Safety and feasibility of conduction system pacing in patients with congenital heart disease.

INTRODUCTION: Conduction system pacing (CSP) has emerged as an ideal physiologic pacing strategy for patients with permanent pacing indications. We sought to evaluate the safety and feasibility of CSP in a consecutive series of unselected patients with congenital heart disease (CHD). METHODS: Consecutive patients with CHD in which CSP was attempted were included. Safety and feasibility, implant tools and electrical parameters at implant and at follow-up were evaluated. RESULTS: A total of 20 patients were included (10 with a previous device). A total of 10 patients had complex forms of CHD, 9 moderate defects and 1 a simple defect. CSP was achieved in 75% of cases (10 His bundle pacing, 5 left bundle branch pacing) with left ventricular septal pacing in the remaining 5 patients. Procedure times and fluoroscopy times were prolongued (126 ± 82 min and 27 ± 30 min, respectively). Ventricular lead implant times widely varied ranging from 4 to 115 min, (mean 31 ± 28 min) and the use of multiple delivery sheaths was frequent (50%). The QRS width was reduced from 145 ± 36 ms at baseline to 116 ± 18 ms with CSP. Implant electrical parameters included: CSP pacing threshold 0.95 ± 0.65 V; R wave amplitude 9.2 ± 8.8 mV and pacing impedance 632 ± 183 Ohms, and remained stable at a median follow-up of 478 days (interquartile range: 225-567). Systemic ventricle systolic function and NYHA class (1.50 ± 0.51 vs. 1.10 ± 0.31; p = .008) significantly improved at follow-up. Lead revision was required in one patient at Day 4. CONCLUSIONS: Permanent CSP is safe and feasible in patients with CHD although implant technique is complex.

Genotype FBN1/phenotype relationship in a cohort of patients with Marfan syndrome.

Marfan syndrome (MFS) is a systemic connective tissue disorder caused by mutations in the fibrillin-1 (FBN1) gene, and cardiovascular involvement is the leading cause of mortality. We sought to examine the genotype/phenotype realtionship in 61 consecutive patients with a phenotype and genotype compatible with MFS. The FBN1 gene was analyzed by massive sequencing using a hybridization capture-based target enrichment custom panel. Forty-three different variants of FBN1 were identified, of which 17 have not been previously reported. The causal variants of MFS were grouped into mutations resulting in haploinsufficiency (HI group; 23 patients) and mutations producing a dominant-negative effect (DN group; 38 patients). Patient information was collected from electronic medical records and clinical evaluation. While no significant differences were found between the two groups, the HI group included more cases with aortic dissection and occurring at a younger age that the DN group (34.7% vs. 15.8%; p = 0.160). Irrespective of the mutation group, males presented with a higher probability of aortic involvement (4-fold higher risk than females) and aortic dissections events occurred at younger ages. Patients with DN variants carrying a cysteine substitution had a higher incidence of ectopia lentis.

Legibility of Text and Pictograms in Variable Message Signs: Can Single-Word Messages Outperform Pictograms?

OBJECTIVE: The current research shows the advantage of single-word messages in the particular case of variable message signs (VMSs) with a high aspect ratio. BACKGROUND: Early studies on traffic sign design proposed that pictorial information would advantage equivalent text messages in static signs. METHOD: We used a driving simulator to present individually 36 VMSs, showing six words (e.g., "congestion") and six danger signs (e.g., congestion traffic sign). In Experiment 1, 18 drivers read aloud the text or orally identified the pictograms as soon as they could correctly do it. In Experiment 2, a different sample of 18 drivers gave a motor response, according to the meaning of the message. We analyzed the legibility distance and accuracy, driving performance (speed variability), and glance behavior. RESULTS: Our results show that single-word messages were associated with better performance (farther reading distances) and required less visual demands (fewer glances and less glancing times) than pictograms. CONCLUSION: As typical configurations of VMSs usually have a high aspect ratio, and thus allow large character heights, single-word messages can outperform the legibility of pictograms. However, the final advantage of text or pictorial messages would depend on several factors, such as the driver's knowledge of the language and the pictogram set, the use of single or multiple words, the particular design and size of critical details in letters and pictograms, environmental factors, and driver age. APPLICATION: Potential applications include the design of VMSs and other devices aimed at displaying text and/or pictograms with a high aspect ratio.

Effects of pelvic and core strength training on biomechanical risk factors for anterior cruciate ligament injuries.

