The "safe falls, safe schools" multicentre international project: Evaluation and analysis of backwards falling ability in Italian secondary schools

Problem statement: Different studies have reported on the epidemiology related to injuries resulting from falls, which are the most common causes of injury in Italy. The World Health Organization considers falls as the second leading cause of accidental or unintentional deaths worldwide. However, it has been demonstrated that the Safe Fall, Safe Schools Programme (SFSSP) based on 10-min warm-up sessions is able to teach techniques for falling backwards in safe way during physical education (PE) classes. Unfortunately, there are no studies that have analysed extensive warm-up and detraining effects related to the age. Aim: The aim of this study was to assess extensive specific warm-up (20 min) and detraining effects after five weeks on the SFSSP on Italian secondary school students according to age. Methods: Eighty-seven secondary school students took part in this investigation. Students were divided into two groups, equally distributed by age. The trial-control group (TC=39) and the control-trial group (CT=48) performed the same PE lesson for 10 weeks. In the first five weeks, two different 20-min warm-up exercises were performed (TC=SFSSP; CT=conventional warm-up); after five weeks, the warm-ups were inverted (TC=conventional warm-up; CT=SFSSP). The backwards falling ability test carried out among both groups was evaluated in relation to the position of the neck, trunk, knees, hips and hands, before and after five and 10 weeks. Results: McNemar\u2019s test showed significant differences (between pre-and mid-time points, P<0.05) for the neck, trunk, hip and hands, while no significant differences were found in the knee value (P=0.581 in TC). No differences were found between the mid-and post-time points for TC. In CT, no differences were found in-between (pre-and mid-time points, P>0.05) for all variables studied. Significant differences (P<0.05) were found in-between the mid-and post- time points for CT in all variables studied. Analysis of the total scores for SFSSP showed significantly differences in TC and CT (P<0.0001). The Wilcoxon signed-rank test showed no significant differences (total scores: first year=1.68\ub11.05 AU; fifth year=1.47\ub10.86 AU; P=0.34) before the SFSSP intervention, while the SFSSP was able to improve the ability after intervention (total scores: first year=4.47\ub10.84 AU; fifth year=3.91\ub11.40 AU; P<0.01). Conclusions: The SFSSP was able to improve motor ability for both groups and the detraining effect was found to maintain the same ability level compared to that after the SFSSP intervention. Participants started with the same level of backwards falling ability and each group, after the intervention, significantly raised its score, confirming the efficacy of the intervention. Therefore, the SFSSP could be included in the standard national programme without changing the standard training lesson

Passive drag in young swimmers: Effects of body composition, morphology and gliding position

The passive drag (Dp) during swimming is affected by the swimmer’s morphology, body density and body position. We evaluated the relative contribution of morphology, body composition, and body position adjustments in the prediction of a swimmer’s Dp. This observational study examined a sample of 60 competitive swimmers (31 male and 29 female) with a mean (±SD) age of 15.4 ± 3.1 years. The swimmer’s Dp was measured using an electro-mechanical towing device and the body composition was assessed using a bioelectrical impedance analyser. Body lengths and circumferences were measured in both the standing position and the simulated streamlined position. Partial correlation analysis with age as a control variable showed that Dp was largely correlated (p < 0.05) with body mass, biacromial-and bi-iliac-breadth, streamline chest circumference and breadth. Body mass, Body Mass Index, chest circumference and streamline chest circumference showed a significant and moderate to strong effect (η2 > 0.55) on Dp. Body mass was the best predictor of Dp explaining 69% of the variability. These results indicate that swimmers with lower Dp values were: (i) slimmer, with lower fat and fat-free mass; (ii) thinner, with lower shoulder breadth, chest circumference, and streamline trunk diameters (iii), shorter, with lower streamline height. These findings can be used for talent identification in swimming, with particular reference to the gliding performance

Impact of DEL22q11, trisomy 21, and other genetic syndromes on surgical outcome of conotruncal heart defects

