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The efficacy of cardiac resynchronization therapy (CRT) in patients with a narrow QRS duration has not been established. We present a patient with a narrow QRS duration and left anterior fascicular block in which CRT was effective. Left ventricular lead implantation at the optimal site and appropriately-timed left ventricular pacing (LVP) resulted in left ventricle reverse remodeling. Left ventricular dyssynchrony did not improve with LVP at a timing that resulted in narrower QRS than an intrinsic QRS duration. The optimization of LVP timing in CRT for patients with a narrow QRS duration is discussed.

The best strategy for durable left atrial posterior wall isolation (PWI) after completion of pulmonary vein isolation (PVI) is not yet determined. This study aimed to examine the differences in the durability of PWI based on the isolation process and the predictors of the reconduction of PWI.Among the 221 patients (mean age, 65 ± 11 years) with consecutive non-paroxysmal atrial fibrillation (AF) who completed PVI and PWI, 50 patients undergoing repeat AF ablation were enrolled and divided into the following groups based on how PWI was achieved at the initial procedure: by only the first line on the roof and floor line (group A), by additional gap ablation to the first line or second liner ablation next to the first line (group B), and by adjunct ablation inside the PW revealing the earliest activation (group C).Reconduction of PWI occurred in 24 of the 50 patients (48%). The durability of PWI in groups A, B, and C was 81% (17 of 21 patients), 75% (6 of 8 patients), and 14% (3 of 21 patients), respectively (p 0.01). In a multivariate analysis, the ablation inside the PW for PWI was the independent predictor of the reconduction of PWI (p 0.001).PWI achieved by the ablation inside the PW resulted in a high rate of reconduction. It may be necessary to aim to achieve the PWI without ablating the inside of the PW to prevent reconduction.

In recent years, the habitat distribution of wild boar has expanded in Japan, and the damage caused by wild boar has been significantly increased. In Bingo Sports Park, a regional park, wild boar damage has also been increasingly severe. To take effective measures, it is necessary to understand where wild boars enter the park, how they move through it, and where the damage is caused. Therefore, this study examines both environmental characteristics inside and outside the park and behavioral characteristics of wild boar using drones, sensor technology and GIS, and then clarifies the main factors contributing to wild boar damage based on t-test analysis and logistic regression analysis. In addition, countermeasures such as installing electric fences and repellents were taken, and their effectiveness was verified. There were three main findings. First, the behavioral pattern of wild boars was found to be likely to enter from valleys and usually move on roads in the park. Second, the wild boars tend to cause more damage in areas with more natural land cover and closer to roads and valleys. Third, the countermeasures have a significant effect on reducing wild boar damage since the amount of damage in the multi-purposed field-installed countermeasure was too small.

Hafnia (HfO2, hafnium dioxide) is a wide band gap and high-κ material, and the metastable cubic hafnia has a much higher permittivity compared with the normal monoclinic hafnia. Here, we employ a one-step process, the pulsed plasma in liquid (PPL) method to synthesize two types of hafnia nanoparticles (NPs): one which is mainly in cubic phase (cubic: 81.7 at%, monoclinic: 18.3 at%) and the other which is in monoclinic phase. High-resolution transmission electron microscopy images showed that the particles were small (particle size ~3 nm). X-ray absorption fine structure analysis showed no chemical shifts, indicating that the synthetic hafnia NPs contained no oxygen vacancy. The synthetic hafnia NPs mainly in cubic phase showed a much higher relative permittivity than that of the commercial hafnia (monoclinic), and have a larger band gap than the synthetic monoclinic hafnia NPs.

Bi-atrial tachycardia, involving Bachmann's bundle in the circuit, has sometimes been observed after mitral anterior line ablation. In this article, we present a case of bi-atrial tachycardia, involving a long epicardial circuit, composed of Bachmann's bundle and the left atrial ridge. We discuss the optimal ablation technique for this tachycardia based on our experience in addition to the relationship between Bachmann's bundle and the left atrial ridge. Furthermore, the evaluation method for the mitral anterior block line is also discussed. This article is protected by copyright. All rights reserved.

