タイワン ニ オケル コウブンショ カンリ ホウセイ ノ ゲンジョウ ト カダイ

資料李 秉昊／

The impact of empirical Marshall vein ethanol infusion as a first-choice intraoperative strategy on the long-term outcomes in patients with persistent atrial fibrillation undergoing mitral isthmus ablation

BackgroundMarshall vein ethanol infusion (MVEI) as an additional therapy to conventional catheter ablation (CA) has been proved to be efficacious in patients with persistent atrial fibrillation (PeAF). However, whether empirical MVEI could be the first-line strategy in mitral isthmus (MI) ablation has seldom been investigated. Here, we aim to compare the efficacy, safety, and long-term outcomes between provisional and empirical MVEI in PeAF patients undergoing the index MI ablation procedure.MethodsWe enrolled 133 patients with PeAF either in the provisional group (n = 38, MVEI was performed when conventional endocardial and/or epicardial ablation procedures were inadequate to achieve bidirectional MI block) or in the empirical group (n = 95, MVEI was performed empirically before MI CA).ResultsAll of the baseline characteristics were comparable. Less spontaneous or inducible atrial tachycardias (ATs) were encountered in the empirical group of patients (P < 0.001). More epicardial ablations were applied (26.3% vs. 9.5%, P = 0.016) and a higher incidence of CA-facilitated restoration of sinus rhythm was recorded (86.8% vs. 11.7%, P < 0.001) in the provisional group of patients. Although more fluoroscopy time (6.4[4.2, 9.3] vs. 9.5[5.9, 11.6] min, P = 0.019) and radiation exposure (69.0[25.3, 160.2] vs. 122.0[62.5, 234.1] mGy, P = 0.010) were documented in the empirical group with comparable procedure time, less time (455.9 ± 192.2 vs. 366.5 ± 161.3 s, P = 0.038) was consumed to achieve bidirectional MI block during endocardial ablation in the provisional group. Incidences of procedure-related complications were similar between the two groups. During a 16.5 ± 4.4-month follow-up, the empirical group of patients showed a significantly higher rate of freedom from AT recurrence (95.8% vs. 81.6%, log-rank P = 0.003), while the rate of freedom from AF or atrial tachyarrhythmias (combining AF and AT) was similar. Both univariate (HR 0.19, 95% CI 0.05–0.64, P = 0.008) and multivariate (HR 0.25, 95% CI 0.07–0.92, P = 0.037) Cox regression analyses indicated that empirical MVEI was independently associated with lower long-term AT recurrence.ConclusionAmong patients with PeAF who underwent the index MI ablation procedure, empirical MVEI could reduce endocardial MI ablation time and provide greater long-term freedom from AT recurrence

A High-Precision Machine Learning Algorithm to Classify Left and Right Outflow Tract Ventricular Tachycardia

Introduction: Multiple algorithms based on 12-lead ECG measurements have been proposed to identify the right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT) locations from which ventricular tachycardia (VT) and frequent premature ventricular complex (PVC) originate. However, a clinical-grade machine learning algorithm that automatically analyzes characteristics of 12-lead ECGs and predicts RVOT or LVOT origins of VT and PVC is not currently available. The effective ablation sites of RVOT and LVOT, confirmed by a successful ablation procedure, provide evidence to create RVOT and LVOT labels for the machine learning model. Methods: We randomly sampled training, validation, and testing data sets from 420 patients who underwent successful catheter ablation (CA) to treat VT or PVC, containing 340 (81%), 38 (9%), and 42 (10%) patients, respectively. We iteratively trained a machine learning algorithm supplied with 1,600,800 features extracted via our proprietary algorithm from 12-lead ECGs of the patients in the training cohort. The area under the curve (AUC) of the receiver operating characteristic curve was calculated from the internal validation data set to choose an optimal discretization cutoff threshold. Results: The proposed approach attained the following performance: accuracy (ACC) of 97.62 (87.44–99.99), weighted F1-score of 98.46 (90–100), AUC of 98.99 (96.89–100), sensitivity (SE) of 96.97 (82.54–99.89), and specificity (SP) of 100 (62.97–100). Conclusions: The proposed multistage diagnostic scheme attained clinical-grade precision of prediction for LVOT and RVOT locations of VT origin with fewer applicability restrictions than prior studies

A Human-Machine-Cooperative-Driving Controller Based on AFS and DYC for Vehicle Dynamic Stability

