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.

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.

Drilling-based measuring method for the c-φ parameter of rock and its field application

The technology of drilling tests makes it possible to obtain the strength parameter of rock accurately in situ. In this paper, a new rock cutting analysis model that considers the influence of the rock crushing zone(RCZ) is built. The formula for an ultimate cutting force is established based on the limit equilibrium principle. The relationship between digital drilling parameters(DDP) and the c-φ parameter(DDP-cφ formula, where c refers to the cohesion and φ refers to the internal friction angle) is derived, and the response of drilling parameters and cutting ratio to the strength parameters is analyzed. The drillingbased measuring method for the c-φ parameter of rock is constructed. The laboratory verification test is then completed, and the difference in results between the drilling test and the compression test is less than 6%. On this basis, in-situ rock drilling tests in a traffic tunnel and a coal mine roadway are carried out, and the strength parameters of the surrounding rock are effectively tested. The average difference ratio of the results is less than 11%, which verifies the effectiveness of the proposed method for obtaining the strength parameters based on digital drilling. This study provides methodological support for field testing of rock strength parameters.

ST-LSTM-SA:A New Ocean Sound Velocity Field Prediction Model Based on Deep Learning

The scarcity of in-situ ocean observations poses a challenge for real-time information acquisition in the ocean.Among the crucial hydroacoustic environmental parameters,ocean sound velocity exhibits significant spatial and temporal variability and it is highly relevant to oceanic research.In this study,we propose a new data-driven approach,leveraging deep learning techniques,for the prediction of sound velocity fields(SVFs).Our novel spatiotemporal prediction model,STLSTM-SA,combines Spatiotemporal Long Short-Term Memory(ST-LSTM) with a self-attention mechanism to enable accurate and real-time prediction of SVFs.To circumvent the limited amount of observational data,we employ transfer learning by first training the model using reanalysis datasets,followed by fine-tuning it using in-situ analysis data to obtain the final prediction model.By utilizing the historical 12-month SVFs as input,our model predicts the SVFs for the subsequent three months.We compare the performance of five models:Artificial Neural Networks(ANN),Long ShortTerm Memory(LSTM),Convolutional LSTM(ConvLSTM),ST-LSTM,and our proposed ST-LSTM-SA model in a test experiment spanning 2019 to 2022.Our results demonstrate that the ST-LSTM-SA model significantly improves the prediction accuracy and stability of sound velocity in both temporal and spatial dimensions.The ST-LSTM-SA model not only accurately predicts the ocean sound velocity field(SVF),but also provides valuable insights for spatiotemporal prediction of other oceanic environmental variables.

Field test of high-power microwave-assisted mechanical excavation for deep hard iron ore

Microwave-assisted mechanical excavation has great application prospects in mines and tunnels,but there are few field experiments on microwave-assisted rock breaking.This paper takes the Sishanling iron mine as the research object and adopts the self-developed high-power microwave-induced fracturing test system for hard rock to conduct field experiments of microwave-induced fracturing of iron ore.The heating and reflection evolution characteristics of ore under different microwave parameters(antenna type,power,and working distance)were studied,and the optimal microwave parameters were obtained.Subsequently,the ore was irradiated with the optimal microwave parameters,and the cracking effect of the ore under the action of the high-power open microwave was analyzed.The results show that the reflection coefficient(standing wave ratio)can be rapidly(<5 s)and automatically adjusted below the preset threshold value(1.6)as microwave irradiation is performed.When using a right-angle horn antenna with a working distance of 5 cm,the effect of automatic reflection adjustment reaches the best among other antenna types and working distances.When the working distance is the same,the average temperature of the irradiation surface and the area of the high-temperature area under the action of the two antennas(right-angled and equal-angled horn antenna)are basically the same and decrease with the increase of working distance.The optimal microwave parameters are:a right-angle horn antenna with a working distance of 5 cm.Subsequently,in further experiments,the optimal parameters were used to irradiate for 20 s and 40 s at a microwave power of 60 kW,respectively.The surface damage extended 38 cm×30 cm and 53 cm×30 cm,respectively,and the damage extended to a depth of about 50 cm.The drilling speed was increased by 56.2%and 66.5%,respectively,compared to the case when microwaves were not used.