Background Subcutaneous implantable cardioverter–defibrillator (S-ICD) represents an efficient alternative to transvenous ICD in patients who do not require pacing. The intraoperative defibrillation test (DFT) is recommended during S-ICD implantation to confirm appropriate sensing and successful 65-J termination of induced ventricular fibrillation (VF). However, few cases of oversensing of noise inhibiting therapies have been reported. Case summary We report the case of a 50-year-old man who underwent S-ICD implantation for secondary prevention of sudden cardiac death. Immediately after S-ICD implantation, VF was induced using a 50-Hz burst; however, shock was not delivered owing to sustained noise on the electrogram in the primary vector. Therefore, an external rescue shock was needed at 150 J. We changed the sensing vector from primary to secondary and performed a second DFT. The S-ICD could deliver an appropriate shock and was able to successfully terminate VF without noise markers in the secondary vector. During the second DFT, one back-up pacing was delivered after the shock; the sensing vector then automatically switched from the secondary to the alternate vector. However, noise was observed in the alternate vector despite sinus rhythm restoration. Discussion The present case demonstrated that noise was recorded in two different vectors during DFT, possibly supporting the hypothesis that the muscle spasm of the diaphragm induced by the 50-Hz burst causes oversensing of noise by the S-ICD.

Cerium oxide (CeO2-x) nanoparticles were synthesized using a simple one-step method known as the pulsed plasma in liquid (PPL). XRD analysis showed the production of pure cubic cerium oxide (Fm 3 ‾ m). HRTEM and XANES analysis confirmed the monophase cubic CeO2-x, and exclude the presence of the hexagonal Ce2O3 and/or mix phase of CeO2/Ce2O3 in the particle layers. HRTEM analysis showed that most particles were about 3 nm in diameter. XPS analysis showed that the cerium oxide nanoparticles synthesized by the PPL method had a higher Ce3+ proportion (42.2%) than some commercial powders, and also higher than the previous reported nanoparticles. The present cerium oxide nanoparticles showed high visible light-induced photocatalytic activity in the degradation of methyl orange (MO) and better polishing characteristics of quartz glass, compared to commercial samples. These results may attribute to the high Ce3+-ion content and/or the small particle size.

Recently, output-dependent QRS transition was reported to be required to confirm left bundle branch (LBB) capture in LBB area pacing (LBBAP) procedure. This study aimed to evaluate the achievement rate and the learning curve of LBB capture in LBBAP procedure performed with the goal of demonstrating output-dependent QRS transition, and investigate predictors of LBB capture.The LBBAP procedure was performed in 126 patients with bradyarrhythmia. LBB capture was defined as a demonstration of output-dependent QRS transition. The following pacing definitions were used for evaluation: (1) LBBAP, which met the previously reported LBBAP criteria, (2) LBB pacing (LBBP), LBB capture was confirmed, and (3) available LBBP, LBB threshold was clinically usable (3 V at 0.4 ms). The learning curve was evaluated by division into three time-periods. The achievement rates of LBBAP, LBBP, and available LBBP were 88.1%, 41.2%, and 35.7%, respectively. The achievement rates of all three pacing definitions significantly increased with experience (p .01), but the achievement rate of available LBBP was still 50% in the third period. As predictors of LBB capture, the interval between LBB-Purkinje potential and QRS onset ≥22 ms had high specificity of 98.3%, while R wave peak time in V6 68 ms had insufficient sensitivity of 79% and specificity of 68%.Even if LBB capture was aimed in LBBAP procedure, it was not easy to achieve, and there was a clear learning curve. Much of LBBAP may be left ventricular septal pacing that does not capture LBB.

Background Perioesophageal vagal nerve (VN) injury after atrial fibrillation (AF) ablation remains an important complication. The VN provides parasympathetic innervation to the majority of the abdominal organs—including the stomach and the sphincter of Oddi (SO)—and regulates smooth muscle contraction. We present an unusual case of SO spasm induced by VN injury after cryoballoon ablation (CBA). Case summary A 71-year-old woman presented to our institution with paroxysmal AF. The patient had a history of cholecystectomy and SO dysfunction. She had undergone CBA for AF. Immediately after the procedure, the patient developed epigastric pain. Computed tomography showed dilation of the intra- and extrahepatic bile ducts, with the diameter of the common bile duct measuring ∼15.6 mm. Blood tests on postoperative Day 1 revealed severely elevated aminotransferase levels (aspartate aminotransferase, 3156 U/L; alanine aminotransferase, 2084 U/L; lactate dehydrogenase, 2279 U/L; total bilirubin 1.7 mg/dL). Discussion It is known that VN denervation induces SO spasms. The right and left vagal trunks descend alongside the oesophagus, forming a perioesophageal plexus and innervating most of the gastrointestinal organs. In our case, SO spasm was induced as a result of the perioesophageal plexus injury caused by CBA. Underlying SO dysfunction and post-cholecystectomy also played an important role. Coupled with the absence of the gallbladder, which is the reservoir of bile juice and coordinator of SO, SO spasm caused severe elevation of the bile duct pressure. Care should be taken when performing AF ablation with regards to the stomach and the SO.

