Durable pulmonary vein isolation with optimized high-power and very high-power short-duration temperature-controlled ablation: A step-by-step guide.

INTRODUCTION: Through systematic scientific rigor, the CLOSE guided workflow was developed and has been shown to improve pulmonary vein isolation durability. However, this technique was developed at a time when using power-controlled ablation catheters with conventional power ranges was the norm. There has been increased adoption of a high-power and very high-power short-duration ablation practice propelled by the availability of the temperature-controlled radiofrequency QDOT MICRO catheter. METHODS: There are fundamental differences in biophysics between very high-powered temperature guided ablation and conventional ablation strategy that may impact patient outcomes. The catheter's design and ablation modes offer flexibility in technique while accommodating the individual operator's clinical discretion and preference to deliver a durable, transmural, and contiguous lesion set. RESULTS: Here, we provide recommendations for 3 different workflows using the QDOT MICRO catheter in a step-by-step manner for pulmonary vein isolation based on our cumulative experience as early adopters of the technology and the data available in the scientific literature. CONCLUSIONS: With standardization, temperature-controlled ablation with the QDOT MICRO catheter provides operators the flexibility of implementing different ablation strategies to ensure durable contiguous pulmonary vein isolation depending on patient characteristics.

A Simply Synthesized Shaking-induced Small Molecule System with Repeatableand Instantaneous Discoloration Response.

Force-related discoloration materials are highly valuable because of their characteristics of visualization, easy operation, and environment friendliness. Most force-related discoloration materials focus on polymers and depend on bond scission, which leads to insensitivity and unrecoverable. Small-molecule systems based on well-defined molecular structures and simple composition with high sensitivity would exhibit considerable mechanochromic potential. However, to date, researches about force-related discoloration materials based on small molecule solution remain limited and are rarely reported. In this study, we developed a repeatable and instantaneous discoloration small molecule solution system by simple one-pot synthesis method. It exhibited an instantaneous chromic change from yellowish to dark green under shaking and reverting back to yellow within 1 minute after removal of the shaking. Experimental results confirmed that the discoloration mechanism is attributed to the oscillation accelerating the production of unstable ortho-OH phenoxyl radical. The newly developed shaking-induced discoloration small molecule system (SDSMS) promises in field of mechanical force sensing and optical encryption.

Contact force sensing manual catheter versus remote magnetic navigation ablation of atrial fibrillation: a single-center comparison.

BACKGROUND: Data comparing remote magnetic catheter navigation (RMN) with manual catheter navigation in combination with contact force sensing (MCN-CF) ablation of atrial fibrillation (AF) is lacking. The primary aim of the present retrospective comparative study was to compare the outcome of RMN versus (vs.) MCN-CF ablation of AF with regards to AF recurrence. Secondary aim was to analyze periprocedural risk, ablation characteristics and repeat procedures. METHODS: We retrospectively analyzed 452 patients undergoing a total of 605 ablations of AF: 180 patients were ablated using RMN, 272 using MCN-CF. RESULTS: Except body mass index there was no significant difference between groups at baseline. After a mean 1.6 ± 1.6 years of follow-up and 1.3 ± 0.4 procedures, 81% of the patients in the MCN-CF group remained free of AF recurrence compared to 53% in the RMN group (P < 0.001). After analysis of 153 repeat ablations (83 MCN-RF vs. 70 RMN; P = 0.18), there was a significantly higher reconnection rate of pulmonary veins after RMN ablation (P < 0.001). In multivariable Cox-regression analysis, RMN ablation (P < 0.001) and left atrial diameter (P = 0.013) was an independent risk factor for AF recurrence. Procedure time, radiofrequency application time and total fluoroscopy time and fluoroscopy dose were higher in the RMN group without difference in total number of ablation points. Complication rates did not differ significantly between groups (P = 0.722). CONCLUSIONS: In our retrospective comparative study, the AF recurrence rate and pulmonary vein reconnection rate is significantly lower with more favorable procedural characteristics and similar complication rate utilizing MCN-CF compared to RMN.

Holy grail of tissue regeneration: Size.

