Right Ventricular Septal Pacing: Has it come of age?

Prolonged pacing from the right ventricular (RV) apex has been shown to be associated with progressive left ventricular dysfunction as demonstrated by heart failure, atrial fibrillation and an increased morbidity and mortality [1-6]. This has led to an interest in alternate RV pacing sites and in particular the mid RV septum and the RV outflow tract (RVOT) septum [7-11]. These sites are theoretically associated with a more physiological ventricular activation. Despite the perceived advantages of septal pacing, results to date are not confirmatory [12-18]. These studies were generally acute or extended to 6-months and the leads secured to the RVOT and thus were not necessarily septal. On review of the early work of Durrer et al in 1970 [19] the septal regions of the RVOT and mid RV are the first zones of the ventricle to depolarize, suggesting that pacing from these areas on the right side of the septum would achieve as normal a contraction pattern as possible. In contrast, the free wall of the RV is the last zone to be depolarized. When attempting to prove the physiologic and hemodynamic benefits of septal pacing, it seems illogical to choose the RVOT with a mix of both septal and free wall pacing. The potential benefits of septal pacing would possibly be negated by free wall pacing and thus it is not surprising that there has been no consistent benefit over RV apical pacing demonstrated

A NOVEL STUDY EXAMINING COGNITIVE-MOTOR INTERFERENCE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

The aim of this study is to assess the feasibility of examining cognitive motor interference (CMi) in athletes following anterior cruciate ligament reconstruction (ACLR) and return to sport through electroencephalography (EEG) and three-dimensional motion capture recordings. A 128-electrode EEG system is used to track brain wave patterns for specific biomarkers of CMi during sitting and balance tasks. An 8-camera Optitrack system is used to obtain three-dimensional kinematics during anticipated and unanticipated drop vertical jumps. Preliminary EEG N200 amplitudes (ACL: -4.99 ± 2.39; Control: -7.75 ± 5.83) and peak knee flexion (ACL: 93.29 ± 12.92°; Control: 92.87 ± 7.17°) during dual-task and unanticipated landings, respectively, demonstrate the feasibility of this study. Future work will continue to assess the effect of CMi on risk factors for secondary ACL injury

Treading carefully: a qualitative ethnographic study of the clinical, social and educational uses of exercise ECG in evaluating stable chest pain

Objective To examine functions of the exercise ECG in the light of the recent National Institute for Health and Clinical Excellence guidelines recommending that it should not be used for the diagnosis or exclusion of stable angina. Design Qualitative ethnographic study based on interviews and observations of clinical practice. Setting 3 rapid access chest pain clinics in England. Participants Observation of 89 consultations in chest pain clinics, 18 patient interviews and 12 clinician interviews. Main outcome measure Accounts and observations of consultations in chest pain clinics. Results The exercise ECG was observed to have functions that extended beyond diagnosis. It was used to clarify a patient's story and revise the initial account. The act of walking on the treadmill created an additional opportunity for dialogue between clinician and patient and engagement of the patient in the diagnostic process through precipitation of symptoms and further elaboration of symptoms. The exercise ECG facilitated reassurance in relation to exercise capacity and tolerance, providing a platform for behavioural advice particularly when exercise was promoted by the clinician. Conclusions Many of the practices that have been built up around the use of the exercise ECG are potentially beneficial to patients and need to be considered in the re-design of services without that test. Through its contribution to the patient's history and to subsequent advice to the patient, the exercise ECG continues to inform the specialist assessment and management of patients with new onset stable chest pain, beyond its now marginalised role in diagnosis

Presence of Putative Repeat-in-Toxin Gene tosA in Escherichia coli Predicts Successful Colonization of the Urinary Tract

