Creation Of Block Research Articles

High efficacy and safety of endocardial pulsed electrical field ablation via contact force-controlled catheters for mitral isthmus ablation

Abstract Background A new technology of a pulsed field generator enables established contact force-controlled radiofrequency (RF) catheters to apply point by point monopolar pulsed electrical field (PEF) energy for linear lesions in atrial fibrillation (AF) ablation. Purpose We evaluated this novel monopolar PEF ablation technique for creating lateral mitral isthmus ablation lines in case of perimitral flutter or complex AF patients non responder to pulmonary vein isolation (PVI). Methods Patients (n=44, age 65±11 years) referred for ablation/re-ablation of AF with spontaneous or inducible perimitral atrial flutter (n=34, 77%) or persistent AF and severe enlarged atrium (n=7) or de novo longstanding persistent AF (n=3) without signs of atrial fibrosis were included in our patient cohort for lateral mitral isthmus ablation with PEF applications. After 3D high density voltage mapping of the left atrium with multipolar microelectrode catheters, and confirmation/completion of PVI, an endocardial lateral mitral isthmus line was performed. Using contact force sensing catheter, 25A PEF energy pulses were applied targeting a minimum of 10g contact force and an interlesion distance ≤5mm. Before PEF application 0.2 mg nitroglycerin was intravenously injected. If the inferolateral mitral isthmus line to the left inferior pulmonary vein could not be blocked, a more superior lateral line to the left superior pulmonary vein was performed. If the mitral isthmus could not be blocked by endocardial PEF application or conduction recurred after adenosine injection an additional epicardial ablation via RF application in the coronary sinus was performed. Results Exclusively endocardial PEF application blocked the lateral mitral line in 37 out of 42 cases (88%) with 23±14 PEF applications. After an unsuccessful inferior lateral mitral line, in 34% of cases a second superior lateral mitral line have to be performed. Only in five cases additional epicardial RF applications via coronary sinus were necessary to complete the mitral isthmus block. Block time between superior lateral mitral anulus and infero lateral coronary sinus was 196±48 ms. One pericardial tamponade which could be successfully drained, and no other serious complication occurred throughout all procedures (no ST segment elevation, no tamponade requiring surgery, no cerebrovascular event). Limited follow-up will be available at the time of presentation. Conclusion Blockade of left atrial mitral isthmus line with PEF application via contact force-sensing catheters for ablation of complex atrial fibrillation patients is very efficient and safe. Especially the high efficacy of exclusively endocardial PEF application for creation of a lateral mitral isthmus block in most patients is very promising. However, the long term permanence of the linear lines have to be awaited.

A Lightweight Hybrid Model with Location-Preserving ViT for Efficient Food Recognition.

Food-image recognition plays a pivotal role in intelligent nutrition management, and lightweight recognition methods based on deep learning are crucial for enabling mobile deployment. This capability empowers individuals to effectively manage their daily diet and nutrition using devices such as smartphones. In this study, we propose an Efficient Hybrid Food Recognition Net (EHFR-Net), a novel neural network that integrates Convolutional Neural Networks (CNN) and Vision Transformer (ViT). We find that in the context of food-image recognition tasks, while ViT demonstrates superiority in extracting global information, its approach of disregarding the initial spatial information hampers its efficacy. Therefore, we designed a ViT method termed Location-Preserving Vision Transformer (LP-ViT), which retains positional information during the global information extraction process. To ensure the lightweight nature of the model, we employ an inverted residual block on the CNN side to extract local features. Global and local features are seamlessly integrated by directly summing and concatenating the outputs from the convolutional and ViT structures, resulting in the creation of a unified Hybrid Block (HBlock) in a coherent manner. Moreover, we optimize the hierarchical layout of EHFR-Net to accommodate the unique characteristics of HBlock, effectively reducing the model size. Our extensive experiments on three well-known food image-recognition datasets demonstrate the superiority of our approach. For instance, on the ETHZ Food-101 dataset, our method achieves an outstanding recognition accuracy of 90.7%, which is 3.5% higher than the state-of-the-art ViT-based lightweight network MobileViTv2 (87.2%), which has an equivalent number of parameters and calculations.