Cells and tissue within injured organs undergo a complicated healing process that still remains poorly understood. Interestingly, smaller organisms respond to injury with tissue regeneration and restoration of function, while humans and other large organisms respond to injury by forming dysfunctional, fibrotic scar tissue. Over the past few decades, allometric scaling principles have been well established to show that larger organisms experience exponentially higher tissue forces during movement and locomotion and throughout the organism's lifespan. How these evolutionary adaptations may affect tissue injury has not been thoroughly investigated in humans. We discuss how these adapations may affect healing and demonstrate that blocking the most evolutionary conserved biologic force sensor enables large organisms to heal after injury with true tissue regeneration. Future strategies to disrupt tissue force sensors may unlock the key to regenerating after injury in a wide range of organ systems.

Validation of the accuracy of contact force measurement by contemporary force-sensing ablation catheters.

INTRODUCTION: Contact force sensing catheters are widely used for ablation of cardiac arrhythmias. They allow quantification of catheter-to-tissue contact, which is an important determinant for lesion formation and may reduce the risk of complications. The accuracy of these sensors may vary across the measurement range, catheter-to-tissue angle, and amongst manufacturers. We aim to compare the accuracy and reproducibility of four different force sensing ablation catheters. METHODS: A measurement setup containing a heated saline water bath with an integrated force measurement unit was constructed and validated. Subsequently, we investigated four different catheter models, each equipped with a unique measurement technology: Tacticath Quartz (Abbott), AcQBlate Force (Biotronik/Acutus), Stablepoint (Boston Scientific), and Smarttouch SF (Biosense Webster). For each model, the accuracy of three different catheters was measured within the range of 0-60 g and at contact angles of 0°, 30°, 45°, 60°, and 90°. RESULTS: In total, 6685 measurements were performed using 4 × 3 catheters (median of 568, interquartile range: 511-606 measurements per catheter). Over the entire measurement-range, the force measured by the catheters deviated from the real force by the following absolute mean values: Tacticath 1.29 ± 0.99 g, AcQBlate Force 2.87 ± 2.37 g, Stablepoint 1.38 ± 1.29 g, and Smarttouch 2.26 ± 2.70 g. For some models, significant under- and overestimation of >10 g were observed at higher forces. Mean absolute errors of all models across the range of 10-40 g were <3 g. CONCLUSION: Contact measured by force-sensing catheters is accurate with 1-3 g deviation within the range of 10-40 g. Significant errors can occur at higher forces with potential clinical consequences.

A Modular 3-Degrees-of-Freedom Force Sensor for Robot-Assisted Minimally Invasive Surgery Research.

Effective force modulation during tissue manipulation is important for ensuring safe, robot-assisted, minimally invasive surgery (RMIS). Strict requirements for in vivo applications have led to prior sensor designs that trade off ease of manufacture and integration against force measurement accuracy along the tool axis. Due to this trade-off, there are no commercial, off-the-shelf, 3-degrees-of-freedom (3DoF) force sensors for RMIS available to researchers. This makes it challenging to develop new approaches to indirect sensing and haptic feedback for bimanual telesurgical manipulation. We present a modular 3DoF force sensor that integrates easily with an existing RMIS tool. We achieve this by relaxing biocompatibility and sterilizability requirements and by using commercial load cells and common electromechanical fabrication techniques. The sensor has a range of ±5 N axially and ±3 N laterally with errors of below 0.15 N and maximum errors below 11% of the sensing range in all directions. During telemanipulation, a pair of jaw-mounted sensors achieved average errors below 0.15 N in all directions. It achieved an average grip force error of 0.156 N. The sensor is for bimanual haptic feedback and robotic force control in delicate tissue telemanipulation. As an open-source design, the sensors can be adapted to suit other non-RMIS robotic applications.

IoT System for Real-Time Posture Asymmetry Detection.

The rise of the Internet of Things (IoT) has enabled the development of measurement systems dedicated to preventing health issues and monitoring conditions in smart homes and workplaces. IoT systems can support monitoring people doing computer-based work and avoid the insurgence of common musculoskeletal disorders related to the persistence of incorrect sitting postures during work hours. This work proposes a low-cost IoT measurement system for monitoring the sitting posture symmetry and generating a visual alert to warn the worker when an asymmetric position is detected. The system employs four force sensing resistors (FSR) embedded in a cushion and a microcontroller-based read-out circuit for monitoring the pressure exerted on the chair seat. Java-based software performs the real-time monitoring of the sensors' measurements and implements an uncertainty-driven asymmetry detection algorithm. The shifts from a symmetric to an asymmetric posture and vice versa generate and close a pop-up warning message, respectively. In this way, the user is promptly notified when an asymmetric posture is detected and invited to adjust the sitting position. Every position shift is recorded in a web database for further analysis of the sitting behavior.

