Explantation of a fully deployed coronary stent.

Percutaneous extraction of a freshly implanted stent is rarely reported, as it requires high technical expertise and accurate selection of instruments to ensure a safe retrieval process. Herein, we report a case of successful snaring of an erroneously deployed stent in the aorto-ostial position using the coaxial snare technique after successful recanalization of a complex right coronary artery chronic total occlusion. .

Percutaneous Coronary Intervention Vs Coronary Artery Bypass Surgery for Unprotected Left Main Coronary Disease: G-LM Registry.

Coronary artery bypass surgery (CABG) has been the standard of care for revascularization for patients with obstructive unprotected left main coronary disease (ULMCA). There have been multiple randomized and registry data demonstrating the technical and clinical efficacy of PCI in certain patients with ULMCA. The purpose of this study is to evaluate clinical outcomes of ULMCA PCI as compared to CABG in patients requiring revascularization in three Gulf countries. All ULMCA cases treated by PCI with DES versus CABG were retrospectively identified from 14 centers in 3 Arab Gulf countries (KSA, UAE, and Bahrain) from January 2015 to December 2019. In total, 2138 patients were included: 1222 were treated with PCI versus 916 with CABG. Patients undergoing PCI were older, and had higher comorbidities and mean European System for Cardiac Operative Risk Evaluation (EuroSCORE). Aborted cardiac arrest and cardiogenic shock were reported more in the PCI group at hospital presentation. In addition, lower ejection fractions were reported in the PCI group. In hospital mortality and major adverse cardiovascular and cerebrovascular events (MACCE) occurred more in patients undergoing CABG than PCI. At median follow-up of 15 months (interquartile range, 30), no difference was observed in freedom from revascularization, MACCE, or total mortality between those treated with PCI and CABG. While findings are similar to Western data registries, continued follow-up will be needed to ascertain whether this pattern continues into latter years.

Influence of COVID-19 Pandemic on Cardiac Services in Bahrain: Building Cardiovascular Protocol for Future Pandemics.

BACKGROUND: There are different protocols initiated to maintain the workflow in cardiovascular units around the world. Variable responses were seen in different populations. We adapted certain protocols during coronavirus disease-2019 (COVID-19) pandemic because we want to know the key element that maintains an acceptable standard of cardiovascular care during future pandemics. METHODS: Four hundred and fifty-four cardiac patients were admitted during COVID-19 era. Patients from March to July 2020 were included in this study. Those patients were divided into two periods: strict-COVID-19 from March 19, 2020, to May 18, 2020 (132 patients) and mid-COVID-19 from May 19, 2020, to July 18, 2020 (322 patients). These were compared to admissions at the pre-COVID-19 era from January 19, 2020, to March 18, 2020 (600 patients). All patients' data were collected through the quality department from the electronic medical records. RESULTS: Throughout the COVID-19 pandemic, the admission number and ST-elevation myocardial infarction (STEMI) cases were dramatically reduced during the strict-COVID-19 time yet recovered back in the mid-COVID-19 period. The admission rate was reduced from 600 to 132, while the STEMI cases dropped from 91 in pre-COVID-19 to 41 in strict-COVID-19 and then back to 81 cases in mid-COVID 19 period (P > 0.05/P = 0.02 between pre and mid-COVID-19 periods). CONCLUSION: Our cardiac center continues to serve our population without a complete lockdown period due to multiple key elements adapted during this pandemic. The flexibility in the protocols of managing acute cardiac cases has maintained the mortality rate stable through all COVID-19 periods and return to working efficiently to near-normal levels.

Case Series and Brief Review Report: Excimer Laser Coronary Atherectomy, Facilitating Daily Complex Interventional Challenges.

The excimer laser has revolutionary impact on lesion preparation and chronic total occlusion outcomes. Furthermore, this technology has made huge progression in modern percutaneous intervention, especially in ones labeled as noncrossable lesions. This device has the advantage of crossing lesions that 0.14 wire pass through. The mechanism through which excimer laser coronary atherectomy (ELCA) works are photochemical, photothermal, and photomechanical. In this review cases article, we discuss the uses of ELCA in daily catheterization laboratory alone and with other plaque modification tools. We touch on acute coronary syndrome uses of ELCA, no-balloon crossing lesion, and intervening on deformed stents.

Cannabis sativa research trends, challenges, and new-age perspectives.

Cannabis sativa L. has been one of the oldest medicinal plants cultivated for 10,000 years for several agricultural and industrial applications. However, the plant became controversial owing to some psychoactive components that have adverse effects on human health. In this review, we analyzed the trends in cannabis research for the past two centuries. We discussed the historical transitions of cannabis from the category of herbal medicine to an illicit drug and back to a medicinal product post-legalization. In addition, we address the new-age application of immuno-suppressive and anti-inflammatory extracts for the treatment of COVID-19 inflammation. We further address the influence of the legal aspects of cannabis cultivation for medicinal, pharmaceutical, and biotechnological research. We reviewed the up-to-date cannabis genomic resources and advanced technologies for their potential application in genomic-based cannabis improvement. Overall, this review discusses the diverse aspects of cannabis research developments ranging from traditional use as herbal medicine to the latest potential in COVID-19, legal practices with updated patent status, and current state of art genetic and genomic tools reshaping cannabis biotechnology in modern age agriculture and pharmaceutical industry.

