Musicalidad y juego en la primera infancia: el andamiaje que el juego con las formas de la vitalidad provee al juego de ficción / Musicality and play in early childhood: the scaffolding that forms of vitality play provides to pretend play

Resumen El juego de ficción, aquel que comporta la creación de una situación imaginaria, ha sido un objeto de estudio privilegiado en la psicología del desarrollo y se ha señalado su rol en el desarrollo de funciones psicológicas complejas. Recientemente, gracias a la utilización de herramientas de análisis de las artes temporales, se ha documentado una nueva forma de juego, el juego con las formas de la vitalidad, cuyo foco es la repetición y variación de motivos sonoro-kinéticos de modo interactivo, en detrimento de cualquier contenido figurativo. Se ha observado que durante el tercer año de vida este tipo de juego se presenta de modo combinado con el juego de ficción y que en esos casos podría ser parte del andamiaje del desarrollo del juego de ficción. El objetivo del presente estudio fue realizar un microanálisis de los sonidos y movimientos de una escena de juego de ficción combinado con juego con las formas de la vitalidad de una niña de 1 año y 11 meses de edad, con el fin de conocer cómo se produce dicho andamiaje. Entre los resultados se destacan la presencia de sincronía interactiva basada en un pulso subyacente, la construcción de una mutualidad entre adulto e infante a partir de la calidad de los motivos compartidos, la ampliación del espacio de juego y el sostenimiento de la atención conjunta y la fluidez interactiva.

Abstract The pretend play, one that involves the creation of an imaginary situation, has been a privileged object of study in developmental psychology framed in the linguistic turn. Its important role in the development of complex psychological functions, such as language, theory of mind or narrative capacity, has been pointed out. In recent years, there has been a change in focus in the human sciences that has been dubbed the corporal turn: a re-focus on the analysis and conceptualization of bodily aspects that are at the base of various cognitive capacities. Thanks to the use of analysis tools typical of the temporal arts -such as music and dance- to the field of cognitive psychology, a new form of play has been documented in early childhood: the forms of vitality play. It recovers the idea of forms of vitality from Stern (2010), which refers to affects that cannot be reflected in the lexicon of Darwinian emotions. The forms of vitality are a Gestalt, an emergent property where movement, time, force, space and directionality/intentionality are integrated; they are a fundamental property of multimodal exchanges in the adult-baby dyad as well as of the experience, as spectator or performer, of non-figurative temporal arts such as dance and music. The forms of vitality play arise as a reconceptualization of the notion of musical play and is considered a reissue of early social play with a symmetrical participation of the child in the composition of play. It is defined as any pleasant or self-remunerative activity, in which motifs of movements and/or sounds are elaborated according to the repetition-variation form, at the expense of any figurative content. The forms of vitality play have been observed in the third year of the child's life and it has been pointed out that it can manifest in a simple way or in combination with the pretend play. Likewise, it was suggested that when the pretend play is presented in combination with the forms of vitality play, the latter could be scaffolding the pretend play, although how this happens has not been clearly specified. The objective of the present study is to carry out a microanalysis of the sounds and movements of a pretend play scene combined with forms of vitality play of a girl of 1 year and 11 months of age and an adult, in order to know how such scaffolding is produced. The sound envelope was analyzed in order to identify and describe the timing of the sounds. Regarding movement, specialized software was used to graph its trajectory and for the analysis of the expression of movements, the basic categories "Shape and Effort" of the Laban-Bartenieff system of movement analysis were used (Laban, 1971). The results indicate the presence of interactive synchrony based on an underlying pulse that sustains mutuality between the players and provides a temporal structure on which the synchrony of the self can be anchored. Furthermore, it allows the sharing of continuity and contrast in the quality of sounds and movements and thus provides the dyad with a primary level of understanding with non-mediated meanings; promotes the exploration of the play space and the expansion of the potential of the fictional scene; it favors the maintenance of joint attention and mutual understanding through ontogenetically pre-fiction semiotic mechanisms, which favor the interactive fluidity of play.

Predictive value of significant coronary stenosis in patients suspected of non-ST-segment elevation acute coronary syndrome by two-dimensional speckle tracking imaging combined with real-time three-dimensional echocardiography / 中华超声影像学杂志

