Left bundle branch pacing vs biventricular pacing in heart failure patients with left bundle branch block:A systematic review and meta-analysis

BACKGROUND Left bundle branch pacing(LBBP)is a novel pacing modality of cardiac resynchronization therapy(CRT)that achieves more physiologic native ventricular activation than biventricular pacing(BiVP).AIM To explore the validity of electromechanical resynchronization,clinical and echocardiographic response of LBBP-CRT.METHODS Systematic review and Meta-analysis were conducted in accordance with the standard guidelines as mentioned in detail in the methodology section.RESULTS In our analysis,the success rate of LBBP-CRT was determined to be 91.1%.LBBP CRT significantly shortened QRS duration,with significant improvement in echocardiographic parameters,including left ventricular ejection fraction,left ventricular end-diastolic diameter and left ventricular end-systolic diameter in comparison with BiVP-CRT.CONCLUSION A significant reduction in New York Heart Association class and B-type natriuretic peptide levels was also observed in the LBBP-CRT group vs BiVP-CRT group.Lastly,the LBBP-CRT cohort had a reduced pacing threshold at follow-up as compared to BiVP-CRT.

Layout Design of Conductive Heat Channel by Emulating Natural Branch Systems

To design effective and easy-to-manufacture conductive heat channels, a heuristic method by emulating the natural branch systems is suggested. The design process of the method is divided into two steps, which are the principal channel design and the lateral channel design. During the process, the width of each channel is controlled by the bifurcation law, and the end point of the channel is located at the point with the maximum temperature while the start points of the principal channel and the lateral channel are respectively determined by the location of the heat sink and the law of the minimum thermal resistance. Four design examples with different boundary conditions are studied by the suggested method, and the design results are compared with that of the traditional structural topology optimization method. Not only lower maximum temperature and relatively uniform distribution of temperature are obtained by the suggested method, but also straight channels are achieved without gray element, which is easy to manufacture. The suggested method inspired by the natural branch systems can provide an effective solution for heat channel design in the heat dissipation structures.

Targeted puncture of left branch of intrahepatic portal vein in transjugular intrahepatic portosystemic shunt to reduce hepatic encephalopathy

BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) is currently used for the treatment of complications of portal hypertension. The incidence of hepatic encephalopathy(HE) remains a problem in TIPS placement. It has been reported that the right branch mainly receives superior mesenteric venous blood while the left branch mainly receives blood from the splenic vein. We hypothesized that targeted puncture of the left portal vein would divert the non-nutritive blood from the splenic vein into the TIPS shunt; therefore, targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE.AIM To evaluate the influence of targeted puncture of left branch of portal vein in TIPS on HE.METHODS A retrospective analysis of 1244 patients with portal-hypertension-related complications of refractory ascites or variceal bleeding who underwent TIPS from January 2000 to January 2013 was performed. Patients were divided into group A(targeting left branch of portal vein, n = 937) and group B(targeting right branch of portal vein, n = 307). TIPS-related HE and clinical outcomes were analyzed.RESULTS The symptoms of ascites and variceal bleeding disappeared within a short time.By the endpoint of follow-up, recurrent bleeding and ascites did not differ significantly between groups A and B(P = 0.278, P = 0.561, respectively).Incidence of HE differed significantly between groups A and B at 1 mo(14.94% vs36.80%, χ~2 = 4.839, P = 0.028), 3 mo(12.48% vs 34.20%, χ~2 = 5.054, P = 0.025), 6 mo(10.03% vs 32.24%, χ~2 = 6.560, P = 0.010), 9 mo(9.17% vs 31.27%, χ~2 = 5.357, P =0.021), and 12 mo(8.21% vs 28.01, χ~2 = 3.848, P = 0.051). There were no significant differences between groups A and B at 3 years(6.61% vs 7.16%, χ~2 = 1.204, P =0.272) and 5 years(5.01% vs 6.18%, χ~2 = 0.072, P = 0.562). The total survival rate did not differ between groups A and B(χ~2 = 0.226, P = 0.634, log-rank test).CONCLUSION Targeted puncture of the left branch of the intrahepatic portal vein during TIPS may reduce the risk of HE but has no direct influence on prognosis of portalhypertension-related complications.