High efficacy and safety of pulsed electrical field ablation via contact force-controlled radiofrequency catheters for atrial fibrillation ablation with linear lesions in the left atrium

Abstract Background Pulsed Field Ablation have been shown to be efficient and safe for Pulmonary vein isolation (PVI) in catheter ablation of atrial fibrillation (AF). The bipolar application of pulsed electrical energy for electroporation of myocardium has been established with specially designed catheters, which are not used for linear ablation. Purpose We evaluated a novel monophasic PEF ablation technique applied by commercially available CF-controlled catheters for linear ablation lines beyond PVI for treatment of complex AF patients. Methods Patients (n=31, age 64±12 years, 29% females, BMI 29±4) referred for re-ablation of AF and presented with recurrence of persistent AF (n=13) or atypical atrial flutter (n=14) after a PVI procedure, or patients with longstanding persistent AF and severe enlarged atrium (n=4) were included in our patient cohort for additional AF substrate ablation with PEF applications. After high density voltage mapping of the left atrium with multipolar microelectrode catheters, and PVI, or re-PVI was completed (8 patients), additional left atrial linear lesions were performed according to the atrial flutter mechanism or as fibrosis-guided substrate ablation. All but one patient showed low voltage areas (bipolar electrograms <0.5mV) in 35±31% of the left atrial surface. Using contact force sensing catheters, maximal PEF energy pulses were applied with a minimum of 5g contact force and an interlesion distance ≤6mm. Performed linear lesions were left atrial roof line, lateral mitral isthmus line, anterior mitral line, left posterior wall isolation, and cavotricuspid isthmus (CTI) line. Before PEF application close-by a coronary artery (lateral mitral line, CTI) nitroglycerie 0.2mg i.v. was injected. Results Complete lines with exclusively PEF applications and proofed bidirectional conduction block were 100% for roof lines (n=20), posterior wall isolation (n=8), anterior mitral lines (n=10). Exclusively endocardial PEF applications blocked the lateral mitral line in 14 out of 16 cases (88%). Only in two cases additional epicardial RF applications via coronary sinus and endocardial additional RF applications were necessary to complete the mitral isthmus block. In 7 out of 8 cases CTI were blocked by linear PEF applications (88%), however, in one case additional RF applications became necessary. No ECG ST segment elevation was recorded. No serious complications occurred throughout all procedures. Follow up will be available at presentation time. Conclusion Catheter ablation of complex AF patients with linear lesions is performd very efficient and safe with PEF applications by CF-sensing RF ablation catheters. Especially the high efficacy of exclusively endocardial PEF applications for creation of a lateral mitral isthmus block is very promising. However, the long term permanence of the linear lines have to be awaited.

Implementation of energy-saving projects within the framework of the energy mana-gement strategy at budget facilities

The article is devoted to the issues of implementing energy-saving projects within the framework of the energy management strategy at the objects of the budget sphere. Based on the research, it was proposed to arrange the adaptation tools for managing energy-saving projects. The purpose of the study was to study the implementation of energy-saving projects within the framework of the energy management strategy at the objects of the budget sphere. Effective energy management system implementation considers not only material and financial resources but also human resources and previous experience in implementing energy-saving measures. The specified features of the energy management principles must be followed when implementing energy-saving projects at budget facilities. Attention is focused on the expediency of analyzing the stages of general energy quality management in detail, which must be considered for energy saving. Some obstacles are given that prevent energy management from creating the proper conditions for increasing energy saving at budget-sector facilities. It has been proven that developing a general strategy for implementing the energy management system at public sector facilities is essential for creating an energy-saving program. The approach to the formation of energy characteristics at the objects of the budget sphere allows the top management to present historical consumption trends, energy costs, the level of competence in energy management, a list of possible projects with an indication of the ratio of costs and benefits; study of experience and results achieved in other institutions. For this, it is necessary to strengthen the commitment of management, which is essential for the success of the energy management system. This commitment includes defining the organizational structure, setting, and approving goals, obtaining the necessary resources, and systematically spreading and supporting the energy conservation program. Modeling the organizational structure of the energy management system is based on interconnected components: the creation of an energy-saving block or zone, the creation of an energy-saving commission, and the hiring of an advisory group. Therefore, within the framework of the conducted research, it is proposed, with the use of adaptive management tools of energy-saving projects, at the beginning of the process, it is necessary to determine the priorities of different local communities and the location features of budget objects in order to ensure a fair transition in the distribution of resources between budget objects about the implementation of energy saving projects within energy management strategies. Keywords: energy diagnostics, energy-saving projects, strategy, energy management, budget objects.