It is a difficult and important project to coordinate active front steering (AFS) and direct yaw moment control (DYC), which has great potential to improve vehicle dynamic stability. Moreover, the balance between driver’s operation and advanced technologies’ intervention is a critical problem. This paper proposes a human-machine-cooperative-driving controller (HMCDC) with a hierarchical structure for vehicle dynamic stability and it consists of a supervisor, an upper coordination layer, and two lower layers (AFS and DYC). The range of AFS additional angle is constrained, with consideration of the influence of AFS on drivers’ feeling. First, in the supervisor, a nonlinear vehicle model was utilized to predict vehicle states, and the reference yaw rate, and side slip angle values were calculated. Then, the upper coordination layer decides the control object and control mode. At last, DYC and AFS calculate brake pressures and the range of active steering angle, respectively. The proposed HMCDC is evaluated by co-simulation of CarSim and MATLAB. Results show that the proposed controller could improve vehicle dynamic stability effectively for the premise of ensuring the driver’s intention

A variable frequency injection method for modular multilevel converters in variable speed drives

Modular multilevel converter (MMC) is a novel circuit that has appeared in the last few decades, and has been extensively applied to medium/high voltage scenarios, especially in motor drive owing to its scalability and easy to supply a higher number of output voltage levels. As theoretical analysis shows, the sub-module (SM) capacitor voltage magnitude is positively related to the converter output current amplitude and conversely connected to the fundamental frequency. Therefore, the prime challenge of applying MMC to variable speed drives is that there is a huge voltage oscillation in SM capacitor voltage during low-speed working. An innovative high-frequency voltage injection modality to diminish the fluctuation of the capacitor voltage in variable speed drives is proposed in this paper, in which the frequency of the injected component can be changed with the operating frequency of the converter and the low frequency component of power can be converted into high frequency component. The discussed measure not only significantly reduces the voltage float in capacitor, but also avoids the overmodulation of arm voltage modulation waveform caused by high frequency of injection component when converter works in low frequency. With the improved method, the performance of motor at low frequency is enhanced. Finally, the feasibility and effectiveness of the proposed improved high-frequency voltage injection method are verified by simulation and experiment

Socioeconomic status index is an independent determinant of breast cancer screening practices: Evidence from Eastern China.

BackgroundBreast cancer is the most prevalent malignancy affecting Chinese women, and early routine screening is incredibly important for its prevention and control. This study aimed to investigate the role of socioeconomic status (SES) in female breast cancer screening practices using the composite SES index.MethodsThis cross-sectional study involved 1816 women in Eastern China. Data were collected using an online self-administered questionnaire from January 2020 to May 2021. We used principal component analysis to construct the composite SES index using educational level, annual household income, and occupation. Logistic regression was used to analyze the association between the SES index and breast cancer screening utilization.ResultsOf the participants, 19.27% reported having performed breast self-examination, 12.89% reported having undergone clinical breast examination, and 3.52% reported having received mammography. The SES has a significant influence on the patronage of female breast cancer screening in Eastern China. The composite SES index was found to have a positive and significant association with breast cancer screening practices. An interaction was found between the SES index and patient characteristics, such as health awareness, marital status, and location of residence. In addition, the SES index had a positive effect on breast cancer-related knowledge.ConclusionsSocioeconomic inequalities existed in Eastern China and were related to breast cancer screening patronage. The composite SES index was identified as a significant determinant of breast cancer screening practices. Our results highlighted the negative impacts of socioeconomic inequities on female breast cancer screening utilization. This suggests that reducing socioeconomic inequalities in breast cancer screening requires more focused interventions and concerted outreach activities for groups with lower education levels, lower income, or lower occupational classes

Motion Similarity Evaluation between Human and a Tri-Co Robot during Real-Time Imitation with a Trajectory Dynamic Time Warping Model

Precisely imitating human motions in real-time poses a challenge for the robots due to difference in their physical structures. This paper proposes a human–computer interaction method for remotely manipulating life-size humanoid robots with a new metrics for evaluating motion similarity. First, we establish a motion capture system to acquire the operator’s motion data and retarget it to the standard bone model. Secondly, we develop a fast mapping algorithm, by mapping the BVH (BioVision Hierarchy) data collected by the motion capture system to each joint motion angle of the robot to realize the imitated motion control of the humanoid robot. Thirdly, a DTW (Dynamic Time Warping)-based trajectory evaluation method is proposed to quantitatively evaluate the difference between robot trajectory and human motion, and meanwhile, visualization terminals render it more convenient to make comparisons between two different but simultaneous motion systems. We design a complex gesture simulation experiment to verify the feasibility and real-time performance of the control method. The proposed human-in-the-loop imitation control method addresses a prominent non-isostructural retargeting problem between human and robot, enhances robot interaction capability in a more natural way, and improves robot adaptability to uncertain and dynamic environments

Proportion of breast cancer screening practices (n = 1816).

BSE, breast self-examination; CBE, clinical breast examination; SESI, socioeconomic status index.</p