Idioventricular Rhythm: A Rare Presentation of Left Ventricular Pseudoaneurysm Following Radiofrequency Ablation.

Left ventricular pseudoaneurysm (PsA) is a rare complication of radiofrequency ablation (RFA) of cardiac arrhythmias. Presentation can vary widely in terms of timeline, signs, and symptoms. Idioventricular rhythm is a rare presentation of PsA post-ablation. No cases of post-ablation PsA presenting with idioventricular rhythm have been reported in the literature to date. A 72-year-old male presented with symptomatic idioventricular rhythm 34 days post RFA for premature ventricular complexes (PVCs). A PsA involving the distal anterolateral of his left ventricle wall was identified on transthoracic echo and computed tomography (CT). This patient underwent surgical patch repair which resolved his ventricular arrhythmia.

Atmospheric modelling of grass pollen rupturing mechanisms for thunderstorm asthma prediction.

The world's most severe thunderstorm asthma event occurred in Melbourne, Australia on 21 November 2016, coinciding with the peak of the grass pollen season. The aetiological role of thunderstorms in these events is thought to cause pollen to rupture in high humidity conditions, releasing large numbers of sub-pollen particles (SPPs) with sizes very easily inhaled deep into the lungs. The humidity hypothesis was implemented into a three-dimensional atmospheric model and driven by inputs from three meteorological models. However, the mechanism could not explain how the Melbourne event occurred as relative humidity was very low throughout the atmosphere, and most available grass pollen remained within 40 m of the surface. Our tests showed humidity induced rupturing occurred frequently at other times and would likely lead to recurrent false alarms if used in a predictive capacity. We used the model to investigate a range of other possible pollen rupturing mechanisms which could have produced high concentrations of SPPs in the atmosphere during the storm. The mechanisms studied involve mechanical friction from wind gusts, electrical build up and discharge incurred during conditions of low relative humidity, and lightning strikes. Our results suggest that these mechanisms likely operated in tandem with one another, but the lightning method was the only mechanism to generate a pattern in SPPs following the path of the storm. If humidity induced rupturing cannot explain the 2016 Melbourne event, then new targeted laboratory studies of alternative pollen rupture mechanisms would be of considerable value to help constrain the parameterisation of the pollen rupturing process.

The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors.

BACKGROUND: A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies. METHODS: Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions. FINDINGS: Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74-2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28-16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died. INTERPRETATION: Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma. FUNDING: None.

Usefulness of Released Cardiac Myosin Binding Protein-C as a Predictor of Cardiovascular Events.

Cardiac myosin binding protein-C (cMyBP-C) is a heart muscle-specific thick filament protein. Elevated level of serum cMyBP-C is an indicator of early myocardial infarction (MI), but its value as a predictor of future cardiovascular disease is unknown. Based on the presence of significant amount of cMyBP-C in the serum of previous study subjects independent of MI, we hypothesized that circulating cMyBP-C is a sensitive indicator of ongoing cardiovascular stress and disease. To test this hypothesis, 75 men and 83 women of similar ages were recruited for a prospective study. They underwent exercise stress echocardiography to provide pre- and poststress blood samples for subsequent determination of serum cMyBP-C levels. The subjects were followed for 1 to 1.5 years. Exercise stress increased serum cMyBP-C in all subjects. Twenty-seven primary events (such as death, MI, revascularization, invasive cardiovascular procedure, or cardiovascular-related hospitalization) and 7 critical events (CE; such as death, MI, stroke, or pulmonary embolism) occurred. After adjusting for sex and cardiovascular risk factors with multivariate Cox regression, a 96% sensitive prestress cMyBP-C threshold carried a hazard ratio of 8.1 with p = 0.041 for primary events. Most subjects (6 of 7) who had CE showed normal ejection fraction on echocardiography. Prestress cMyBP-C demonstrated area under receiver operating curve of 0.91 and multivariate Cox regression hazard ratio of 13.8 (p = 0.000472) for CE. Thus, basal cMyBP-C levels reflected susceptibility for a variety of cardiovascular diseases. Together with its high sensitivity, cMyBP-C holds potential as a screening biomarker for the existence of severe cardiovascular diseases.

Evidence for the honeybee's place knowledge in the vicinity of the hive.

Upon leaving the nest for the first time, honeybees employ a tripartite orientation/exploration system to gain the requisite knowledge to return to their hive after foraging. Focal exploration comes first- the departing bee turns around to face the return target and oscillates in a lateral flight pattern of increasing amplitude and distance. Thereafter, for the peripheral exploration, the forward flying bee circles the return-goal area with expanding and alternating clockwise and counterclockwise arcs. After this two- part proximal exploration follows distal exploration, the bee flies straight towards her potential distal goal. For the return path, supported by the preceding exploratory learning, the return navigational performance is expected to reflect the three exploratory parts in reverse order. Previously only two performance parts have been experimentally identified: focal navigation and distal navigation. Here we discovered peripheral navigation as being distinct from focal and distal navigation. Like focal navigation, yet unlike distal navigation, peripheral navigation is invariably triggered by local place recognition. Whereas focal navigation (orientation) is close to unidirectional, peripheral navigation makes use of multiple goal-vector knowledge. We term the area in question the Peripheral Correction Area because within it peripheral navigation is triggered, which in turn is capable of correcting errors that accumulated during a preceding distal dead-reckoning based flight.

Application of satellite precipitation data to analyse and model arbovirus activity in the tropics.

BACKGROUND: Murray Valley encephalitis virus (MVEV) is a mosquito-borne Flavivirus (Flaviviridae: Flavivirus) which is closely related to Japanese encephalitis virus, West Nile virus and St. Louis encephalitis virus. MVEV is enzootic in northern Australia and Papua New Guinea and epizootic in other parts of Australia. Activity of MVEV in Western Australia (WA) is monitored by detection of seroconversions in flocks of sentinel chickens at selected sample sites throughout WA. Rainfall is a major environmental factor influencing MVEV activity. Utilising data on rainfall and seroconversions, statistical relationships between MVEV occurrence and rainfall can be determined. These relationships can be used to predict MVEV activity which, in turn, provides the general public with important information about disease transmission risk. Since ground measurements of rainfall are sparse and irregularly distributed, especially in north WA where rainfall is spatially and temporally highly variable, alternative data sources such as remote sensing (RS) data represent an attractive alternative to ground measurements. However, a number of competing alternatives are available and careful evaluation is essential to determine the most appropriate product for a given problem. RESULTS: The Tropical Rainfall Measurement Mission (TRMM) Multi-satellite Precipitation Analysis (TMPA) 3B42 product was chosen from a range of RS rainfall products to develop rainfall-based predictor variables and build logistic regression models for the prediction of MVEV activity in the Kimberley and Pilbara regions of WA. Two models employing monthly time-lagged rainfall variables showed the strongest discriminatory ability of 0.74 and 0.80 as measured by the Receiver Operating Characteristics area under the curve (ROC AUC). CONCLUSIONS: TMPA data provide a state-of-the-art data source for the development of rainfall-based predictive models for Flavivirus activity in tropical WA. Compared to ground measurements these data have the advantage of being collected spatially regularly, irrespective of remoteness. We found that increases in monthly rainfall and monthly number of days above average rainfall increased the risk of MVEV activity in the Pilbara at a time-lag of two months. Increases in monthly rainfall and monthly number of days above average rainfall increased the risk of MVEV activity in the Kimberley at a lag of three months.