Safety and efficacy of low-power pure-cut hot snare polypectomy for small nonpedunculated colorectal polyps compared with conventional resection methods: A propensity score matching analysis.

Objectives: Cold snare polypectomy (CSP) is widely performed for small colorectal polyps. However, small colorectal polyps sometimes include high-grade adenomas or carcinomas that require endoscopic resection with electrocautery. This study aimed to evaluate the efficacy and safety of a novel resection technique, hot snare polypectomy with low-power pure-cut current (LPPC-HSP) for small colorectal polyps, compared with CSP and conventional endoscopic mucosal resection (EMR). Methods: Records of patients who underwent CSP, EMR, or LPPC-HSP for nonpedunculated colorectal polyps less than 10 mm between April 2021 and March 2022 were retrospectively evaluated. We analyzed and compared the treatment outcomes of CSP and EMR with those of LPPC-HSP using propensity score matching. Results: After propensity score matching of 396 pairs, an analysis of CSP and LPPC-HSP indicated that LPPC-HSP had a significantly higher R0 resection rate (84% vs. 68%; p < 0.01). Delayed bleeding was observed in only two cases treated with CSP before matching. Perforation was not observed with either treatment. After propensity score matching of 176 pairs, an analysis of EMR and LPPC-HSP indicated that their en bloc and R0 resection rates were not significantly different (99.4% vs. 100%, p = 1.00; 79% vs. 81%, p = 0.79). Delayed bleeding and perforation were not observed with either treatment. Conclusions: The safety of LPPC-HSP was comparable to that of CSP. The treatment outcomes of LPPC-HSP were comparable to those of conventional EMR for small polyps. These results suggest that this technique is a safe and effective treatment for nonpedunculated polyps less than 10 mm.

Pressure Control Surrogate Formula for Estimating Mechanical Power in ARDS is Associated with Mortality.

BACKGROUND: Mechanical power applied to the respiratory system (MPRS) is associated with ventilator-induced lung injury (VILI) and ARDS mortality. Absent automated ventilator MPRS measurements, the alternative is clinically unwieldy equations. However, simplified surrogate formulas are now available and accurately reflect values produced by airway pressure-volume curves. This retrospective, observational study examined whether the surrogate pressure-control equation alone could accurately assess mortality risk in ARDS subjects managed almost exclusively with volume-control ventilation.METHODS: 948 subjects were studied in whom invasive mechanical ventilation and implementation of ARDSNet ventilator protocols commenced ≤ 24hr after ARDS onset, and who survived > 24hr. MPRS was calculated as 0.098 x respiratory frequency x VT x (PEEP + driving pressure [PDR]). MPRS was assessed as a risk factor for hospital mortality, and compared between non-survivors and survivors across Berlin Definition classifications. In addition, mortality was compared across 4 MPRS thresholds associated with VILI or mortality (ie. 15, 20, 25 and 30 J/m).RESULTS: MPRS was associated with increased mortality risk: Odds Ratio (95% CI) of 1.06 (1.04-1.07) per J/m, P<0.001). Median MPRS differentiated non-survivors from survivors in Mild (24.7 vs. 18.5 J/m, respectively, P==0.034); Moderate (25.7 vs. 21.3 J/m, P<0.001); and Severe ARDS (28.7 vs. 23.5 J/m, P<0.001). Across 4 MPRS thresholds mortality increased from 23-29% when MPRS was < threshold vs. 38-51% when MPRS was > threshold (P<0.001). In the > cohort the Odds Ratio (95%CI) increased from 2.03 (1.34-3.12) to 2.51 (1.87-3.33).CONCLUSION: The pressure control surrogate formula is sufficiently accurate to assess mortality in ARDS, even when using volume control ventilation. In our subjects when MPRS exceeds established cut-off values for VILI or mortality risk, we found mortality risk consistently increased by a factor of > 2.0.

Spectral Power Distribution of Heart Rate Variability in Contiguous Short-Term Intervals.