Objective:To evaluate the left ventricular myocardial strain and mechanical synchrony in patients suspected of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) by two-dimensional speckle tracking imaging (2D-STI) and real-time three-dimensional echocardiography (RT-3DE), and to investigate the value of combined echocadiographic parameters in predication of significant coronary artery stenosis.Methods:A total of 95 patients suspected of NSTE-ACS, definitely planed to run coronary angiography (CAG) within 24-72 hours of admission were recruited in the Department of Cardiology, General Hospital of the Southern Theatre Command, PLA from December 2020 to June 2021. Regular echocardiography exam, 2D-STI and RT-3DE were performed prior to CAG.Global longitudinal peak strain (GLPS), territorial longitudinal peak strain (T RCALPS, T LADLPS, T LCXLPS) were computed by 2D-STI; the maximal difference of time to minimal systolic volume of 16-segments (Tmsv16-Dif), standard deviation of time to minimal systolic volume of 16-segment (Tmsv16-SD) and heart rate adjusted standard deviation of time to minimal systolic volume of 16-segment (Tmsv16-SD/R-R) were obtained by RT-3DE. The patients were divided into two groups according to the degree of coronary stenosis.Significant coronary artery stenosis group was defined as ≥70% of left main or any other main branch luminal narrowing ( n=53), non-significant coronary artery stenosis group was defined as <70% of luminal narrowing ( n=42). The differences of general clinical features, left ventricular strain and mechanical synchronization parameters between the two groups were compared. A binary logistic regression model was established to draw the ROC curve for predicting the severity of coronary stenosis by single and combined ultrasound parameters, and calculate the area under the ROC curve (AUC). Results:Compared with non-significant coronary artery stenosis group, GLPS were significantly reduced, while Tmsv16-SD, Tmsv16-Dif and Tmsv16-SD/R-R were significantly increased in sginificant coronary artery stenosis group (all P<0.05). The AUC of GLPS and Tmsv16-SD, Tmsv16-Dif and Tmsv16-SD/R-R for predicting significant coronary stenosis in suspected NSTE-ACS patients were 0.78, 0.69, 0.71 and 0.67, respectively. The result of joint test analysis for the dignosis of NSTE-ACS suspected significant coronary stenosis were as follows: the specificity of tandem test was 90.5%; the sensitivity of parallel test was 83.0%; the sensitivity, specificity and AUC of GLPS-Tmsv16-Dif joint index prediction test were 90.7%, 60.1% and 0.82 (95% CI=0.73-0.89) with 0.508 as Youden index. Conclusions:NSTE-ACS suspected patients with significant coronary stenosis are often accompanied by impaired left ventricular myocardial strain and mechanical dyssynchrony. A simple combination of left ventricular myocardial strain and contractility synchronization improves noninvasive prediction of high-risk coronary artery stenosis in suspected NSTE-ACS, which maybe helpful for screening patients requiring invasive examination.

Astrocytic Gap Junctions Contribute to Aberrant Neuronal Synchronization in a Mouse Model of MeCP2 Duplication Syndrome / 神经科学通报·英文版

Abnormal synchronous neuronal activity has been widely detected by brain imaging of autistic patients, but its underlying neural mechanism remains unclear. Compared with wild-type mice, our in vivo two-photon imaging showed that transgenic (Tg1) mice over-expressing human autism risk gene MeCP2 exhibited higher neuronal synchrony in the young but lower synchrony in the adult stage. Whole-cell recording of neuronal pairs in brain slices revealed that higher neuronal synchrony in young postnatal Tg1 mice was attributed mainly to more prevalent giant slow inward currents (SICs). Both in vivo and slice imaging further demonstrated more dynamic activity and higher synchrony in astrocytes from young Tg1 mice. Blocking astrocytic gap junctions markedly decreased the generation of SICs and overall cell synchrony in the Tg1 brain. Furthermore, the expression level of Cx43 protein and the coupling efficiency of astrocyte gap junctions remained unchanged in Tg1 mice. Thus, astrocytic gap junctions facilitate but do not act as a direct trigger for the abnormal neuronal synchrony in young Tg1 mice, revealing the potential role of the astrocyte network in the pathogenesis of MeCP2 duplication syndrome.

A phantom study on the feasibility of recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology in Cyberknife Synchrony-based respiratory tracking / 中华放射医学与防护杂志

Objective:To explore the feasibility of recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology in the Cyberknife Synchrony-based respiratory tracking.Methods:CT scans of an inflatable pig lung after anti-rot processing were obtained. Then, eight simulated tumor lesion sites were designed in the left and right lung lobes using intelligent navigation software, with four classified as the sputum bronchial environment group and four classified as the wet bronchial environment group. Based on the implantation principle of Cyberknife fiducial markers, 32 recoverable fiducial markers were implanted around various simulated tumor lesions via bronchus under intelligent guidance. Then, the end-expiratory state of the pig lung was simulated, the pig lung was scanned again to obtain CT images of the implanted recoverable fiducial markers, and the number of successfully implanted fiducial markers was recorded. Eight deliverable Synchrony treatment protocols were designed using the Cyberknife planning system (Multiplan v4.6), and then the pig lung with simulated respiratory movements was exposed to radiation. After radiation, the implanted recoverable fiducial markers were retrieved using the bronchoscopy technique, and the number of successfully retrieved fiducial markers was recorded. Moreover, the translational errors, rotational errors, and rigid body errors were extracted from the Cyberknife log file and analyzed.Results:No recoverable fiducial markers slipped or fell during the experiment. Thirty-two recoverable fiducial markers were successfully implanted and recovered under the guidance of intelligent navigation bronchoscopy, with implantation and recovery success rates of both 100%. Moreover, the tracking rate and rigid body errors of the fiducial markers were 100% and less than 5 mm, respectively. The data from the Cyberknife log file indicated that there was no significant difference between the sputum bronchial environment group and the wet bronchial environment group in the translational errors in the left-right direction, the rotational errors in the roll direction, and the rotational errors in the pitch direction ( P>0.05). Compared to the wet bronchial environment group, the sputum bronchial environment group had slightly higher translational errors in front-back ( Z=-3.57, P<0.01) and cranio-caudal ( Z=-2.53, P<0.05) directions, lower rotational errors along the yaw axis ( Z = -3.88, P < 0.01), and lower rigid body error ( Z=-3.32, P<0.01), and the differences were all statistically significant. Conclusions:The recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology is feasible. Recoverable fiducial markers are stable in the bronchus of the phantom, and the Cyberknife tracking precision can meet clinical requirements. Therefore, the recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology has promising prospects in clinical and teaching applications.