Blockchain-based Cryptocurrency Price Prediction with Chaos Theory, Onchain Analysis, Sentiment Analysis and Fundamental-Technical Analysis

Crypto assets succeeded in making their name known to large masses with Bitcoin, which emerged as a result of the creation of the first genesis block in 2008. Until 2010, the aforementioned recognition showed itself mostly in areas such as games, but over time it managed to enter the portfolios of individual investors. Especially as of end of 2017, the rapid increases in monetary value quickly attracted the attention of corporate companies and then the (Central Banks). These assets have created different alternatives (also know as altcoins) by working and have managed to become one of the important financial instruments today. This study has examined in detail the techniques (Chaos theory, Onchain analysis and Sentiment analysis) developed on the price predictions of crypto assets, which are very important in terms of the number and quality of investors. In the study, findings were obtained that new techniques such as onchain and sentiment are more prominent in estimating crypto asset prices compared to traditional asset price estimation methods of crypto assets and that these techniques can make consistent estimations.

Development of Corpus Linguistic Using Lexical Teaching to Improve English Writing

The study of language based on text corpora is known as corpus linguistics. The aesthetic analysis with corpus linguistics to give a novel description of the phenomena of speech, writing, and thinking presentation, often known as ‘speech reporting’ or ‘writing presentation.’ With the vigorous development of corpus linguistics, linguists propose the concept of “block” through a large amount of corpus and use the phrase as the teaching unit of English writing to enhance the fluency and accuracy of language expression. In order to study the creation of linguistics academic English vocabulary block, the author used empirical research, mainly experiments, supplemented by questionnaires and personal interviews. At the same time, this paper used the corpus and Java Web technology for further experimental analysis. After a series of studies, it is concluded that corpus linguistics is a new research method and a trend of future language teaching. It is anticipated that the course will point out methods to supplement by adding activities that provide a greater writing purpose for English language acquisition. The findings of this investigation give a number of specific phenomena, including speculative speech, writing, and concept organization, integrated speech, writing, and idea demonstration, and uncertainty in speech, composing, and thought demonstration.

Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter.

Although radiofrequency (RF) catheter ablation of cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL. RF delivery was guided by the DirectSense™ algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. 392 point-by-point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4±12Ω prior to ablation and 92.0±11Ω after ablation (p<0.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8±6Ω vs. 8.7±4Ω; RedV: 17.2±6Ω vs. 7.8±5Ω; UPC: 19.6±6Ω vs. 10.1±5Ω, all p<0.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5Ω to 19.9). BDB was obtained in all cases. No procedure-related adverse events were reported. A LI-guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy. Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.

FPGA simulation of chaotic tent map‐based S‐Box design

AbstractThe chaotic system has a characteristically random behavior by nature, and these systems have their own characteristics in a completely deterministic structure. This feature of a chaotic system makes it difficult to predict encryptions designed based on such a system. Thanks to this unpredictable and strong feature, maps produced from chaotic systems are an important alternative in the field of encryption. One of the structures obtained by employing chaotic maps is the substitution box. S‐Box, which provides the confusion principle used in block ciphers, is the main block that dynamically replaces unencrypted data with confidential data and makes a significant contribution to ensuring high security in the encryption system. Therefore, S‐Boxes hold a critical role in block ciphers. Speed and reliability are important parameters in the creation of this main block. Especially, applications performed on hardware are more reliable and high performance. Therefore, in this study, an S‐Box was designed using field‐programmable gate arrays (FPGA) simulation from a chaotic tent map to create a fast and reliable S‐Box because FPGAs offer solutions that may be important in this field considering their fast and customizable architecture. In the proposed method, the S‐Box was created in 0.16 s. In addition, the dynamic properties of the chaotic tent map were analyzed with Lyapunov exponents, and the NIST SP 800‐22 test was applied for the information encryption suitability of the proposed chaotic system. Also, to test the reliability of the produced S‐Box structures, SAC, non‐linearity, bit independence criteria, and input/output XOR distribution table metrics were implemented. The results showed that the proposed chaotic map was dynamic and passed the reliability tests successfully.

