Real-Time Measurement of Energy Metabolism Over Circadian Time Using Indirect Calorimetry-Enabled Metabolic Cages.

Indirect calorimetry probes the relationship between fuel consumed and energy produced, and in doing so provides an estimation of whole-body energy expenditure and fuel preference. When assayed continuously in real-time, rhythms appear and illuminate the temporal regulation of energy metabolism by the circadian clock. Here we describe a method for recording circadian energy metabolism in mice using indirect calorimetry-enabled metabolic cages, encompassing mouse entrainment, experimental design, data acquisition and analysis, troubleshooting of common problems, and important considerations. This method is adaptable to the end user's equipment and serves as an effective tool to study, for example, mutant mice, dietary interventions, drug treatments, or circadian disruption.

A real-time analysis of intraoperative interruptions in relation to use of simple preventive measures including a sign on the door and a checklist-based team brief.

This study aimed to evaluate intraoperative interruptions by frequency, type, interference and source, and preventive measures. The interruptions in the operating theatre were evaluated for 52 surgical procedures based on real-time recordings and divided into routine operative procedures (ROP, n = 26, without intervention) and intervened operative procedures (IOP, n = 26, observed after team brief and placement of a warning sign for unnecessary door openings) groups. Intervened operative procedures vs. routine operative procedures was associated with a significantly lower number of interruptions (p = 0.014). Implementation of preventive measures was associated with a significantly lower number of entrances and exits (p = 0.001) and equipment issues (p = 0.003), interruptions that affected the circulating nurse or anaesthesia technician/associate (p = 0.003) and those caused by team members other than assisting surgeon and scrub nurse (p-value ranged from 0.015 to 0.009). Our findings revealed significantly reduced interruptions after a simple preventive measure including team brief and the placement of a warning sign for unnecessary door openings.

A real-time measurement of general practice workload in the Republic of Ireland: a prospective study.

BACKGROUND: Demand for GP services in the Republic of Ireland (RoI) is increasing, and the resultant escalation in workload demands is an issue of growing concern. Accordingly, the accurate measurement and description of GP workload is essential to inform future healthcare planning. AIM: To provide a real-time measurement of GP workload with respect to hours worked and of proportional time expenditure on typical workload activities. DESIGN AND SETTING: A prospective study among GPs in the RoI that took place from January 2019 to March 2019. METHOD: Participants were invited to enrol in the study by direct email invitation and via notifications posted within GP-specific monthly journals; online forums; and a social media platform. Participants used a time-management software program to self-record workload activity in real time over 6 weeks. RESULTS: In total, 123 GPs were included for final analyses with a total of 8930 hours of activity recorded. The mean duration of a two-session day (excluding break-time) was 9.9 hours (95% confidence interval [CI] = 9.7 to 10.0; interquartile range [IQR] 7.9 to 13.9). Of this time, 64% was spent on clinical consultations. In total, 25.4% of activity was recorded outside the hours of 9.00 am and 5.00 pm. An average of 12.4 face-to-face consultations were completed per session of activity. The mean duration of a 10-session week was greatest for the partner (50.8 hours; 95% CI = 49.8 to 51.9) and >55-year-old (50.8 hours; 95% CI = 49.3 to 52.2) demographics, relative to their respective colleagues. CONCLUSION: To the authors' knowledge, this is the first study to provide an objective, accurate, and granular real-time measurement of GP workload in the RoI, demonstrating the significant volume and variety of work undertaken by GPs in the RoI.

Does Size Matter? Cryoballoon-Based Pulmonary Vein Isolation Using a Novel 25-mm Circular Mapping Catheter.

BACKGROUND: Real-time recording of pulmonary vein isolation (PVI) using a circular mapping catheter has become a key aspect of cryoballoon (CB) ablation. The aim of this study was to investigate the procedural safety, efficacy and rate of real-time pulmonary vein (PV) recording using a novel circular mapping catheter with a 25-mm loop size for CB-based PVI.Methods and Results:A total of 40 patients with symptomatic atrial fibrillation (AF) underwent PVI using a second-generation CB and a novel 25-mm circular mapping catheter. A total of 159 PV were identified and successfully isolated. Real-time PV recording was achieved in 80% of the PV. In 3 right inferior PV the circular mapping catheter had to be exchanged for a stiff guidewire due to insufficient mechanical support. Therefore, acute PVI using exclusively the circular mapping catheter was achieved in 156/159 PV (98%). Mean procedure and fluoroscopy times were 66±21 min and 15±6 min, respectively. Transient phrenic nerve palsy occurred in 1 patient as the only procedural complication. CONCLUSIONS: The exclusive use of a novel 25-mm circular mapping catheter for CB ablation of AF results in a real-time PV recording rate of 80% and isolation of 98% of targeted PV.

