Successful Branch Research Articles

A mcgyvering way to left bundle branch area pacing : using the treadmill test machine ECG system and modified V1 / V6 leads connected to the pacing system analyser for left bundle branch area pacing

Abstract Background Left bundle branch area pacing (LBBaP) is a novel pacing modality which provides physiological synchronisation of both the ventricles. However, its use and adoption requires the presence of a standardised electrophysiological (EP) system with 12 lead ECG to show left bundle branch area capture. Purpose The aim of the study was to assess the feasibility and outcomes of using the conventional treadmill test (TMT) machine 12 lead ECG system and modified V1 and V6 leads connected to the pacing system analyser (PSA) to demonstrate conduction system capture during left bundle branch area pacing (LBBaP). Methods LBBaP was attempted by a single operator in a mixed cohort of patients at peripheral hospitals lacking the standardised EP system. The presence of LBB area capture was tested with the aid of the 12 lead ECG system connected to the standard TMT machine (1). Conduction system capture was also assessed using modified V1 and V6 leads connected to the PSA for measurement of V6 left ventricular activation time (LVAT)(2) . The baseline clinical, procedural, pacing, electrocardiographic parameters, echocardiographic response (> 10% improvement in ejection fraction {EF}) and clinical response to LBBaP were assessed. Results LBBaP was attempted in 19 patients and was successful in 18 patients (94.7%). Patient characteristics include age 66.7 +/- 11.47 years, female 47.37%, male 52.63%, ischaemic cardiomyopathy 10.52% and non-ischaemic cardiomyopathy 5.26% .The mean baseline EF and QRS duration was 45%+/-14% and 130.18 +/-10.45 milliseconds(ms) respectively. LBBaP threshold was 0.59 +/-0.168 volts and R wave amplitude was 12+/-3.5 millimetres , which remained stable during the mean follow up of 15.9 +/-13.67 months. The mean fluoroscopic duration was 11.57 +/-2.58 minutes and procedural time was 108.78+/-29.20 minutes. LBBaP resulted in impressive narrowing of the QRS duration to 102.39 +/-10.55 ms (p<0.001) with LVAT of 68.94 +/-9.94 ms. LVEF improved in the patients with cardiomyopathy from 33.4 +/- 5.77 % to 48.2+/-12.37 % (p=0.028) .Clinical and echocardiographic response was noted in 87.5% of patients with cardiomyopathy. Conclusion The 12 lead ECG system with the standardised TMT machine in conjunction with the modified V1 and V6 leads connected to the PSA is a feasible alternative to the EP system to perform successful left bundle branch area pacing.ECG leads connected during LBBapClinical profile of patients

Predictors of functional mitral regurgitation improvement in patients with left bundle branch block treated with left bundle branch area pacing.

Functional mitral regurgitation (FMR) and its severity are associated with adverse outcomes in heart failure patients. This study aims to analyze the predictors of FMR improvement after successful left bundle branch area pacing (LBBAP) in patients with LVEF<50% and complete left bundle branch block (CLBBB). Consecutive patients with LVEF<50% and CLBBB who underwent successful LBBAP from July 2018 to July 2023 were retrospectively identified. Significant MR was defined as regurgitation of moderate severity or greater. Patients with significant FMR were included in the analysis. FMR improvement (FMRI) was defined as a reduction of at least one grade in regurgitation severity compared to baseline at 3 months or longer follow-up. Among the 81 identified patients, 42 patients with significant FMR preoperatively were included. After LBBAP, QRS duration significantly shortened from 170.6±18.8ms to 114.5±20.2ms (p<.001). Significant FMR improves in approximately 76.2%, and the patients were divided into an FMRI group (n=32) and a non-FMRI group (n=10). Univariate analysis showed that absence of persistent atrial fibrillation, typical CLBBB, and left atrium diameter at baseline were associated with improvement of FMR after LBBAP. Of these variables, only absence of persistent atrial fibrillation remains an independent predictor in the multivariate model (OR 12.436, p=.009). LBBAP is able to improve FMR in heart failure patients who had CLBBB with LVEF<50%. Meanwhile, the absence of persistent atrial fibrillation is an independent predictor of FMR improvement.