INTRODUCTION: Heart rate variability (HRV) is determined by the variation of consecutive cardiac electrical excitations, usually from RR intervals of an EKG. The sequence of intervals is a time series that yields three HRV parameter categories: time domain, frequency domain, and nonlinear. Parameter estimates are based on widely different EKG sample times: short-term (~5-10 minutes), longer (24 hours), and ultra-short (<5 minutes). Five-minute intervals are useful to evaluate intervention effects that change HRV in a single session by comparing pre-to-post values. This approach relies on knowing the minimal detectible change (MDC) that indicates a real change in clinical and research studies. The specific aims of this pilot study were to (1) evaluate HRV power and its spectral distribution among contiguous five-minute intervals, (2) compare the power distribution in a five-minute interval with a full 45-minute assessment, and (3) provide data to aid estimation of the MDC between pre- and post-interventions during a single session.  Methods: Twelve self-reported healthy young adults participated after signing an approved consent. Participation required subjects who had no history of cardiovascular disease or were taking vasoactive substances. Persons with diabetes were not eligible. While subjects were supine, EKG leads were placed, and EKG was recorded for 45 minutes at 1000 samples/sec. The 45 minutes were divided into nine five-minute contiguous intervals, and the spectral density in each was determined. Total power and spectral percentages within each interval were assessed in the very low (VLF, 0.003-0.04 Hz), low (LF, 0.04-0.15 Hz), and high (HF, 0.15-0.4 Hz) frequency bands. These were compared among intervals and to the full 45-minute sample. The MDC was determined by comparing powers in five-minute intervals separated by 10 minutes. The standard error of the measurement (SEME) for each pair was calculated from the square root of the mean square error (√MSE). MSE was based on a two-factor analysis of variance, and MDC was 2×√2×SEME. RESULTS: Differences in total power and spectral power distribution among intervals were not statistically significant. The total mean power±SD was 4561±1434 ms². The maximum difference in total power was 7.85%. The mean power for the VLF, LF, and HF bands was respectively 1713±1736 ms², 1574±1072 ms², and 1257±1016 ms². The maximum percentage difference in spectral power across all intervals for VLF, LF, and HF was respectively 3.75%, 8.5%, and 7.4%. The percentage of power in the VLF, LF, and HF bands was respectively 37.9%, 36.1%, and 25.9%. The ratios of spectral to total power for VLF, LF, and HF bands were respectively 0.80±0.07, 1.20±0.11, and 1.22±0.10. MDC percentage values were 21.0±4.9% for the HF band, 25.7±1.4% for the LF band, and 30.4±5.5% for the VLF band. CONCLUSION: Results offer initial estimates of variations in HRV power in the VLF, LF, and HF bands in contiguous five-minute intervals and estimates of the minimum detectible "real" changes between intervals separated by 10 minutes. The pattern of variation and data are useful in experimental planning in which HRV spectral power changes are assessed subsequent to a short-duration intervention during a single session. MDC values (21.0% in the HF band to 30.4% in the VLF band) provide initial estimates useful for estimating the number of participants needed to evaluate the impact of an intervention on spectral components of HRV.

Performance and emission profiles of petroleum nut (Pittosporum resineferum Hemsl.) biodiesel in combustion ignition engine-generator for power generation.

One of the traditional fuels for power generation in the Philippines is the petroleum diesel (PD). However, its extensive usage contributes to environmental degradation, health risks and climate change concerns. Alternative fuels such as petroleum nut biodiesel (PNB) may address the increasing consumption of PD amidst depleting fossil reserves and related issues. This study aimed to produce, characterize, and observe the behavior of PNB as a fuel in a compression ignition (CI) engine-power generation system at various loads of 0 %, 25 %, 50 %, 75 % and 100 %. Petroleum nut fruits were collected, extracted of oil then transesterified to produce PNB. The performance and emission profiles of the latter were determined. Degumming increased the PNB yield by 24.28 %. Additional refining decreased colorants and impurities. Majority of the chemical and physical properties of the PNB showed comparable values with those of PD. Various blends of PNB-PD were prepared and tested in terms of their performance and emissions. The 20 % PNB mixed with 80 % PD (B20) showed the most efficient performance after 100 % PD with at least 3.95 % decrease, whereas PNB for specific fuel consumption (SFC) showed at most 30.78 % higher than all fuels for all loads. The heat release rate (HRR) increases with increasing %PNB in the PNB-PD blend. PNB generally showed the highest CO2 and NOx emissions with at least 16.67 % and 80.52 % lower with PD respectively, but the lowest for CO emission with at least 13.42 % difference compared with PD. Finally, the study confirms that CI engine-generator can be operated with 100 % PNB and its blends without engine modification.