Laparoscopic left hemihepatectomy guided by indocyanine green fluorescence: A cranial-dorsal approach

BACKGROUND Advancements in laparoscopic technology and a deeper understanding of intra-hepatic anatomy have led to the establishment of more precise laparoscopic hepatectomy(LH)techniques.The indocyanine green(ICG)fluorescence navi-gation technique has emerged as the most effective method for identifying hepatic regions,potentially overcoming the limitations of LH.While laparoscopic left hemihepatectomy(LLH)is a standardized procedure,there is a need for innova-tive strategies to enhance its outcomes.important anatomical markers,surgical skills,and ICG staining methods.METHODS Thirty-seven patients who underwent ICG fluorescence-guided LLH at Qujing Second People's Hospital between January 2019 and February 2022 were retrospectively analyzed.The cranial-dorsal approach was performed which involves dissecting the left hepatic vein cephalad,isolating the Arantius ligament,exposing the middle hepatic vein,and dissecting the parenchyma from the dorsal to the foot in order to complete the anatomical LLH.The surgical methods,as well as intra-and post-surgical data,were recorded and analyzed.Our hospital’s Medical Ethics Committee approved this study(Ethical review:2022-019-01).RESULTS Intraoperative blood loss during LLH was 335.68±99.869 mL and the rates of transfusion and conversion to laparotomy were 13.5%and 0%,respectively.The overall incidence of complications throughout the follow-up(median of 18 months;range 1-36 months)was 21.6%.No mortality or severe complications(level IV)were reported.CONCLUSION LLH has the potential to become a novel,standardized approach that can effectively,safely,and simply expose the middle hepatic vein and meet the requirements of precision surgery.

Reactor field reconstruction from sparse and movable sensors using Voronoi tessellation-assisted convolutional neural networks

The aging of operational reactors leads to increased mechanical vibrations in the reactor interior.The vibration of the incore sensors near their nominal locations is a new problem for neutronic field reconstruction.Current field-reconstruction methods fail to handle spatially moving sensors.In this study,we propose a Voronoi tessellation technique in combination with convolutional neural networks to handle this challenge.Observations from movable in-core sensors were projected onto the same global field structure using Voronoi tessellation,holding the magnitude and location information of the sensors.General convolutional neural networks were used to learn maps from observations to the global field.The proposed method reconstructed multi-physics fields(including fast flux,thermal flux,and power rate)using observations from a single field(such as thermal flux).Numerical tests based on the IAEA benchmark demonstrated the potential of the proposed method in practical engineering applications,particularly within an amplitude of 5 cm around the nominal locations,which led to average relative errors below 5% and 10% in the L_(2) and L_(∞)norms,respectively.

Strong coupling and catenary field enhancement in the hybrid plasmonic metamaterial cavity and TMDC monolayers

Strong coupling between resonantly matched surface plasmons of metals and excitons of quantum emitters results in the formation of new plasmon-exciton hybridized energy states.In plasmon-exciton strong coupling,plasmonic nanocavities play a significant role due to their ability to confine light in an ultrasmall volume.Additionally,two-dimensional transition metal dichalcogenides(TMDCs) have a significant exciton binding energy and remain stable at ambient conditions,making them an excellent alternative for investigating light-matter interactions.As a result,strong plasmon-exciton coupling has been reported by introducing a single metallic cavity.However,single nanoparticles have lower spatial confinement of electromagnetic fields and limited tunability to match the excitonic resonance.Here,we introduce the concept of catenary-shaped optical fields induced by plasmonic metamaterial cavities to scale the strength of plasmon-exciton coupling.The demonstrated plasmon modes of metallic metamaterial cavities offer high confinement and tunability and can match with the excitons of TMDCs to exhibit a strong coupling regime by tuning either the size of the cavity gap or thickness.The calculated Rabi splitting of Au-MoSe_2 and Au-WSe_2 heterostructures strongly depends on the catenary-like field enhancement induced by the Au cavity,resulting in room-temperature Rabi splitting ranging between 77.86 and 320 me V.These plasmonic metamaterial cavities can pave the way for manipulating excitons in TMDCs and operating active nanophotonic devices at ambient temperature.

Electromagnetic fields in ultra-peripheral relativistic heavy-ion collisions

Ultra-peripheral heavy-ion collisions(UPCs)offer unique opportunities to study processes under strong electromagnetic fields.In these collisions,highly charged fast-moving ions carry strong electromagnetic fields that can be effectively treated as photon fluxes.The exchange of photons can induce photonuclear and two-photon interactions and excite ions.This excitation of the ions results in Coulomb dissociation with the emission of photons,neutrons,and other particles.Additionally,the electromagnetic fields generated by the ions can be sufficiently strong to enforce mutual interactions between the two colliding ions.Consequently,the two colliding ions experience an electromagnetic force that pushes them in opposite directions,causing a back-to-back correlation in the emitted neutrons.Using a Monte Carlo simulation,we qualitatively demonstrate that the above electromagnetic effect is large enough to be observed in UPCs,which would provide a clear means to study strong electromagnetic fields and their effects.