Successful left bundle branch area pacing in a patient with three TriClip devices.

Successful left bundle branch area pacing in a patient with three TriClip devices.

The association between paced left ventricular activation time and cardiac reverse remodeling in heart failure patients with left bundle branch block.

The association between paced LVAT and cardiac structure and function at baseline, as well as whether longer LVAT is associated with worse cardiac reverse remodeling in patients with heart failure (HF) and left bundle branch block (LBBB) has not been well investigated. The purpose of this study is to investigate the association between paced LVAT and baseline echocardiographic parameters and cardiac reverse remodeling at follow-up. Patients with HF and LBBB receiving successful left bundle branch pacing (LBBP) from June 2018 to April 2023 were enrolled and grouped based on paced LVAT. NT-proBNP and echocardiographic parameters were recorded during routine follow-up. The relationships between paced LVAT and echocardiographic parameters at baseline and follow-up were analyzed. Eighty-three patients were enrolled (48 males, aged 65 ± 9.8, mean LVEF 32.1 ± 7.5%, mean LVEDD 63.0 ± 8.5 mm, median NT-proBNP 1057[513-3158] pg/mL). The paced QRSd was significantly decreased (177 ± 17.9 vs. 134 ± 18.5, p < .001) and median paced LVAT was 80[72-88] ms. After a median follow-up of 12[9-29] months, LVEF increased to 52.1 ± 11.2%, LVEDD decreased to 52.6 ± 8.8 mm, and NT-proBNP decreased to 215[73-532]pg/mL. Patients were grouped based on paced LVAT: LVAT < 80 ms (n = 39); 80 ≤ LVAT < 90 ms (n = 24); LVAT ≥ 90 ms (n = 20). Patients with longer LVAT had larger LVEDD and lower LVEF (LVEDDbaseline: p < .001; LVEFbaseline: p = .001). The difference in LVEF6M was statistically significant among groups (p < .001) and patients with longer LVAT had lower LVEF6M, while the difference in LVEF1Y was not seen (p = .090). There was no significant correlation between ΔLVEF6M-baseline, ΔLVEF1Y-6M and LVAT respectively (ΔLVEF6M-baseline: p = .261, r = -.126; ΔLVEF1Y-6M: p = .085, r = .218). Long paced LVAT was associated with worse echocardiographic parameters at baseline, but did not affect the cardiac reverse remodeling in patients with HF and LBBB. Those with longer LVAT required longer time to recover.

ADME Studies of Phytochemicals in Stachys pilifera Benth plant species

Medicinal chemistry is a constantly changing and developing field. It is a successful and prosperous branch due to the new technologies, the changing complexities of medicine, and the expansion of medicinal chemistry knowledge. In drug design, many aspects need to be checked. The first step in drug development is discovering when new insights and technologies become available. Discovery is possible to find new treatments for diseases. This can begin with thousands of different computational methods, including under Computer-aided drug design (CADD). It provides a no. of tools and techniques that assist the various stages of drug design which can minimize the cost of drug research and development time. For this particular project, we use the SwissADME web tool it is a free web tool, easily assessable and convenient. It can characterize any chemical compound within a min. it allows you to compute physiochemical descriptors also to predict ADME parameters, pharmacokinetic properties, drug like nature of our compound, and medicinal chemistry friendliness of many small molecules to support drug discovery. For ADME analysis we chose a plant in which the isolation of its chemical compound is already done. i.e. stachys pilifera benth plant species. We did the ADME study of their chemical compounds using SwissADME and concluded its drug-like nature, its bioavailability, its synthetic accessibility, and many medicinal properties. We can say that Swiss ADME is the Asset for medicinal chemistry.