Co-firing characteristic prediction of solid waste and coal for supercritical CO2 power cycle based on CFD simulation and machine learning algorithm.

The co-firing technology of combustible solid waste (CSW) and coal in the supercritical CO2 (S-CO2) circulating fluidized bed (CFB) can effectively deal with domestic waste, promote social and environmental benefits, improve the coal conversion rate, and reduce pollutant emission. This study focuses on the co-firing characteristics of CSW and coal under S-CO2 power cycle, and simulations are conducted by employing Multiphase Particle-in-cell (MP-PIC) method integrated with the comprehensive chemical reaction models in a 300 MW S-CO2 CFB boiler. Effects of operating parameters including fuel mixture proportion and first stage stoichiometry on the gas emission characteristics are further analyzed. Based on training and testing database based on the simulation results, a novel Improved Whale Optimization Algorithm and Bi-dictionary Long Short-Term Memory (IWOA-BiLSTM) algorithm model is established to predict CFB temperature, NOx emission concentration, and SO2 emission concentration, respectively. Results show that CO and SO2 decrease with the coal mass ratio of the fuel mixture increasing, while NOx increases. With the increase of first stage stoichiometry, CO increases, NOx declines, and the change of SO2 is not obvious. Compared with two other basic algorithm models, the prediction error of the proposed algorithm model for the three targets is minimal with the average relative error of 0.032 %, 0.231 %, and 0.157 %, respectively, which can meet the prediction requirements with acceptable accuracy.

When a Patient Is at Foreseeable Risk of Losing Decisional and Functional Capacity.

The four-skills model of decisional capacity for providing informed consent for medical treatment developed by Appelbaum and Grisso is codified into most state statutes in articulating the legal criteria for establishing capacity. Decisional capacity is traditionally determined at a point in time based on a narrow clinical question; however, there are clinical scenarios in which patients may currently have decisional capacity but their recurrent nonadherence to care places them at foreseeable risk of being acutely incapacitated, both decisionally and functionally, in the near future. There is a gap in terms of how these four skills ought to be adapted when applied to a patient with recurrent altered mental status, especially delirium, because of nonadherence. To describe this clinical situation, we introduce a new risk factor, "foreseeable risk of losing decisional and functional capacity," and discuss the clinical evaluation of a patient who currently has capacity but for whom this risk factor applies. We consider the implications of being at foreseeable risk of losing capacity and how foreseeable risk can be translated into a capacity determination in the present. We also describe interventions that can serve to protect the patient's rights and safety.

A brief review of perovskite quantum dot solar cells:Synthesis, property and defect passivation.

Perovskite quantum dot solar cells (PQDSCs), as the promising candidate for the next generation of solar cell, have garnered the significant attention over the past decades. However, the performance and stability of PQDSCs are highly dependent on the properties of interfaces between the perovskite quantum dots (PQDs) and the other layers in the device. This work provides a brief overview of PQDSCs, including the synthesis of PQDs, the characteristics and preparation methods of PQDs, the photoelectric properties as the light absorption layer and optimization methods for PQDSCs with high efficiency. Future directions and potential applications are also highlighted.

Self-Templating Synthesis of Mesoporous Carbon Cathode Materials for High-Performance Lithium-Ion Capacitors.