Safe preoperative regional nerve blocks

BackgroundProcedural time-outs and checklists are proven to be an effective means of improving teamwork and preventing wrong-sided procedures. The main objective of this study was to ensure that all regional...

Relationship between Surpoint Tag Index, a Radiofrequency Ablation lesion quality indicator, and Atrial wall thickness in Cavotricuspid isthmus Ablations exhibiting bidirectional block.

BackgroundAn RFA lesion quality indicator, Surpoint Tag Index® (TI) incorporates key factors: power, time, and contact force, impacting lesion quality. TI accurately estimates lesion depth in animal studies. However, the relationship between TI and in‐vivo atrial wall thickness in patients exhibiting bidirectional block remains unknown.ObjectiveTo describe the relationship between atrial wall thickness and TI in CTI exhibiting bidirectional block.MethodsData from 492 RFA lesions from 25 patients undergoing PVI and CTI ablations in SR with point‐by‐point RF lesions (<45 W) utilizing a Thermocool Smarttouch® SF ablation catheter and CARTO‐3 mapping were retrospectively analyzed. Operators were blinded to TI data and CTI thickness. CTI thickness was obtained using ICE images on Cartosound pre‐ablation. Durable lesions were defined as part of a lesion set exhibiting bidirectional block of >30 min.ResultsIn lesions exhibiting bidirectional block, the thinnest (1–2 mm; 5% lesions) and thickest (8–10 mm; 6% lesions) portions of the CTI correlated with the lowest (429 ± 75) and highest (516 ± 64) TI. The bulk of thickness (2–6 mm; 80%) correlated with a TI of 455 ± 72 (p = 0.001). There was a weak but positive correlation between TI and CTI thickness (r = 0.2; p ≤ 0.01). Examined in sectors, the anterior 1/3rd CTI was the thickest (4.8 ± 1.9 mm) but correlated with a similar TI value (479 ± 75 vs. 471 ± 70; p = 0.34) as the thinner middle 1/3rd (3.8 ± 1.7 mm; p ≤ 0.0001).ConclusionA mean TI value of 455 correlates with bidirectional block across the bulk of CTI with lower and higher values needed for the thinner and thicker portions, respectively. Tissue composition, aside from wall thickness, influences TI values for the creation of the bidirectional block.

Application of Statecharts in Buck-Boost DC-DC Converter Simulation

A very attractive and relatively simple option to simulate a DC-DC converter is to use a hybrid model. In this case, the need to use very small simulation steps (as those necessary to simulate models carried out at the physical level) is avoided. Furthermore, unlike the averaged state-space models, it has the advantage that the model is valid throughout the entire working range of the converter and for both conduction modes (continuous and discontinuous). By simulating several renewable energy conversion systems incorporating DC-DC converters, the authors have discovered the true potential of this modeling method. Despite its inherent advantages, this approach to DC-DC converters simulation is not as widely adopted as it should be. This work tries to encourage the reader of its use in certain typical situations. In this article the implementation of the hybrid model of the DC-DC Buck-Boost converter, using Statechart techniques, is performed. This model was written in the Stateflow language, a tool from the MATLAB®/Simulink environment, and allowed the creation of a building block formed by the described converter model with adequate interfaces to the SimPowerSystem and Simulink environments. The block is validated by comparing simulation results, realized under different operating conditions, with calculations done employing well-known and proven formulas. As an example of the use of the presented block, a buck-boost DC-DC converter with voltage and current control loops is simulated, corroborating its correct performance

