Anatomical and Electrophysiological Characteristics of Dual-Loop Re-Entry in Atypical Atrial Flutter: Implications for Mapping and Catheter Ablation.

Background: Atypical atrial flutter (AFL) can be challenging to ablate, especially when involving dual-loop re-entry. We sought to assess the electroanatomical characteristics of single- and dual-loop AFLs in patients undergoing catheter ablation. Methods: We analyzed 25 non-cavotricuspid isthmus-dependent macro-re-entrant AFL in 19 consecutive patients. Three-dimensional high-density activation mapping was performed, and active re-entry loops were confirmed by entrainment mapping. Results: Of 25 AFLs (24 left, 1 right atrial), 13 (52%) exhibited dual-loop re-entry. The most common circuits included, in 6/13 (46% of dual loops), a perimitral re-entry with a second loop around the right/left pulmonary veins (PV) and, in 6/13 (46%), involved a right PV ostium with a second loop around either a functional conduction block or another PV. Ablation at the common isthmus of dual-loop AFLs and at the critical isthmus of single-loop AFLs terminated the arrhythmia more frequently than ablation at a secondary isthmus of dual-loop AFLs (5/6 (83%) and 8/11 (73%) versus 1/8 (13%), respectively, p = 0.013). Conclusions: More than half of AFLs exhibited a dual-loop re-entrant mechanism. Most critical isthmuses were found at the mitral isthmus, the left atrial roof or right PV ostia. Ablation targeting the common isthmus resulted in a higher termination rate.

Modular probe integrating with quantum dots based versatile platform for sensitive and label-free biomarker detection.

Multiplexed analysis of biomarkers in a single sample tube is essential for accurate diagnosis and therapy of diseases. However, the existing detection platforms suffer from many drawbacks, such as low specificity, limited applicable sceneries, and complicated operation. Hence, it is highly important to develop a versatile biomarker detection platform that can be used for disease diagnosis and pathophysiological research. In this study, we provide a versatile method for detecting biomarkers using dual-loop probes and quantum dots (QDs). This approach utilizes a dual-loop probe that consists of a recognition module for identifying specific targets, a template recognition module for initiating subsequent chain replacement cycles, and a signal module for facilitating the fixation of QDs on the 96-well plate. The lower limit of detection for miRNA-21 is determined to be at the aM level. Furthermore, this design may be easily expanded to simultaneously detect several targets, such as miRNA and C-reactive protein. The experimental results demonstrated the successful construction of the versatile biomarkers detection platform, and indicated that the sensitive and versatile platform has significant potential in the areas of bio-sensing, clinical diagnostics, and environmental sample analysis.

Identification of 2 Distinct Boundaries Distinguishes Critical From Noncritical Isthmuses in Ablating Atypical Atrial Flutter.

BACKGROUND: Atypical atrial flutters often involve complex circuits. Classic methods of identifying ablation targets, including detailed electroanatomical mapping and entrainment within a well-defined isthmus, may not always be sufficient to allow the critical isthmus to be delineated and ablated, with flutter termination and prevention of reinduction. OBJECTIVES: This study sought a systematic method to classify conduction barriers and isthmuses as critical or noncritical that would improve understanding and ablation success. We also sought a construct unifying single- and dual-loop re-entry. Re-entrant circuits are bounded on 2 sides, although these are not consistently identified. We hypothesized 2 distinct critical boundaries, and a critical isthmus could be consistently defined without requiring entrainment, and ablation connecting these 2 boundaries would terminate tachycardia. METHODS: Activation maps were created electroanatomically. Conduction barriers were classified as noncritical barriers or critical boundaries. Critical boundaries showed sequential activation around the barrier, spanning ≥90% of the cycle length. Noncritical barriers showed nonsequential, parallel, or colliding activation or <90% of the cycle length. Only tissue separating the 2 critical boundaries defined a critical isthmus (CI); all others were considered noncritical. The effect of ablation across a CI was assessed. RESULTS: Complete maps were obtained in 128 cases in 121 patients (28 atypical right atrial, 100 left atrial). In all cases, 2 distinct critical boundaries were identified. Ablation across a CI connecting these critical boundaries terminated tachycardia in 123 of 128 cases (96.1%). Failures were due to inability to achieve block across the isthmus. CONCLUSIONS: Activation mapping of atypical atrial flutter allows consistent identification of 2 critical boundaries. Successful ablation connecting the 2 critical boundaries reliably results in termination of atypical atrial flutter.