Pressure-strain loops technique detects the effects of different pacing modes of left bundle branch on left ventricular myocardial work / 中华超声影像学杂志

Objective:To evaluate the effects of different pacing modes (unipolar/bipolar) under left bundle branch pacing(LBBP) on ventricular mechanical synchrony and myocardial work using the pressure-strain loop technique.Methods:Twenty-nine patients with LBBP due to symptomatic bradycardia were collected as LBBP group in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from December 2018 to July 2020. Another 29 matched patients with right ventricular pacing (RVP) during the same period were also included as a RVP group. Each LBBP patient was programmed to different pacing modes (uni-/bio-polar) within 1 week after the operation.Under each pacing mode, the inter- and intra-ventricular mechanical synchronization were evaluated. Meanwhile, the global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) were obtained by the left ventricular pressure-strain loops technique.Results:Compared with the RVP group, the mechanical synchrony in the LBBP group was significantly improved (all P<0.05). GWI, GCW, and GWE increased, while GWW decreased, and the differences were statistically significant (all P<0.05), there were no significant differences in ventricular mechanical synchronization, GWI, GCW, GWE, and GWW between unipolar and bipolar pacing in the LBBP group (all P>0.05), there were no significant differences in these parameters when increasing output voltage (all P>0.05). Conclusions:LBBP induces better mechanical synchronization and higher myocardial work efficiency than RVP. Different LBBP pacing modes do not affect ventricular mechanical synchronization and myocardial work efficiency.

Síndrome de marcapasos: cuál es el mecanismo? / Pacemaker syndrome: what is the mechanism?

Resumen Presentamos un caso de síndrome de marcapasos asociado a la ausencia de sincronía aurículo-ventricular, debido a la colocación invertida e inadvertida de los electrodos, en una paciente portadora de bloqueo aurículo-ventricular completo; para su diagnóstico, es fundamental un cuidadoso análisis del electrocardiograma, las imágenes con rayos X y los electrogramas intracavitarios.

Abstract Pacemaker syndrome: what is the mechanism? We present the case of pacemaker syndrome related to the absence of atrioventricular synchrony, due to inverted and inadvertent placement of the electrodes, in a patient with complete atrioventricular block. A careful analysis of the electrocardiogram, X-ray images and intracavitary electrograms are essential for its diagnosis.

Change of left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy / 上海交通大学学报（医学版）

Objective: To assess left ventricular torsion function and systolic synchronization in children with hypertrophic cardiomyopathy (HCM) by using two-dimensional speckle tracking echocardiography (2D-STI), so as to provide theoretical basis for early clinical evaluation of cardiac function in children. Methods: Twenty-nine children with HCM in Shanghai Children’s Hospital, Shanghai Jiao Tong University from October 2018 to March 2019 were divided into two groups according to whether having clinical symptoms, i.e., asymptomatic HCM group (n=17) and symptomatic HCM group (n=12). Thirty normal children were also enrolled in the normal control group. All subjects underwent echocardiography, and the torsion-and strain-related data of the whole and different myocardial segments in the cardiac sections of left ventricle were obtained by 2D-STI. Results: Left ventricular strain analysis showed that the left ventricular longitudinal strains of both HCM groups decreased significantly compared with the normal control group (P<0.05), while the radial and circumferential strains increased significantly (P<0.05). The maximum difference of peak time in different segments on six cardiac sections in the symptomatic HCM group was significantly higher than that in the normal control group (P=0.000), while the difference between the asymptomatic HCM group and the normal control group was not significant. Left ventricular torsion function analysis showed that the global peak twists of left ventricle and positive peaks of rotation velocity in both HCM groups were significantly higher compared with the normal control group (P<0.05), standardized times to peak were longer (P<0.05), and negative peaks of rotation velocity and the untwisting rates were lower (P<0.05). Conclusion: In the children with HCM, the left ventricular torsion function is enhanced and diastolic function is weakened. In the symptomatic children, the left ventricular systolic synchrony is poor.

Very Early (<2 h) Versus Early (12 h) Administration of Caffeine Citrate for Reducing Need for Mechanical Ventilation within 24 h of Life in Preterm Infants on Continuous Positive Airway Pressure

