultrasound with the results of physical examination and with standard echocardiograph (SE) in the cardiomegaly patients in emergency department. Background: Recently, small portable ultrasound devices have been introduced, and they need more extensive study to evaluate their application. Methods: We used the OptiGo™ (Agilent Technologies, Andover, MA) portable device to evaluate emergency patients, and compared it with two SE devices available for this study, the Hewlett Packard (Sono 5500; Andover, MA) or the Vingmed (System V; Horten, Norway). Each of 100 patients was studied by physical examination first then examined with the portable ultrasound and standard echocardiography. The yields from physical examination and portable echocardiography were compared and results of the standard and portable were also compared. Results: There were a total of 243 cardiovascular findings detected by the standard echocardiographic examination in the 100 patients studied. Cardiac examination failed to detect 40% of the overall findings but the portable device missed only 17% of all findings. The portable device evaluated 201 conditions correctly (83%) and missed relevant clinical findings in 37 (17%) as compared to standard echocardiography, but in only 12 (5%) were these findings of major importance As an overall measure of diagnostic value, the portable device would have added to clinical judgment, thus boosting diagnostic accuracy from 62% to 83%. Conclusions: Portable ultrasound technology can provide rapid, readily available and important clinical information for emergency physicians in the management of emergency patients with cardiomegaly.

A 53-year-old man presented with chest tightness and a positive treadmill test. A percutaneous coronary intervention (PCI) was performed on the distal total occlusion of the right coronary artery (RCA) with a 6-F Amplatz Left 1 guiding catheter and a Runthrough floppy wire (Terumo, Leuven, Belgium

Materials are a multi-suits science and an essential platform for practical engineering. It has multi-dimensional impacts to the society on energy, environment, medical science, transportation, communications, automobiles, aerospace, civil infrastructure, and so on and on. Rapid advances in the design and synthesis of new materials and associated technologies have prompted many major discoveries and innovations, pushing the quality of our living world to a higher level. The thrust of the paper is placed on civil engineering materials with building, maintaining, and operating the urban centre’s civil infrastructure in mind. The discussion focuses to cement-based materials like concrete and composites which are expected to propel most problems faced on urban engineering systems to good solutions.

Pixel level image processing algorithms have to work with noisy sensor data to extract spatial features. This often required the use of operators which amplify high frequency noise. One method of dealing with this problem is to perform image smoothing prior to any use of spatial differentiation. Such spatial smoothing results in the spread of object characteristics beyond the object boundaries. Identification of discontinuities and explicit use of these as boundaries for smoothing has been proposed as a technique to overcome this problem. This approach has been used to perform cooperative computations between multiple descriptions of the scene, e.g., fusion of edge and motion field for a given scene. This approach is extended to multisensor systems. The discontinuities detected in the output of one sensor are used to define regions of smoothing for a second sensor. For example, the depth discontinuities present in laser radar can be used to define smoothing boundaries for infrared focal plane arrays. The authors have recently developed a CMOS chip (28 X 36) which performs this task in real time. This chip consists of a resistive network and elements that can be switched ON or OFF, by loading a suitable bit pattern. The bit pattern for the control of switches can be generated from the discontinuities found in the output of sensor #1. The output of sensor #2 is applied to the resistive network for data smoothing. If all the switches are held in conducting state, this chip performs the usual data smoothing. However, if switches along object boundaries are turned OFF, a region for bounded smoothing is created. In this chip, information from a third sensor data (e.g., intensity data from laser radar) can be incorporated in the form of a map of 'confidence in data.' The results obtained with this chip using synthetic data and other potential applications of this chip are described.

Standard regularization theory combines least squares methods with smoothness constraints, whichleads to quadratic variational functionals with a unique, global minimum (Horn and Schunck [2];Hildreth[3}; Pogglo, Torre and Koch[4}; Poggio, Voorhees and Yuille, [5]; Grimson[6]). Thesequadratic functionals can be mapped onto linear resistive networks, such that the stationary voltagedistribution, corresponding to the state of least power dissipation, is equivalent to the solution ofthe variational functional (Horn[7}; Poggio and Koch, [8]). Data is provided through the correctchoice of data-dependent voltage sources and resistors at each node. Much research has gone intoextending these quadratic variational functionals to allow for discontinuities. Geman and Geman[9]first introduced a class of stochastic algorithms, based on Markov random fields, that explicitlyencode the absence or presence of discontinuities by means of binary variables. Their approach wasextended and modified by numerous researchers to account for discontinuities in depth, texture

Autonomous systems have to overcome two major problems in interpreting the data collected by sensors. These problems are due to the fact that multiple real world scenes can produce a given intensity distribution and that sensor data is often corrupted by noise. These problems can be solved by imposing certain a priori knowledge about the world to arrive at a unique solution. This reduces early vision problems to constrained optimization problems, which can be conveniently formulated as energy minimization problems in the framework of Regularization Theory. These energy functions can be implemented in analog hardware. This feature makes this approach very attractive for real time autonomous systems. We are presently developing algorithms and analog CMOS chips based on this approach for focal plane image processing.