Semi-analytical investigation of heat transfer in a porous convective radiative moving longitudinal fin exposed to magnetic field in the presence of a shape-dependent trihybrid nanofluid

The thermal examination of a non-integer-ordered mobile fin with a magnetism in the presence of a trihybrid nanofluid(Fe_3O_4-Au-Zn-blood) is carried out. Three types of nanoparticles, each having a different shape, are considered. These shapes include spherical(Fe_3O_4), cylindrical(Au), and platelet(Zn) configurations. The combination approach is utilized to evaluate the physical and thermal characteristics of the trihybrid and hybrid nanofluids, excluding the thermal conductivity and dynamic viscosity. These two properties are inferred by means of the interpolation method based on the volume fraction of nanoparticles. The governing equation is transformed into a dimensionless form, and the Adomian decomposition Sumudu transform method(ADSTM) is adopted to solve the conundrum of a moving fin immersed in a trihybrid nanofluid. The obtained results agree well with those numerical simulation results, indicating that this research is reliable. The influence of diverse factors on the thermal overview for varying noninteger values of γ is analyzed and presented in graphical representations. Furthermore, the fluctuations in the heat transfer concerning the pertinent parameters are studied. The results show that the heat flux in the presence of the combination of spherical, cylindrical, and platelet nanoparticles is higher than that in the presence of the combination of only spherical and cylindrical nanoparticles. The temperature at the fin tip increases by 0.705 759% when the value of the Peclet number increases by 400%, while decreases by 11.825 13% when the value of the Hartman number increases by 400%.

Hypertrophic cardiomyopathy and left ventricular non-compaction:Distinct diseases or variant phenotypes of a single condition?

Hypertrophic cardiomyopathy(HCM)is a genetically determined myocardial disease characterized by an increased thickness of the left ventricle(LV)wall that cannot be solely attributed to abnormal loading conditions.HCM may present with an intraventricular or LV outflow tract obstruction,diastolic dysfunction,myocardial fibrosis and/or ventricular arrhythmias.Differentiating HCM from other diseases associated with LV hypertrophy,such as hypertension,aortic stenosis,or LV non-compaction(LVNC),can at times be challenging.LVNC is defined by excessive LV trabeculation and deep recesses between trabeculae,often accompanied by increased LV myocardial mass.Previous studies indicate that the LVNC phenotype may be observed in up to 5%of the general population;however,in most cases,it is a benign finding with no impact on clinical outcomes.Nevertheless,LVNC can occasionally lead to LV systolic dysfunction,manifesting as a phenotype of dilated or non-dilated left ventricular cardiomyopathy,with an increased risk of thrombus formation and arterial embolism.In extreme cases,where LVNC is associated with a very thickened LV wall,it can even mimic HCM.There is growing evidence of an overlap between HCM and LVNC,including similar genetic mutations and clinical presentations.This raises the question of whether HCM and LVNC represent different phenotypes of the same disease or are,in fact,two distinct entities.

A new electric field mill array with each of the mill’s rotor controlled precisely by a GPS module:Equipment and initial results

We have newly designed an electrostatic sensor,called an electric field mill(EFM),to simplify the estimation of the charge position and charge amount transferred by lightning discharges.It is necessary for this remote estimation of the transferred charge to measure electric field changes caused by charge loss at the time of a lightning strike at multiple locations.For multiple-station measurement of electric field changes,not only speed but also phase for exposure and shielding of the sensing plates inside each EFM of the array should be synchronized to maintain the sensitivities of the deployed instruments.Currently,there is no such EFM with specified speed and phase control performance of the rotary part.Thus,we developed a new EFM in which the rotary mechanism was controlled consistently to within 3%error by a GPS module.Five EFMs had been distributed in the Hokuriku area of Japan during the winter season of 2022-2023 for a test observation.Here we describe the design and a simple calibration method for our new EFM array.Data analysis method based on the assumption of a simple monopole charge structure is also summarized.For validation,locations of assumed point charges were compared with three-dimensional lightning mapping data estimated by radio observations in the MF-HF bands.Initial results indicated the validity to estimate transferred charge amounts and positions of winter cloud-to-ground lightning discharges with our new EFM array.

