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Hearing impaired listeners show different phoneme confusions during speech recognition testing. The aim of the study was to analyze phoneme recognition in patients with sensorineural hearing loss during word recognition testing with monosyllable words, as well as, to compare consonant confusions in different vowel context. Recognition of 18 initial and final consonants was analyzed in a total of 698 presentations of the words. There were 1154 (82.7%) correct recognitions and 100 consonant confusions (7.2%). The patients did not response at a total of 71 presentations of the words which means that consonants in 142 cases (10.2%) were not recognized, nor confused. There are no consonant confusion patterns during suprathreshold testing with real words. In cases of phoneme confusions, listeners replace the stimulus word with another word from the lexical neighborhood. In terms of the vowel context, the consonants are the most easily identified in the context of the vowel /a/. © 2023, Institute for Human Rehabilitation. All rights reserved.

BACKGROUND: Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in patients suffering from chronic heart failure (CHF). Optimal device programming is crucial for maximum patient benefit. The goal of the present study was to assess device settings from CHF patients undergoing CRT optimization in a "real world" setting, and to delineate parameters most frequently requiring adjustment. METHODS: All patients who underwent CRT device implantation in the Cardiology Clinic at the University Hospital Zurich between January 2011 and September 2012 and in whom follow-up was available were included in this analysis. RESULTS: A total of 170 CHF patients were included in this analysis. True biventricular pacing was present in 44.0% of all patients, while QRS fusion was detected in 49.9%. The majority of the patients presented with suboptimal AV delays requiring adjustment. AV delays were therefore shortened due to the presence of QRS fusion in 53.3% and 38.1% of patients (sAV and pAV, respectively) or prolonged because of truncation of the A wave in the LV inflow pulse wave Doppler measurement (17.5% and 28.4% for sAV and pAV, respectively). In contrast, interventricular delay (VV delay) was rarely changed (11.9%). CONCLUSIONS: In our "real world" cohort, a substantial proportion of patients presented to their first post-operative consultation with suboptimal device settings. Our data indicate that the opportunity to optimize device settings is frequently wasted in the "real world", underlining the necessity for expert device follow-up to deliver optimal care to this challenging group of heart failure patients.

BACKGROUND:Percutaneous carotid artery stenting (CAS) became a widely used procedure in patients with symptomatic and asymptomatic carotid artery stenosis. However its role compared to carotid endarterectomy (CAD) remains questioned. We analysed the safety of carotid artery stenting program of a prospective CAS register program of a tertiary teaching hospital. METHOD:Between July 2003 and December 2010, 208 patients underwent CAS procedure. Baseline, procedural and follow-up data were prospectively collected. Primary peri-interventional outcome was defined as 30-day major adverse events (MAE), including death, stroke or myocardial infarction, and mid- to long-term follow-up outcome included ipsilateral stroke, myocardial infarction or death. Secondary outcome was restenosis rate ≥ 50% per lesion. RESULTS:Unilateral carotid artery interventions were performed in 186 patients. In 22 patients CAS was performed bilaterally as stages procedures. The 30-day MAE rate was 1.9% consisting of two contralateral strokes and two ipsilateral stroke. Mean clinically follow-up was 22 months. Mid- to long-term MAE was 8.1% with 6.3% (n = 13) deaths, 1.9% (n = 4) myocardial infarctions and 0.9% (n = 2) ipsilateral stroke. The restenosis rate ≥ 50% per lesion was 4.3% at a mean follow-up of 22 months. Target lesion revascularization was performed in one patient, because of restenosis at 9 months follow-up after first CAS. CONCLUSION:Implementation of a carotid artery stenting program at a tertiary, teaching hospital is a safe method for treatment of carotid artery stenosis. The adverse event rate during mid-to-long-term follow-up suggests an appropriate patient selection.

BACKGROUND: For successful cardiac resynchronisation therapy (CRT) a spatial and electrical separation of right and left ventricular electrodes is essential. The spatial distribution of electrical delays within the coronary sinus (CS) tributaries has not yet been identified. OBJECTIVE: Electrical delays within the CS are described during sinus rhythm (SR) and right ventricular pacing (RVP). A coordinate system grading the mitral ring from 0° to 360° and three vertical segments is proposed to define the lead positions irrespective of individual CS branch orientation. METHODS: In 13 patients undergoing implantation of a CRT device 6±2.5, (median 5) lead positions within the CS were mapped during SR and RVP. The delay to the onset and the peak of the local signal was measured from the earliest QRS activation or the pacing spike. Fluoroscopic positions were compared to localizations on a nonfluoroscopic electrode imaging system. RESULTS: During SR, electrical delays in the CS were inhomogenous in patients with or without left bundle branch block (LBBB). During RVP, the delays increased by 44±32 ms (signal onset from 36±33 ms to 95±30 ms; p<0.001, signal peak from 105±44 ms to 156±30 ms; p<0.001). The activation pattern during RVP was homogeneous and predictable by taking the grading on the CS ring into account: (% QRS) = 78-0.002 (grade-162)(2), p<0.0001. This indicates that 78% of the QRS duration can be expected as a maximum peak delay at 162° on the CS ring. CONCLUSION: Electrical delays within the CS vary during SR, but prolong and become predictable during RVP. A coordinate system helps predicting the local delays and facilitates interindividual comparison of lead positions irrespective of CS branch anatomy.

