RESUMEN
The first steps toward maize (Zea mays subspecies mays) domestication occurred in the Balsas region of Mexico by â¼9,000 calendar years B.P. (cal B.P.), but it remains unclear when maize was productive enough to be a staple grain in the Americas. Molecular and microbotanical data provide a partial picture of the timing and nature of morphological change, with genetic data indicating that alleles for some domestication traits were not yet fixed by 5,300 cal B.P. in the highlands of Mexico. Here, we report 88 radiocarbon dates on the botanical remains from El Gigante rockshelter (Honduras) to establish a Bayesian chronology over the past â¼11,000 y spanning the transition to maize-based food production. Botanical remains are remarkably well preserved and include over 10,000 maize macrofossils. We directly dated 37 maize cobs to establish the appearance and local change of maize at the site. Cobs are common in deposits dating between 4,340 and 4,020 cal B.P., and again between 2,350 and 980 cal B.P. The earliest cobs appear robustly domesticated, having 10-14 rows, suggesting strong selection for increased yield. The later cobs are comparable to these earliest ones, but show clear emergence of diverse traits, including increased cob width, rachis segment length, and cupule width. Our results indicate that domesticated landraces of maize productive enough to be a staple grain existed in Central America by 4,300 cal B.P.
Asunto(s)
Agricultura/historia , Fósiles , Variación Genética , Zea mays/genética , América Central , Geografía , Historia Antigua , Honduras , México , Datación Radiométrica , Especificidad de la Especie , Factores de Tiempo , Zea mays/clasificación , Zea mays/crecimiento & desarrolloRESUMEN
Peripheral monocytes from patients with common variable immunodeficiency (CVID) had on average a 2 fold greater tendency to form giant cells in medium without additional cytokines. Giant cell formation was faster and 3 to 5 fold higher in most CVID cells compared to normal. Addition of IL4, GMCSF, IFNγ, TNFa and both T cell and monocyte conditioned media promoted monocyte fusion of some CVID individuals over 5 fold the normal average level, with combinations of cytokines and monokines acting synergistically. The reduction of normal giant cell formation by anti-IFNγ antibody and a greater tendency of CVID cells to fuse in immunoglobulin conditioned media suggests that standard IVIg treatment contributes to granuloma formation. CVID and normal giant cells expressed similar levels of phenotypic molecules and had similar phagocytic activity. Monocytes from many CVID patients have an elevated tendency to fuse which may explain the high incidence of granulomatous complications in CVID.
Asunto(s)
Inmunodeficiencia Variable Común/inmunología , Células Gigantes/inmunología , Granuloma/inmunología , Enfermedad Granulomatosa Crónica/inmunología , Adulto , Anciano , Femenino , Humanos , Interferón gamma/inmunología , Interleucina-4/inmunología , Leucocitos Mononucleares/inmunología , Masculino , Persona de Mediana Edad , Monocitos/inmunología , Linfocitos T/inmunología , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
BACKGROUND: Mycoplasma amphoriforme has been associated with infection in patients with primary antibody deficiency (PAD). Little is known about the natural history of infection with this organism and its ability to be transmitted in the community. METHODS: The bacterial load was estimated in sequential sputum samples from 9 patients by quantitative polymerase chain reaction. The genomes of all available isolates, originating from patients in the United Kingdom, France, and Tunisia, were sequenced along with the type strain. Genomic data were assembled and annotated, and a high-resolution phylogenetic tree was constructed. RESULTS: By using high-resolution whole-genome sequencing (WGS) data, we show that patients can be chronically infected with M. amphoriforme manifesting as a relapsing-remitting bacterial load, interspersed by periods when the organism is undetectable. Importantly, we demonstrate transmission of strains within a clinical environment. Antibiotic resistance mutations accumulate in isolates taken from patients who received multiple courses of antibiotics. CONCLUSIONS: Mycoplasma amphoriforme isolates form a closely related species responsible for a chronic relapsing and remitting infection in PAD patients in the United Kingdom and from immunocompetent patients in other countries. We provide strong evidence of transmission between patients attending the same clinic, suggesting that screening and isolation may be necessary for susceptible patients. This work demonstrates the critical role that WGS can play in rapidly unraveling the biology of a novel pathogen.
