His-Purkinje system re-entry in patients with clustering ventricular tachycardia episodes

AIMS: Multiple arrhythmia re-inductions were recently shown in His-Purkinje system (HPS) ventricular tachycardia (VT). We hypothesized that HPS VT was a frequent mechanism of repetitive or incessant VT and assessed diagnostic criteria to select patients likely to have HPS VT. METHODS AND RESULTS: Consecutive patients with clustering VT episodes (>3 sustained monomorphic VT within 2 weeks) were included in the analysis. HPS VT was considered plausible in patients with (i) impaired left ventricular function associated with dilated cardiomyopathy or valvular heart disease; or (ii) ECG during VT similar to sinus rhythm QRS or to bundle-branch block QRS. HPS VT was plausible in 12 of 48 patients and HPS VT was demonstrated in 6 of 12 patients (50%, or 13% of the whole study group). Median VT cycle length was 318 ms (250-550). Catheter ablation was successful in all six patients. CONCLUSION: His-Purkinje system VT is found in a significant number of patients with repetitive or incessant VT episodes, and in a large proportion of patients with predefined clinical or electrocardiographic characteristics. Since it is easily amenable to catheter ablation, our data support the screening of all patients with repetitive VT in this regard and an invasive approach in a selected group of patients.

Guest Speaker

David Salmela is the special guest speaker for the opening reception.

Studies of spatial clustering of inertial particles in turbulence

We present studies of the spatial clustering of inertial particles embedded in turbulent flow. A major part of the thesis is experimental, involving the technique of Phase Doppler Interferometry (PDI). The thesis also includes significant amount of simulation studies and some theoretical considerations. We describe the details of PDI and explain why it is suitable for study of particle clustering in turbulent flow with a strong mean velocity. We introduce the concept of the radial distribution function (RDF) as our chosen way of quantifying inertial particle clustering and present some original works on foundational and practical considerations related to it. These include methods of treating finite sampling size, interpretation of the magnitude of RDF and the possibility of isolating RDF signature of inertial clustering from that of large scale mixing. In experimental work, we used the PDI to observe clustering of water droplets in a turbulent wind tunnel. From that we present, in the form of a published paper, evidence of dynamical similarity (Stokes number similarity) of inertial particle clustering together with other results in qualitative agreement with available theoretical prediction and simulation results. We next show detailed quantitative comparisons of results from our experiments, direct-numerical-simulation (DNS) and theory. Very promising agreement was found for like-sized particles (mono-disperse). Theory is found to be incorrect regarding clustering of different-sized particles and we propose a empirical correction based on the DNS and experimental results. Besides this, we also discovered a few interesting characteristics of inertial clustering. Firstly, through observations, we found an intriguing possibility for modeling the RDF arising from inertial clustering that has only one (sensitive) parameter. We also found that clustering becomes saturated at high Reynolds number.

Phylogenetic analysis of Prevotella nigrescens, Prevotella intermedia and Porphyromonas gingivalis clinical strains reveals a clear species clustering

Prevotella nigrescens, Prevotella intermedia and Porphyromonas gingivalis are oral pathogens from the family Bacteroidaceae, regularly isolated from cases of gingivitis and periodontitis. In this study, the phylogenetic variability of these three bacterial species was investigated by means of 16S rRNA (rrs) gene sequence comparisons of a set of epidemiologically and geographically diverse isolates. For each of the three species, the rrs gene sequences of 11 clinical isolates as well as the corresponding type strains was determined. Comparison of all rrs sequences obtained with those of closely related species revealed a clear clustering of species, with only a little intraspecies variability but a clear difference in the rrs gene with respect to the next related taxon. The results indicate that the three species form stable, homogeneous genetic groups, which favours an rrs-based species identification of these oral pathogens. This is especially useful given the 7% sequence divergence between Prevotella intermedia and Prevotella nigrescens, since phenotypic distinction between the two Prevotella species is inconsistent or involves techniques not applicable in routine identification.

Are clustering effects accounted for in statistical analysis in leading dental specialty journals?