Instant deep sea debris detection for maneuverable underwater machines to build sustainable ocean using deep neural network

Deep sea debris is any persistent man-made material that ends up in the deep sea. The scale and rapidly increasing amount of sea debris are endangering the health of the ocean. So, many marine communities are struggling for the objective of a clean, healthy, resilient, safe, and sustainably harvested ocean. That includes deep sea debris removal with maneuverable underwater machines. Previous studies have demonstrated that deep learning methods can successfully extract features from seabed images or videos, and are capable of identifying and detecting debris to facilitate debris collection. In this paper, the lightweight neural network (termed DSDebrisNet), which can leverage the detection speed and identification performance to achieve instant detection with high accuracy, is proposed to implement compound-scaled deep sea debris detection. In DSDebrisNet, a hybrid loss function considering the illumination and detection problem was also introduced to improve performance. In addition, the DSDebris dataset is constructed by extracting images and video frames from the JAMSTEC dataset and labeled using a graphical image annotation tool. The experiments are implemented on the deep sea debris dataset, and the results indicate that the proposed methodology can achieve promising detection accuracy in real-time. The in-depth study also provides significant evidence for the successful extension branch of artificial intelligence to the deep sea research domain.

Ekol Ukraine: transformation and growth

Learning outcomes Students comprehend the importance of the transformational idea and apply it in their leadership. Students can analyze how to spread the transformational idea across the team and the organization. Students understand the value of working with different stakeholders (partners, headquarters). Students can analyze the role of focusing on a client and apply client-centric way of thinking. Students can apply the concept of the transformational idea to create (synthesize) possible solutions for the presented dilemma. Case overview/synopsis This case tells the transformation story of the logistics company Ekol Ukraine, which began in 2013. This company was the most successful branch of Ekol Logistics, an international corporation operating in 13 countries. From 2013 till 2021, Ekol Ukraine experienced a crisis related to the start of a conflict between Ukraine and Russian militants. It proved its ability to cope with challenges, gained almost complete autonomy from the head office, transformed the business model and culture and achieved considerable success in building an ecosystem. Having this stage of transformation completed by 2021, the company reached a plateau and had to decide what the following changes would be. In 2021, only 14% of Ukrainian businesses used outsourcing logistics services (like the ones Ekol Ukraine provided). The remaining 86% had in-house logistics and were not ready to change the model. So, Ekol Ukraine faced a problem: how could a logistics provider grow in a market that was not mentally ready to outsource? Complexity academic level MBA programs. Supplementary materials Teaching notes are available for educators only. Subject code CSS 7: Management science.

Light Contraction Hierarchies: Hierarchical Search Without Shortcuts

Hierarchical search such as Contraction Hierarchies is a popular and successful branch of optimization techniques for shortest path computation. Existing hierarchical techniques have one component in common: they add edges to the graph, so called shortcuts. This component usually causes a considerable space overhead but is mandatory in order to preserve correctness. In this work we show a hierarchical method that requires to store only one additional number per node and no shortcuts at all. We prove the correctness of our method and experimentally show that it improves query times by one order of magnitude compared to Dijkstra's bidirectional algorithm.

Evaluation of the shortening of the stimulus-to-peak left ventricular activation time at continuous low output to confirm left bundle branch capture.