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Genoma Bacteriano , Síndromes de Inmunodeficiencia/complicaciones , Infecciones por Mycoplasma/microbiología , Mycoplasma/genética , Adulto , Carga Bacteriana , Transmisión de Enfermedad Infecciosa , Farmacorresistencia Bacteriana/genética , Genómica , Humanos , Mutación , Mycoplasma/clasificación , Mycoplasma/aislamiento & purificación , Infecciones por Mycoplasma/etiología , Infecciones por Mycoplasma/transmisión , Filogenia , Recurrencia , Esputo/microbiologíaRESUMEN
BACKGROUND: Quadripolar left ventricular pacing leads permit a variety of pacing configurations from different sites within a coronary vein. There may be advantages to selecting a specific pacing vector. This study examines whether the range of cardiac outputs obtained at cardiac resynchronization therapy (CRT) implantation is greater between different poles within a vein, or greater between two different veins. METHODS AND RESULTS: The cardiac index (CI, L/min/m(2) ) was measured during CRT implantation using a noninvasive cardiac output monitor (NICOM™, Cheetah Medical Inc., Newton Center, MA, USA) and a quadripolar left ventricle (LV) lead, in 22 patients with sinus rhythm. CI was recorded during right atrial-biventricular pacing at 70/min with fixed atrioventricular and ventriculo-ventricular delay, from each LV electrode in one vein, and then from an alternate vein. Phrenic nerve stimulation (PNS) occurred in nine of 15 posterior and three of 21 anterior veins (P = 0.005). At least one electrode in each vein had no PNS. The mean (standard deviation [SD]) difference between best and worst CI within any one vein was 13.1% (±9%). The mean (SD) difference between the best CI in one vein compared to the other was 9.8% (±8%; P = 0.043). In 16 of 22 patients, the range of CI was greater between poles within one vein, rather than between two veins (best of one vein compared to best from the other). In four of 22 patients, the range was greater between veins (P = 0.0003). CONCLUSION: A greater range of CI is found within a single vein than between two different veins. This finding has implications both for the approach to implant technique and postimplant programming and optimization.
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Gasto Cardíaco , Terapia de Resincronización Cardíaca/métodos , Vasos Coronarios/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Insuficiencia Cardíaca/prevención & control , Insuficiencia Cardíaca/fisiopatología , Anciano , Dispositivos de Terapia de Resincronización Cardíaca , Electrodos Implantados , Femenino , Insuficiencia Cardíaca/diagnóstico , Humanos , Masculino , Resultado del TratamientoRESUMEN
Mycoplasma amphoriforme is a recently described organism isolated from the respiratory tracts of patients with immunodeficiency and evidence of chronic infection. Novel assays for the molecular detection of the organism by real-time quantitative PCRs (qPCRs) targeting the uracil DNA glycosylase gene (udg) or the 23S rRNA gene are described here. The analytical sensitivities are similar to the existing conventional M. amphoriforme 16S rRNA gene PCR, with the advantage of being species specific, rapid, and quantitative. By using these techniques, we demonstrate the presence of this organism in 17 (19.3%) primary antibody-deficient (PAD) patients, 4 (5%) adults with lower respiratory tract infection, 1 (2.6%) sputum sample from a patient attending a chest clinic, and 23 (0.21%) samples submitted for viral diagnosis of respiratory infection, but not in normal adult control subjects. These data show the presence of this microorganism in respiratory patients and suggest that M. amphoriforme may infect both immunocompetent and immunocompromised people. Further studies to characterize this organism are required, and this report provides the tools that may be used by other research groups to investigate its pathogenic potential.