In this paper, possibilities of identifying important engineering characteristics of the structures using selected inspection and test results are examined. Recently, methods of system identification have been used to obtain a set of differential equations or generalized impulse response functions for the representation of the dynamic behavior of a given structure. It is suggested herein that the characteristics to be thus identified can include such functions as the damage and reliability of the structure at the time of the test and inspection. The general problem of structural identification is formulated and considered. The literature on damage function and reliability functions of structures are reviewed and summarized. Possible applications of various testing procedures including nondestructive and proof-load tests for structural identification purposes are also considered. Finally, the potentially practical implementation of such a methodology is suggested.

The structural model is typical of single or multistory buildings with floor, ceiling, or wall-supported equipment assemblies. Attention is especially focused on the random properties of the earthquake environment and structural response. The method is applied to the problem of protecting industrial equipment in the vicinity of an active fault. When compared to conventional earthquake design and deterministic methods of analysis, the advantages of this approach are: (1) The random properties of the ground motion are analyzed at all earthquake intensity levels; (2) the results reflect the location, protection level, and service life of the building; (3) earthquake damage cost, protection cost, and reliability are important design factors; and (4) cost-effective and optimal design configurations are disclosed.

Two 10-member ensembles of digitally generated waveforms that simulate real earthquake accelerograms are used to excite mathematical models of two-story to 20-story buildings of widths ranging from 100 ft to 300 ft and founded on soils characterized by shear-wave velocities of up to 4,000 fps. Realistic equivalent structural damping is determined and used in this analysis based on the actual building response data recorded during the San Fernando earthquake of 1971. Calculated upper bound motion responses on floors throughout the buildings are presented in terms of peak values of accelaration, velocity, and displacement. Envelopes of damped response spectra derived from the in-building accelerograms are also presented, and the use of these spectra is demonstrated with an illustrative example.

The paper includes the description of the functional features of the often used raised floor systems and the factors affecting their seismic performance. After describing some practical methods to support their frameworks and cabinets, considerations for the design of earthquake-resistant raised floor systems are suggested. Attention is given to the concept and design of the isolation system for the entire raised floor. Practical and economically feasible methods to provide such an isolation are recommended. The concept of a new nested isolation system and some preliminary test results indicate the practical merits of such a system.

Based upon the concept of infinite impulse trains, the paper introduces a physically realizable stochastic model defined as an impulse process. This model allows the random amplitudes to be correlated. The input-output dynamics of linear filtering of the impulse process is investigated and the response spectral density, correlation and variance functions are derived and their behavior closely examined. Time series modelings by spectral and correlation approaches are described and digitally simulated samples for the impulse process and its response are presented. The analysis indicates that the impulse process and its filtered response process are very flexible and may be used to model a large class of random phenomena in engineering physics. The results of the analysis are also described with emphasis on their application in earthquake simulations.

Presented are analytic results of study on site properties and their use in ground-motion prediction and simulation. Spectral simulations of random-type ground motions based on modal contributions are formulated. Linear filters representing ground transfer characteristics of seismic stations are investigated. Single-mode and two-mode stochastic models are developed to permit prediction of random-type ground motions and the induced response statistics of structures. From the viewpoint of stochastic simulation, the autocorrelation function or the power spectral density function derived from the recorded accelerogram can be used to characterize the specific ground motion. By matching the power spectral density function of an existing ground-motion record to that of the appropriate output of a linear single- (or multi-) degree-of-freedom system subject to white noise, the predominant modal ground frequencies and dampings can be determined.

The autocorrelation and power spectral density functions of a total of 14 strong-motion accelerograms of the Parkfield earthquake are obtained. When the ground motions are treated as random phenomena, these functions are found appropriate to be used as statistical characterization functions for the ground motions. Spectral simulation procedure is employed to determine the modal contributions of the motion and the ground characteristic damping and frequency at each station. The results can be used to construct reasonable single- or two-degree-of-freedom linear filters for the generation of a stationary stochastic model for the ground motion. The implications and engineering significance of the basic results are also discussed in some detail.

A simple approach using a Fast Fourier Transform (FFT) algorithm for obtaining the transient structural response to earthquakes is presented. Two different foundation models are used, a rigid circular plate and a rigid two-dimensional strip bonded to the elastic soil half space. A numerical procedure is used to obtain all pertinent transfer functions which are subsequently used in conjunction with FFT subroutines to obtain the response time histories. It is shown that over a range of scaled wave numbers which characterize the soil properties, significant base rocking can be expected only when either the slenderness parameter or the mass-ratio parameter is small. The specific advantages of the new approach are: (1) it is computational efficient; (2) it can take into account the frequency-dependent interaction forces; and (3) it is general, readily adaptable in practical applications, and can be used with any linear structure or interaction model.

An approach to the time-varying spectral analysis for shock and vibration data is presented. The approach follows and extends Page’s concept of instantaneous power spectra. Various input-output relations for simple linear systems are derived. The error involved in the evaluation of the time-varying spectra of the response and conditions that reduce it are discussed in some detail. Numerical spectra and energy distribution function of four shock functions are provided and their significance is discussed.

A stationary, Gaussian random process, having a prescribed nonuniform power spectral density function determined by a special simulation procedure which realizes the local site geology is used to analyze the response statistics of nonlinear yield type structures subjected to earthquake excitations. The structures investigated are single-mode oscillators covering long and short periods, high and low viscous dampings, and having history-dependent and -independent interanal energy dissipation mechanisms as represented respectively by stiffness degrading and ordinary elasto-plastic models. Emphasis of the analysis is placed on the probability distribution of the single highest displacement (SHD) response of structures and the accumulation of damages caused by consecutive earthquake loadings.