Background: Auditory neuropathy, auditory dys-synchrony, and auditory neuropathy spectrum disorder (ANSD) are variableterms used to describe an auditory disorder seen in patients ranging in age from infants to adults. The prevalence of ANSD indeaf schoolchildren is 2.46% within the age range of 6–12 years. In children, they are detected by the presence of otoacousticemissions (OAEs) in the absence of ABRs. In older age group, difficulty hearing in noise, fluctuating hearing, and speechperception performance not predict ed by the level of residual hearing have been reported. The multitude of etiologies forANSD results in heterogeneous group of patients – making the management strategies even more challenging. The commonetiologies put forward are – prematurity, neonatal insult, genetic abnormality, ototoxic drugs, and head injury.Aim of the Study: This study aims to study the audiological profile in ANSD in a tertiary care hospital and to study the etiologyof ANSD cases.Materials and Methods: A total of 42 patients attending the ENT Outpatient Department of Government Medical College,Kozhikode, with ANSD were included in the study. An ethical committee clearance was obtained before the commencement ofthe study. An ethical committee cleared consent form was used for the study. All ANSD patients were evaluated with a detailedhistory including perinatal and development history, ototoxic drug exposure, head trauma, neurodegenerative conditions, andfamily history. Following clinical evaluation which included general examinations, ENT examination, and central nervous systemexamination, an audiological evaluation, which included pure tone audiometry, speech audiometry, immittance evaluation, OAE,and auditory brainstem response, was done. Radiological investigation (magnetic resonance imaging brain with inner ear – focusingon any structural anomalies; cochlea, vestibulocochlear nerve, and internal auditory canal) was done. Patients were counseledregarding the rehabilitation options based on their audiological and radiological results and the need for follow-up was explained.Observation and Results: A total of 42 patients attending the ENT Outpatient Department (OPD) of Government MedicalCollege, Kozhikode, with ANSD were included in the study. Among the 42 patients, 21 (50%) were in the age group of 11–20 yearsfollowed by 13 patients who were between 0 and 10 years (30.95%). The remaining 8 were aged above 20 years (19.04%).The youngest patient was 10 months old and the oldest was aged 38 years with a mean age of 10.35 ± 2.10 years. Therewere 29 (69.04%) females and 13 (30.95%) males. 3/42 (7.14%) patients gave a history of exposure to ototoxic drugs suchas streptomycin, gentamicin, and kanamycin, but never had a history of loss of hearing before that. History of premature birthwas noted in 10 (23.80%) patients and the remaining patients did not show premature birth history. Among the 42 patients ofthis study group, 23 (54.76%) had low birth weight, of which 2/42 (4.76%) were <1.5 kg. 21/42 (50%) patients had birth weightabove 1.5 kg. 10/42 patients (23.80%) gave a history of neonatal intensive care unit (NICU) admissions at the time of their birth.Conclusions: The major risk factor identified in this study for ANSD was low birth weight with prematurity, NICU admissions,and viral infections having significant contributions. On audiological evaluation, hearing loss was of mild-to-moderate rangewith a low-frequency loss. There was no statistical correlation between pure audiometry values and speech audiometry whichwas a characteristic observation. OAEs were present in the majority of patients with absent cochlear microphonics (reversepolarity) and acoustic reflexes.

Application of modified tracking components in CyberKnife treatment of thoracic and abdominal tumors / 肿瘤研究与临床

Objective@#To improve synchrony tracking components of CyberKnife (tracking vest and tracking markers) and to analyze the clinical application value of the improved tracking components in CyberKnife treatment of thoracic and abdominal tumors.@*Methods@#The tracking apron was made of knitted four-side elastic spandex cloth and suture design of Velcro, which was used to stick the tracking markers on the chest and abdomen of patients. The tracking markers added a 2 cm thick light foam block to the bottom of the original markers, and then the hook face of the Velcro was fixed to the bottom of the light foam. The improved trace component (the improved component) and the original component (the vendor component) were applied to the lung tracking treatment model, and the manufacturer components were included in the reference group. Adoption of improved components into the observation group; 20 different types of respiratory waveforms were simulated and applied to the same mold plan. After treatment, the coverage rate, mean standard deviation, maximum standard deviation and the slope of XYZ-axis vs. R correlation graph were recorded. The relevant parameters of Synchrony model and wearable time of two components were compared, and the application significances of the improved tracking component in the breathing tracking process of the CyberKnife were evaluated.@*Results@#The maximum slope [median(interquartile range)] of XYZ-axis vs. R related graph in the reference group was 0.73 (3.89), 0.27 (0.49) and 0.34 (1.02), respectively. The maximum slope of XYZ-axis vs. R related graph in the observation group was 0.70 (2.78), 0.31 (0.30) and 0.36 (0.75), respectively. There was no statistically significant difference in the slope of XYZ-axis vs. R between the reference group and the observation group (all P > 0.05). There was no significant difference in the average standard error and maximum standard error between the reference group and the observation group [(1.7±0.4) mm vs. (1.7±0.5) mm, t=-0.382, P= 0.710; (2.0±0.6) mm vs. (1.7±0.5) mm, t=-0.877, P= 0.401], and the difference of the model coverage rate between the two groups was statistically significant [(48±18)% vs. (60±22)%, t= 2.762, P= 0.042]. The setup time of tracking components in the observation group was less than that in the reference group, and the difference was statistically significant [(44±24) s vs. (81±15) s, t=-4.310, P= 0.001].@*Conclusions@#The improved tracking components are comparable to the manufacturer tracking components in the standard error of the Synchrony model. The improved components shorten the wear time and appropriately improve the coverage of the Synchrony model.

Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective@#To evaluate the characteristics of left ventricular structure, function, myocardial mechanics, hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy (HCM) using state-of-the-art echocardiography.@*Methods@#A consecutive series of 85 adult HCM patients who were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected. According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography, the patients were divided into three groups: patients with non-obstructive HCM (n=28), those with labile-obstructive HCM (n=27), and those with obstructive HCM (n=30). In addition, 16 normal family members of HCM patients were included as control group. Two-dimensional speckle tracking imaging, tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states.@*Results@#①As compared with the control group, left ventricular end-diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups(all P<0.05). Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM, followed by labile-obstructive and non-obstructive HCM, and the lowest in the control group (all P<0.05). ②At rest, the left ventricular global longitudinal, circumferential and radial strain (GLS, GCS and GRS), as well as the twist of obstructive HCM were significantly lower than the other three groups (all P<0.05). As compared with the control group, the GLS and twist decreased in the labile-obstructive and non-obstructive HCM(all P<0.05), but there were no significant changes of GCS and GRS (all P>0.05). The obstructive HCM had the lowest mitral annular plane systolic excursion (MAPSE) and s′, and the longest systolic peaking time standard deviation(Ts-SD) and early diastolic peaking time standard deviation(Te-SD) (all P<0.05). The left ventricular diastolic function of obstructive HCM (e′, the E/e′ ratio and the left atrial volume index) was the worst, labile-obstruction and non-obstructive HCM were better, and the control group was the best (all P<0.001). ③During exercise, the GLS, GCS, GRS, twist of the left ventricle and the MAPSE were the lowest in the obstructive HCM, which increased in the labile-obstructive and non-obstructive HCM, and were best in the control group. The Ts-SD and Te-SD were the shortest in the control group, were prolonged in non-obstructive and labile-obstruction HCM, and were longest in obstructive HCM (all P<0.05). Additionally, the exercise time of the control group was the longest, followed by non-obstructive and labile-obstruction HCM, and the shortest in the obstructive HCM (all P<0.05). The METs of obstructive HCM were significantly lower than the other three groups (all P<0.05).@*Conclusions@#In obstructive HCM, the left ventricular systolic strain and synchronization, as well as the MAPSE, are significantly impaired in patients both at rest and during exercise. The patients with labile-obstructive and non-obstructive HCM have reduced left ventricular GLS, twist, and e′, but normal left ventricular GCS, GRS, synchrony, and MAPSE at rest, which are all impaired during exercise.

Quantification of left ventricular performance in different phenotypes of hypertrophic cardiomyopathy / 中华超声影像学杂志

Objective To evaluate the characteristics of left ventricular structure ,function ,myocardial mechanics ,hemodynamics and synchrony in different phenotypes of hypertrophic cardiomyopathy ( HCM ) using state‐of‐the‐art echocardiography . Methods A consecutive series of 85 adult HCM patients w ho were admitted to the Xi Jing HCM center from January 2016 to November 2017 were collected . According to the peak left ventricular outflow tract pressure gradient in exercise stress echocardiography ,the patients were divided into three groups :patients with non‐obstructive HCM ( n ＝28) ,those with labile‐obstructive HCM ( n ＝27) ,and those with obstructive HCM ( n ＝ 30 ) . In addition ,16 normal family members of HCM patients were included as control group . T wo‐dimensional speckle tracking imaging ,tissue Doppler imaging and exercise stress echocardiography were used to evaluate the left ventricular function in resting and exercise states . Results ① As compared with the control group ,left ventricular end‐diastolic diameter decreased and left ventricular ejection fraction increased in all three HCM groups ( all P ＜ 0 .05 ) . Left ventricular maximum wall thickness and left ventricular mass index were the highest in obstructive HCM , followed by labile‐obstructive and non‐obstructive HCM ,and the lowest in the control group ( all P ＜0 .05) . ②A t rest ,the left ventricular global longitudinal ,circumferential and radial strain ( GLS ,GCS and GRS) ,as well as the twist of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . As compared with the control group ,the GLS and twist decreased in the labile‐obstructive and non‐obstructive HCM ( all P ＜0 .05 ) ,but there were no significant changes of GCS and GRS ( all P ＞ 0 .05 ) . T he obstructive HCM had the lowest mitral annular plane systolic excursion ( M APSE ) and s′,and the longest systolic peaking time standard deviation( T s‐SD) and early diastolic peaking time standard deviation ( Te‐SD) ( all P ＜0 .05) . T he left ventricular diastolic function of obstructive HCM ( e′,the E/e′ratio and the left atrial volume index ) was the worst ,labile‐obstruction and non‐obstructive HCM were better ,and the control group was the best ( all P ＜ 0 .001 ) . ③ During exercise ,the GLS ,GCS ,GRS ,twist of the left ventricle and the M APSE were the lowest in the obstructive HCM ,which increased in the labile‐obstructive and non‐obstructive HCM ,and were best in the control group . T he T s‐SD and Te‐SD were the shortest in the control group ,were prolonged in non‐obstructive and labile‐obstruction HCM ,and were longest in obstructive HCM ( all P ＜ 0 .05 ) . Additionally ,the exercise time of the control group was the longest , followed by non‐obstructive and labile‐obstruction HCM ,and the shortest in the obstructive HCM ( all P ＜0 .05) . T he M ET s of obstructive HCM were significantly lower than the other three groups ( all P ＜0 .05) . Conclusions In obstructive HCM ,the left ventricular systolic strain and synchronization ,as well as the M APSE ,are significantly impaired in patients both at rest and during exercise . T he patients with labile‐obstructive and non‐obstructive HCM have reduced left ventricular GLS , twist ,and e′,but normal left ventricular GCS ,GRS ,synchrony ,and M APSE at rest ,which are all impaired during exercise .