Characteristics of turbulent flow distribution in branch piping system

Flow distribution in branch piping system is affected by flow characteristics and different geometric variations. Most of the flow distribution studies are performed with one-dimensional analysis to yield overall information only. However, detailed analysis is required to find effects of design parameters on the flow distribution. For this aspect, three-dimensional turbulent flow analysis was performed to assess turbulence model performance and effects of upstream pressure and branch pipe geometry. Three different turbulence models of standard k-e model, realizable k-e model and standard k-co yield similar results, indicating small effects of turbulence models on flow characteristics analysis. Geometric variations include area ratio of main and branch pipes, branch pipe diameter, and connection shape of main and branch pipes. Among these parameters, area ratio and branch diameter and shape show strong effect on flow distribution due to high friction and minor loss. Uniform flow distribution is one of common requirements in the branch piping system and this can be achieved with rather high total loss design.

Analysis of the role of branching angle in the dynamic rupture process on a 3-D branching fault system

The fault branching phenomenon,which may heavily influence the patterns of rupture propagation in fault systems,is one of the geometric complexities of fault systems that is widely observed in nature.In this study,we investigate the effect of the branching angle on the rupture inclination and the interaction between branch planes in two-fork branching fault systems by numerical simulation and theoretical analysis based on Mohr’s circle.A friction law dependent on normal stress is used,and special attention is paid to studying how ruptures on the upper and lower branch planes affect the stress and rupture on each other separately.The results show that the two branch planes affect each other in different patterns and that the intensity of the effect changes with the branching angle.The rupture of the lower branch plane has a negative effect on the rupture of the upper branch plane in the case of a small branching angle but has almost no negative effect in the case of a large branching angle.The rupture of the upper branch plane,however,suppresses the rupture of the lower branch plane regardless of whether the branching angle is large or small.

Parallelization of a Branch and Bound Algorithm on Multicore Systems

The general m-machine permutation flowshop problem with the total flow-time objective is known to be NP-hard for m ≥ 2. The only practical method for finding optimal solutions has been branch-and-bound algorithms. In this paper, we present an improved sequential algorithm which is based on a strict alternation of Generation and Exploration execution modes as well as Depth-First/Best-First hybrid strategies. The experimental results show that the proposed scheme exhibits improved performance compared with the algorithm in [1]. More importantly, our method can be easily extended and implemented with lightweight threads to speed up the execution times. Good speedups can be obtained on shared-memory multicore systems.

Engineering high amylose and resistant starch in maize by CRISPR/Cas9-mediated editing of starch branching enzymes

To improve the amylose content(AC)and resistant starch content(RSC)of maize kernel starch,we employed the CRISPR/Cas9 system to create mutants of starch branching enzyme I(SBEI)and starch branching enzyme IIb(SBEIIb).A frameshift mutation in SBEI(E1,a nucleotide insertion in exon 6)led to plants with higher RSC(1.07%),lower hundred-kernel weight(HKW,24.71±0.14 g),and lower plant height(PH,218.50±9.42 cm)compared to the wild type(WT).Like the WT,E1 kernel starch had irregular,polygonal shapes with sharp edges.A frameshift mutation in SBEIIb(E2,a four-nucleotide deletion in exon 8)led to higher AC(53.48%)and higher RSC(26.93%)than that for the WT.E2 kernel starch was significantly different from the WT regarding granule morphology,chain length distribution pattern,X-ray diffraction pattern,and thermal characteristics;the starch granules were more irregular in shape and comprised typical B-type crystals.Mutating SBEI and SBEIIb(E12)had a synergistic effect on RSC,HKW,PH,starch properties,and starch biosynthesis-associated gene expression.SBEIIa,SS1,SSIIa,SSIIIa,and SSIIIb were upregulated in E12 endosperm compared to WT endosperm.This study lays the foundation for rapidly improving the starch properties of elite maize lines.

Left bundle branch pacing set to outshine biventricular pacing for cardiac resynchronization therapy?

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.

The Channel Branches & Network Vessels on the Tianhui Lacquered Meridian Figurine——Taking the Heart-Regulated Channel as an Example

Along with the surge of unearthed medical literature and cultural relics in recent years,a network of channels in the system of medical conduit vessels(meridians) during the early Western Han dynasty has become much clearer gradually.In it,the increasing number of channel branches,network vessels and needle insertion holes(acupoints) is an important feature of the development of channel medicine during the Western Han dynasty.This is not only a reflection of the expanding requirements of the theoretical system of the main trunk channels and other vessels,but also an inevitable result of the continuous enrichment and accumulation of clinical experience.This article integrates the information about channel branches,network vessels,inscriptions,dots and further relics on the Tianhui(天回) Lacquered Meridian Figurine to compare the unearthed literature of the channel genre with the transmitted classical literature about acupuncture.The “Heart-Regulated Channel” in Medical Manuscripts on Bamboo Slips from Tianhui(《天回医简》) serves as an example to explain the occurrence,development and changes of the channel branches and network vessels in the early system of medical channels.

