Reports on the association between the PR-interval and atrial fibrillation (AF) are conflicting. We hypothesized that inconsistencies stem from that fact that the PR-interval is not a single electrocardiographic (ECG) phenotype, and it is more likely to represent a composite of several distinct components. We examined the association of the PR-interval and its components (P-wave onset to P-wave peak duration, P-wave peak to P-wave end duration, and PR-segment) with incident AF in 14,924 participants (mean age=54±5.8 years; 26% black; 55% female) from the Atherosclerosis Risk In Communities study. The PR-interval and its components were automatically measured at baseline (1987–1989) from standard 12-lead ECGs. PR-interval >200 ms was considered prolonged and values >95th percentile defined abnormal PR-interval components. AF was ascertained during follow-up through December 31, 2010. Over a median follow-up of 21.2 years, 1,985 (13%) participants developed AF. Prolonged PR-interval was associated with an increased risk of AF (HR=1.19, 95% CI=1.02, 1.40). However, PR-interval components showed varying levels of associations with AF (P-wave onset to P-wave peak duration: HR=1.57, 95%CI=1.31, 1.88; P-wave peak to P-wave end duration: HR=1.20, 95%CI=0.99, 1.46; and PR-segment: HR=1.05, 95%CI=0.85, 1.29). Additionally, the components of the PR-interval had weak to moderate correlation with each other (correlation r ranged from −0.44 to 0.06). In conclusion, our findings suggest that the PR-interval represents a composite of distinct components that are not uniformly associated with AF. Without considering the contribution of each component, inconsistent associations between the PR-interval and AF are inevitable.

Hermansky-Pudlak syndrome (HPS) is an autosomal recessive disorder resulting from mutations in a family of genes required for efficient transport of lysosomal-related proteins from the trans-Golgi network to a target organelle. To date, there are several genetically distinct forms of HPS. Many forms of HPS exhibit aberrant trafficking of melanosome-targeted proteins resulting in incomplete melanosome biogenesis responsible for oculocutaneous albinism observed in patients. In HPS-1, melanosome-targeted proteins are localized to characteristic membranous complexes, which have morphologic similarities to macroautophagosomes. In this report, we evaluated the hypothesis that HPS-1-specific membranous complexes comprise a component of the lysosomal compartment of melanocytes. Using indirect immunofluorescence, an increase in co-localization of misrouted tyrosinase with cathepsin-L, a lysosomal cysteine protease, occurred in HPS-1 melanocytes. In addition, ribophorin II, an integral endoplasmic reticulum protein that is also a component of macroautophagosomes, and LC3, a specific marker of macrophagosomes, demonstrated localization to membranous complexes in HPS-1 melanocytes. At the electron microscopic level, the membranous complexes exhibited acid phosphatase activity and localization of exogenously supplied horseradish peroxidase (HRP)-conjugated gold particles, indicating incorporation of lysosomal and endosomal components to membranous complexes, respectively. These results confirm that membranous complexes of HPS-1 melanocytes are macroautophagosomal representatives of the lysosomal compartment.

As the number and complexity of cardiovascular implantable electronic devices has increased, so too has the incidence of device-related infections. Such a rise requires that the focus be directed toward developing universal standards for infected lead removal. To date, no consensus currently exists regarding the optimal management of patients with large vegetations (diameter > 2 cm). In these individuals, medical therapy is universally ineffective and they are often too ill for surgical extraction; furthermore, transvenous lead extraction (TLE) carries with it a risk of large septic pulmonary emboli. We present a series of five cases in which the AngioVac thrombectomy system (AngioDynamics Inc., Latham, NY, USA) was used as an adjunct to TLE. Debridement of infected leads prior to percutaneous lead extraction was accomplished as either a bridge to or as concomitant therapy with laser lead removal at our institution. This study included three males and two females with an average age of 52 years. The sizes of vegetations removed from leads ranged from 1.5 cm to 3.9 cm in the largest dimension and the average diameter was 2.65 cm ± 1.1 cm. The vegetations were successfully debulked in all five patients. This suggests that TLE performed with assistance from the AngioVac system (AngioDynamics Inc., Latham, NY, USA) is a safe and effective alternative to open surgical lead removal in patients with large lead vegetations.

Radial access for CATH and PCI reduced access site complications and overall costs compared to FA procedures with similar baseline clinical and procedural characteristics, making it an economically advantageous strategy.

Let $S$ be a set of $n$ points in $\mathbb{R}^3$, no three collinear and not all coplanar. If at most $n-k$ are coplanar and $n$ is sufficiently large, the total number of planes determined is at least $1 + k \binom{n-k}{2}-\binom{k}{2}(\frac{n-k}{2})$. For similar conditions and sufficiently large $n$, (inspired by the work of P. D. T. A. Elliott in \cite{Ell67}) we also show that the number of spheres determined by $n$ points is at least $1+\binom{n-1}{3}-t_3^{orchard}(n-1)$, and this bound is best possible under its hypothesis. (By $t_3^{orchard}(n)$, we are denoting the maximum number of three-point lines attainable by a configuration of $n$ points, no four collinear, in the plane, i.e., the classic Orchard Problem.) New lower bounds are also given for both lines and circles.Comment: 37 page