Identification of the dominant loop of a dual-loop macro-reentry left atrial flutter without prior intervention using high-density mapping technology: A case report.

BACKGROUND: Left atrial flutter without prior cardiac interventions is uncommon, especially dual-loop macro-reentry atrial flutter. The critical step to ablate dual-loop macro-reentry atrial flutter is to identify the dominant loop and key isthmus. Although entrainment mapping could help identify the dominant loop and key isthmus, it may alter or terminate tachycardia. High-density mapping allows the generation of electroanatomic maps without altering or terminating tachycardia. CASE SUMMARY: Here, we report a case of symptomatic left atrial flutter without prior intervention. In this case, high-density mapping revealed a dual-loop macro-reentry around the mitral annulus and central scar of the anterior wall. The propagation result showed that the dominant loop was around the mitral annulus, and the key isthmus was between the central scar and mitral annulus. The atrial flutter terminated successfully after ablation was performed. CONCLUSION: In this case, we demonstrate that high-density mapping technology may help identify the dominant loop of dual-loop atrial flutter without entrainment, which makes ablation easier.

Understanding the concept of a novel tool requires interaction of the dorsal and ventral streams.

The left hemisphere tool-use network consists of the dorso-dorsal, ventro-dorsal, and ventral streams, each with distinct computational abilities. In the dual-loop model, the ventral pathway through the extreme capsule is associated with conceptual understanding. We performed a learning experiment with fMRI to investigate how these streams interact when confronted with novel tools. In session one, subjects observed pictures and video sequences in real world action of known and unknown tools and were asked whether they knew the tools and whether they understood their function. In session two, video sequences of unknown tools were presented again, followed again by the question of understanding their function. Different conditions were compared to each other and effective connectivity (EC) in the tool-use network was examined. During concept acquisition of an unknown tool, EC between dorsal and ventral streams was found posterior in fusiform gyrus and anterior in inferior frontal gyrus, with a functional interaction between BA44d and BA45. When previously unknown tools were presented for a second time, EC was prominent only between dorsal stream areas. Understanding the concept of a novel tool requires an interaction of the ventral stream with the dorsal streams. Once the concept is acquired, dorsal stream areas are sufficient.

The Roles of Pre-P-wave Versus Peri-P-wave Fractionated Electrograms for Atrial Substrate Beyond Entrainment Response.

Atrial tachycardia (AT) with alternating cycle lengths is sparsely reported, and, hence, the ideal mapping strategy has not been firmly established. Beyond the entrainment during tachycardia, some fragmentation characteristics might also give important clues for its possible participation in the macro-re-entrant circuit. We discuss a patient with prior atrial septal defect surgical closures who presented with dual macro-re-entrant ATs related to a fragmented area on the right atrial free wall (240 ms) and the cavotricuspid isthmus (260 ms), respectively. After ablation of the fastest AT on the lateral right atrial free wall, the cycle of the first AT changed to the second AT that was interrupted on cavotricuspid isthmus, proving the dual tachycardia mechanism. This case report addresses the utilization of electroanatomic mapping information as well as fractionated electrogram timing with respect to the surface P-wave as guides for ablation location.

Atrial Tachycardia with Cycle Length Alternans.

Tachycardia-induced tachycardia, or so-called double tachycardia, appears to be a relatively rare condition. The underlying mechanism for stable beat-to-beat cycle length variability (alternans) in atrial tachycardia has been sparsely reported.

A novel vertical dual-loop reactor for rapid start-up of simultaneous partial nitrification and anammox process in treating landfill leachate: Performances and mechanisms.

A novel vertical dual-loop reactor (VDLR) was developed to start and conduct a single-stage partial nitritation (PN) and anammox (PN/A) process for treating landfill leachate. Results showed that the total nitrogen (TN) removal reached 1.54 kg N/m3·d in the VDLR. It exhibited excellent mixing uniformity and buffer performance, which can increase the nitrogen removal performance up to 42.1 % via the improvement of anammox granular sludge activity (a particle size of 0.5-1 mm). Mass balance and microbial analysis indicated that the VDLR achieved efficient TN removal via anammox (99.24 %) and AOB (Nitrosomonas and Ellin6067) and anAOB (Candidatus kuenenia) played a vital role in this process.