The Making of an Inclusive Museum:The Example of‘General Branch Museum System’of Datong Museum,China

A museum is a not-for-profit,permanent institution in the service of society that researches,collects,conserves,interprets and exhibits tangible and intangible heritage.In order to effectively integrate public cultural resources,many museums at home and abroad have begun to explore general branch museum system.This mode develops rapidly in China and forms many models.However,the general branch museum system of each museum has its own characteristics.Based on this,this paper mainly introduced the example of“general branch museum system”of Datong Museum,China.For the time being,Datong Museum is implementing“general branch museum system”.Datong Museum is located in Shanxi Province,China.It is a comprehensive museum and now it is a national first-level museum.There are more than 170,000 cultural relics in Datong Museum.Besides the general one,the other nine branches have opened to the public.It is different from the National Museum Wales,the Smithsonian Institution,and the Cathedral Museum Complex in Toscana District.Led by theme of integration of the main,not only each of the nine branch museums bears its own specific theme and distinct characteristics,but they also link and complement each other.In future,we will further explore the exhibitions of other thematic displays to tell the complete history of Datong,and supplement the untold historical stories,as well as boost recognition of cultural identity and cultural confidence of the public.

ON THE EMPTY BALLS OF A CRITICAL OR SUBCRITICAL BRANCHING RANDOM WALK

Let{Z_(n)}_(n)≥0 be a critical or subcritical d-dimensional branching random walk started from a Poisson random measure whose intensity measure is the Lebesugue measure on R^(d).Denote by R_(n):=sup{u>0:Z_(n)({x∈R^(d):∣x∣<u})=0}the radius of the largest empty ball centered at the origin of Z_(n).In this work,we prove that after suitable renormalization,Rn converges in law to some non-degenerate distribution as n→∞.Furthermore,our work shows that the renormalization scales depend on the offspring law and the dimension of the branching random walk.This completes the results of Révész[13]for the critical binary branching Wiener process.

Thermal pretreatment of willow branches impacts yield and pore development of activated carbon in subsequent activation with ZnCl_(2) via modifying cellulose structure

Development of pore structures of activated carbon(AC)from activation of biomass with ZnCl_(2) relies on content and structure of cellulose/hemicellulose in the feedstock.Thermal pretreatment of biomass could induce dehydration and/or aromatization to change the structure of cellulose/hemicellulose.This might interfere with evolution of structures of AC,which was investigated herein via thermal pretreatment of willow branch(WB)from 200 to 360℃and the subsequent activation with ZnCl_(2) at 550℃.The results showed that thermal pretreatment at 360℃(WB-360)could lead to substantial pyrolysis to form biochar,with a yield of 31.9%,accompanying with nearly complete destruction of cellulose crystals and remarkably enhanced aromatic degree.However,cellulose residual in WB-360 could still be activated to form AC-360 with specific surface area of 1837.9 m~2·g^(-1),which was lower than that in AC from activation of untreated WB(AC-blank,2077.8 m~2·g^(-1)).Nonetheless,the AC-200 from activation of WB-200 had more developed pores(2113.9 m~2·g^(-1))and superior capability for adsorption of phenol,due to increased permeability of ZnCl_(2) to the largely intact cellulose structure in WB-200.The thermal pretreatment did increase diameters of micropores of AC but reduced the overall yield of AC(26.8%for AC-blank versus 18.0%for AC-360),resulting from accelerated cracking but reduced intensity of condensation.In-situ infrared characterization of the activation showed that ZnCl_(2) mainly catalyzed dehydration,dehydrogenation,condensation,and aromatization but not cracking,suppressing the formation of derivatives of cellulose and lignin in bio-oil.The thermal pretreatment formed phenolic-OH and C=O with higher chemical innerness,which changed the reaction network in activation,shifting morphology of fibrous structures in AC-blank to“melting surface”in AC-200 or AC-280.