BACKGROUND In performing left bundle branch pacing (LBBP), various QRS morphologies are observed as the lead penetrates the ventricular septum (VS). This study aimed to evaluate these characteristics and infer the mechanism underlying each QRS morphology. METHODS In 19 patients who met the strict criteria for LBB capture, we classified the QRS morphologies observed during the LBBP procedure into seven patterns, the first five of which were determined by the depth of penetration: right ventricular septal pacing (RVSP), intraventricular septal pacing (IVSP1 and IVSP2), endocardial side of left ventricular septal pacing (LVSeP), nonselective LBBP (NS-LBBP), selective LBBP (S-LBBP), and NS-LBBP with anodal capture. The parameters of the QRS morphologies in these seven patterns were evaluated. RESULTS Among the first five patterns, stimulus-QRSend duration (s-QRSend) was the narrowest in IVSP1 rather than in NS-LBBP, and stimulus-to-peak of R wave in V6 (s-LVAT) was significantly shortened in two steps, from RVSP to IVSP1 (96 ± 11; 82 ± 8 ms, p

Recent years have seen a decrease in the population of Japan. If urban areas continue to expand to the suburbs with this depopulation, various urban problems will arise including increase in energy consumption and the cost of developing and maintaining infrastructure due to high dependence on car use in daily life and inefficient development and maintenance of urban infrastructure. To address this, a compact urban structure is proposed corresponding to the decreasing population especially in provincial small towns. However, it is not clear where denser urban areas are expected and how much of the population will remain located there. Consequently, this study aims to examine a preferable future population distribution pattern from the viewpoint of CO2 emissions and infrastructure costs in Fuchu City, Hiroshima Prefecture, a provincial small town. This study quantitatively assesses the reductive effect of such a population compaction on CO2 emissions and infrastructure costs. Results reveal that creating a compact urban structure will reduce CO2 emissions and infrastructure costs, and the effects differ widely based on scenarios. Furthermore, the study considers the effects of “population density in a compact district,” “population balance among inside and outside of compact district,” and “central place of compact district” on CO2 emissions and infrastructure costs.

FePt alloys are an important class of materials in permanent magnetic applications because of their large uniaxial magnetocrystalline anisotropy and good chemical stability. We have applied the pulsed plasma in liquid method to synthesis nanoparticles. Short duration of pulse and quenching effects of the surrounding liquid limit the size of crystal. That enable synthesis of small size and metastable nanoparticles. In this study, ferromagnetic FePt nanoparticles were successfully synthesized. Face-centered-cubic (FCC) A1-type phase was synthesized from FePt (Fe:PT=50:50, 55:45 in atomic %) alloy rod electrodes using the pulsed plasma in ethanol. The ordered face-centered-tetragonal (FCT) L10-type phase FePt was obtained by annealing the A1-type phase at 400oC for 1 h. The average diameter of L10-type FePt nanoparticles was less than 10 nm. Vibrating Sample Magnetometer (VSM) analysis showed that the coercivity of L10-type nanoparticles was much larger than that of the A1-type phase nanoparticles.

It has been reported that rhythm control for persistent atrial fibrillation (per-AF) patients by catheter ablation improves their exercise tolerance, subjective symptoms, and quality of life (QoL). However, clinical factors that can predict future improvement of exercise capacity after successful catheter ablation in per-AF patients are unclear.This study consisted of 62 patients (mean age 65.6 ± 8.7 years, 77% males) with per-AF who underwent catheter ablation from June 2017 to May 2018. All patients were subjected to extended pulmonary vein isolation. Exercise tolerance was evaluated using a symptom-limited cardiopulmonary exercise test before and 3 months after catheter ablation. Primary endpoints were QoL measurements using an original questionnaire and functional assessments performed at 3 months.The questionnaire revealed significant improvement in QoL after catheter ablation (minimal metabolic equivalents occurring symptoms: from 5.48 ± 1.14 to 5.64 ± 1.06; p = 0.01). Endurance exercise characteristics improved significantly after catheter ablation, demonstrated by a shift in anaerobic threshold (from 13.3 ± 3.0 to 15.2 ± 3.3 ml/kg/min; p 0.001), peak oxygen uptake (from 19.1 ± 4.6 to 22.5 ± 5.0 ml/kg/min; p 0.001), and minute ventilation vs carbon dioxide production slope (from 28.3 ± 6.1 to 25.7 ± 3.8; p 0.001). Multivariate Cox regression analysis revealed that a decreased left ventricular ejection fraction, high left atrial appendage velocity, and high CHADSCatheter ablation for per-AF patients improves QoL and exercise tolerance. The effect was especially remarkable in patients with reduced ventricular function, those who had a preserved atrial function, or those at high risk of thromboembolism.