Analysis on quality assurance of Cyberknife Synchrony in 3D direction / 医疗卫生装备

Objective To determine whether the quality insurance verification of Cyberknife Synchrony meet the clinical requirements of 3D tumor motion. Methods CT images were collected with modified Sunchrony phantom, and then a Synchrony E2E treatment plan was developed.A ball-cube with EBT film was loaded on the bed,and then placed in different movement directions to implement phantom verification plan.E2E film analysis software was used for film analysis to obtain the tracking error. Results The treatment accuracy of Synchrony in one-dimensional, two-dimensional and three-dimensional directions were 0.91, 1.03 and 0.90 mm respectively. Conclusion The present quality assurance validation method of Synchrony meets the demand of clinical three-dimensional tumor motion.

Assessment of relationship between atrial synchrony and paroxysmal atrial fibrillation by two-dimensional speckle tracking imaging in patients with sick sinus syndrome / 中华医学超声杂志（电子版）

Objective To evaluate the relationship between atrial synchrony and paroxysmal atrial fibrillation (PAF) in patients with sick sinus syndrome (SSS) by two-dimensional speckle tracking imaging. Methods Forty-four SSS patients who underwent echocardiographic examination at Department of Ultrasound, No. 2 Hospital of Yinzhou in Ningbo City of Zhejiang Province from January 2015 to August 2016 were enrolled, including 25 without PAF and 19 with PAF. Twenty-eight normal adults who underwent echocardiographic examination at this department at the same time were included as a normal control group. The structural and functional parameters of the left ventricle of all enrolled subjects were evaluated by echocardiographic examination. After two-dimensional speckle tracking images of the right atrium free wall, atrial septum, and left atrium free wall were obtained, the time interval from the initial point of P wave on electrocardiograph to the second negative wave of the diastolic phase in two-dimensional speckle tracking images were measured to calculate the electrical-mechanical time of the right atrium free wall (P-RA), the electrical-mechanical time of the atrial septum (P-IAS), and the electrical-mechanical time (P-LA) of the left atrium free wall. Subsequently, the parameters of atrial synchrony were calculated. Conventional echocardiographic parameters, P-RA, P-IAS, P-LA, and the parameters of atrial synchrony were compared among the three groups by one-way ANOVA, and further comparisons between any two groups were performed by the SNK-q test. The relationship between the parameters of electrical-mechanical time, parameters of atrial synchrony, and PAF were analyzed by Spearman correlation analysis. Receiver operating characteristic curve (ROC) analysis was then performed to evaluate the value of the parameters of electrical-mechanical time and parameters of atrial synchrony in predicting PAF. Results The left atrial size was significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.18, 5.37, both P＜0.05), although there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-RA and P-IAS were significantly larger in the SSS without PAF group and SSS with PAF group than in the normal control group (q=4.03, 4.10; q=4.16, 4.31, all P＜0.05), but there was no significant difference between the SSS without PAF group and SSS with PAF group. The P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony showed a gradually rising trend from the normal control group to the SSS without PAF group and SSS with PAF group, and the difference between any two groups was statistically significant (q=5.18, 11.23, 4.43; q=5.25, 11.74, 4.63; q=7.38, 14.67, 4.73; q=8.01, 16.37, 6.39, all P＜0.05). Spearman correlation analysis showed that P-LA, right atrial intra-atrial synchrony, left atrial intra-atrial synchrony, and inter-atrial synchrony were significantly positively correlated with PAF in patients with SSS (r=0.61, 0.55, 0.75, 0.78, all P ＜ 0.01), and the correlation between inter-atrial synchrony and PAF was the highest. ROC analysis demonstrated the optimal threshold of P-LA for prediction of PAF was 94 ms [sensitivity: 68.42%; specificity: 76.00%; the area under the ROC curve (AUC): 0.764 (95% CI: 0.612-0.879)]; the optimal threshold of right atrial intra-atrial synchrony was 19 ms [sensitivity: 57.89%; specificity: 76.00%; AUC: 0.714 (95% CI: 0.558-0.840)];the optimal threshold of left atrial intra-atrial synchrony was 42 ms [sensitivity: 78.95%; specificity: 76.00%;AUC: 0.860 (95% CI : 0.722-0.946)]; and the optimal threshold of inter-atrial synchrony was 68 ms [sensitivity:84.21%; specificity: 84.00%; AUC: 0.859 (95% CI: 0.721-0.945)]. These results suggest that left atrial intra-atrial synchrony and inter-atrial synchronization are superior to right atrial intra-atrial synchrony in predicting PAF in patients with SSS. Conclusion Atrial electro-mechanical motion time parameters and synchrony parameters are closely related to PAF in patients with SSS, and left atrial intra-atrial synchrony and inter-atrial synchronization are the most effective parameters in predicting PAF in patients with SSS.