Towards the revolution and democratization of education: a framework to overcome challenges and explore opportunities through Industry 4.0

Education 4.0 (E4) aims to improve the teaching-learning process and democratize access to quality education by using Industry 4.0 technologies in educational environments. The main objective of this article is to propose a framework containing a package of policies and initiatives for the drivers of society (industry, government, and academia) to develop E4. The framework was elaborated through systematic review based on good practices, challenges, and opportunities of E4, which were systematized considering the technical-scientific literature and the authors' experience. The main scientific contribution of this work is the creation of a new block of knowledge about E4 that expands and at the same time deepens the existing literature and can support new research and foster initiatives on the subject. Its main applied contribution is to increase access to quality education through the development of E4.

Production balance of the regional economy

The article is devoted to the creation of the material block of the Leontief input-output model. Its purpose is to reflect the activities of both production and trade enterprises, i.e., objects that create real GDP within each region of a particular territorial entity (including the entire economy of the Russian Federation). This activity involves the production/import of products on the territory of the region by all industries and its distribution among both manufacturing and commercial enterprises to ensure their functioning. In addition to displaying the trade part of these commodity flows, the novelty of the model is to take into account public procurement, the use, along with the standards of specific consumption of material resources/goods not only in production but also in trade. Formal relationships have also been developed between investment in scientific and technical development and the growth/reduction of resource costs for the production/sale of a unit of production. The model indicators are made up of parts - contributions from production and trade while having a multi-aspect representation, data sets of which are formed by annual, regional and industry sections, decomposed respectively into months, districts and corporations. This allows you to generate the necessary time series for calculations using hypercube data technology and implement them using 4GL generation languages. The model has relations that determine the desired values of its variable parameters based on economic growth including the saturation of the regional market with the products of the industry, an indicator of which is its consumption by the service sector. This indicator is greater than zero in the case of covering the needs of all other economic entities in the region and less than or equal to zero otherwise.

Optimized radiofrequency lesions through local impedance guidance for effective cavo-tricuspid isthmus ablation in typical right atrial flutter: data from the CHARISMA registry

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency (RF) catheter ablation of the cavo-tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL). However, whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective remains to be established. Purpose We aimed to investigate the ability of LI to predict ablation efficacy in patients (pts) with RAFL and to characterize the CTI in terms of LI. Methods Consecutive pts undergoing RAFL ablation from the CHARISMA registry were enrolled at 9 centers. A novel RF ablation catheter with dedicated algorithm (DirectSense - DS -) was used to measure LI at the distal electrode of this catheter. RF applications (RFC) were targeted to a minimum LI drop of 10 Ω within 30 seconds and were stopped when a maximum cutoff LI drop of &amp;lt;40 Ω was observed. Successful single RFC was defined according with a split in two separate potentials (SPL), reduction of voltage (RedV) by at least 50% or changes at unipolar EGM (UPC). Agreement among criteria was evaluated. Ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. Results A total of 279 ablation spot lesions were delivered in 30 pts (mean RFC 9 ± 6 lesions per pt): 106 (38%) at anterior, 115 (41%) at mid and 58 (21%) at posterior portions of the CTI. BDB was obtained in all cases and no complications were observed. The median RFC delivery time was 30 [19–45] seconds per lesion. 132 (47%), 150 (54%) and 86 (31%) ablation spots were effective according with SPL, RedV and UPC, respectively. Complete agreement of all the criteria was reached in 70% of the cases. The mean LI was 104.4 ± 11Ω prior to ablation and 92.1 ± 11Ω after ablation (p &amp;lt; 0.0001, mean absolute LI drop 12.2 ± 7Ω, mean time to LI drop 13 ± 8 seconds). Effective ablation spots showed a higher LI drop compared with ineffective sites at each single criteria (16.6 ± 7Ω vs 8.3 ± 4Ω for SPL, p &amp;lt; 0.0001; 16.1 ± 6Ω vs 7.8 ± 5Ω at for RedV, p &amp;lt; 0.0001; 19 ± 6Ω vs 9.2 ± 4Ω for UPC, p &amp;lt; 0.0001) and LI drop values significantly increase according to the number of criteria satisfied (ranging from 7.5Ω % -no criteria- to 19.1 -all criteria-). A 15Ω cut-off value for LI (AUC 0.91, sensitivity = 67%, specificity = 92%, p &amp;lt; 0.0001) was associated with the achievement of all criteria with an OR of 21.9 (95%CI: 11.1 to 43.5, p &amp;lt; 0.0001) and a positive predictive value of 76%. Starting LI and LI drop seem to be higher at mid-septal areas. Conclusion In our preliminary experience, a LI-guided approach of CTI seems to be safe and effective in RAFL ablation. The magnitude of LI drop was associated with effective lesion formation and conduction block and could be used as a marker of ablation efficacy.