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Técnicas de Diagnóstico Molecular/métodos , Infecciones por Mycoplasma/diagnóstico , Mycoplasma/aislamiento & purificación , Reacción en Cadena en Tiempo Real de la Polimerasa/métodos , Infecciones del Sistema Respiratorio/diagnóstico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Mycoplasma/genética , Infecciones por Mycoplasma/microbiología , ARN Ribosómico 23S/genética , Infecciones del Sistema Respiratorio/microbiología , Sensibilidad y Especificidad , Uracil-ADN Glicosidasa/genética , Adulto JovenRESUMEN
In this paper we present a review of the most current avenues of research into Kinect-based elderly care and stroke rehabilitation systems to provide an overview of the state of the art, limitations, and issues of concern as well as suggestions for future work in this direction. The central purpose of this review was to collect all relevant study information into one place in order to support and guide current research as well as inform researchers planning to embark on similar studies or applications. The paper is structured into three main sections, each one presenting a review of the literature for a specific topic. Elderly Care section is comprised of two subsections: Fall detection and Fall risk reduction. Stroke Rehabilitation section contains studies grouped under Evaluation of Kinect's spatial accuracy, and Kinect-based rehabilitation methods. The third section, Serious and exercise games, contains studies that are indirectly related to the first two sections and present a complete system for elderly care or stroke rehabilitation in a Kinect-based game format. Each of the three main sections conclude with a discussion of limitations of Kinect in its respective applications. The paper concludes with overall remarks regarding use of Kinect in elderly care and stroke rehabilitation applications and suggestions for future work. A concise summary with significant findings and subject demographics (when applicable) of each study included in the review is also provided in table format.
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Terapia por Ejercicio/métodos , Rehabilitación de Accidente Cerebrovascular , Anciano , HumanosRESUMEN
One of the great advantages of organic-inorganic metal halides is that their structures and properties are highly tuneable and this is important when optimizing materials for photovoltaics or other optoelectronic devices. One of the most common and effective ways of tuning the electronic structure is through anion substitution. Here, we report the inclusion of bromine into the layered perovskite [H3N(CH2)6NH3]PbBr4 to form [H3N(CH2)6NH3]PbBr4·Br2, which contains molecular bromine (Br2) intercalated between the layers of corner-sharing PbBr6 octahedra. Bromine intercalation in [H3N(CH2)6NH3]PbBr4·Br2 results in a decrease in the band gap of 0.85 eV and induces a structural transition from a Ruddlesden-Popper-like to Dion-Jacobson-like phase, while also changing the conformation of the amine. Electronic structure calculations show that Br2 intercalation is accompanied by the formation of a new band in the electronic structure and a significant decrease in the effective masses of around two orders of magnitude. This is backed up by our resistivity measurements that show that [H3N(CH2)6NH3]PbBr4·Br2 has a resistivity value of one order of magnitude lower than [H3N(CH2)6NH3]PbBr4, suggesting that bromine inclusion significantly increases the mobility and/or carrier concentration in the material. This work highlights the possibility of using molecular inclusion as an alternative tool to tune the electronic properties of layered organic-inorganic perovskites, while also being the first example of molecular bromine inclusion in a layered lead halide perovskite. By using a combination of crystallography and computation, we show that the key to this manipulation of the electronic structure is the formation of halogen bonds between the Br2 and Br in the [PbBr4]∞ layers, which is likely to have important effects in a range of organic-inorganic metal halides.
RESUMEN
Marine sedimentary rocks deposited across the Neoproterozoic Cryogenian Snowball interval, ~720-635 million years ago, suggest that post-Snowball fertilization of shallow continental margin seawater with phosphorus accelerated marine primary productivity, ocean-atmosphere oxygenation, and ultimately the rise of animals. However, the mechanisms that sourced and delivered bioavailable phosphate from land to the ocean are not fully understood. Here we demonstrate a causal relationship between clay mineral production by the melting Sturtian Snowball ice sheets and a short-lived increase in seawater phosphate bioavailability by at least 20-fold and oxygenation of an immediate post-Sturtian Snowball ocean margin. Bulk primary sediment inputs and inferred dissolved seawater phosphate dynamics point to a relatively low marine phosphate inventory that limited marine primary productivity and seawater oxygenation before the Sturtian glaciation, and again in the later stages of the succeeding interglacial greenhouse interval.