Hintergrund: Die kardiale Resynchronisationstherapie (cardiac resynchronisation therapy, CRT) ist bei Patienten mit schwerer Herzinsuffizienz zu einem Standardbehandlungsverfahren geworden, nicht zuletzt, da in grossen randomisierten Studien eine Reduktion der Morbidität und Mortalität nachgewiesen werden konnte. Es war das Ziel der vorliegenden Studie, die gängige Praxis der CRT unter alltäglichen Bedingungen (im „Real World“ Setting) an einem grossen Schweizer Zentrum zu untersuchen. Methoden: Sämtliche Patienten, bei denen im Zeitraum zwischen 2003 und 2010 ein CRT-Device (CRT-Schrittmacher oder CRT-ICD) am Universitätsspital Zürich implantiert wurde, wurden in diese retrospektive Analyse eingeschlossen. Resultate: 208 Patienten, mit einem mittleren Alter von 63.8 (±10.9) Jahren, 79% davon Männer, wurden in die Studie eingeschlossen. Eine ischämische Ursache der Herzinsuffizienz lag in 49% der Fälle vor, 79% der Patienten waren in NYHA-Klasse III/IV. Die mittlere QRS Dauer lag bei 153ms (± 30ms) und die mittlere EF bei 26 ± 8%. Die mediane Hospitalisationsdauer zur CRT Implantation betrug 2 Tage. Die perioperative Komplikationsrate war niedrig und vergleichbar mit der grosser randomisierter Studien. Unter CRT konnte eine deutliche klinische und echokardiographische Verbesserung erzielt werden. Während sich NYHA-Klasse von 2.8 ± 0.6 auf 2.1 ± 0.7 reduzierte (P<0.00001), verbesserte sich linksventrikuläre Auswurffraktion auf 33 ± 11% (P<0.00001). Sowohl das indexierte enddiastolische Volumen, als auch das indexierte endsystolische Volumen des linken Ventrikels nahmen signifikant ab (P=0.01 bzw. P=0.004). Konklusion: Die vorliegende Studie zeigt, dass die CRT unter „Real World“ Bedingungen effektiv und sicher ist. Obwohl die Schweiz gegenwärtig hinsichtlich der CRT Implantationsrate nur im europäischen Mittelfeld liegt, ist in Anbetracht positiver Studien, wachsender Vertrautheit und guten eigenen Erfahrungen anzunehmen, dass zunehmend Patienten bezüglich der Indika

The weight of the load, one of the main parameters in electric furnace reductive melting at the Drenas ferronickel plant, Kosovo, depends on the roasting of iron-silicate nickel ore grading 18-20% Fe in a rotating furnace, but the near impossibility of obtaining complete reduction and the problems resulting when more lime was added to counter acidity led to a 3-month study of the benefits of mixing the Kosovan ore with an Albanian laterite grading 28.5% Fe, 23.32% Si, 5.97% Mg, 2.83% Al, 0.89% Ni, 8.06% Co and 1.83% Cr. Roasting of the load composed of ores from both Drenas and Albania was done at c.950 degrees C. Experimental analysis was used to modify some production parameters by reducing the quantity of limestone in the load and increasing the amount of quartz. Mixing the Kosovan and lateritic Albanian ores aimed to reduce the acidity of the burden loaded into the electric furnace; adjusting the lime and quartz parameters enhanced the production process and provided better practical results, the conclusion being that the composition of the load must satisfy a 1:10 ratio of Kosovan to Albanian ore to optimise the melting process., The weight of the load, one of the main parameters in electric furnace reductive melting at the Drenas ferronickel plant, Kosovo, depends on the roasting of iron-silicate nickel ore grading 18-20% Fe in a rotating furnace, but the near impossibility of obtaining complete reduction and the problems resulting when more lime was added to counter acidity led to a 3-month study of the benefits of mixing the Kosovan ore with an Albanian laterite grading 28.5% Fe, 23.32% Si, 5.97% Mg, 2.83% Al, 0.89% Ni, 8.06% Co and 1.83% Cr. Roasting of the load composed of ores from both Drenas and Albania was done at c.950 degrees C. Experimental analysis was used to modify some production parameters by reducing the quantity of limestone in the load and increasing the amount of quartz. Mixing the Kosovan and lateritic Albanian ores aimed to reduce the acidity of the burden loaded into the electric furnace; adjusting the lime and quartz parameters enhanced the production process and provided better practical results, the conclusion being that the composition of the load must satisfy a 1:10 ratio of Kosovan to Albanian ore to optimise the melting process.