P1448Ablation of cti-dependent flutter using a novel advanced mini-electrodes technology: preliminary results from Leonardo registry

Abstract Funding Acknowledgements NO FUNDING OnBehalf LEONARDO study group Background Ablation of cavotricuspid isthmus (CTI) represents the standard therapeutic approach for the creation of bidirectional conduction block (BDB) across the isthmus and the prevention of recurrences, yet recurrence of arrhythmia is common. Objective To evaluate the acute and long-term outcome of CTI ablation through a novel ablation catheter equipped with three radially distributed mini-electrodes (ME) compared with standard ablation catheter technology (ST). Methods Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of pts indicated for AFL ablation from 2015 to 2017. The procedural endpoint was the creation of a BDB. Presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS) were used as criteria for complete BDB. Recurrence of AFL and complications were assessed at 12-month follow-up. Results 205 consecutive pts undergoing typical AFL ablation were included (74% male, 50.6% with history of AF, median of 7[4–11] ablation lesions, median ablation time of 20[10-30] min). Complete BDB was achieved in 175 (85.4%) pts (10 pts had DP only criterion, 19 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). 15 (7.3%) pts experienced AFL recurrence during follow-up. 102 pts (49.8%) underwent ablation procedure with ME catheters whereas 103 (50.2%) pts were treated by ST catheters. The median number of lesions/pt was significantly lower in the ME group compared to the ST one (4[3-6] vs 8.5[6-12], p &amp;lt; 0.0001), whereas no differences were found in terms of fluoroscopy time (10.5[7-15] min vs 10[5.8 ± 15] min, p = NS) or ablation time (22.5[10-30.5] min vs 18[10-26] min, p = NS). No complications were reported. The acute procedural success was comparable between groups (81.4% vs 89.2%, p = NS) whereas the time to AFL recurrence was significantly longer among pts targeted with ME catheters (HR = 0.343; 0.12 to 0.97; log-rank p = 0.044). Conclusions In our preliminary experience, the use of the ME technology seemed safe and effective. It resulted in fewer lesions/pt and a lower AFL recurrence rate at 1-year follow-up compared with ST ablation catheters.

P1447Use of novel local impedance-based catheter in typical right atrial flutter ablation: preliminary data from a multicenter Italian study