Lithium-ion capacitors (LICs) have attracted considerable interest because of their excellent power and energy densities. However, the development of LICs is limited by the low capacity of the cathode and the kinetics mismatch between the cathode and anode. In this work, mesoporous carbon materials (MCs) with uniform pore sizes were prepared using magnesium citrate as the raw material through a self-templating method. During the carbonization process, MgO nanoparticles generated from magnesium citrate act as a template, resulting in a more orderly pore structure. The resultant MCs demonstrate a high specific surface area of 1673 m2 g-1 and an abundance of small mesopores, which significantly accelerated ion migration within the electrolyte and expedited the formation of electric double layers. Benefiting from these advantages, the MCs cathode demonstrates a high reversible specific capacity, excellent cycling stability, and rate performance. The assembled MCs-based LIC provides a high energy density of 152.2 Wh kg-1 and a high power density of 14.3 kW kg-1. After 5000 cycles, a capacity retention rate of 80% at the current density of 1 A g-1 is obtained. These results highlight the excellent potential of MCs as a cathode material for LICs.

Ultrasound effect on a biorefinery lignin-cellulose mixture.

Forest biorefineries provide multiple new avenues for applied research. The main concept lies in the malleability of the processes and their stepwise organization. The core element of the biorefinery concept addressed in the present study is the pretreatment step; here, wood biomass is converted into free hemicellulosic sugars, lignin and cellulose. In traditional approaches, the pretreatment step is a starting point for isolating and separating lignin or cellulose through different processes. In this study, instead of performing any separation, a lignin-cellulose mixture was used as its own material, and the effects of ultrasound treatment with a probe system at 20 kHz, with various amplitude, sonication time and dry matter content were investigated with the aim of assessing the formation of a nanocellulose structure with a high lignin content (>30 %) and investigating the stability of the lignin-cellulose mixture under aqueous conditions. We demonstrated the importance of dry matter content for the specific particle size and water retention values for this mixture. US treatment of lignin-cellulose mixtures <4 % dry matter formed a gel-like material, with low particle size (90 % below 30 µm and smallest at nanoscale). Low dry matter loading led to better US transfer and higher conversion of cellulose to <100 nm nanoparticles. Our study can serve as a baseline for future developments in the field of stable emulsions, filtering materials or inputs for material synthesis.

Successful Treatment of Multiple Large Intrarenal Stones in a 2-Year-Old Boy Using a Single-Use Flexible Ureteroscope and High-Power Laser Settings.

The standard treatment procedures for managing renal calculi in the pediatric population are similar to those in adults. The application of flexible ureteroscopy has contributed to the increased popularity of retrograde intrarenal surgery (RIRS) as an alternative therapeutic modality that can be successfully applied in children. One of the most significant innovations of the last decade is the introduction of single-use flexible ureteroscopes (fURSs). In this case report, we present the case of a 2-year-old boy with multiple large calculi in his right kidney, which were successfully removed after a single session of RIRS using a 7.5 F single-use fURS and high-power laser settings. The total operative and lithotripsy times were estimated at 90 and 75 min, respectively. No complications were recorded. The hemoglobin loss was calculated at 0.3 mg/dL, while the creatinine level was decreased by 0.1 mg/dL. The urethral catheter was removed on the first postoperative day, and the patient was discharged. The management of multiple or large kidney stones is very challenging in the pediatric population under the age of three years. Convenient preoperative planning and the appropriate use of available equipment may lead to excellent outcomes accompanied by a reduced risk for complications.

Enhancing Recovery and Performance Through Plyometric Training for a Badminton Athlete After Anterior Cruciate Ligament (ACL) Reconstruction: A Case Report.

Anterior cruciate ligament (ACL) injuries are widespread, particularly in sports that involve rapid changes in direction, such as badminton, and it incapacitates an athlete severely and for a long time. ACL reconstruction followed by a structured rehabilitation program is essential for returning to peak performance. Plyometric training, known for enhancing explosive power and agility, is increasingly incorporated in post-ACL reconstruction rehabilitation for athletes. This case report presents the rehabilitation of a 19-year-old female badminton player operated for ACL reconstruction through the inculcation of plyometric training in the later phase to optimize better performance outcomes. The athlete demonstrated significant improvements in knee stability, strength, and functional performance. Plyometric exercises played a crucial role in restoring explosive power and agility, essential for competitive badminton, thereby facilitating a successful return to sport.