Pulmonary vein isolation with real-time pulmonary vein potential recording using second-generation cryoballoon: Procedural and biophysical predictors of acute pulmonary vein reconnection.

OBJECTIVE: The study sought to evaluate the procedural and biophysical factors related to acute pulmonary vein isolation (PVI) guided by real-time pulmonary vein (PV) potential recordings. METHODS: A total of 180 consecutive patients with drug-resistant atrial fibrillation (AF) undergoing CB2 (second-generation version of cryoballoon) ablation were enrolled. Real-time monitoring of PV potentials was obtained using an inner lumen spiral mapping catheter. RESULTS: Acute isolation was achieved in all PVs without touch-up ablation. Real-time assessment of PV disconnection was possible in 611 of 711 (85.9%) PVs. A total of 617 (86.8%) PVs were isolated during the initial freeze. Longer time cycle integration (TCI) (TTI * freeze cycle, TCI) (254.6 ± 112.8 seconds vs 74.1 ± 59.7 seconds, P < 0.001), time to isolation (TTI) (94.3 ± 34.0 seconds vs 46.3 ± 26.2 seconds, P < 0.001), higher nadir temperature (-45.5 ± 5.3°C vs -50.4 ± 5.5°C, P < 0.001), longer time to -40°C (77.3 ± 22.7 seconds vs 55.7 ± 23.2 seconds, P < 0.001), faster interval rewarming time at 0°C (9.4 ± 4.3 seconds vs 12.4 ± 4.9 seconds, P = 0.008), and total balloon rewarming time (38.1 ± 11.6 seconds vs 47.7 ± 14.0 seconds, P = 0.003) were observed in PVs with acute reconduction. TTI ≤ 65 seconds predicted absence of acute reconnection with 84.2% sensitivity and 75.7% specificity, whereas TCI ≤ 119 seconds presented 94.7% sensitivity and 80.2% specificity. At a mean follow-up of 4.7 ± 1.4 months, 82.2% of patients were free of AF. None of those with PV reconnections suffered from AF recurrences. CONCLUSIONS: The ablation using CB2 is effective in achieving acute PVI. Real-time assessment of PVI could be achieved during CB application in 86% of PVs. The incidence of spontaneous PV reconnection is very low, observed in just 3% of isolated PVs. TTI ≤ 65 seconds and TCI ≤ 119 seconds predicted absence of acute PV reconnection. Although they may identify effective cryoapplications in the acute phase, their performance still needs to be verified in the long term.

Construction of Asymmetrical Hexameric Biomimetic Motors with Continuous Single-Directional Motion by Sequential Coordination.

The significance of bionanomotors in nanotechnology is analogous to mechanical motors in daily life. Here the principle and approach for designing and constructing biomimetic nanomotors with continuous single-directional motion are reported. This bionanomotor is composed of a dodecameric protein channel, a six-pRNA ring, and an ATPase hexamer. Based on recent elucidations of the one-way revolving mechanisms of the phi29 double-stranded DNA (dsDNA) motor, various RNA and protein elements are designed and tested by single-molecule imaging and biochemical assays, with which the motor with active components has been constructed. The motor motion direction is controlled by three operation elements: (1) Asymmetrical ATPase with ATP-interacting domains for alternative DNA binding/pushing regulated by an arginine finger in a sequential action manner. The arginine finger bridges two adjacent ATPase subunits into a non-covalent dimer, resulting in an asymmetrical hexameric complex containing one dimer and four monomers. (2) The dsDNA translocation channel as a one-way valve. (3) The hexameric pRNA ring geared with left-/right-handed loops. Assessments of these constructs reveal that one inactive subunit of pRNA/ATPase is sufficient to completely block motor function (defined as K = 1), implying that these components work sequentially based on the principle of binomial distribution and Yang Hui's triangle.