Abstract Funding Acknowledgements NO FUNDING Background Many studies demonstrated the importance of an optimal tissue contact to obtain safe and effective lesions and to improve the clinical outcome in ablation of cavotricuspid isthmus (CTI) for typical right atrial flutter (AFL). Data about a novel technology able to measure local tissue impedance (LI) providing a measure of tissue characteristics and lesion formation is still lacking in right atrium or CTI working. Purpose This analysis explores the relationship between LI measures and ablation spot lesion locations during ablation of CTI in common AFL patients (pts). Methods Consecutive pts undergoing AFL ablation from the CHARISMA registry were included. A novel RF ablation catheter with dedicated algorithm (DirectSense - DS -) was used to measure LI at the distal electrode of this catheter. Each targeted spot was characterized in terms of LI parameters during RF delivery at the lateral, intermediate and posterior portions of the CTI. Successful single RF ablation was defined according with a reduction of voltage (RedV) by at least 50% or split in two separate potentials (SPL). Ablation endpoint was the creation of bidirectional conduction block across the isthmus. Results A total of 135 ablation spot lesions were delivered in 20 pts (median 5 [3-11] lesions per pt): 7 (5%) at lateral, 88 (65%) at intermediate and 40 (30%) at posterior portions of the CTI. Acute success was obtained in all cases and no complications were observed. The median ablation time was 26 [17 – 36] seconds per lesion. 100 (74%) and 51 (38%) ablation spots were effective according with RedV or SPL, respectively. The mean LI was 106 ± 15Ω prior to ablation and 93 ± 13Ω after ablation (p &amp;lt; 0.0001, mean absolute LI drop 14 ± 7Ω, mean percentage LI drop 13%±6). Effective ablation spots showed a higher absolute impedance drop (15 ± 7Ω at effective RedV vs 9.6 ± 8Ω at ineffective RedV, p = 0.0001; 15.6 ± 7Ω at effective SPL vs 12.5 ± 7Ω at ineffective SPL, p = 0.0173) or % impedance drop (14%±6 at effective RedV vs 9%±7 at ineffective RedV, p &amp;lt; 0.0001; 14.5%±6 at effective SPL vs 11.6%±6 at ineffective SPL, p = 0.0103) compared with ineffective sites. No significant differences were found in terms of starting LI, ending LI or LI drop among CTI areas. The percentage of LI drop was associated both with RedV (odd ratio 1.17 (95%CI: 1.08 to 1.26, p = 0.0001)) and with SPL (odd ratio 1.08 (1.02 to 1.14, p = 0.0132)). Conclusion In our preliminary experience, measured LI before and after RF delivery and LI drop appear to be consistent and homogeneous across different CTI ablation locations. The magnitude of the LI drop was associated with effective lesion formation and conduction block.

Cytodiagnosis and protein typing of amyloid from a vitreous washing: initial diagnostic workup of hereditary amyloidosis

Hereditary amyloidosis is a challenging but critical diagnosis, with serious implications with regard to treatment and disease surveillance for both patients and their families. Systemic symptomology is often vague. As vitreous amyloid deposition is strongly linked to the systemic, hereditary disease, its cytodiagnosis in the vitreous may be the incipient finding of hereditary amyloidosis. We describe a 64-year-old man with a history of heart disease and peripheral neuropathy who presented with asymmetric visual disturbances and vitreous opacities, leading to diagnostic vitrectomy. Amyloid was identified on a ThinPrep slide of the vitreous sample via Congo red stain. Creation of a cell block from the residual ThinPrep sample allowed for amyloid protein typing, identifying ATTR (transthyretin)-type amyloid and strongly suggesting hereditary amyloidosis. Subsequent sequencing of the patient's TTR gene identified a pathogenic variant that is associated with autosomal dominant hereditary transthyretin-mediated amyloidosis.

МЕТОД МИФОПОЭТИКИ В ДИЗАЙНЕ

The appeal to mythopoetics is emerging in modern design with the focus on its environmental and information spheres. The analysis of literature leads to considering mythopoetics as a design and research method, whose subject is a specific type of mythological consciousness and the product of its work – the system of ideas about the world, formed into a model. Mythopoetics appears in cognitive, sense-forming, value-modeling and environmental aspects. The essence of mythopoetic design is becoming more relevant in the modern worldview due to the need for reproducing the world model. At the stage of mythological consciousness, practical activi-ty was regulated by ritual reproduction of the model. In the modern worldview, the regulating function is performed by culture. Therefore, the task of mythopoetic design is to form a concept of a project filled with value cultural meanings. The basic terms of mythopoetics include traditionally used concepts (an archetype, a mythol-ogeme, a mytheme), philosophical and cultural terms (a concept, a cultural meanings, an imaginative invariant of thinking, a chronotope), and specific concepts (axiomatic state of individual conscious-ness, artistic and imaginative invariants, a spatiotemporal context of a project, an artistic and imagina-tive model of the world). In design, the result of work of artistic consciousness and design thinking is the concept of a project shaped into the artistic and imaginative model of the world. The semantic core of the design concept is based on cultural meanings and axioms, which are comprehended by means of axiomatic state of individual consciousness and expressed as consumer’s value orientations. The periphery of the design concept is formed by the spatial and time context of project. The artistic and imaginative model of the world appears as a compositional integrity consisting of structural elements, i.e. artistic and imaginative invariants. The conducted analysis of mythopoetic models of the world yields a system of artistic and imaginative invariants, includingnatural, anthropo-morphic, social, sacred, objective, spatial, and dynamic. The structural elements of the model are orga-nized into blocks using the principles of organization. The principles of semantic organization are applied in the creation of a semantic block. The spatiotemporal context of the design concept is formed by the principles of space and time organization. The method of mythopoetics presupposes the sequence of design stages: recognition of cultural meanings, their “implantation” into the individual worldview, and visualization of artistic and imaginative invariants in design objects.The method of mythopoetic design solves the task of synthesis of traditional and innovative aspects, natural and cultural aspects, universal cultural and individual mean-ings, and value orientations in the design concept.