CFHBA-PID Algorithm: Dual-Loop PID Balancing Robot Attitude Control Algorithm Based on Complementary Factor and Honey Badger Algorithm.

The PID control algorithm for balancing robot attitude control suffers from the problem of difficult parameter tuning. Previous studies have proposed using metaheuristic algorithms to tune the PID parameters. However, traditional metaheuristic algorithms are subject to the criticism of premature convergence and the possibility of falling into local optimum solutions. Therefore, the present paper proposes a CFHBA-PID algorithm for balancing robot Dual-loop PID attitude control based on Honey Badger Algorithm (HBA) and CF-ITAE. On the one hand, HBA maintains a sufficiently large population diversity throughout the search process and employs a dynamic search strategy for balanced exploration and exploitation, effectively avoiding the problems of classical intelligent optimization algorithms and serving as a global search. On the other hand, a novel complementary factor (CF) is proposed to complement integrated time absolute error (ITAE) with the overshoot amount, resulting in a new rectification indicator CF-ITAE, which balances the overshoot amount and the response time during parameter tuning. Using balancing robot as the experimental object, HBA-PID is compared with AOA-PID, WOA-PID, and PSO-PID, and the results demonstrate that HBA-PID outperforms the other three algorithms in terms of overshoot amount, stabilization time, ITAE, and convergence speed, proving that the algorithm combining HBA with PID is better than the existing mainstream algorithms. The comparative experiments using CF prove that CFHBA-PID is able to effectively control the overshoot amount in attitude control. In conclusion, the CFHBA-PID algorithm has great control and significant results when applied to the balancing robot.

Paradoxical delayed capture proved the dual-loop tachycardia mechanism of a cavotricuspid isthmus-dependent atrial flutter.

A 37-year-old man underwent catheter ablation for a cavotricuspid isthmus-dependent atrial flutter. Two 20-pole deflectable electrode catheters were placed in a parallel position on the tricuspid annulus and right atrial lateral wall. The dual-loop tachycardia mechanism of the atrial flutter was suggested by paradoxical delayed capture of the lateral wall of the right atrium during entrainment pacing from the lateral tricuspid annulus.

Verification and Comparison of Nine Exhaust Gas Recirculation Mass Flow Rate Estimation Methods.

Modern Diesel engines have complex exhaust gas recirculation (EGR) systems. Due to the high temperatures, it is a typical issue to measure EGR mass flow rates in these complex control systems. Therefore, it is expedient to estimate it. Several sensed values can help the estimation: the fresh air mass flow rate, the fuel consumption, pressures, temperatures and mass fractions in the air path system. In most of the articles, the EGR mass flow rate estimation is done by the pressures. However, gas composition based models usually would be better for control aims. In this paper, nine EGR estimation methods will be presented: an important outcome is to present the required sensor architectures and estimation challenges. The comparison will be made by measurement results both in stationary operation points and transient cycles. The estimated EGR mass flow rates will be evaluated by verification conditions. The results will prove that the intake and exhaust side oxygen sensors can give verifiable signals for EGR mass flow rate estimation. In contrast, the applied fresh air mass flow rate and the nitrogen-oxide signals are not accurate enough to provide verifiable EGR mass flow rates in every operating condition. The effects of sensor inaccuracies will also be considered.

Anatomy of brain lesions after stroke predicts effectiveness of mirror therapy.