Validation of a rapid method for synchrony tracking precision detection for the CyberKnife system / 中华放射医学与防护杂志

Objective To establish a rapid synchrony tracking precision detection method for the CyberKnife system by comparing the data between experimental measurements and end to end (E2E) result.Methods The auto quality assurance (AQA) phantom was placed on the synchrony motion plat and irradiated by two orthogonal beams.The concentricity of the beam projection center on the film and the wolfram center were analyzed through AQA software to detect tracking precision.The planning implement time of experimental measurements and E2E was then compared.Results No significant difference was found between the measurement and E2E data (P ＞ 0.05).The time for setting up and modeling in two approaches was identical and the average time for planning implement was 144 and 723 s,respectively.Conclusions The method in our analysis could reduce the procedure time and supplement the AQA and synchrony E2E test,which might be conducted in the morning quality assurance (QA) or weekly QA for CyberKnife system.

Effects of different ultrasound power application on left ventricular myocardium synchrony in vivo open -chest Beagle canines / 中华超声影像学杂志

Objective To evaluate left ventricular ( LV ) myocardial mechanical synchrony with contrast agent and different power irradiation in open-chest Beagle canines . Methods The anesthetized open-chest Beagle canines were assigned into two groups randomly : Group A ( n = 6 ) for baseline , diagnostic ultrasound power irradiation ( 300 mW ) 5 min ,combined with contrast agent irradiation 5 min and contrast agent 20 min conditions ;Group B ( n = 6) for baseline and intensity ultrasound irradiation ( 1 W ,2 W and 3 W ,5 min respectively) conditions . The standard short-axis gray-scale views at levels of mitral annulus ( MV) ,papillary muscle( PM ) ,and apex( AP) during 3 complete cardiac cycles in open-chest Beagle canine models were acquired . The global radial displacement peak time ( RD-PT) and standard deviation of peak time ( RD-PT SD ) of LV subendomyocardium ( subendo ) and subepimyocardium ( subepi ) were measured and analyzed by using a dedicated Syngo velocity vector imaging ( VVI) method . Results In group A ,compared with baseline condition , the RD-PT and RD-PT SD of subendo and subepi had no significant different among diagnostic power irradiation ,contrast agent irradiation 5 min and contrast agent 20 min ( all P < 0 .05) . There was no significant different in the RD-PT and RD-PT SD between subendo and subepi in A group in all conditions ( all P < 0 .05) . In group B ,the RD-PT and RD-PT SD of subendo and subepi with power 1 W ,2 W and 3 W was higher than those with baseline condition ;the RD-PT and RD-PT SD of subendo were significant different on 2 W compared with those on baseline condition ( all P <0 .05) ;the RD-PT and RD-PT SD of subendo ,subepi were significant different on 3 W compared with baseline condition ( all P < 0 .05) ;the RD-PT and RD-PT SD were significant difference between subendo and subepi in only 3 W condition ( all P < 0 .05 ) . Conclusions Diagnostic ultrasound power irradiation 5 min and combined with contrast agent irradiation 5 min and contrast agent 20 min conditions do not effect the synchrony of LV myocardial mechanics . Power more than 1 W can induce the delay of RD-PT and RD-PT SD of LV subendo and subepi . Power 3 W can result in dyssynchrony of LV myocardial mechanics .

A condição do ser falante no nó borromeano / The condition of being speaker in the borromean knot / La condición del ser hablante en el nudo borromeo

Este artigo aborda a condição do ser falante como um nó borromeano de três círculos representativos do Real, do Simbólico e do Imaginário, interrogando a estruturação sincrônica da constituição subjetiva e apontando "cortes reais" da experiência psíquica que possibilitam novas condições de organização para o sujeito. A partir do achatamento do nó borromeano, procurou-se detalhar seus campos de "ex-sistência" e gozos, além de articular a inibição, o sintoma e a angústia às nominações imaginária, simbólica e real como quarto elo.

This manuscript discusses the condition of the human being speaker as a borromean knot of three representative circles of the Real, the Symbolic and the Imaginary, lauching a question about the synchronic structure of the subjective constitution and pointing "real cuts" of psychic experience that enable new organizational conditions for the subject. From the flatness of the borromean knot, this paper tried to detail their fields of "ex-istence" and enjoyments, in addition to joint inhibition, symptom and anguish to the imaginary, symbolic and real nominations as the fourth link.

Este trabajo discute la condición del ser hablante como um nudo borromeo de tres círculos representativos de lo real, lo simbólico y lo imaginario, interrogando acerca de la estructura sincrónica de la constitución subjetiva y señalando "cortes reales" de la experiencia psíquica que permiten nuevas condiciones organizativas para el sujeto. De la perspectiva de la planitud del nudo borromeo, este trabajo tiene como objetivo detallar sus campos de "ex-sistencia" y goces, y mostrar el vínculo entre la inhibición, síntoma y angustia a lo largo de las nominaciones imaginarias, simbólicas y reales como representaciones del cuarto enlace.