Is Atrial Fibrillation a Risk Factor for Worse Outcomes in Severe COVID-19 Patients: A Single Center Retrospective Cohort.

INTRODUCTION: New onset atrial fibrillation leads to worse outcomes in patients with sepsis. The association between new onset atrial fibrillation (AF) in COVID19 patients with COVID19 outcomes are lacking. This study aims to determine whether new onset atrial fibrillation in COVID19 patients admitted in the ICU is a risk factor for death or requirement of mechanical ventilation (MV). METHODS: This is a retrospective study conducted in a cohort of COVID-19 patients admitted to Bahrain Defence Force COVID19 Field ICU between April 2020 to November 2020. Data were extracted from the electronic medical records. The patients who developed new onset AF during admission were compared to patients who remained in sinus rhythm. Multivariate logistic regression models were used to control for confounders and estimate the effect of AF on the outcomes of these patients. RESULTS: Our study included a total of 492 patients out of which 30 were diagnosed with new onset AF. In the AF group, the primary outcome occurred in 66.7% of patients (n = 20). In the control group, 17.1% (n = 79) developed the primary outcome. Upon adjusting for the confounders in the multivariate regression model, AF had an odds ratio of 3.96 (95% CI: 1.05-14.98; p = 0.042) for the primary outcome. CONCLUSION: Our results indicate that new onset AF is a risk factor for worse outcomes in patients admitted with COVID19 in the ICU.

Precision Percutaneous Coronary Intervention of a Complex Lesion.

BACKGROUND: Balloon dilation and atherectomy have several limitations in the treatment of heavily calcific coronary lesions. INTRODUCTION: Intravascular lithotripsy (IVL) is a state-of-the-art system that modifies severe calcific coronary plaques efficiently. In this paper, we report our experience with IVL in the context of a calcific in-stent chronic total occlusion. CASE SUMMARY: A 75-year-old gentleman whose status was post percutaneous coronary intervention, with the deployment of two overlapping bare-metal stents in the mid-left anterior descending artery (LAD) 20 years ago, was admitted to our cardiac center for the elective intervention of in-stent chronic total occlusion (CTO) of LAD, which was performed using an antegrade wire escalation (AWE) technique. After recanalization of the CTO body, optical coherence tomography pullback confirmed a very high calcium score. Balloon dilatation attempts failed, so we proceeded with shockwave lithotripsy with successful full expansion of the 3.5-mm IVL balloon followed by a straightforward stent delivery. The procedure was complicated by distal wire perforation, which was handled in a timely manner with coil embolization. The patient's postoperative course was uneventful. CONCLUSION: This case illustrates the feasibility and effectiveness of IVL that powerfully cracks coronary calcium while minimizing vessel wall trauma in the context of heavily calcific in-stent CTO. In our case, coronary perforation occurred in a small-caliber side branch, which was identified in a timely manner before hemodynamic compromise and treated successfully straight away with coil embolization.

Virus-induced gene silencing (VIGS) in Cannabis sativa L.

BACKGROUND: The raised demand of cannabis as a medicinal plant in recent years led to an increased interest in understanding the biosynthetic routes of cannabis metabolites. Since there is no established protocol to generate stable gene knockouts in cannabis, the use of a virus-induced gene silencing (VIGS) method, resulting in a gene knockdown, to study gene functions is desirable. RESULTS: For this, a computational approach was employed to analyze the Cannabis sativa L. transcriptomic and genomic resources. Reporter genes expected to give rise to easily scorable phenotypes upon silencing, i.e. the phytoene desaturase (PDS) and magnesium chelatase subunit I (ChlI), were identified in C. sativa. Subsequently, the targets of specific small interfering RNAs (siRNAs) and silencing fragments were predicted and tested in a post-transcriptional gene silencing (PTGS) approach. Here we show for the first time a gene knockdown in C. sativa using the Cotton leaf crumple virus (CLCrV) in a silencing vector system. Plants transiently transformed with the Agrobacterium tumefaciens strain AGL1, carrying the VIGS-vectors, showed the desired phenotypes, spotted bleaching of the leaves. The successful knockdown of the genes was additionally validated by quantitative PCR resulting in reduced expression of transcripts from 70 to 73% for ChlI and PDS, respectively. This is accompanied with the reduction of the chlorophyll a and carotenoid content, respectively. In summary, the data clearly demonstrate the potential for functional gene studies in cannabis using the CLCrV-based vector system. CONCLUSIONS: The applied VIGS-method can be used for reverse genetic studies in C. sativa to identify unknown gene functions. This will gain deeper inside into unknown biosynthetic routes and will help to close the gap between available genomic data and biochemical information of this important medicinal plant.

Identification of Putative Precursor Genes for the Biosynthesis of Cannabinoid-Like Compound in Radula marginata.

