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心血管磁共振及单光子发射体层成像用于诊断冠心病(CE-MARC):一项前瞻性试验
背景:在疑诊为冠心病(CHD)的患者中,单光子发射体层成像(SPECT)是评估心肌缺血应用最广泛的检测,但有报道其诊断的准确性不一,并将患者暴露于电离辐射。本研究的目的,是在疑诊为CHD的患者中,确立将X线冠状动脉造影作为参考标准时多参数心血管磁共振(CMR)诊断的准确性,并将CMR与SPECT进行比较。
方法:在本前瞻性试验中,疑诊为心绞痛及至少存在一项心血管危险因素的患者被分配接受CMR、SPECT及X线冠状动脉造影。CMR由静息和腺苷负荷灌注、电影成像、晚期钆增强及MR冠状动脉造影组成。门控腺苷负荷及静息SPECT应用99mTc。主要结局为CMR诊断的准确性。本试验已在controlled-trials.com注册,编号为ISRCTN77246133。
结果:在752例招募的患者中,39%经X线冠状动脉造影确定患CHD。多参数CMR的敏感性为86.5%(95%CI 81.8%~90.1%),特异性为83.4%(95%CI 79.5%~86.7%),阳性预测值为77.2%(95%CI 72.1%~81.6%),阴性预测值为90.5%(95%CI 87.1%~93.0%)。SPECT的敏感性为66.5%(95%CI 60.4%~72.1%),特异性为82.6%(95%CI 78.5%~86.1%),阳性预测值为71.4%(95%CI 65.3%~76.9%),阴性预测值为79.1%(95%CI 74.8%~82.8%)。CMR和SPECT的敏感性和阴性预测值差异显著(两者P<0.000 1),但特异性和阳性预测值无显著差异(分别为P=0.916和P=0.061)。
结论:CE-MARC是一项目前在实践操作中前瞻性评估CMR的最大型试验,并确立了CMR在诊断CHD中的准确性,更优于SPECT。应将其用于更多的CHD研究中。



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USA as a world power? In E-Sim it is possible!

In E-Sim we have a huge, living world, which is a mirror copy of the Earth. Well, maybe not completely mirrored, because the balance of power in this virtual world looks a bit different than in real life. In E-Sim, USA does not have to be a world superpower, It can be efficiently managed as a much smaller country that has entrepreneurial citizens that support it's foundation. Everything depends on the players themselves and how they decide to shape the political map of the game.

Work for the good of your country and see it rise to an empire.

Activities in this game are divided into several modules. First is the economy as a citizen in a country of your choice you must work to earn money, which you will get to spend for example, on food or purchase of weapons which are critical for your progress as a fighter. You will work in either private companies which are owned by players or government companies which are owned by the state. After progressing in the game you will finally get the opportunity to set up your own business and hire other players. If it prospers, we can even change it into a joint-stock company and enter the stock market and get even more money in this way.


In E-Sim, international wars are nothing out of the ordinary.

"E-Sim is one of the most unique browser games out there"

Become an influential politician.

The second module is a politics. Just like in real life politics in E-Sim are an extremely powerful tool that can be used for your own purposes. From time to time there are elections in the game in which you will not only vote, but also have the ability to run for the head of the party you're in. You can also apply for congress, where once elected you will be given the right to vote on laws proposed by your fellow congress members or your president and propose laws yourself. Voting on laws is important for your country as it can shape the lives of those around you. You can also try to become the head of a given party, and even take part in presidential elections and decide on the shape of the foreign policy of a given state (for example, who to declare war on). Career in politics is obviously not easy and in order to succeed in it, you have to have a good plan and compete for the votes of voters.


You can go bankrupt or become a rich man while playing the stock market.

The international war.

The last and probably the most important module is military. In E-Sim, countries are constantly fighting each other for control over territories which in return grant them access to more valuable raw materials. For this purpose, they form alliances, they fight international wars, but they also have to deal with, for example, uprisings in conquered countries or civil wars, which may explode on their territory. You can also take part in these clashes, although you are also given the opportunity to lead a life as a pacifist who focuses on other activities in the game (for example, running a successful newspaper or selling products).


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E-Sim is a unique browser game. It's creators ensured realistic representation of the mechanisms present in the real world and gave all power to the players who shape the image of the virtual Earth according to their own. So come and join them and help your country achieve its full potential.


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