Enhancing rice yield prediction: a deep fusion model integrating ResNet50-LSTM with multi source data.

Rice production is pivotal for ensuring global food security. In Pakistan, rice is not only the dominant Kharif crop but also a significant export commodity that significantly impacts the state's economy. However, Pakistan faces challenges such as abrupt climate change and the COVID-19 pandemic, which affect rice production and underscore the need for predictive models for informed decisions aimed at improving productivity and ultimately the state's economy. This article presents an innovative deep learning-based hybrid predictive model, ResNet50-LSTM, designed to forecast rice yields in the Gujranwala district, Pakistan, utilizing multi-modal data. The model incorporates MODIS satellite imagery capturing EVI, LAI, and FPAR indices along with meteorological and soil data. Google Earth Engine is used for the collection and preprocessing of satellite imagery, where the preprocessing steps involve data filtering, applying region geometry, interpolation, and aggregation. These preprocessing steps were applied manually on meteorological and soil data. Following feature extraction from the imagery data using ResNet50, the three LSTM model configurations are presented with distinct layer architectures. The findings of this study exhibit that the model configuration featuring two LSTM layers with interconnected cells outperforms other proposed configurations in terms of prediction performance. Analysis of various feature combinations reveals that the selected feature set (EVI, FPAR, climate, and soil variables) yields highly accurate results with an R2 = 0.9903, RMSE = 0.1854, MAPE = 0.62%, MAE = 0.1384, MRE = 0.0062, and Willmott's index of agreement = 0.9536. Moreover, the combination of EVI and FPAR is identified as particularly effective. Our findings revealed the potential of our framework for globally estimating crop yields through the utilization of publicly available multi-source data.

Social status mediates the propagation of unfairness.

Fairness constitutes a cornerstone of social norms, emphasizing equal treatment and equitable distribution in interpersonal relationships. Unfair treatment often leads to direct responses and can spread to others through a phenomenon known as pay-it-forward (PIF) reciprocity. This study examined how unfairness spreads in interactions with new partners who have higher, equal, or lower status than the participants. In the present study, participants (N = 47, all Korean) were given either fair or unfair treatment in the first round of a dictator game. They then allocated monetary resources among partners positioned at various hierarchical levels in the second round. Our main goal was to determine if the severity of inequity inflicted on new partners was influenced by their hierarchical status. The results revealed an inclination among participants to act more generously towards partners of higher ranking despite prior instances of unfair treatment, whereas a tendency for harsher treatment was directed towards those with lower ranking. The interaction between the fairness in the first round (DG1) and the hierarchical status of the partner in the second round (DG2) was significant, indicating that the effect of previous fairness on decision-making differed depending on the ranking of the new partners. This study, therefore, validates the presence of unfairness PIF reciprocity within hierarchical contexts.

Environmental impact assessment of different power generation strategies in Oman: A comparative life-cycle analysis.

This paper presents a comparative environmental impact assessment considering different power generation strategies in Oman. The Life-Cycle Assessment (LCA) methodology, and the OpenLCA tool, were employed in carrying out comprehensive analysis, and evaluation of the various environmental aspects in filling the research gap, by replacing conventional diesel generators with natural gas alternatives in Oman. The obtained results indicate that utilizing natural gas significantly reduces environmental impacts, including a decrease in global warming potential to 2.27 million kg CO2 eq, fossil fuel depletion to 34.5 million kg oil-eq, and ozone depletion to 0.13 kg CFC-11 eq. This study would help in policy decision-making to support a potential shift in power generation system, transitioning from the current use of diesel generator sets to flared produced Natural Gas across crude oil processing plants. Thus, mitigating operational cost, and improving efficiencies, for sustainable developments. Another salient part of this study is the implementation of more sustainable energy practices that supports the broader application of LCA in evaluating industrial environmental impacts. Furthermore, the results obtained in this work are in line with recent global climate change commitments and Oman's Vision 2040, in achieving cleaner energy sources to minimize environmental harm in the oil and gas sector.