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Sitios de Unión , Inmunodeficiencia Variable Común/genética , Subunidad gamma Común de Receptores de Interleucina/genética , Células Asesinas Naturales/metabolismo , Linfopenia/genética , Mutación , Regiones Promotoras Genéticas , Adulto , Preescolar , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/metabolismo , Humanos , Linfopenia/diagnóstico , Linfopenia/metabolismo , Masculino , Unión Proteica , Proteínas Proto-Oncogénicas c-ets/metabolismoRESUMEN
Skeletal remains and historical accounts indicate that grey whales (Eschrichtius robustus) existed in the North Atlantic Ocean from the Pleistocene into the seventeenth century. Fossil and sub-fossil occurrences in this basin are rare, distributed from the east coast of the United States to Iceland and Europe. Here, we report an incomplete skeleton of a Holocene grey whale from Pender County, North Carolina, USA. This specimen represents a physically immature individual and is the most complete North Atlantic grey whale specimen reported to date. It comprises 42 cranial and postcranial elements, including the cranium, parts of the rostrum, both mandibles, both scapulae, humeri, radii and ulnae, most of the vertebral column anterior to the lumbar region and numerous ribs. Its provenance near the inlet of a large estuary is consistent with previous findings from the southeastern USA and parallels the species' habitat use in Baja California breeding and calving grounds in the North Pacific Ocean. Radiocarbon dating indicates an age of 827 ± 172 years before present. Cut marks on multiple skeletal elements indicate that the animal was butchered, suggesting some level of human exploitation of the species in the southeastern USA in the twelfth century, approximately 500 years prior to its extirpation in the North Atlantic.
RESUMEN
Lipopolysaccharide (LPS), a product of Gram-negative bacteria, is potent mediator of tumor necrosis factor (TNF)alpha production by myeloid/macrophage cells. Inhibitors capable of blocking the signaling events that result in TNF alpha production could provide useful therapeutics for treating septic shock and other inflammatory diseases. Broad spectrum tyrosine inhibitors are known to inhibit TNF alpha production, however, no particular family of tyrosine kinases has been shown to be essential for this process. Here we show that the Bruton's tyrosine kinase (Btk)-deficient mononuclear cells from X-linked agammaglobulinemia patients have impaired LPS-induced TNF alpha production and that LPS rapidly induces Btk kinase activity in normal monocytes. In addition, adenoviral overexpression of Btk in normal human monocytes enhanced TNF alpha production. We examined the role of Btk in TNF alpha production using luciferase reporter adenoviral constructs and have established that overexpression of Btk results in the stabilization of TNF alpha mRNA via the 3' untranslated region. Stimulation with LPS also induced the activation of related tyrosine kinase, Tec, suggesting that the Tec family kinases are important components for LPS-induced TNF alpha production. This study provides the first clear evidence that tyrosine kinases of the Tec family, in particular Btk, are key elements of LPS-induced TNF alpha production and consequently may provide valuable therapeutic targets for intervention in inflammatory conditions.
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Leucocitos Mononucleares/metabolismo , Lipopolisacáridos/farmacología , Proteínas Tirosina Quinasas/metabolismo , Factor de Necrosis Tumoral alfa/metabolismo , Adolescente , Adulto , Agammaglobulinemia Tirosina Quinasa , Agammaglobulinemia/genética , Agammaglobulinemia/metabolismo , Células Cultivadas , Activación Enzimática , Humanos , Proteínas I-kappa B/metabolismo , Leucocitos Mononucleares/citología , Leucocitos Mononucleares/efectos de los fármacos , Factor Estimulante de Colonias de Macrófagos/farmacología , Masculino , Inhibidor NF-kappaB alfa , Proteínas Tirosina Quinasas/genética , Factor de Necrosis Tumoral alfa/genéticaRESUMEN
The European Common Variable Immunodeficiency Disorders registry was started in 1996 to define distinct clinical phenotypes and determine overlap within individual patients. A total of 7 centers contributed patient data, resulting in the largest cohort yet reported. Patients (334), validated for the diagnosis, were followed for an average of 25.6 years (9461 patient-years). Data were used to define 5 distinct clinical phenotypes: no complications, autoimmunity, polyclonal lymphocytic infiltration, enteropathy, and lymphoid malignancy. A total of 83% of patients had only one of these phenotypes. Analysis of mortality showed a considerable reduction in the last 15 years and that different phenotypes were associated with different survival times. Types of complications and clinical phenotypes varied significantly between countries, indicating the need for large, international registries. Ages at onset of symptoms and diagnosis were shown to have a Gaussian distribution, but were not useful predictors of phenotype. The only clinical predictor was polyclonal lymphocytic infiltration, which was associated with a 5-fold increased risk of lymphoid malignancy. There was widespread variation in the levels of serum immunoglobulin isotypes as well as in the percentages and absolute numbers of B cells, confirming the heterogeneity of these conditions. Higher serum IgM and lower circulating CD8 proportions were found to be predictive markers for polyclonal lymphocytic infiltration and autoimmunity, respectively.