Uropathogenic Escherichia coli (UPEC) strains, which cause the majority of uncomplicated urinary tract infections (UTIs), carry a unique assortment of virulence or fitness genes. However, no single defining set of virulence or fitness genes has been found in all strains of UPEC, making the differentiation between UPEC and fecal commensal strains of E. coli difficult without the use of animal models of infection or phylogenetic grouping. In the present study, we consider three broad categories of virulence factors simultaneously to better define a combination of virulence factors that predicts success in the urinary tract. A total of 314 strains of E. coli, representing isolates from fecal samples, asymptomatic bacteriuria, complicated UTIs, and uncomplicated bladder and kidney infections, were assessed by multiplex PCR for the presence of 15 virulence or fitness genes encoding adhesins, toxins, and iron acquisition systems. The results confirm previous reports of gene prevalence among isolates from different clinical settings and identify several new patterns of gene associations. One gene, tosA, a putative repeat-in-toxin (RTX) homolog, is present in 11% of fecal strains but 25% of urinary isolates. Whereas tosA-positive strains carry an unusually high number (11.2) of the 15 virulence or fitness genes, tosA-negative strains have an average of only 5.4 virulence or fitness genes. The presence of tosA was predictive of successful colonization of a murine model of infection, even among fecal isolates, and can be used as a marker of pathogenic strains of UPEC within a distinct subset of the B2 lineage

On p-saturable groups

AbstractA pro-p group G is a PF-group if it has central series of closed subgroups {Ni}i∈N with trivial intersection satisfying N1=G and [Ni,G,…p−1,G]⩽Ni+1p. In this paper, we prove that a finitely generated pro-p group G is a p-saturable group, in the sense of Lazard, if and only if it is a torsion free PF-group. Using this characterization, we study certain families of subgroups of p-saturable groups. For example, we prove that any normal subgroup of a p-saturable group contained in the Frattini is again p-saturable

Horizontal coherence of low-frequency fixed-path sound in a continental shelf region with internal-wave activity

Author Posting. © Acoustical Society of America, 2012. This article is posted here by permission of Acoustical Society of America for personal use, not for redistribution. The definitive version was published in Journal of the Acoustical Society of America 131 (2012): 1782-1797, doi:10.1121/1.3666003.Sound at 85 to 450 Hz propagating in approximately 80-m depth water from fixed sources to a joint horizontal/vertical line array (HLA/VLA) is analyzed. The data are from a continental shelf area east of Delaware Bay (USA) populated with tidally generated long- and short-wavelength internal waves. Sound paths are 19 km in the along-shore (along internal-wave crest) direction and 30 km in the cross-shore direction. Spatial statistics of HLA arrivals are computed as functions of beam steering angle and time. These include array gain, horizontally lagged spatial correlation function, and coherent beam power. These quantities vary widely in magnitude, and vary over a broad range of time scales. For example, correlation scale can change rapidly from forty to five wavelengths, and correlation-scale behavior is anisotropic. In addition, the vertical array can be used to predict correlation expected for adiabatic propagation with cylindrical symmetry, forming a benchmark. Observed variations are in concert with internal-wave activity. Temporal variations of three coherence measures, horizontal correlation length, array gain, and ratio of actual correlation length to predicted adiabatic-mode correlation length, are very strong, varying by almost a factor of ten as internal waves pass.This work was supported by Office of Naval Research (ONR) Grants Nos. N00014-05-1-0482 and N00014-11-1- 0194 to T.F.D., ONR Grant No. N00014-04-1-0146 to J.F.L., and an ONR Ocean Acoustics Postdoctoral Fellowship awarded to J.M.C. under Professor William Carey at Boston University

BMQ

BMQ: Boston Medical Quarterly was published from 1950-1966 by the Boston University School of Medicine and the Massachusetts Memorial Hospitals

Detectability of gravitational wave events by spherical resonant-mass antennas

We have calculated signal-to-noise ratios for eight spherical resonant-mass antennas interacting with gravitational radiation from inspiralling and coalescing binary neutron stars and from the dynamical and secular bar-mode instability of a rapidly rotating star. We find that by using technology that could be available in the next several years, spherical antennas can detect neutron star inspiral and coalescence at a distance of 15 Mpc and the dynamical bar-mode instability at a distance of 2 Mpc.Comment: 39 pages, 4 EPS Figures, some additional SNRs for secular instabilities, some changes to LIGO SNRs, Appendix added on the asymptotic expansion of energy sensitivity, corrected supernova rates. Results available at http://www.physics.umd.edu/rgroups/gen_rel_exp/snr.html Submitted to Phys. Rev.