A Novel Catheter Distal Contact Force Sensing for Cardiac Ablation Based on Fiber Bragg Grating with Temperature Compensation.

OBJECTIVE: To accurately achieve distal contact force, a novel temperature-compensated sensor is developed and integrated into an atrial fibrillation (AF) ablation catheter. METHODS: A dual elastomer-based dual FBGs structure is used to differentiate the strain on the two FBGs to achieve temperature compensation, and the design is optimized and validated by finite element simulation. RESULTS: The designed sensor has a sensitivity of 90.5 pm/N, resolution of 0.01 N, and root-mean-square error (RMSE) of 0.02 N and 0.04 N for dynamic force loading and temperature compensation, respectively, and can stably measure distal contact forces with temperature disturbances. CONCLUSION: Due to the advantages, i.e., simple structure, easy assembly, low cost, and good robustness, the proposed sensor is suitable for industrial mass production.

The Design and Development of Instrumented Toys for the Assessment of Infant Cognitive Flexibility.

The first years of an infant's life represent a sensitive period for neurodevelopment where one can see the emergence of nascent forms of executive function (EF), which are required to support complex cognition. Few tests exist for measuring EF during infancy, and the available tests require painstaking manual coding of infant behaviour. In modern clinical and research practice, human coders collect data on EF performance by manually labelling video recordings of infant behaviour during toy or social interaction. Besides being extremely time-consuming, video annotation is known to be rater-dependent and subjective. To address these issues, starting from existing cognitive flexibility research protocols, we developed a set of instrumented toys to serve as a new type of task instrumentation and data collection tool suitable for infant use. A commercially available device comprising a barometer and an inertial measurement unit (IMU) embedded in a 3D-printed lattice structure was used to detect when and how the infant interacts with the toy. The data collected using the instrumented toys provided a rich dataset that described the sequence of toy interaction and individual toy interaction patterns, from which EF-relevant aspects of infant cognition can be inferred. Such a tool could provide an objective, reliable, and scalable method of collecting early developmental data in socially interactive contexts.

DNA Nanotechnology for Investigating Mechanical Signaling in the Immune System.

Immune recognition occurs at specialized cell-cell junctions when immune cells and target cells physically touch. In this junction, groups of receptor-ligand complexes assemble and experience molecular forces that are ultimately generated by the cellular cytoskeleton. These forces are in the range of piconewton (pN) but play crucial roles in immune cell activation and subsequent effector responses. In this minireview, we will review the development of DNA based molecular tension sensors and their applications in mapping and quantifying mechanical forces experienced by immunoreceptors including T-cell receptor (TCR), Lymphocyte function-associated antigen (LFA-1), and the B-cell receptor (BCR) among others. In addition, we will highlight the use of DNA as a mechanical gate to manipulate mechanotransduction and decipher how mechanical forces regulate antigen discrimination and receptor signaling.

Utilization of coupled eigenmodes in Akiyama atomic force microscopy probes for bimodal multifrequency sensing.

Akiyama atomic force microscopy probes represent a unique means of combining several of the desirable properties of tuning fork and cantilever probe designs. As a hybridized mechanical resonator, the vibrational characteristics of Akiyama probes result from a complex coupling between the intrinsic vibrational eigenmodes of its constituent tuning fork and bridging cantilever components. Through a combination of finite element analysis modeling and experimental measurements of the thermal vibrations of Akiyama probes we identify a complex series of vibrational eigenmodes and measure their frequencies, quality factors, and spring constants. We then demonstrate the viability of Akiyama probes to perform bimodal multi-frequency force sensing by performing a multimodal measurement of a surface's nanoscale photothermal response using photo-induced force microscopy imaging techniques. Further performing a parametric search over alternative Akiyama probe geometries, we propose two modified probe designs to enhance the capability of Akiyama probes to perform sensitive bimodal multifrequency force sensing measurements.