BACKGROUND AND OBJECTIVES This study aimed to evaluate the utility of high-sensitive troponin T (hs-TnT) for predicting AF recurrence and major adverse cardiovascular events (MACE) after AF ablation. METHODS AND RESULTS A total of 227 consecutive patients with AF (mean age, 66 ± 10 years; persistent AF, n = 98) who underwent an initial ablation were enrolled. We measured hs-TnT before AF ablation and divided the patients into three groups according to the hs-TnT level: low, lesser than or equal to 0.005 µg/L (n = 54); medium, 0.006-0.013 µg/L (n = 127); and high, greater than or equal to0.014 µg/L (n = 46). We evaluated the composite endpoint of AF recurrence or MACE (including death, stroke, acute coronary syndrome, and heart failure hospitalization) after the ablation. The median hs-TnT level was 0.008 µg/L. The values of chronic kidney disease prevalence, CHA2 DS2 -VASc score, B-type natriuretic peptide level, and left atrial diameter were the highest in the high hs-TnT group among the three groups. During a mean follow-up of 15 ± 8 months, AF recurrence and MACE occurred in 56 (25%) and 9 (4%) patients, respectively. The high hs-TnT group had the highest incidence of AF recurrence and MACE among the three groups (high: 39% and 15%, medium: 22% and 2%, and low: 19% and 0%, respectively; log-rank P

We synthesized Pd-Fe series nanoparticles in solid solution using pulsed plasma in liquid with Pd-Fe bulk mixture electrodes. The Pd-Fe atomic percent ratios were 1:3, 1:1, and 3:1, and the particle size was measured to be less than 10 nm by high-resolution transmission electron microscopy (HR-TEM). The nanoparticles showed face-centered cubic structure. The lattice parameter increased with increasing Pd content and followed Vegard&rsquo, s law, and energy-dispersive X-ray spectra were consistent with the ratios of the starting samples, which showed a solid solution state. The solid solution structure and local structure were confirmed by HR-TEM and X-ray absorption fine structure.

Recent years have seen a decrease in the population of Japan. If urban areas continue to expand to the suburbs with this depopulation, various urban problems will arise including difficulty of maintaining public transport system and increase in energy consumption. To address this, compact urban structure is proposed, corresponding to the decreasing population. Actually, Japanese government announced, in 2014 guideline and policy for compact city. This encourages local governments to decide "inducing area for urban functions" in which urban functions should be concentrated and "inducing area for dwelling" that should attract residents. However, it is not clear where these areas should be located. It is important to examine the positive and negative zone for living in term of various perspectives and future urban structure should be designed based on the evaluations. This study aims to examine the high potential area for living in term of six viewpoints such as public transport convenience, disaster risk, environmental load, infrastructure cost, economy and convenience of welfare and medical facilities and create scenarios by concentrating population to efficient zones classified by cluster analysis with evaluation data. Finally, the scenarios are evaluated in the same method and compared to assess the impact of compaction on some indexes and differences from BAU. Results show that cluster 2 zones (around the inside of urbanization areas) are higher positive potential in all indexes. The scenario compacted based on all evaluations is more efficient in all aspects than BAU. However, other scenario compacted based on one criterion has tradeoff between other indexes.

We study the properties of two-dimensional conformal field theories (CFTs) with sine-square deformation (SSD). We show that there are no eigenstates of finite norm for the Hamiltonian of a unitary CFT with SSD, except for the zero-energy vacuum state $|0\rangle$. We then introduce a regularized version of the SSD Hamiltonian which is related to the undeformed Hamiltonian via a unitary transformation corresponding to the Mobius quantization. The unitary equivalence of the two Hamiltonians allows us to obtain zero-energy states of the deformed Hamiltonian in a systematic way. The regularization also provides a way to compute the expectation values of observables in zero-energy states that are not necessarily normalizable., Comment: 17 pages, 4 figures