Simulation methodologies to determine statistical power in laboratory animal research studies.

Null hypothesis significance testing is a statistical tool commonly employed throughout laboratory animal research. When experimental results are reported, the reproducibility of the results is of utmost importance. Establishing standard, robust, and adequately powered statistical methodology in the analysis of laboratory animal data is critical to ensure reproducible and valid results. Simulation studies are a reliable method for assessing the power of statistical tests, however, biologists may not be familiar with simulation studies for power despite their efficacy and accessibility. Through an example of simulated Harlan Sprague-Dawley (HSD) rat organ weight data, we highlight the importance of conducting power analyses in laboratory animal research. Using simulations to determine statistical power prior to an experiment is a financially and ethically sound way to validate statistical tests and to help ensure reproducibility of findings in line with the 4R principles of animal welfare.

Comparison of measurements and calculated lens power using three biometers: a Scheimpflug tomographer with partial coherence interferometry and two swept source optical coherence tomographers.

PURPOSE: To compare the biometric measurements obtained from the Pentacam AXL Wave, IOLMaster 700, and ANTERION and calculate the recommended intraocular lens power using the Barrett Formulae. METHODS: This was a retrospective cross-sectional study of patients who underwent biometry using the Pentacam AXL Wave, IOLMaster 700, and ANTERION. Flat keratometry (K1), steep keratometry (K2), anterior chamber depth (ACD), and axial length (AL) from each device were measured and compared. These parameters were used to calculate the recommended IOL powers using the Barrett formula. RESULTS: The study included 252 eyes of 153 patients. The IOLMaster had the highest acquisition rate among the two biometers. The Pentacam obtained the shortest mean AL, the IOLMaster measured the highest mean keratometry values, and the ANTERION measured the highest mean ACD. In terms of pairwise comparisons, keratometry and axial length were not significantly different between the Pentacam-IOLMaster and ANTERION-IOLMaster groups, while the rest of the pairwise comparisons were statistically significant. In nontoric and toric eyes, 35-45% of patients recommended the same sphere of IOL power. In another 30-40%, the Pentacam and ANTERION recommended an IOL power one step greater than that of the IOLMaster-derived data. 50% of the study population recommended the same toric-cylinder IOL power. CONCLUSIONS: The Pentacam AXL Wave, IOLMaster 700, and ANTERION can reliably provide data for IOL power calculations; however, these data are not interchangeable. In nontoric and toric eyes, 35-45% of cases recommended the same sphere IOL power, and in another 30-40%, the Pentacam and ANTERION recommended one-step higher IOL power than the IOLMaster-derived data. In targeting emmetropia, selecting the first plus IOL power is advisable when using the Pentacam and ANTERION to approximate the IOL power calculations recommended by the IOLMaster 700.

Estimating power in complex nonlinear structural equation modeling including moderation effects: The powerNLSEM R-package.

The model-implied simulation-based power estimation (MSPE) approach is a new general method for power estimation (Irmer et al., 2024). MSPE was developed especially for power estimation of non-linear structural equation models (SEM), but it also can be applied to linear SEM and manifest models using the R package powerNLSEM. After first providing some information about MSPE and the new adaptive algorithm that automatically selects sample sizes for the best prediction of power using simulation, a tutorial on how to conduct the MSPE for quadratic and interaction SEM (QISEM) using the powerNLSEM package is provided. Power estimation is demonstrated for four methods, latent moderated structural equations (LMS), the unconstrained product indicator (UPI), a simple factor score regression (FSR), and a scale regression (SR) approach to QISEM. In two simulation studies, we highlight the performance of the MSPE for all four methods applied to two QISEM with varying complexity and reliability. Further, we justify the settings of the newly developed adaptive search algorithm via performance evaluations using simulation. Overall, the MSPE using the adaptive approach performs well in terms of bias and Type I error rates.