To improve clinical outcome, one longstanding goal in treating stroke patients has been an individual therapy based on functional and anatomical knowledge of the single patient. Therefore, in this study brain imaging of 36 chronic stroke patients was analyzed to identify parameters predicting clinical recovery. T1-weighted MRI was acquired to assess the lesion; functional MRI was used to visualize existing resources; DTI for the integrity of the corticospinal tract (CST) and long association tracts. These data were related to the clinical course. All patients were treated intensively with the mirror therapy (MT) only. After the training period, we analyzed which patient's feature would predict a beneficial course. Patients as a group improved after MT, but according to the fMRI activation of primary sensorimotor cortex (SMC), they could be divided in two groups with very diverging clinical outcome: those with ipsilesional SMC activation showed a noticeable increase of clinical scores, accompanied with ipsilesional activation in the frontal projection areas of the dorsal and ventral streams during action observation in fMRI. Those with contralesional SMC activation had lesions affecting both the dorsal and ventral stream and did not benefit from MT. The outcome for this therapy was not related to affection of CST. This study demonstrates that only in patients in which dorsal and ventral streams are not affected and therefore an interaction between these streams in post- and prerolandic regions is possible, MT can induce clinical improvement. Consequently, knowledge of the anatomical lesion can predict the beneficial course of MT.

Design of a Dual-Loop Controller with Two Voltage-Dependent Current Compensators for an LLC-Based Charger.

A two-stage charger (PFC+LLC) is developed for Power Mobility Device (PMD) charging applications (i.e., power wheelchairs). The LLC topology is selected due to its ability to maintain ZVS operation over a wide range of load variations. This paper discusses the challenges of designing a dual-loop controller for an LLC-based charger with a wide operation region. It proposes modifying the inner current loop to maintain stable operation over a wide input and output range-the proposed internal loop control switches intelligently between two current controllers based on the output voltage level. A 300-W prototype is designed and tested with a resistive load. Moreover, simulation and experimental results are compared to validate the robustness and stability of the proposed controller.

Language-Related White-Matter-Tract Deficits in Children with Benign Epilepsy with Centrotemporal Spikes: A Retrospective Study.

BACKGROUND AND PURPOSE: Benign epilepsy with centrotemporal spikes (BECTS) is one of the most common pediatric epilepsies, and it generally has a good prognosis. However, recent research has indicated that the epileptic activity of BECTS can cause cognitive defects such as language, visuospatial, and auditory verbal memory deficits. This study assessed language-delivery deficits in BECTS patients using diffusion-tensor magnetic resonance imaging (DTI). METHODS: T1-weighted MRI, DTI, and language tests were conducted in 16 BECTS patients and 16 age-matched controls. DTI data were analyzed using the TRActs Constrained by Underlying Anatomy tool in FreeSurfer 5.3, and 18 major white-matter tracts were extracted, which included 4 language-related tracts: the inferior longitudinal fasciculus, superior longitudinal fasciculus-parietal terminations, superior longitudinal fasciculus-temporal terminations, and uncinate fasciculus (UNC). Language tests included the Korean version of the Receptive and Expressive Vocabulary Test, Test of Problem-Solving Abilities (TOPS), and the mean length of utterance in words. RESULTS: The BECTS group exhibited decreased mean fractional anisotropy and increased mean radial diffusivity, with significant differences in both the superior longitudinal fasciculus and the left UNC (p<0.05), which are the language-related white-matter tracts in the dual-loop model. The TOPS language test scores were significantly lower in the BECTS group than in the control group (p<0.05). CONCLUSIONS: It appears that BECTS patients can exhibit language deficits. Seizure activities of BECTS could alter DTI scalar values in the language-related white-matter tracts.

Virtual Dual-Loop Feedback Control with Model-Construction Linear Extended State Observer for Free Space Optical Communication.

The stable alignment and transmission of free space optical communication (FSO) is susceptible to internal dynamics and external disturbances. In this paper, a virtual dual-loop feedback control (VDFC) with model-construction linear extended state observer (MCLESO), which is applied to the fast tip-tilt mirror platform to enhance the disturbance suppression ability (DSA) for FSO. MCLESO, which is modified on a classical linear extended state observer by introducing the available model information, is shown to use the input and output signal data of the system to observe total disturbances, including internal dynamics and external disturbance. Since the position and velocity signals are both observed only with the optoelectronic target detector and MCLESO, the controllers of the dual-loop feedback control (DFC) system are employed directly. This method has a more accurate control performance after model construction, which enhances the DSA of the tip-tilt mirror control system in low and medium frequency. It is also beneficial to miniaturization and cost saving by not using velocity sensors. Both simulations and experiments validate the effectiveness of the proposed method in the tip-tilt mirror control system under the condition of disturbance.