Predicting cardiovascular events in out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block: role of CTA and echocardiographic Global Longitudinal Strain

Background Out-of-hospital patients presenting with atypical chest pain and complete left bundle branch block(LBBB)have to be stratified for the presence of coronary artery disease and the risk of developing heart failure(HF).We investigated the pro-gnostic role of coronary CT-angiography(CTA)and echocardiographic global longitudinal strain(GLS)in those patients in a mid-term follow-up.Methods Out-of-hospital patients with LBBB underwent echocardiography and a 64-slice CT angiography were evaluated ret-rospectively.Development of HF or a cardiovascular death were the events scheduled.Results Seventy-eight patients(32 female;mean age:66.0±10.4 years were enrolled.During a follow-up of 33 months(IQR:17-77),one patient(1.5%)experienced a cardiovascular death,14 patients(17.9%)required urgent outpatient visits due to acute de-compensated HF(12 hospitalizations).Echocardiography showed a slightly reduced left ventricular ejection fraction(LVEF)(50.0%±9.8%)and GLS within the normal range(-16.2%±4.1%).CTA analysis showed coronary stenosis>50%in 28 patients(35.9%).A high Agatston score(>100)was observed in 29.5%.Notably,25 patients(32.1%)were diagnosed with left main coron-ary artery disease and 15 patients(16.7%)underwent revascularization during the follow up.Significant associations were ob-served between events and LVEF(P=0.001),diastolic dysfunction grade≥2(P=0.02),GLS(P<0.001),multiple coronary stenos-is(P=0.04)and Agatston score(P=0.05).Multivariate analysis confirmed the relationships with LVEF(R^(2)=0.89,P<0.001),dia-stolic dysfunction(R^(2)=3.30,P=0.04),GLS(R^(2)=1.43,P<0.001),and Agatston score(R^(2)=1.01,P=0.05).Conclusions In patients with complete LBBB,CTA and GLS identified those at a high risk of development HF.

Left bundle branch area pacing combined with implantable cardioverter-defibrillator treatment for heart failure after myocardial infarction

Left bundle branch area pacing(LBBAP)has emerged as a new physiological pacing mode.Previous studies have confirmed the feasibility and efficacy of LBBAP for cardiac resynchronization therapy(CRT)in heart failure(HF)patients with left bundle branch block(LBBB)and a narrower QRS duration(QRSd)to have a higher percentage of super responders,and lower pacing thresholds than biventricular pacing(BiVP).

Composite outcomes of drug-coated balloon using in left main bifurcation lesions:a systematic review

Background Left main coronary bifurcation lesions account for 50%of left main coronary artery disease cases.Although a drugcoated balloon(DCB)has the advantages of immediate release of the drug to the arterial wall and no remaining struts,there is no conclusive evidence to support DCB use.Methods&Results We conducted a systematic review in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analyses(PRISMA)statement.Eighteen retrospective studies and two prospective studies in which left main bifurcation lesions were treated with DCBs were included in our qualitative analysis.The studies were divided into two groups according to the type of DCB used:DCB only and DCB+stent.At the midterm follow-up,the use of DCBs had noninferior or even superior angiographic and clinical outcomes in treating left main bifurcation lesions compared with the use of drug-eluting stents or conventional balloons,whether for de novo or in-stent restenosis lesions.Additionally,side branch late lumen enlargement was observed in several of the included studies,which indicates that DCBs may have the advantage of side branch protection.Conclusions According to our descriptive analysis,the DCB technique has a favorable safety and efficacy profiles for the treatment of left main bifurcation lesions.However,additional studies,especially randomized controlled trials,are needed to establish standards for the DCB technique.

Unilateral branch retinal artery occlusion in association with COVID-19:a case report

Dear Editor,I am Kunihiko Hirosawa of the Department of Ophthalmology at Juntendo University Hospital.I am writing to present a case of concomitant Coronavirus Disease 2019(COVID-19)with branch retinal artery occlusion(BRAO).BRAO presents as a sudden,painless loss of vision on the afflicted side and is most often focal in nature[1].