Electrification and specialist training associated with decreased neonatal mortality and increased admissions in Sierra Leone.

AIM: The aim of this study was to describe the evolution of a regional neonatal service in Sierra Leone and changes in mortality and service use as it transitioned from a non-specialist service to a dedicated special care baby unit (SCBU). METHODS: This was a retrospective observational study. Anonymised data were taken from the ward admissions books at Bo Government Hospital, and trends in admissions and mortality within the neonatal service were examined for each stage of the department's evolution. RESULTS: Four phases of the service's development were identified between November 2015 and October 2019. Records of 2377 admissions and 333 deaths were identified. The average number of admissions per month and deaths per month varied by service development phase. There was a trend towards reduced death rates and increased numbers of admissions as the unit evolved into a dedicated neonatal unit with a reliable electricity supply. CONCLUSIONS: The development of an adequately sized SCBU with a reliable electricity supply and specially trained staff was associated with a reduction in the death rate and an increase in admissions.

Comparative analysis of recurrence predictors and outcomes for atrial tachyarrhythmia following atrial fibrillation ablation: high-power short-duration vs. conventional pulmonary vein isolation.

Atrial fibrillation (AF) is a common cardiac arrhythmia, with structural and electrical remodeling being significant risk factors for recurrence post-catheter ablation. The advent of high-power short-duration pulmonary vein isolation (HPSD-PVI) presents a novel approach, potentially enhancing procedural success rates through the creation of transmural lesions without overheating. This study investigates the predictors of atrial tachyarrhythmia (ATA) recurrence and compares outcomes between HPSD-PVI and conventional PVI techniques. A total of 1005 patients undergoing radiofrequency catheter ablation (RFA) for AF were retrospectively analyzed in this study. The cohort was divided based on the ablation strategy: conventional PVI from February 2013 to September 2018, and HPSD-PVI from October 2018 onwards. The primary objective was to compare the predictors of ATA recurrence and the outcome between the two groups. Among 969 patients analyzed after exclusions, independent predictors of recurrence differed between groups; higher CHADS2/CHA2DS2-VASc scores and lower left ventricular ejection fraction (LVEF) were significant in the HPSD-PVI group, while non-paroxysmal AF, larger left atrial volume index (LAVI), and longer AF history were predictors in the conventional PVI group. The HPSD-PVI group showed a trend toward lower ATA recurrence rates compared to the conventional PVI group in the propensity-score-matched (PSM) cohort (log-rank test, p = 0.06). Higher CHADS2/CHA2DS2-VASc scores and lower LVEF were also independent predictors of ATA recurrence in the PSM cohort.

Assessment of haemolysis models for a positive-displacement total artificial heart.

The assessment and reduction of haemolysis within mechanical circulatory support (MCS) remains a concern with regard to device safety and regulatory approval. Numerical methods for predicting haemolysis have typically been applied to rotary MCS devices and the extent to which these methods apply to positive-displacement MCS is unclear. The aim of this study was to evaluate the suitability of these methods for assessing haemolysis in positive-displacement blood pumps. Eulerian scalar-transport and Lagrangian particle-tracking approaches derived from the shear-based power-law relationship were used to calculate haemolysis in a computational fluid dynamics model of the Realheart total artificial heart. A range of power-law constants and their effect on simulated haemolysis were also investigated. Both Eulerian and Lagrangian methods identified the same key mechanism of haemolysis: leakage flow through the bileaflet valves. Whilst the magnitude of haemolysis varied with different power-law constants, the method of haemolysis generation remained consistent. The Eulerian method was more robust and reliable at identifying sites of haemolysis generation, as it was able to capture the persistent leakage flow throughout the entire pumping cycle. This study paves the way for different positive-displacement MCS devices to be compared across different operating conditions, enabling the optimisation of these pumps for improved patient outcomes.