Second-generation cryoballoon ablation without the use of real-time recordings: A novel strategy based on a temperature-guided approach to ablation.

BACKGROUND: The achievement of -40°C within the first 60 seconds during cryoenergy applications has proven to independently predict durable pulmonary vein (PV) isolation in the setting of second-generation cryoballoon (CB-A; Medtronic, Minneapolis, MN) ablation. OBJECTIVE: We sought to evaluate a strategy based on the attainment of the specific parameter of -40°C within the first 60 seconds during cryoenergy applications in the setting of CB-A ablation without the use of an inner lumen mapping catheter (Achieve, Medtronic) for the visualization of real-time recordings. METHODS: A total of 52 patients having undergone CB ablation for paroxysmal atrial fibrillation (AF) between 1 February 2015 and 30 June 2015 who underwent a temperature-guided approach based on achieving -40°C within 60 seconds without real-time recordings (wire group) were compared with a cohort of 52 propensity score-matched patients having undergone CB ablation performed with an inner lumen mapping catheter (Achieve group). All PVs were checked for electrical isolation at the end of the procedure with a circular mapping catheter in the wire group. RESULTS: Electrical isolation could be obtained in all patients in the Achieve group and in 99% of PVs in the wire group. Freedom from AF without antiarrhythmic drugs at a mean follow-up of 12.4 ± 3.0 months did not significantly differ between both groups (85% vs 88%, respectively; P = .56). CONCLUSION: A temperature-guided approach based on achieving -40°C within 60 seconds is effective in producing PV isolation and affords freedom from AF at 12-month follow-up in 85% of patients affected by paroxysmal AF after a 3-month blanking period.

Pulmonary Vein Isolation Using the First-Generation Cryoballoon Technique in Chinese Patients.

BACKGROUND: Cryoballoon ablation is an alternative for the treatment of atrial fibrillation (AF). We assess the relationship among pulmonary vein (PV) electrophysiology, balloon temperature, and persistent PV isolation (PVI), and report procedural properties, safety, and efficacy of this technique in a Chinese center for the first time. METHODS: A total of 70 patients with paroxysmal (n = 57) and persistent (n = 13) AF were consecutively enrolled. PVI was performed with cryoballoon catheter. Real-time recording of dissociation of PV potentials was attempted using a circumferential mapping catheter. RESULTS: Successful PVI was achieved in 274 of 282 (97.2%) PVs. Procedural duration was 115.2 ± 24.8 minutes and fluoroscopy time was 29.6 ± 8.9 minutes. Real-time PV potential recording was achieved in 232 (84.3%) PVs. Regarding time to isolation, a cut-off value of less than 60 seconds was predictive of persistent PVI with a sensitivity of 0.76 and specificity of 0.82 (area under curve = 0.835; P < 0.0001). The nadir balloon temperature was significantly lower in PVs without early reconduction (-46.3 ± 0.5°C vs -40.2 ± 1.3°C, P < 0.0001). However, there was an insignificant trend that the balloon temperature at isolation was higher in PVs without reconduction (-33.9 ± 0.7°C vs -36.4 ± 2.0°C, P = 0.14). The overall complication rate was 5.7%. After a median follow-up of 6.5 (range 3.2-14.9) months, 76% of patients were free of AF recurrence with a blanking period of 3 months. CONCLUSIONS: Real-time PV potentials can be recorded in most PVs. The time to isolation is predictive of the persistency of PVI. The nadir balloon temperature, not the balloon temperature at isolation, is significantly lower in PVs without reconduction.

Searching for the use of virtual reality and real-time recording technique in the functional ex-periment teaching / 中华医学教育探索杂志

Functional experiment plays an important role in understanding the mechanisms of diseases and principles of diagnosis and treatment. It requires students to master basic skills of func-tional operation, and complicated disciplines of functional alteration as well. Thus functional experi-ment needs to be an open course. The use of the virtual reality (VR) and real-time recording tech-niques provides potential for this exploration. By the way of real-time recording system, HD video of experiment operation is played, which helps guiding students to learn basic experiment skills; while based on the development status of VR technology, it is more applicable for learning by oneself, such as preview before the class and review for the test, and furthermore, the advantage of VR technique will be more apparent, if the key development focuses on experiment extensions to disclose more compli-cated functional alterations. This new technique helps to improve teaching effects of functional experi-ment.