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Inmunodeficiencia Variable Común/clasificación , Edad de Inicio , Autoinmunidad , Linfocitos T CD8-positivos/inmunología , Estudios de Cohortes , Inmunodeficiencia Variable Común/complicaciones , Inmunodeficiencia Variable Común/mortalidad , Inmunodeficiencia Variable Común/patología , Humanos , Isotipos de Inmunoglobulinas/sangre , Infiltración Leucémica , Fenotipo , Pronóstico , Sistema de RegistrosRESUMEN
This study aimed to assess the feasibility of conducting a nutrition trial in adult male prisoners. Adult male prisoners were recruited for a 16-week randomised control trial comparing the effect of ingestion of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) and multivitamin supplements versus placebo on aggressive behaviour. The baseline and post-intervention assessments from the participant blood samples were the erythrocyte n-3 LCPUFA levels as well as measures of aggressive behaviour determined through institutional records of misconduct (IRM), the Inmate Behaviour Observation Scale (IBOS), and questionnaires. A total of 136 adult male prisoners consented to the study with a retention rate of 60%, and 93% of blood samples were successfully collected. The IRM and IBOS scores were collected for 100% of participants, whilst 82-97% of participants completed the questionnaires. From the baseline data, the Odds Ratio shows that prisoners are 4.3 times more likely to have an IBOS >2 if they are below the 6% cut off on the omega-3 index. Both groups improved across all outcome measures and, at the current sample size, no significant differences were seen between them. A power calculation suggests a total sample size of 600 participants is required to detect the effects of this dietary supplementation, and that this supplementation study is feasible in a Correctional Centre. Important criteria for the exclusion and consideration of logistics and compliance are presented.
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Agresión/efectos de los fármacos , Suplementos Dietéticos , Ácidos Grasos Omega-3/farmacología , Prisioneros/estadística & datos numéricos , Adolescente , Adulto , Anciano , Australia , Método Doble Ciego , Ácidos Grasos Omega-3/administración & dosificación , Ácidos Grasos Omega-3/sangre , Estudios de Factibilidad , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Getting incapacity benefit (IB) claimants into work has become a focus for policy makers. Strategies to help this group depend on an understanding of the reasons for claiming benefit at a local level where variations from a national strategy may be needed. METHODS: Data supplied by the Department for Work and Pensions (DWP) was analysed to establish reasons for claiming benefit in Scotland and Glasgow between 2000 and 2007. RESULTS: There has been a continuing rise in mental health diagnosis and a corresponding fall in musculoskeletal diagnosis during this period. More people were claiming because of mental health problems in Glasgow than in Scotland. Also those with a poor employment history (credits-only claimants) are more likely to claim IB because of a mental health problem. This study has shown a breakdown into 25 categories those claiming IB because of a mental health problem. CONCLUSION: DWP data can be used to provide important insights into the trends in reasons for claiming IB, in particular those claiming because of mental health problems. This study also highlighted the growing importance of problems caused by alcohol and drug-abuse claimants, a subset of the mental health category. DWP data should be used at a local as well as a national level to guide and evaluate interventions to help this vulnerable group.
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Personas con Discapacidad/psicología , Seguro por Discapacidad/tendencias , Salud Mental , Adulto , Alcoholismo/epidemiología , Femenino , Humanos , Masculino , Trastornos Mentales/epidemiología , Escocia/epidemiologíaRESUMEN
BACKGROUND: Common variable immunodeficiency (CVID) comprises a heterogeneous group of primary antibody deficiencies with complex clinical and immunological phenotypes. The recent discovery that some CVID patients show monogenic defects in the genes encoding ICOS, TACI or CD19 prompted us to investigate several functional candidate genes in individuals with CVID. RESULTS: The exonic, protein coding regions of the genes encoding: APRIL, BCMA, IL10, IL10Ralpha, IL10Rbeta, IL21, IL21R, and CCL18, were analyzed primarily in familial CVID cases, who showed evidence of genetic linkage to the respective candidate gene loci and CVID families with a recessive pattern of inheritance. Two novel SNPs were identified in exon 5 and exon 8 of the IL21R gene, which segregated with the disease phenotype in one CVID family. Eleven additional SNPs in the genes encoding BCMA, APRIL, IL10, IL10Ralpha, IL21 and IL21R were observed at similar frequencies as in healthy donors. CONCLUSION: We were unable to identify obvious disease causing mutations in the protein coding regions of the analyzed genes in the studied cohort.