Comparison of Cryoballoon and Contact Force-Sensing Radiofrequency Ablation for Persistent Atrial Fibrillation in Clinical Practice.

BACKGROUND: Outcomes of cryoballoon ablation for persistent atrial fibrillation (AF) are unclear, especially in Japanese patients, so the effectiveness and safety of cryoballoon ablation in clinical practice were retrospectively compared with those of contact force-sensing radiofrequency (CFRF) ablation including the high-power protocol.Methods and Results:Consecutive patients with persistent AF were reviewed, and 253 and 265 patients who underwent cryoballoon and CFRF ablation, respectively, were enrolled. The primary endpoint was atrial arrhythmia recurrence. The secondary endpoints were periprocedural complications and repeat ablation. The rate of additional left atrial (LA) ablation after pulmonary vein isolation (PVI) was similar between groups (68.8% cryoballoon vs. 74.0% CFRF, P=0.19). Freedom from atrial arrhythmia recurrence was comparable between groups over a follow-up of 25.5±12.5 months (72.3% cryoballoon vs. 69.8% CFRF; adjusted hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.59-1.21, P=0.36). Outcomes were similar in the subgroups of PVI alone and PVI plus additional LA ablation. LA posterior wall isolation, absence of defragmentation, and low creatine clearance, but not catheter selection, were associated with the primary endpoint. Periprocedural complications (adjusted HR 0.73, 95% CI 0.34-1.54, P=0.41) and repeat ablation (adjusted HR 1.11, 95% CI 0.71-1.74, P=0.64) were similar for both procedures. CONCLUSIONS: Cryoballoon ablation for persistent AF in Japanese clinical practice had acceptable outcomes comparable to those of advanced CFRF ablation.

Direct measurement of near-nano-Newton forces developed by self-organizing actomyosin fibers bound α-catenin.

BACKGROUND INFORMATION: Actin cytoskeleton contractility plays a critical role in morphogenetic processes by generating forces that are then transmitted to cell-cell and cell-ECM adhesion complexes. In turn, mechanical properties of the environment are sensed and transmitted to the cytoskeleton at cell adhesion sites, influencing cellular processes such as cell migration, differentiation and survival. Anchoring of the actomyosin cytoskeleton to adhesion sites is mediated by adaptor proteins such as talin or α-catenin that link F-actin to transmembrane cell adhesion receptors, thereby allowing mechanical coupling between the intracellular and extracellular compartments. Thus, a key issue is to be able to measure the forces generated by actomyosin and transmitted to the adhesion complexes. Approaches developed in cells and those probing single molecule mechanical properties of α-catenin molecules allowed to identify α-catenin, an F-actin binding protein which binds to the cadherin complexes as a major player in cadherin-based mechanotransduction. However, it is still very difficult to bridge intercellular forces measured at cellular levels and those measured at the single-molecule level. RESULTS: Here, we applied an intermediate approach allowing reconstruction of the actomyosin-α-catenin complex in acellular conditions to probe directly the transmitted forces. For this, we combined micropatterning of purified α-catenin and spontaneous actomyosin network assembly in the presence of G-actin and Myosin II with microforce sensor arrays used so far to measure cell-generated forces. CONCLUSIONS: Using this method, we show that self-organizing actomyosin bundles bound to micrometric α-catenin patches can apply near-nano-Newton forces. SIGNIFICANCE: Our results pave the way for future studies on molecular/cellular mechanotransduction and mechanosensing.

Soft Multi-Directional Force Sensor for Underwater Robotic Application.

Tactile information is crucial for recognizing physical interactions, manipulation of an object, and motion planning for a robotic gripper; however, concurrent tactile technologies have certain limitations over directional force sensing. In particular, they are expensive, difficult to fabricate, and mostly unsuitable for underwater use. Here, we present a facile and cost-effective synthesis technique of a flexible multi-directional force sensing system, which is also favorable to be utilized in underwater environments. We made use of four flex sensors within a silicone-made hemispherical shell structure. Each sensor was placed 90° apart and aligned with the curve of the hemispherical shape. If the force is applied on the top of the hemisphere, all the flex sensors would bend uniformly and yield nearly identical readings. When force is applied from a different direction, a set of flex sensors would characterize distinctive output patterns to localize the point of contact as well as the direction and magnitude of the force. The deformation of the fabricated soft sensor due to applied force was simulated numerically and compared with the experimental results. The fabricated sensor was experimentally calibrated and tested for characterization including an underwater demonstration. This study would widen the scope of identification of multi-directional force sensing, especially for underwater soft robotic applications.