OBJECTIVES In dental research multiple site observations within patients or taken at various time intervals are commonplace. These clustered observations are not independent; statistical analysis should be amended accordingly. This study aimed to assess whether adjustment for clustering effects during statistical analysis was undertaken in five specialty dental journals. METHODS Thirty recent consecutive issues of Orthodontics (OJ), Periodontology (PJ), Endodontology (EJ), Maxillofacial (MJ) and Paediatric Dentristry (PDJ) journals were hand searched. Articles requiring adjustment accounting for clustering effects were identified and statistical techniques used were scrutinized. RESULTS Of 559 studies considered to have inherent clustering effects, adjustment for this was made in the statistical analysis in 223 (39.1%). Studies published in the Periodontology specialty accounted for clustering effects in the statistical analysis more often than articles published in other journals (OJ vs. PJ: OR=0.21, 95% CI: 0.12, 0.37, p<0.001; MJ vs. PJ: OR=0.02, 95% CI: 0.00, 0.07, p<0.001; PDJ vs. PJ: OR=0.14, 95% CI: 0.07, 0.28, p<0.001; EJ vs. PJ: OR=0.11, 95% CI: 0.06, 0.22, p<0.001). A positive correlation was found between increasing prevalence of clustering effects in individual specialty journals and correct statistical handling of clustering (r=0.89). CONCLUSIONS The majority of studies in 5 dental specialty journals (60.9%) examined failed to account for clustering effects in statistical analysis where indicated, raising the possibility of inappropriate decreases in p-values and the risk of inappropriate inferences.

Clustering of HCV coinfections on HIV phylogeny indicates domestic and sexual transmission of HCV

BACKGROUND: HCV coinfection remains a major cause of morbidity and mortality among HIV-infected individuals and its incidence has increased dramatically in HIV-infected men who have sex with men(MSM). METHODS: Hepatitis C virus (HCV) coinfection in the Swiss HIV Cohort Study(SHCS) was studied by combining clinical data with HIV-1 pol-sequences from the SHCS Drug Resistance Database(DRDB). We inferred maximum-likelihood phylogenetic trees, determined Swiss HIV-transmission pairs as monophyletic patient pairs, and then considered the distribution of HCV on those pairs. RESULTS: Among the 9748 patients in the SHCS-DRDB with known HCV status, 2768(28%) were HCV-positive. Focusing on subtype B(7644 patients), we identified 1555 potential HIV-1 transmission pairs. There, we found that, even after controlling for transmission group, calendar year, age and sex, the odds for an HCV coinfection were increased by an odds ratio (OR) of 3.2 [95% confidence interval (CI) 2.2, 4.7) if a patient clustered with another HCV-positive case. This strong association persisted if transmission groups of intravenous drug users (IDUs), MSMs and heterosexuals (HETs) were considered separately(in all cases OR >2). Finally we found that HCV incidence was increased by a hazard ratio of 2.1 (1.1, 3.8) for individuals paired with an HCV-positive partner. CONCLUSIONS: Patients whose HIV virus is closely related to the HIV virus of HIV/HCV-coinfected patients have a higher risk for carrying or acquiring HCV themselves. This indicates the occurrence of domestic and sexual HCV transmission and allows the identification of patients with a high HCV-infection risk.

Clustering Assessment: Enhancing Synergies among Multilateral Environmental Agreements

Against the background of a widely fragmented and diluted international environmental governance architecture, different reform options are currently being discussed. This issue brief considers whether streamlining international environmental regimes by grouping or ‘clustering’ international agreements could improve effectiveness and efficiency. It outlines the general idea of the clustering approach, draws lessons from the chemicals and waste cluster and examines the implications and potentials of clustering multilateral environmental agreements.

Clustering subspecies of Aeromonas salmonicida using IS630 typing.

BACKGROUND The insertion element IS630 found in Aeromonas salmonicida belongs to the IS630-Tc1-mariner superfamily of transposons. It is present in multiple copies and represents approximately half of the IS present in the genome of A. salmonicida subsp. salmonicida A449. RESULTS By using High Copy Number IS630 Restriction Fragment Length Polymorphism (HCN-IS630-RFLP), strains of various subspecies of Aeromonas salmonicida showed conserved or clustering patterns, thus allowing their differentiation from each other. Fingerprints of A. salmonicida subsp. salmonicida showed the highest homogeneity while 'atypical' A. salmonicida strains were more heterogeneous. IS630 typing also differentiated A. salmonicida from other Aeromonas species. The copy number of IS630 in Aeromonas salmonicida ranges from 8 to 35 and is much lower in other Aeromonas species. CONCLUSIONS HCN-IS630-RFLP is a powerful tool for subtyping of A. salmonicida. The high stability of IS630 insertions in A. salmonicida subsp. salmonicida indicates that it might have played a role in pathoadaptation of A. salmonicida which has reached an optimal configuration in the highly virulent and specific fish pathogen A. salmonicida subsp. salmonicida.