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Inmunodeficiencia Variable Común/genética , Pruebas Genéticas , Antígeno de Maduración de Linfocitos B/genética , Quimiocinas CC/genética , Familia , Femenino , Humanos , Interleucina-10/genética , Subunidad alfa del Receptor de Interleucina-10/genética , Interleucinas/genética , Masculino , Linaje , Polimorfismo de Nucleótido Simple/genética , Receptores de Interleucina-21/genética , Miembro 13 de la Superfamilia de Ligandos de Factores de Necrosis Tumoral/genéticaRESUMEN
BACKGROUND: Common variable immunodeficiency (CVID) is the most common primary antibody deficiency syndrome in humans, but it remains a diagnosis of exclusion in most cases. Several genetically defined primary immunodeficiencies mimic CVID. Among them is the X-linked lymphoproliferative syndrome (XLP) which was shown to be caused by either mutations in the gene SH2D1a/SAP or, more recently, in the BIRC4/XIAP gene. METHODS: We therefore analyzed a cohort of 28 male CVID patients and 2 patients with an IgG subclass deficiency for the prevalence of mutations in BIRC4, encoding for XIAP by direct sequencing. RESULTS: All patients showed a wild-type sequence of BIRC4/XIAP. Two SNPs, rs5956583 (dbSNP126) located in exon 6 (P-->Q) and rs28382740 (dbSNP126) in the 3' untranslated region were observed at the same frequencies as reported in public databases. CONCLUSIONS: We found no patient with a defect in the coding sequence of BIRC4/XIAP in our cohort of 30 hypogammaglobulinemic patients. We therefore estimate that XLP caused by XIAP deficiency may be a very rare differential diagnosis in male patients with CVID.
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Inmunodeficiencia Variable Común/genética , Trastornos Linfoproliferativos/genética , Proteína Inhibidora de la Apoptosis Ligada a X/genética , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Inmunoglobulina G/inmunología , Masculino , Persona de Mediana Edad , Polimorfismo de Nucleótido Simple , Análisis de Secuencia de ADNRESUMEN
BACKGROUND: Incapacity Benefit (IB) is the key contributory benefit for people who are incapable of work because of illness or disability. METHODS: The aims were to establish the utility of routinely collected data for local evaluation and to provide a descriptive epidemiology of the IB population in Glasgow and Scotland for the period 2000-05 using data supplied by the Department for Work and Pensions. RESULTS: Glasgow's IB population is large in absolute and relative terms but is now falling, mainly due to a decrease in on flow. Claimants, tend to be older, have a poor work history and suffer from mental health problems. The rate of decline has been greater in Glasgow than Scotland, although the rate of on flow is still higher. CONCLUSIONS: Department for Work and Pensions (DWP) data can be used locally to provide important insights into the dynamics of the IB population. However, to be truly useful, more work needs to be undertaken to combine the DWP data with other information.
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Enfermedad Crónica , Recolección de Datos , Evaluación de la Discapacidad , Personas con Discapacidad , Política de Salud , Evaluación de Programas y Proyectos de Salud , Ausencia por Enfermedad , Humanos , Escocia , Reino UnidoRESUMEN
Wireless left ventricular endocardial pacing with the WiSE CRT system has recently become available as alternative to conventional epicardial CRT pacing. We report the first comparison of the acute electrical and hemodynamic response produced by the two CRT pacing modalities in a patient undergoing WiSE CRT implant after a failed conventional CRT procedure. WiSE CRT pacing showed an additive acute benefit compared with conventional CRT. These findings could potentially translate into long-term clinical benefit and introduce the potential for tri-ventricular pacing using both systems simultaneously.