Objective: Genetic syndromes occur in more than 20% of patients with conotruncal heart defects. We investigated the impact of genetic syndromes on the surgical outcome of conotruncal anomalies in infancy. Methods: This retrospective study reviews the outcome of 787 patients (median age 6.3 months) who underwent primary (598) or staged (189) repair of a conotruncal defect between 1992 and 2007. Results: Proven genetic syndrome was diagnosed in 211 patients (26.8%), including del22q11 (91 patients), trisomy 21 (29 patients), VACTERL (18 patients), and other syndromes (73 patients). Primary repair was accomplished in 80.9% of nonsyndromic patients and 74.4% of syndromic patients (P ¼ .18) Fifteen-year cumulative survival was 84.3% 2.3% in nonsyndromic patients and 73.2% 4.2% in syndromic patients (P<.001). Primary and staged repair allowed similar 15-year survival (81.4% 4.5% vs 79.1% 5.1%, P ¼ .8). Freedom from noncardiac cause of death was significantly lower in syndromic patients (P ¼ .0056). Fifteen- year Kaplan–Meier survival was 87.6% 3.9% for del22q11, 95.8% 4.1% for trisomy 21, 56.8% 6.3% for VACTERL, and 62.3% 12.7% for patients with other syndromes (P ¼ .022). Total intensive care unit stay was 10.8 4.9 days in syndromic patients and 5.1 1.7 days in nonsyndromic patients (P<.001). Freedom from reintervention 15 years after repair was 79.6% 4.9%in nonsyndromic patients and 62.4% 7.4%in syndromic patients (P ¼ .007). Conclusion: Del22q11 and trisomy 21 do not represent risk factors for mortality after repair of conotruncal anomalies, whereas other syndromes adversely affect the surgical outcome for predominant noncardiac attrition. Higher morbidity and lower mid-term freedom from reintervention can be predicted in syndromic patients

Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair

Objective: We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract. Methods: Between 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down’s syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle–to–pulmonary artery conduit in 11 (33%). Results: There were no hospital deaths. Actuarial survival was 96% 3.9% at 5 years and 85.9 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival (P ¼ .16), nor did the choice to use a valved conduit (P ¼ .82). Primary correction (P ¼ .05) and lower weight at repair (P ¼ .05) were associated with higher probability of survival. Mean follow-up was 69.3 5.9 months (range 0.2–282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38%at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions (P<.05). Conclusions: Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle–to–pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention

Transannular patching is a valid alternative for tetralogy of Fallot and complete atrioventricular septal defect repair

Objective: We report our experience with repair of tetralogy of Fallot associated with complete atrioventricular septal defect, addressing in particular the need for a pulmonary valve in the right ventricular outflow tract. Methods: Between 1992 and 2006, 33 children with tetralogy of Fallot and complete atrioventricular septal defect were admitted; 26 had Down’s syndrome (79%). Thirty-two children had complete repair (18 primary, 14 staged); of the 15 who received initial palliation, 1 died before complete repair. Right ventricular outflow tract obstruction was relieved by transannular patch in 14 cases (42%), infundibular patch with preservation of the pulmonary valve in 7 (21%), and right ventricle–to–pulmonary artery conduit in 11 (33%). Results: There were no hospital deaths. Actuarial survival was 96% 3.9% at 5 years and 85.9 1.1% at 10 years. Multivariate analysis showed that type of relief of right ventricular outflow tract obstruction did not influence survival (P ¼ .16), nor did the choice to use a valved conduit (P ¼ .82). Primary correction (P ¼ .05) and lower weight at repair (P ¼ .05) were associated with higher probability of survival. Mean follow-up was 69.3 5.9 months (range 0.2–282 months). There were 2 late deaths. Overall freedom from reoperation was 69% at 5 years and 38%at 10 years. Right ventricular outflow tract reconstruction without use of a valved conduit allowed a significantly higher freedom from reinterventions (P<.05). Conclusions: Tetralogy of Fallot associated with complete atrioventricular septal defect can be corrected at low risk with favorable intermediate survival. Use of right ventricle–to–pulmonary artery conduit can be avoided in two thirds of patients with no impact on survival, possibly improving overall freedom from reintervention

Morning or evening training : effect on heart rate circadian rhythm

Twenty male endurance athletes (aged 20\u201325 years) carried out 2-hour daily training sessions, every day from Monday to Friday, for an overall period of 4 weeks. Four different weekly training time table (09.00-11.00; 11.00-13.00; 16.00-18.00; 18.00-20.00 hours) were followed, changing the time slot each week. Each athlete trained, in turn, in each period. The fifth day of each week, heart rate was monitored for 24-28 hours. Statistical analysis employed the single and mean cosinor methods. The heart rate (HR) circadian rhythm was statistically significant (p<0.05) in all 4 training session time. The HR acrophase is progressively postponed during the afternoon: the heart rate acrophase for training done between 18.00 and 20.00 is delayed by approximately 3 hours compared to that of the training done between 09.00 and 11.00. Training done at different daily times synchronizes the HR circadian rhythm. Temporal programming of physical activity is a tool capable of modifying the temporal structure of physiological variables. This approach can be of great interest for coaches who plan training programs and it may benefit athletes when time zone adjustment is an issue, such as transferring to a different continent for a competitive event

Pneumatic pulsatile ventricular assist device as a bridge to heart transplantation in pediatric patients

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Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult: a case report

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. Arrhythmias or sudden cardiac death in adult life may be the first clinical presentation in patients with ALCAPA. We report a case, where a 39-year old woman presented with ventricular fibrillation during phycial exertion. Coronary angiography and CT-angiography revealed an anomalous origin of the left coronary artery, and an aortic reimplantation of the left coronary artery was performed followed by ICD implantation. A review of the literature on ALCAPA is presented along with CT images before and after surgery

In-hospital interstage improves interstage survival after the Norwood stage 1 operation.