DCFNet:An Effective Dual-Branch Cross-Attention Fusion Network for Medical Image Segmentation

Automatic segmentation of medical images provides a reliable scientific basis for disease diagnosis and analysis.Notably,most existing methods that combine the strengths of convolutional neural networks(CNNs)and Transformers have made significant progress.However,there are some limitations in the current integration of CNN and Transformer technology in two key aspects.Firstly,most methods either overlook or fail to fully incorporate the complementary nature between local and global features.Secondly,the significance of integrating the multiscale encoder features from the dual-branch network to enhance the decoding features is often disregarded in methods that combine CNN and Transformer.To address this issue,we present a groundbreaking dual-branch cross-attention fusion network(DCFNet),which efficiently combines the power of Swin Transformer and CNN to generate complementary global and local features.We then designed the Feature Cross-Fusion(FCF)module to efficiently fuse local and global features.In the FCF,the utilization of the Channel-wise Cross-fusion Transformer(CCT)serves the purpose of aggregatingmulti-scale features,and the Feature FusionModule(FFM)is employed to effectively aggregate dual-branch prominent feature regions from the spatial perspective.Furthermore,within the decoding phase of the dual-branch network,our proposed Channel Attention Block(CAB)aims to emphasize the significance of the channel features between the up-sampled features and the features generated by the FCFmodule to enhance the details of the decoding.Experimental results demonstrate that DCFNet exhibits enhanced accuracy in segmentation performance.Compared to other state-of-the-art(SOTA)methods,our segmentation framework exhibits a superior level of competitiveness.DCFNet’s accurate segmentation of medical images can greatly assist medical professionals in making crucial diagnoses of lesion areas in advance.

Left bundle branch area pacing:A new era of cardiac resynchronization therapy?

The recent systematic review and meta-analysis provided a comprehensive focus on the current state of cardiac resynchronization therapy(CRT).The authors determined the feasibility of physiological left bundle branch area pacing(LBBAP)in patients indicated for CRT through a careful analysis of trials.They found that LBBAP was associated with significant reductions in QRS duration,New York Heart Association functional class,B-type natriuretic peptide levels,and pacing thresholds as well as improvements in echocardiographic parameters compared to biventricular pacing.

Long-Term Impacts of Tree Architectures and Branch Configurations on Tree Growth, Yield, Fruit Quality Attributes, and Leaf Minerals in “Aztec Fuji” Apple

Canopy and branch architectures in high-density orchards can be crucial in production and fruit quality. The influence of two canopy orientations (Upright and Tilted) in combination with two arm (branch) architectures (Shortened or Overlapped) on tree growth, yield components, fruit quality, and leaf mineral nutrients in an “Aztec Fuji” apple (Malus domestica Bork.) high-density orchard was studied over five years. Tilted trees with shortened arm configuration (TilShArm) always had significantly larger trunk cross-sectional area (TCSA) than Upright trees with an Overlapped arm configuration (UpOverArm) every year from 2012 to 2016. Trees with a TilShArm system had more cumulative fruit per tree than those with an Upright orientation. Trees with a tilted canopy (TilShArm and TilOverArm) tended to have higher yield per tree and yield per hectare than those with an upright system. Trees with a TilShArm system were more precocious and had more yield per tree than those with an upright canopy orientation in 2012. When values were polled over five years, trees with an upright canopy-shortened arm system (UpShArm) treatment had a lower biennial bearing index (BBI) than those with an upright canopy-overlapped system (UpOverArm). Trees receiving an arm shortening (UpShArm or TilShArm) configuration often had larger fruits than those with overlapped arms (UpOverArm and TilOverArm). Fruit from trees receiving an UpOverArm had higher fruit firmness than those from trees with other canopy-branch arrangements at harvest due to their smaller size. Fruit from trees with a TilShArm and TilOverArm had significantly higher water core and bitter pit but lower sunburn than trees with an upright canopy (UpShArm and UpOverArm). Leaves from trees with an UpOverArm canopy-branch configuration had the lowest leaf Ca but the highest leaf K and Fe concentrations among all treatments.

Branch and Bound Algorithm for Globally Solving Minimax Linear Fractional Programming

In this paper,we study the minimax linear fractional programming problem on a non-empty bounded set,called problem(MLFP),and we design a branch and bound algorithm to find a globally optimal solution of(MLFP).Firstly,we convert the problem(MLFP)to a problem(EP2)that is equivalent to it.Secondly,by applying the convex relaxation technique to problem(EP2),a convex quadratic relaxation problem(CQRP)is obtained.Then,the overall framework of the algorithm is given and its convergence is proved,the worst-case iteration number is also estimated.Finally,experimental data are listed to illustrate the effectiveness of the algorithm.