Assessment System for Predicting Maximal Safe Range for Heel Height by Using Force-Sensing Resistor Sensors and Regression Models.

Women often wear high-heeled shoes for professional or esthetic reasons. However, high-heeled shoes can cause discomfort and injury and can change the body's center of gravity when maintaining balance. This study developed an assessment system for predicting the maximal safe range for heel height by recording the plantar pressure of participants' feet by using force-sensing resistor (FSR) sensors and conducting analyses using regression models. Specifically, 100 young healthy women stood on an adjustable platform while physicians estimated the maximal safe height of high-heeled shoes. The collected FSR data combined with and without personal features were analyzed using regression models. The experimental results showed that the regression model based on the pressure data for the right foot had better predictive power than that based on data for the left foot, regardless of the module. The model with two heights had higher predictive power than that with a single height. Furthermore, adding personal features under the condition of two heights afforded the best predictive effect. These results can help wearers choose maximal safe high-heeled shoes to reduce injuries to the bones and lower limbs.

Origami-Inspired Structure with Pneumatic-Induced Variable Stiffness for Multi-DOF Force-Sensing.

With the emerging need for human-machine interactions, multi-modal sensory interaction is gradually pursued rather than satisfying common perception forms (visual or auditory), so developing flexible, adaptive, and stiffness-variable force-sensing devices is the key to further promoting human-machine fusion. However, current sensor sensitivity is fixed and nonadjustable after fabrication, limiting further development. To solve this problem, we propose an origami-inspired structure to achieve multiple degrees of freedom (DoFs) motions with variable stiffness for force-sensing, which combines the ductility and flexibility of origami structures. In combination with the pneumatic actuation, the structure can achieve and adapt the compression, pitch, roll, diagonal, and array motions (five motion modes), which significantly increase the force adaptability and sensing diversity. To achieve closed-loop control and avoid excessive gas injection, the ultra-flexible microfiber sensor is designed and seamlessly embedded with an approximately linear sensitivity of ∼0.35 Ω/kPa at a relative pressure of 0-100 kPa, and an exponential sensitivity at a relative pressure of 100-350 kPa, which can render this device capable of working under various conditions. The final calibration experiment demonstrates that the pre-pressure value can affect the sensor's sensitivity. With the increasing pre-pressure of 65-95 kPa, the average sensitivity curve shifts rightwards around 9 N intervals, which highly increases the force-sensing capability towards the range of 0-2 N. When the pre-pressure is at the relatively extreme air pressure of 100 kPa, the force sensitivity value is around 11.6 Ω/N. Therefore, our proposed design (which has a low fabrication cost, high integration level, and a suitable sensing range) shows great potential for applications in flexible force-sensing development.

Carbon Black/PDMS Based Flexible Capacitive Tactile Sensor for Multi-Directional Force Sensing.

Flexible sensing tends to be widely exploited in the process of human-computer interactions of intelligent robots for its contact compliance and environmental adaptability. A novel flexible capacitive tactile sensor was proposed for multi-directional force sensing, which is based on carbon black/polydimethylsiloxane (PDMS) composite dielectric layer and upper and lower electrodes of carbon nanotubes/polydimethylsiloxane (CNTs/PDMS) composite layer. By changing the ratio of carbon black, the resolution of carbon black/PDMS composite layer increases at 4 wt%, and then decreases, which was explained according to the percolation theory of the conductive particles in the polymer matrix. Mathematical model of force and capacitance variance was established, which can be used to predict the value of the applied force. Then, the prototype with carbon black/PDMS composite dielectric layer was fabricated and characterized. SEM observation was conducted and a ratio was introduced in the composites material design. It was concluded that the resolution of carbon sensor can reach 0.1 N within 50 N in normal direction and 0.2 N in 0-10 N in tangential direction with good stability. Finally, the multi-directional force results were obtained. Compared with the individual directional force results, the output capacitance value of multi-directional force was lower, which indicated the amplitude decrease in capacity change in the normal and tangential direction. This might be caused by the deformation distribution in the normal and tangential direction under multi-directional force.