BackgroundLeft bundle branch area pacing (LBBAP) is a physiological pacing method for treatment of atrioventricular block. However, there is a need for a new convenient and safe method for performing left bundle branch pacing (LBBP) and to confirm left conduction system capture.ObjectiveThis study aimed to explore a new convenient and safe method for performing selective LBBP.MethodsA total of 28 patients who had indications for pacing therapy and received LBBAP were recruited retrospectively. Demographic and baseline patient characteristics, electrocardiograms, pacing parameters, and intracardiac electrogram pattern were evaluated. Continuous unipolar pacing at low output (2 V / 0.5 ms) was performed during the whole period of LBBP lead implantation. Successful left bundle branch (LBB) capture was defined as the abrupt change of the pacing stimulus to the peak of R wave in lead V5 during continuous pacing at low output (2 V / 0.5 ms).ResultsThe parameters of the 2 shortenings (stimulus-to-peak left ventricular activation time [S-peak LVAT] before shortening, S-peak LVAT after shortening, and the duration of shortening) all showed a significant positive correlation (Pearson product-moment correlation coefficient [PCC] = 0.915, P < .001; PCC = 0.897, P < 0.001; PCCs = 0.765, P < 0.001). Shortening of the S-peak LVAT with continuous low output had a 100% sensitivity and 33.3% specificity for predicting stimulus-ventricular potential interval (S-V interval).ConclusionAbrupt shortening of the S-peak LVAT at continuous low output was associated with abrupt shortening of the S-peak LVAT at low and high output. High rate of selective LBB capture can be achieved with the method of continuous low output, shortening the S-peak LVAT.

Hydrogen energy pilot introduction – Technology competition

Hydrogen energy technologies are considered as the cutting-edge clean energy technologies all over the world. Novel concept of hydrogen energy development in Russia, proposed by Government has hydrogen technologies equipment development, production and introduction into domestic market as one of the tasks. Foreign experience shows that governmental support is very important for successful branch development. Waste hydrogen from chlorine industry utilization can be energy-efficient and attractive niche for fuel cells and hydrogen-fuelled heat engines application. Lifetime and capital costs are important parameters for technology choice decision. Energy cost and hydrogen consumption comparison were carried out for gas microturbines (MGT), fuel cells (FC) and internal combustion engines (ICE) in this paper. Analysis showed polymer electrolyte membrane fuel cells and gas microturbines to be the most promising technology in this niche while for internal combustion engines lifetime is an issue. Solid oxide fuel cells need significant capital costs decrease for successful market introduction. Solid oxide fuel cells, MGT and ICE have also additional advantage for Russian conditions due to high-potential heat production possibility. • Сhlorine industry waste hydrogen utilization is considered as the prospective niche for hydrogen energy pilot introduction. • Lifetime and capital costs are the main parameters influencing different hydrogen utilization techniques economic efficiency. • Polymer electrolyte membrane fuel cells became the most attractive technology due to price decrease during last decade. • Gas microturbines and internal combustion engines also can be considered in case of need in heat energy.

The common factors underlying successful international branch campuses: towards a conceptual decision-making framework

ABSTRACT The last 25 years have witnessed the emergence of the International Branch Campus (IBC) as a means of providing Transnational Higher Education (TNE). The growth in the number of IBCs has not been without examples of failure and in some cases controversy, necessitating informed decision-making on the part of university leaders contemplating such a venture. Based on a systematic review of literature concerning the motivations for establishing IBCs; the drivers of sustainability and longevity; and case studies of successful and unsuccessful ventures by UK universities, this paper identifies key characteristics of successful IBCs. It proposes a framework – combining strategic, leadership, academic, financial and operational factors – for use by decision-makers in determining whether to establish and how to manage an IBC.

From strong to exact Petri net computers

Petri net paradigm of computing is concerned discussing basic types of Petri net computers and their relations. We developed a technique of parametric specification of Petri nets, built of a few connected components which are repeated depending on a parameter or a set of parameters, and composition of software to generate automatically the corresponding models in a vivid graphical form. We construct explicitly a Petri net that is a strong computer of double exponent after R.J. Lipton. Its nondeterministic computation is represented by a Petri net reachability graph to which a successful branch belongs. Then we minimise and transform the net to obtain twice smaller construct than the original one. Moreover, the obtained net possesses such a marvellous property that addingto it four priority arcs makes it an exact (deterministic) computer having a single firable sequence only. Same as the Lipton’s net, the minimized net allows the proof that the Petri net reachability problem is exponential in space. Besides, it represents an example when simple transformations allow guessing the successful branch of a nondeterministic computation. The practical significance of the approach in applications consists in a state-of-art heuristic technique of solving some NP problems in polynomial time.