OBJECTIVES: The interstage mortality rate after a Norwood stage 1 operation remains 12-20% in current series. In-hospital interstage facilitates escalation of care, possibly improving outcome. METHODS: A retrospective study was designed for hypoplastic left heart syndrome (HLHS) and HLHS variants, offering an in-hospital stay after the Norwood operation until the completion of stage 2. Daily and weekly examinations were conducted systematically, including two-dimensional and speckle-tracking echocardiography. Primary end points included aggregate survival until the completion of stage 2 and interstage freedom from escalation of care. Moreover, we calculated the sensitivity and specificity of speckle-tracking echocardiographic myocardial deformation in predicting death/transplant after the Norwood procedure. RESULTS: Between 2015 and 2019, 33 neonates with HLHS (24) or HLHS variants (9) underwent Norwood stage 1 (31) or hybrid palliation followed by a comprehensive stage 2 operation (2). Stage 1 Norwood-Sano was preferred in 18 (54.5%) neonates; the classic Norwood with Blalock-Taussig shunt was performed in 13 (39.4%) neonates. The Norwood stage 1 30-day mortality rate was 6.2%. The in-hospital interstage strategy was implemented after Norwood stage 1 with a 3.4% interstage mortality rate. The aggregate Norwood stage 1 and interstage Kaplan-Meier survival rate was 90.6 ± 5.2%. Escalation of care was necessary for 5 (17.2%) patients at 2.5 ± 1.2 months during the interstage for compromising atrial arrhythmias (2), Sano-shunt stenosis (1) and pneumonia requiring a high-frequency oscillator (2); there were no deaths. A bidirectional Glenn (25) or a comprehensive-Norwood stage 2 (2) was completed in 27 patients at 4.7 ± 1.2 months with a 92.6% survival rate. The overall Kaplan-Meier survival rate is 80.9 ± 7.0% at 4.3 years (mean 25.3 ± 15.7 months). An 8.7% Δ longitudinal strain 30 days after Norwood stage 1 had 100% sensitivity and 81% specificity for death/transplant. CONCLUSIONS: In-hospital interstage facilitates escalation of care, which seems efficacious in reducing interstage Norwood deaths. A significant reduction of longitudinal strain after Norwood stage 1 is a strong predictor of poor outcome

The fate of children with microdeletion 22q11.2 syndrome and congenital heart defect: clinical course and cardiac outcome

BACKGROUND: This study aimed to evaluate the cardiac outcome for children with microdeletion 22q11.2 and congenital heart defect (CHD). METHODS: A total of 49 consecutive children with 22q11.2 and CHD were retrospectively identified. The CHD consisted of tetralogy of Fallot and variances (n = 22), interrupted aortic arch (n = 10), ventricular septal defect (n = 8), truncus arteriosus (n = 6), and double aortic arch (n = 1). Extracardiac anomalies were present in 46 of 47 children. RESULTS: The median follow-up time was 8.5 years (range, 3 months to 23.5 years). Cardiac surgical repair was performed for 35 children, whereas 5 had palliative surgery, and 9 never underwent cardiac surgery. The median age at repair was 7.5 months (range, 2 days to 5 years). The mean hospital stay was 35 days (range, 7-204 days), and the intensive care unit stay was 15 days (range, 3-194 days). Significant postoperative complications occurred for 26 children (74%), and surgery for extracardiac malformations was required for 21 patients (43%). The overall mortality rate was 22% (11/49), with 1-year survival for 86% and 5-year survival for 80% of the patients. A total of 27 cardiac reinterventions were performed for 16 patients (46%) including 15 reoperations and 12 interventional catheterizations. Residual cardiac findings were present in 25 patients (71%) at the end of the follow-up period. CONCLUSIONS: Children with microdeletion 22q11.2 and CHD are at high risk for mortality and morbidity, as determined by both the severity of the cardiac lesions and the extracardiac anomalies associated with the microdeletion