Numerical simulation of melt flow and temperature field during DC casting 2024 aluminium alloy under different casting conditions

Casting speed,casting temperature and secondary cooling water flow rate are the main process parameters affecting the DC casting process.These parameters significantly influence the flow and temperature fields during casting,which are crucial for the quality of the ingot and can determine the success or failure of the casting operation.Numerical simulation,with the advantages of low cost,rapid execution,and visualized results,is an important method to study and optimize the DC casting process.In the present work,a simulation model of DC casting 2024 aluminum alloy was established,and the reliability of the model was verified.Then,the influence of casting parameters on flow field and temperature field was studied in detail by numerical simulation method.Results show that with the increase of casting speed,the melt flow becomes faster,the depths of slurry zone and mushy zone increase,and the variation of slurry zone depth is greater than that of mushy zone.With an increase in casting temperature,the melt flow rate increases,the depth of the slurry zone becomes shallower,and the depth of the mushy zone experiences only minor changes.The simulation results further indicate that the increase of the flow rate of the secondary cooling water slightly reduces the depths of both slurry and mushy zone.

Strong field ionization of molecules on the surface of nanosystems

Besides the diverse investigations on the interactions between intense laser fields and molecular systems,extensive research has been recently dedicated to exploring the response of nanosystems excited by well-tailored femtosecond laser fields.Due to the fact that nanostructures hold peculiar effects when illuminated by laser pulses,the underlying mechanisms and the corresponding potential applications can make significant improvements in both fundamental research and development of novel techniques.In this review,we provide a summarization of the strong field ionization occurring on the surface of nanosystems.The molecules attached to the nanoparticle surface perform as the precursor in the ionization and excitation of the whole nanosystem,the fundamental processes of which are yet to be discovered.We discuss the influence on nanoparticle constituents,geometric shapes and sizes,as well as the specific waveforms of the excitation laser fields.The intriguing characteristics observed in surface ion emission reflect how enhanced near field affects the localized ionizations and nanoplasma expansions,thereby paving the way for further precision controls on the light-and-matter interactions in the extreme spatial temporal levels.

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.

Double-chambered left ventricle with a thrombus in an asymptomatic patient:A case report

BACKGROUND Double-chambered left ventricle(DCLV)is an extremely rare congenital disease in which the left ventricle(LV)is divided by abnormal muscle tissue.Due to its rarity,there is a lack of data on the disease,including its diagnosis,treatment,and prognosis.Accordingly,we report a case in which DCLV was diagnosed and followed up.CASE SUMMARY A 45-year-old man presented to our hospital due to abnormal findings on an electrocardiogram recorded during a health check.He had no specific cardiac symptoms,comorbidities or relevant past medical history.Echocardiography revealed that the LV was divided into two by muscle fibers.There were no findings of ischemia on coronary angiography and coronary computed tomography angiography performed to exclude differential diagnoses.After comprehensive analysis of the images,DCLV was diagnosed.As it seemed to be asymptomatic DCLV,we decided the patient was to be observed without administering any medication.However,follow-up echocardiography revealed a thrombus in the accessory chamber(AC).Anticoagulant medication was initiated,the thrombus resolved,and the patient is currently undergoing follow-up without any specific symptoms.CONCLUSION Asymptomatic,uncomplicated DCLV was diagnosed through multimodal imaging;however,a thrombus in the AC occurred during the follow-up.The findings highlight that multimodal imaging is essential in diagnosing DCLV,and that anticoagulation is important in its management.

Research progress on semi-continuous casting of magnesium alloys under external field

High-performance magnesium alloys are moving towards a trend of being produced on a large scale and in an integrated manner.The foundational key to their successful production is the high-quality cast ingots.Magnesium alloys produced through the conventional semi-continuous casting process inevitably contain casting defects,which makes it challenging to manufacture high-quality ingots.The integration of external field assisted controlled solidification technology,which combines physical fields such as electromagnetic and ultrasonic fields with traditional semi-continuous casting processes,enables the production of high-quality magnesium alloy ingots characterized by a homogeneous microstructure and absence of cracks.This article mainly summarizes the technical principles of those external field assisted casting process.The focus is on elaborating the refinement mechanism of different types of electromagnetic fields,ultrasonic fields,and combined physical fields during the solidification of magnesium alloys.Finally,the development prospects of producing highquality magnesium alloy ingots through semi-continuous casting under the external field were discussed.