Methodism in Victorian Shetland

Methodism arrived in Shetland in the 1820s, growing until 1866 and remaining relatively strong. It suffered from the handicaps of geography, the weather, poverty and the dictates of the fishing industry. Lay leadership was hard to find, ministers were overburdened, other denominations provided competition and emigration deprived the Methodist movement of talent. On the other hand, patronage, the work of James Loutit and the doctrines and institutions of Methodism provided advantages. Education and temperance drew in the young, the movement fitted into Shetland life and most fundamentally the Evangelical impulse and episodes of revival brought growth. Shetland Methodism became something exceptional: by far the most successful branch of the denomination in Scotland.

Simplicity Radiofrequency Ablation Demonstrates Greater Functional Improvement Than Analgesia: A Prospective Case Series

Pain originating from the posterior sacroiliac complex is notoriously difficult to effectively treat due to its complex anatomy and variable innervation. Data on radiofrequency ablation (RFA) is limited. The Abbott Simplicity probe creates 3 monopolar lesions along the medial aspect of the sacroiliac joint and 2 bipolar lesions between the active portions of the probe. This device has been studied previously with improvement of pain-associated disability and pain reduction, but insufficient data is present to determine its utility at this time. Using the most recent literature for the potential innervation of the posterior sacroiliac joint, it is reasonable to explore this novel device and its ability to treat sacroiliac joint pain. Identify the percentage of improved posterior sacroiliac complex pain and improved function in patients who completed posterior sacroiliac complex radiofrequency ablation using the Simplicity probe. Prospective case series. A single outpatient pain clinic. This prospective case-series occurred at an outpatient pain clinic. Data were analyzed after completion of follow-up appointments. Inclusion criteria included 2 successful lateral branch blocks. Fourteen patients with posterior sacroiliac complex pain were examined and completed sacroiliac ablation with the Simplicity probe. The numeric rating scale and the Modified Oswestry Disability Index were used as outcome measures for pain and function, respectively. The primary outcome measures were improvement in the numeric rating scale score by a reduction of 2.5 points and an improvement in Modified Oswestry Disability Index by 15% based upon previous studies demonstrating these values as the minimal clinical important difference . Patients were followed at a 3 to 6 month interval and 12 month interval (an average of 88 and 352 days, respectively). In total, 14 patients were examined. At the first follow-up, 29% of patients had analgesia and 38% functionally improved. At the second follow-up, 15% of patients had analgesia and 31% functionally improved. Considering data were collected retrospectively, this study relied on completed charts. Therefore, data points of interest were limited to what was previously documented, which included multiple answers or the absence of numerical data points. In addition, patients were disproportionately female (71.4%). Data were also affected by patients lost to follow-up. Also, this study examined a relatively small number of patients, therefore the results should be carefully considered. Radiofrequency ablation of the posterior sacroiliac complex with the Simplicity probe resulted in more functional improvement than analgesia. This study provides more data for clinicians to utilize in managing posterior sacroiliac complex pain. IRB: Protocol number 20170342HU. Not registered in clinical trials.

Combined Cardiac PET-CT and Transcatheter Closure for Left Internal Mammary Artery Side Branch Steal Syndrome

We report on a patient with left internal mammary artery (LIMA) side branch steal syndrome and refractory angina who underwent successful transcatheter LIMA side branch closure after cardiac positron emission tomography−computed tomography assessment. The procedure resulted in improved myocardial ischemia, hyperemic blood flow, coronary flow reserve, and anginal symptoms. (Level of Difficulty: Advanced.)

Left bundle branch area pacing in a young athlete with progressive cardiac conduction (Lev-Lenegre) disease

We present the case of a professional soccer player affected by right bundle branch block and symptomatic 2:1 atrio-ventricular block during effort, due to progressive cardiac conduction disease (Lev-Lenegre disease), who received successful left bundle branch area pacing after a failed attempt at His bundle pacing. The electrocardiographic outcome of paced QRS was consistent with a rapid electrical activation of the left ventricle through the Purkinje system. The pursue of physiological pacing was preferred over conventional, given the young age of our patient and the expectedly high burden of stimulation, to reduce the long-term risk of pacing-induced cardiomyopathy.