A Force-Feedback Methodology for Teleoperated Suturing Task in Robotic-Assisted Minimally Invasive Surgery.

With robotic-assisted minimally invasive surgery (RAMIS), patients and surgeons benefit from a reduced incision size and dexterous instruments. However, current robotic surgery platforms lack haptic feedback, which is an essential element of safe operation. Moreover, teleportation control challenges make complex surgical tasks like suturing more time-consuming than those that use manual tools. This paper presents a new force-sensing instrument that semi-automates the suturing task and facilitates teleoperated robotic manipulation. In order to generate the ideal needle insertion trajectory and pass the needle through its curvature, the end-effector mechanism has a rotating degree of freedom. Impedance control was used to provide sensory information about needle-tissue interaction forces to the operator using an indirect force estimation approach based on data-based models. The operator's motion commands were then regulated using a hyperplanar virtual fixture (VF) designed to maintain the desired distance between the end-effector and tissue surface while avoiding unwanted contact. To construct the geometry of the VF, an optoelectronic sensor-based approach was developed. Based on the experimental investigation of the hyperplane VF methodology, improved needle-tissue interaction force, manipulation accuracy, and task completion times were demonstrated. Finally, experimental validation of the trained force estimation models and the perceived interaction forces by the user was conducted using online data, demonstrating the potential of the developed approach in improving task performance.

Assessment of grip force sense test-retest reliability in healthy male participants.

There has been a lack of research to date regarding the test-retest reliability of grip force sense in healthy adult males. This study was therefore designed to explore this topic across a series of target force levels using an ipsilateral force reproduction task. The same experienced research staff conducted two testing sessions for each study participant, with 1 week between test sessions. Intraclass correlation coefficient values indicated that these force sensing tests exhibited good to fair reliability with respect to both absolute error (0.42-0.63) and constant error (0.49-0.60), although variable error was indicative of poor reliability (-0.85 to 0.14). Together, these results suggest that researchers can achieve a fair level of test-retest reliability when analysing grip force sense in healthy adult males, with results being most reliable at force levels of 20 N and 50 N, as determined based upon measured constant error and absolute error. Practitioner summary: To ensure that grip force sense can be accurately interpreted over time, it is important to assess the test-retest reliability. It is recommended that practitioners measure the absolute error and constant error at force levels of 20 N and 50 N when assessing grip force sense in a clinical setting.

Alternative N-terminal regions of Drosophila myosin heavy chain II regulate communication of the purine binding loop with the essential light chain.

We investigated the biochemical and biophysical properties of one of the four alternative exon-encoded regions within the Drosophila myosin catalytic domain. This region is encoded by alternative exons 3a and 3b and includes part of the N-terminal ß-barrel. Chimeric myosin constructs (IFI-3a and EMB-3b) were generated by exchanging the exon 3-encoded areas between native slow embryonic body wall (EMB) and fast indirect flight muscle myosin isoforms (IFI). We found that this exchange alters the kinetic properties of the myosin S1 head. The ADP release rate (k-D ) in the absence of actin is completely reversed for each chimera compared with the native isoforms. Steady-state data also suggest a reciprocal shift, with basal and actin-activated ATPase activity of IFI-3a showing reduced values compared with wild-type (WT) IFI, whereas for EMB-3b these values are increased compared with wild-type (WT) EMB. In the presence of actin, ADP affinity (KAD ) is unchanged for IFI-3a, compared with IFI, but ADP affinity for EMB-3b is increased, compared with EMB, and shifted toward IFI values. ATP-induced dissociation of acto-S1 (K1k+2 ) is reduced for both exon 3 chimeras. Homology modeling, combined with a recently reported crystal structure for Drosophila EMB, indicates that the exon 3-encoded region in the myosin head is part of the communication pathway between the nucleotide binding pocket (purine binding loop) and the essential light chain, emphasizing an important role for this variable N-terminal domain in regulating actomyosin crossbridge kinetics, in particular with respect to the force-sensing properties of myosin isoforms.