BACKGROUND: Little is known about the changes in biomechanical risk factors for an anterior cruciate ligament (ACL) injury after participation in a pelvic and core strength training (PCST) program in female team players. METHODS: This is a randomized controlled trial for which a total of 29 female soccer players were recruited from a soccer club and split into two groups, namely, experimental group (EG, N.=18; mean [SD] age, 17.8 [2.0 years], weight 64.0 [6.6] kg and height 1.7 [0.0] m) and control group (control, N.=11; mean [SD] age, 16.2 [1.2] years, weight 61.6 [7.3] kg and height 1.7 [0.0] m). The EG participated in an in-season 8-week PCST program (twice/week). Participants in the CG performed their normal training without additional pelvic and core strengthening. Pre- and postintervention knee frontal plane projection angle (FPPA), hip, knee and ankle peak flexion angles and jump height were collected during bilateral and unilateral drop jumps. RESULTS: PCST significantly reduced FPPA at dynamic landing, in both dominant (-7.1º) and non-dominant lower extremities (-8º). Further, this training significantly increased the peak hip (24.4º) and knee flexion angles (14.94º), but not the peak ankle dorsiflexion angle (P>0.05) which, significantly decreased in the CG (-3.5º). Following the intervention, EG significantly increased measures obtained for both bilateral (2.84 cm) and unilateral jumps (1.33 cm for the dominant leg and 1.22 cm for the non-dominant leg) (P<0.05), not so for CG (P<0.05). CONCLUSIONS: PCST resulted in improvements on ACL injury risk factors and vertical drop jump performance, suggesting that strengthening this body part warrants not only injury prevention, but increases jumping performance.

Difficulties of Drivers With Dyslexia When Reading Traffic Signs: Analysis of Reading, Eye Gazes, and Driving Performance.

A group of adult individuals with dyslexia and a matched group of normally reading individuals participated in a driving simulation experiment. Participants were asked to read the word presented on every direction traffic sign encountered along a route, as far as possible from the sign, maintaining driving performance. Word frequency and word length were manipulated as within-subject factors. We analyzed (a) reading accuracy, (b) how far the sign was when the participant started to give the response, (c) where the participant looked during the time leading up to the response, and (d) the variability of the vehicle's speed during that time and during driving on similar segments of the route that did not present the traffic signs. Individuals with dyslexia showed lower levels of performance in the reading task, the roles of word frequency and word length were more influential for them, and there was larger variability of the vehicle's speed during the time they were attempting to read the traffic sign, which did not occur during their driving on similar segments that did not present the targeted traffic signs. Therefore, the specific needs of individuals with dyslexia on the road should be considered in plans aimed at increasing traffic safety and fluidity.

Increasing the default interletter spacing of words can help drivers to read traffic signs at longer distances.

Would an increase in the default interletter spacing improve the legibility of words in traffic signs? Previous evidence on traffic sign design and recent studies on the cognitive processes involved in visual word recognition have provided conflicting results. The present work examined whether an increase in the default interletter spacing would improve the search of a word in direction traffic signs. To achieve this objective, twenty-two drivers participated in a driving simulation experiment. They followed a highway route and indicated whether a target place name was present among a set of distractors shown on direction traffic signs along the route. We compared the default interletter spacing of the Spanish "CC Rige" font (which is based on the internationally-used Transport font) and a 2.5-times expanded interletter spacing. The results revealed that the drivers were able to give a correct response at a distance to the traffic sign that was on average longer in the expanded than in the default spacing condition. This advantage in the legibility distance was observed in the absence of significant differences in reading accuracy, gaze behavior, or driving performance measures. Therefore, the evidence provided supports that drivers can benefit from a slight increase in interletter spacing relative to the standard spacing. Some of the design factors influencing this effect are discussed.

Respiratory infection in congenital cardiac disease. Hospitalizations in young children in Spain during 2004 and 2005: the CIVIC Epidemiologic Study.

OBJECTIVES: To evaluate the rate of hospitalization for acute respiratory tract infection in children less than 24 months with haemodynamically significant congenital cardiac disease, and to describe associated risk factors, preventive measures, aetiology, and clinical course. MATERIALS AND METHODS: We followed 760 subjects from October 2004 through April 2005 in an epidemiological, multicentric, observational, follow-up, prospective study involving 53 Spanish hospitals. RESULTS: Of our cohort, 79 patients (10.4%, 95% CI: 8.2%-12.6%) required a total of 105 admissions to hospital related to respiratory infections. The incidence rate was 21.4 new admissions per 1000 patients-months. Significant associated risk factors for hospitalization included, with odds ratios and 95% confidence intervals shown in parentheses: 22q11 deletion (8.2, 2.5-26.3), weight below the 10th centile (5.2, 1.6-17.4), previous respiratory disease (4.5, 2.3-8.6), incomplete immunoprophylaxis against respiratory syncytial virus (2.2, 1.2-3.9), trisomy 21 (2.1, 1.1-4.2), cardiopulmonary bypass (2.0, 1.1-3.4), and siblings aged less than 11 years old (1.7, 1.1-2.9). Bronchiolitis (51.4%), upper respiratory tract infections (25.7%), and pneumonia (20%) were the main diagnoses. An infectious agent was found in 37 cases (35.2%): respiratory syncytial virus in 25, Streptococcus pneumoniae in 5, and Haemophilus influenzae in 4. The odds ratio for hospitalization due to infection by the respiratory syncytial virus increases by 3.05 (95% CI: 2.14 to 4.35) in patients with incomplete prophylaxis. The median length of hospitalization was 7 days. In 18 patients (17.1%), the clinical course of respiratory infection was complicated and 2 died. CONCLUSIONS: Hospital admissions for respiratory infection in young children with haemodynamically significant congenital cardiac disease are mainly associated with non-cardiac conditions, which may be genetic, malnutrition, or respiratory, and to cardiopulmonary bypass. Respiratory syncytial virus was the most commonly identified infectious agent. Incomplete immunoprophylaxis against the virus increased the risk of hospitalization.