Successful left bundle branch pacing in a patient with dextrocardia using a modified sheath.

Successful left bundle branch pacing in a patient with dextrocardia using a modified sheath.

ECG patterns of successful permanent left bundle branch area pacing in bradycardia patients with typical bundle branch block.

To assess the electrocardiogram patterns of paced QRS narrowing after successful left bundle branch area pacing (LBBAP) and echocardiographic measurements in patients with bradycardia and bundle branch block (BBB). We prospectively enrolled 55 consecutive bradycardia patients with BBB and left ventricular ejection fraction ≥40% who had attempted LBBAP. Successful LBBAP was defined as paced QRS morphology of a right BBB (RBBB) pattern in lead V1 and a recording of abruptly shortened and then constant stimulus to peak left ventricular activation time with high and low output. Pacing characteristics and echocardiographic measurements were evaluated perioperatively and at 6-month follow-up. The success rate of LBBAP was 83.6% in patients with BBB, and median cumulative X-ray dose-area product was 100.5 µGym2 (60.0, 179.3). LBBAP was successful in 19 of 26 patients with left BBB (LBBB) (73.1%) and in 27 of 29 patients with RBBB (93.1%). The QRS duration (QRSd) was significantly shortened in patients with LBBB (QRSd 169.4 ± 22.6 to 119.6 ± 9.5ms), and five forms of QRSd narrowing were observed in patients with RBBB with the mean QRSd shortened from 143.1 ± 16.6ms to 119.5 ± 11.7ms. The thresholds for narrowing of QRSd were higher in RBBB than LBBB (1.74 ± 0.36 V/0.4ms vs 0.79 ± 0.17 V/0.4ms, P<.001). During the 6-month follow-up, both left and right ventricular synchronies were improved, and narrow QRSd persisted in patients with BBB. In most bradycardia patients, RBBB could be completely or partially narrowed by LBBAP at different pacing models in addition to the correction of LBBB with LBBAP.

Sharp Bounds for Genetic Drift in Estimation of Distribution Algorithms

Estimation of distribution algorithms (EDAs) are a successful branch of evolutionary algorithms (EAs) that evolve a probabilistic model instead of a population. Analogous to genetic drift in EAs, EDAs also encounter the phenomenon that the random sampling in the model update can move the sampling frequencies to boundary values not justified by the fitness. This can result in a considerable performance loss. This article gives the first tight quantification of this effect for three EDAs and one ant colony optimizer, namely, for the univariate marginal distribution algorithm, the compact genetic algorithm, population-based incremental learning, and the max-min ant system with iteration-best update. Our results allow to choose the parameters of these algorithms in such a way that within a desired runtime, no sampling frequency approaches the boundary values without a clear indication from the objective function.

WGAN-E: A Generative Adversarial Networks for Facial Feature Security

Artificial intelligence technology plays an increasingly important role in human life. For example, distinguishing different people is an essential capability of many intelligent systems. To achieve this, one possible technical means is to perceive and recognize people by optical imaging of faces, so-called face recognition technology. After decades of research and development, especially the emergence of deep learning technology in recent years, face recognition has made great progress with more and more applications in the fields of security, finance, education, social security, etc. The field of computer vision has become one of the most successful branch areas. With the wide application of biometrics technology, bio-encryption technology came into being. Aiming at the problems of classical hash algorithm and face hashing algorithm based on Multiscale Block Local Binary Pattern (MB-LBP) feature improvement, this paper proposes a method based on Generative Adversarial Networks (GAN) to encrypt face features. This work uses Wasserstein Generative Adversarial Networks Encryption (WGAN-E) to encrypt facial features. Because the encryption process is an irreversible one-way process, it protects facial features well. Compared with the traditional face hashing algorithm, the experimental results show that the face feature encryption algorithm has better confidentiality.