Effect of density heterogeneity on absorbed dose with CyberKnife Synchrony Respiratory Tracking System / 中华放射肿瘤学杂志

Objective To measure the actual absorbed dose of the target in the QUASAR Respiratory Motion Phantom using the CyberKnife Synchrony Respiratory Tracking System, and to evaluate the effect of density heterogeneity on the absorbed dose of tumor gross target volume ( GTV ) . Methods Nine groups were obtained by making different patterns of QUASAR phantom:rib thickness of 0, 20, and 50 mm, and motion amplitudes of 0, 10, and 15 mm. The nine groups were treated with static computed tomography (CT) in different time phases of four-dimensional CT (4DCT) plan, with the same beam and number of monitor units, and the 4D accumulated dose was calculated. The doses of static and 4D plans were calculated using Ray-tracing and Monte Carlo algorithms, and the absorbed doses of GTV in the nine groups were measured at the same time. Results There were a decrease in calculated absorbed dose of GTV and an increase in deviation between the planned and actual dose, with the increases in simulated rib thickness and motion amplitude. Conclusions The density heterogeneity has an impact on the absorbed dose of GTV. Both static CT and 4DCT plan can evaluate the absorbed dose of GTV in case of small rib thickness and motion amplitude, and 4DCT plan with Monte Carlo algorithm may be the optimal method for evaluation of the absorbed dose of GTV in case of large rib thickness and motion amplitude ( deviation<3%)

Neurally adjusted ventilatory assist in pediatric patients / 中国小儿急救医学

Neurally adjusted ventilatory assist ( NAVA ) and non-invasively-NAVA are safe and feasible mode of ventilation in both the pediatric and the neonatal populations. NAVA mode has excellent synchrony and is superior over conventional mode at improving patient-ventilator interaction. NAVA is least vulnerable to changes in airway disease or airway resistance patterns. Non-invasively-NAVA delivers synchro-nized ventilation independent of leaks. NAVA offers maintenance of physiologic variability in breathing. NAVA can effectively avoid excessive ventilation,assist the weaning and has a lung protective function. Bed-side monitoring of Edi is a useful tool for evaluating diaphragm function,central apnea,clinical interventions, and decision support. Further high-quality studies are required to evaluate the long-term clinical prognosis for NAVA mode utilizing in pediatric patients.

Ultrasound targeted microbubbles destruction-mediated the Ang1 gene transfection improves left ventricular mechanical synchrony during the progression of myocardial infarction in canines / 中华超声影像学杂志

Objective To evaluate the left ventricular synchrony after myocardial infarction (MI) by ultrasound targeted microbubbles destruction (UTMD)-mediated angiogenin 1 (Ang1) gene transfection in canine.Methods Twenty-one dogs were divided into three groups (n =7 in each group):①control group (healthy dogs);②MI group (MI dogs without treatment);③UTMD group (MI dogs with UTMD treatment).One month later,the size and systolic function of heart were measured by echocardiography.The synchronization parameters derived from two dimensional-speckle tracking imaging(2D-STI) included the standard deviation and maximum difference of time to peak strain for all left ventricular segments (Tls-SD,Trs-SD,Tcs-SD,Tls-Dif,Trs-Dif and Tcs-Dif).CD31 and α-SMA were applied for quantifying capillary and arteriolar density.The Ang1,SERCA2a and PLB protein were detected by Western blotting.Results ① One month later,the conventional ultrasonic parameters were compared among three groups,the LVEDD,LVESD and E/e'increased and LVEF,e'and E/A reduced in MI group than those in control group,all of them partially recovered in UTMD group than those in MI group,but were still lower than those in control group (P ＜0.05);②The left ventricular synchrony parameters of Tls-SD,Tls-Dif and Trs-SD showed significant differences among the three groups(P ＜0.05),the degree of dyssynchrony increased in MI group than control group,they were lower in UTMD group than those in MI group.The Tcs-SD,Tcs-Dif and Trs-Dif showed no significant difference among three groups (P ＞ 0.05);③ The immunohistochemistry showed the higher blood vessel density in UTMD group than that in MI group(P ＜ 0.05);④The relative quantity of Ang1 was significantly higher in UTMD group.The relative quantity of SERCA2a protein was lower in MI group than that in control group,increased in UTMD group,the trend of PLB was contrary to it.The differences were statistically significant (all P ＜0.05).Conclusions The UTMD-mediated Ang1 gene transfection can promote angiogenesis after MI,reverse left ventricular remodeling and improve left ventricular synchrony.The myocardial synchrony may be related to the expression of calcium ions key protein SERCA2a and PLB.

Effect of density heterogeneity on absorbed dose with CyberKnife Synchrony Respiratory Tracking System / 中华放射肿瘤学杂志

Objective To measure the actual absorbed dose of the target in the QUASAR Respiratory Motion Phantom using the CyberKnife Synchrony Respiratory Tracking System, and to evaluate the effect of density heterogeneity on the absorbed dose of tumor gross target volume ( GTV ) . Methods Nine groups were obtained by making different patterns of QUASAR phantom:rib thickness of 0, 20, and 50 mm, and motion amplitudes of 0, 10, and 15 mm. The nine groups were treated with static computed tomography (CT) in different time phases of four-dimensional CT (4DCT) plan, with the same beam and number of monitor units, and the 4D accumulated dose was calculated. The doses of static and 4D plans were calculated using Ray-tracing and Monte Carlo algorithms, and the absorbed doses of GTV in the nine groups were measured at the same time. Results There were a decrease in calculated absorbed dose of GTV and an increase in deviation between the planned and actual dose, with the increases in simulated rib thickness and motion amplitude. Conclusions The density heterogeneity has an impact on the absorbed dose of GTV. Both static CT and 4DCT plan can evaluate the absorbed dose of GTV in case of small rib thickness and motion amplitude, and 4DCT plan with Monte Carlo algorithm may be the optimal method for evaluation of the absorbed dose of GTV in case of large rib thickness and motion amplitude ( deviation<3%)