The Effect of External Magnetic Field on Electron Scale Kelvin–Helmholtz Instability

We use particle-in-cell,fully electromagnetic,plasma kinetic simulation to study the effect of external magnetic field on electron scale Kelvin–Helmholtz instability(ESKHI).The results are applicable to collisionless plasmas when,e.g.,solar wind interacts with planetary magnetospheres or a magnetic field is generated in AGN jets.We find that as in the case of magnetohydrodynamic(MHD)KHI,in the kinetic regime,the presence of an external magnetic field reduces the growth rate of the instability.In the MHD case,there is a known threshold magnetic field for KHI stabilization,while for ESKHI this is to be analytically determined.Without a kinetic analytical expression,we use several numerical simulation runs to establish an empirical dependence of ESKHI growth rate,Γ(B_(0))ω_(pe),on the strength of the applied external magnetic field.We find the best fit is hyperbolic,Γ(B_(0))ω_(pe)=Γ_(0)ω_(pe)/(A+BB_(0)),where Γ_(0) is the ESKHI growth rate without an external magnetic field and B_(0)=B_(0)/B_(MHD)is the ratio of external and two-fluid MHD stability threshold magnetic field,derived here.An analytical theory to back up this growth rate dependence on the external magnetic field is needed.The results suggest that in astrophysical settings where a strong magnetic field pre-exists,the generation of an additional magnetic field by the ESKHI is suppressed,which implies that nature provides a“safety valve”—natural protection not to“over-generate”magnetic field by the ESKHI mechanism.Remarkably,we find that our two-fluid MHD threshold magnetic field is the same(up to a factor √γ_(0))as the DC saturation magnetic field,previously predicted by fully kinetic theory.

Deep learning echocardiographic intelligent model for evaluation on left ventricular regional wall motion abnormality

Objective To observe the value of deep learning echocardiographic intelligent model for evaluation on left ventricular(LV)regional wall motion abnormalities(RWMA).Methods Apical two-chamber,three-chamber and four-chamber views two-dimensional echocardiograms were obtained prospectively in 205 patients with coronary heart disease.The model for evaluating LV regional contractile function was constructed using a five-fold cross-validation method to automatically identify the presence of RWMA or not,and the performance of this model was assessed taken manual interpretation of RWMA as standards.Results Among 205 patients,RWMA was detected in totally 650 segments in 83 cases.LV myocardial segmentation model demonstrated good efficacy for delineation of LV myocardium.The average Dice similarity coefficient for LV myocardial segmentation results in the apical two-chamber,three-chamber and four-chamber views was 0.85,0.82 and 0.88,respectively.LV myocardial segmentation model accurately segmented LV myocardium in apical two-chamber,three-chamber and four-chamber views.The mean area under the curve(AUC)of RWMA identification model was 0.843±0.071,with sensitivity of(64.19±14.85)%,specificity of(89.44±7.31)%and accuracy of(85.22±4.37)%.Conclusion Deep learning echocardiographic intelligent model could be used to automatically evaluate LV regional contractile function,hence rapidly and accurately identifying RWMA.

Variational Reconstruction and Simulation Experiments of Sea Surface Wind Field for Ocean Data Buoy

The sea surface wind field is an important physical parameter in oceanography and meteorology.With the continuous refinement of numerical weather prediction,air-sea interface materials,energy exchange,and other studies,three-dimensional(3D)wind field distribution at local locations on the sea surface must be measured accurately.The current in-situ observation of sea surface wind parameters is mainly achieved through the installation of wind sensors on ocean data buoys.However,the results obtained from this single-point measurement method cannot reflect wind field distribution in a vertical direction above the sea surface.Thus,the present paper proposes a theoretical framework for the optimal inversion of the 3D wind field structure variation in the area where the buoy is located.The variation analysis method is first used to reconstruct the wind field distribution at different heights of the buoy,after which theoretical analysis verification and numerical simulation experiments are conducted.The results indicate that the use of variational methods to reconstruct 3D wind fields is significantly effective in eliminating disturbance errors in observations,which also verifies the correctness of the theoretical analysis of this method.The findings of this article can provide a reference for the layout optimization design of wind measuring instruments in buoy observation systems and also provide theoretical guidance for the design of new observation buoys in the future.