The liverwort Radula marginata belongs to the bryophyte division of land plants and is a prospective alternate source of cannabinoid-like compounds. However, mechanistic insights into the molecular pathways directing the synthesis of these cannabinoid-like compounds have been hindered due to the lack of genetic information. This prompted us to do deep sequencing, de novo assembly and annotation of R. marginata transcriptome, which resulted in the identification and validation of the genes for cannabinoid biosynthetic pathway. In total, we have identified 11,421 putative genes encoding 1,554 enzymes from 145 biosynthetic pathways. Interestingly, we have identified all the upstream genes of the central precursor of cannabinoid biosynthesis, cannabigerolic acid (CBGA), including its two first intermediates, stilbene acid (SA) and geranyl diphosphate (GPP). Expression of all these genes was validated using quantitative real-time PCR. We have characterized the protein structure of stilbene synthase (STS), which is considered as a homolog of olivetolic acid in R. marginata. Moreover, the metabolomics approach enabled us to identify CBGA-analogous compounds using electrospray ionization mass spectrometry (ESI-MS/MS) and gas chromatography mass spectrometry (GC-MS). Transcriptomic analysis revealed 1085 transcription factors (TF) from 39 families. Comparative analysis showed that six TF families have been uniquely predicted in R. marginata. In addition, the bioinformatics analysis predicted a large number of simple sequence repeats (SSRs) and non-coding RNAs (ncRNAs). Our results collectively provide mechanistic insights into the putative precursor genes for the biosynthesis of cannabinoid-like compounds and a novel transcriptomic resource for R. marginata. The large-scale transcriptomic resource generated in this study would further serve as a reference transcriptome to explore the Radulaceae family.

Chronic lead poisoning in an Iranian opium smoker resident in London.

A 46-year-old man of Iranian origin presented with a 4-day history of colicky abdominal pain and absolute constipation on a background of several weeks of irritability and malaise. He had smoked 10 g of opium per week for a year and a half. On examination, he had diffuse abdominal tenderness and faecal loading. This was cleared, but the abdominal pain, nausea and vomiting persisted. He had extravascular haemolytic anaemia with punctate basophilic stippling on blood film. The patient's serum lead concentration was substantially elevated and he perhaps demonstrated Burton's line. The patient underwent chelation therapy and has recovered clinically and biochemically. Public health experts were notified and conducted an assessment of the risk to the patient and others; their lead exposure questionnaire was subsequently amended. This is an important case report of a UK resident describing lead toxicity secondary to the inhalation of opium.

Nanomaterials in combating cancer: therapeutic applications and developments.

The development of novel nanomaterials and their use in biomedicine has received much attention in recent years. Significant advances have been made in the synthesis of nanomaterials with controlled geometry, physicochemical properties, surface charge, and surface tailoring with bioactive polymers. These successful efforts have resulted in improved biocompatibility and active targeting of tumour tissues, leading to the development of a diverse range of nanomaterials that can recognize cancers, deliver anticancer drugs and destroy tumours by a variety of therapeutic techniques. The focus of this review is to provide an overview of the nanomaterials that have been devised for the detection and treatment of various types of cancer, as well as to underline the emerging possibilities of nanomaterials for applications in anticancer therapy. FROM THE CLINICAL EDITOR: In this comprehensive review, the current state-of-the art of nanomaterials for cancer diagnosis and treatment is presented. Emerging possibilities and future concepts are discussed as well.

Brine shrimp lethality assay 'an effective prescreen': microwave-assisted synthesis, BSL toxicity and 3DQSAR studies-based designing, docking and antitumor evaluation of potent chalcones.

CONTEXT: In the course of searching potential antitumor agents from a library of chalcones synthesized under microwave irradiations, the brine shrimp lethality (BSL) assay and a 3D structure-activity relationship (3DQSAR) studies were followed by the antitumor evaluation of most potent analogues. OBJECTIVE: The objective of the current study was to effectively use the BSL assay for the identification of potential cytotoxic analogues from a set of compounds. METHODS: We applied the comparative molecular field analysis (CoMFA) and devised 3DQSAR on 33 synthesized chalcones leading to prediction of five related compounds with improved activity. The scope of BSL assay for the prediction of antitumor potency was tested through the in vitro antitumor studies against six human tumor cell-lines, docking studies and the tubulin-polymerization assay. RESULTS: The newly designed compounds 34-38 displayed very promising cytotoxic potency. From our results, the BSL toxicity, antitumor efficacy and docking outcomes could be easily co-related. CONCLUSION: The study draws a very good relationship between a simple, inexpensive, and bench-top BSL assay and the antitumor potential of the cytotoxic compounds. Devising the CoMFA analysis helped in designing chalcones with improved cytotoxic potential as displayed through their BSL and cytotoxic activity against human tumor cell lines. The studies are noteworthy as such comprehensive studies were never performed before on the BSL assay. The present studies widen the scope of the BSL model that may prove quite helpful as a preliminary screen in the antitumor drug designing and synthesis expeditions.