Institutional Dimension of the Preservation of the Historical and Cultural Heritage of the United Arab Emirates

There has been researched the institutional direction and its main forms of the preservation of the historical and cultural heritage in the UAE. There has been clarified the role of the National Archives,as an important archival and research institution which assists to implementation of the politics of memory and meaningful filling of the national idea. There have been reviewed main historica museums and cultural objects as important institutions. There has been analyzed activities of the Dhakira Center for Heritage studies in the UAE. The creation of the museum city block on SaadiyatIsland of the Emirate of Abu Dhabi as a center of the national and world cultural heritage, multicultural exchange within the global perception of the world has been studied. The state policy of the preservation of the traditional culture and its material components for strengthening of the national identity has been considered. In this context attention was paid to conducting of cultural andethnographic festivals, working with youth for the purpose of the patriotic education.

P1009Procedural success and long-term outcome of CTI ablation targeted with maximum voltage-guided approach: preliminary results from an Italian multicenter registry

Abstract Background Ablation technique targeting high-amplitude signals (maximum voltage guided - MVG -) on the cavotricuspid isthmus (CTI) has emerged as viable alternative option compared to standard anatomical approach (ST) for the creation of bidirectional conduction block (BDB) across the isthmus but limited data are available to date. Purpose To evaluate the effectiveness of acute and long-term outcome of CTI ablation through MVG technique for AFL compared to standard linear (SL) lesion ablation. Methods Atrial Flutter Ablation in a Real World Population (LEONARDO) is a prospective, multicenter cohort study aimed at providing an estimate of acute to long-term outcome in a large population of patients (pts) indicated for AFL ablation. Recurrence of AFL were retrieved at 12-month follow-up. Complete BDB was defined by agreement with the presence of widely split double potentials (DP) along the ablation line and assessment of the atrial activation sequence (AAS). For MVG technique the ablation catheter was positioned at the site of maximum local electrogram voltage. Results Two-hundred fifteen consecutive pts were included (mean age 68 years, 73% male). A median of 4 [2–6] ablation lesions were required. Median follow up was 359 [192–443] days. Complete BDB was achieved in 175 (81.4%) pts (9 pts had DP only criterion, 30 pts had AAS only criterion whereas in 1 pt we failed to reach a BDB). In the 106 pts with complete data at 1-year follow-up, 10 (9.4%) had a recurrence of AFL. 171 pts (79%) underwent a SL ablation whereas 44 pts (21%) were treated by MVG approach. The median number of lesions/pt was significantly lower in the group of pts targeted with MVG compared to the SL approach (3 [2–4] vs 4 [2–8], p&lt;0.01), whereas no differences were found in terms of fluoroscopy time (16 [12–18] min vs 12 [7–22] min, p=NS) or proportion of pts with BDB achievement (86.4% of the cases for MVG vs 80.1% of the cases for ST, p=NS). No complications were reported. AFL recurrence was comparable during follow-up between groups (8.3% for MVG vs 9.8% for SL ablation; p=NS). Conclusion Ablation of a targeted site through MGV approach seems to be safe and effective as standard anatomical ablation technique. This strategy may avoid unnecessary ablation of the entire anatomic isthmus. Acknowledgement/Funding None