Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection

The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) versus invasive therapy (invasive therapy) (ie, percutaneous coronary intervention or coronary artery bypass grafting). The risk of death (risk ratio [RR] = 0.753; 95% confidence interval [CI]: 0.21-2.73; I² = 21.1%; P = 0.61), recurrence of SCAD (RR = 1.09; 95% CI: 0.61-1.93; I² = 0.0%; P = 0.74), and repeat revascularization (RR = 0.64; 95% CI: 0.21-1.94; I² = 57.6%; P = 0.38) were not statistically different between medical therapy and invasive therapy for a follow-up ranging from 4 months to 3 years. In conclusion, in this meta-analysis of observational studies, the long-term risk of death, recurrent SCAD, and repeat revascularization did not significantly differ among patients with SCAD treated with medical therapy compared with those treated with invasive therapy. These findings support the current expert consensus that patients should be treated with medical therapy when clinically stable and no high-risk features are present. Further large-scale studies including randomized controlled trials are needed to confirm these findings.     

Development of a liquid-phase microextraction based on the freezing of a deep eutectic solvent followed by HPLC-UV for sensitive determination of common pesticides in environmental water samples

In this research, a new extraction method based on liquid-phase microextraction and the freezing of deep eutectic solvent (LPME-FDES) has been developed for the determination of common pesticides in water samples prior to their analysis by high performance liquid chromatography-ultraviolet detection (HPLC-UV). In this method, a green solvent consisting of 1-octyl-3-methylimidazolium chloride and 1-undecanol was used as an extraction solvent, yielding the advantages of material stability, low density, and a suitable freezing point near room temperature. Under the optimum conditions, enrichment factors and extraction recoveries are in the range of 150–180 and 75–90%, respectively. The calibration graphs are linear in the range of 0.2–500 μg L⁻¹ and limit of detections (LODs) are in the range of 0.05–0.50 μg L⁻¹. Relative standard deviation (RSD) values for intra-day and inter-day of the method based on seven replicate measurements of 200 μg L⁻¹ of diazinon and endosulfan, 100 μg L⁻¹ of phosalone, 50.0 μg L⁻¹ of atrazine, desethylatrazine and deisopropylatrazine in water were in the range of 1.3–2.5% and 2.2–3.6%, respectively. The relative recoveries of well, tap and river water samples which have been spiked with different levels of target pesticides are 97–106, 90–108 and 95–107%, respectively. The extraction methodology is simple, rapid, cheap and green since small amounts of non-toxic solvents are necessary.

In this research, a new extraction method based on liquid-phase microextraction and the freezing of deep eutectic solvent has been developed for the determination of pesticides in water prior to their analysis by HPLC-UV.     

Design and in vitro/in vivo evaluations of a multiple-drug-containing gingiva disc for periodontotherapy

In the current work, we set out to develop and evaluate a gingiva disc of cellulose acetate phthalate and poloxamer F-127 for the simultaneous delivery of multiple drugs, namely minocycline, celecoxib, doxycycline hyclate, and simvastatin, to abolish infection, impede inflammation, avert collagen destruction, and promote alveolar bone regeneration, respectively. In vitro release studies revealed the sustained release profiles of the drugs for 12 h and that they were active against Staphylococcus aureus, Escherichia coli and Streptococcus mutans. The in vivo bioactivity levels of these drugs were assessed by comparing the number of colony forming units during different phases of a study on Wistar rats, and the results showed a reduction in the number of bacterial colonies with the applied formulation. A mucosal irritation study conducted on Wistar rat gingiva confirmed the non-irritancy of the optimal gingiva disc. Hence, this customized, non-invasive polymeric gingiva disc displaying a sustained release of drugs can be a useful tool to treat acute to moderate stages of periodontitis.

A gingiva disc of cellulose acetate phthalate and poloxaner F-127 was developed for the simultaneous delivery of multiple drugs, including minocycline, to promote alveolar bone regeneration by abolishing infection, impeding inflammation and averting collagen destruction.     

A single-centre experience of coronary revascularisation in young patients

Background

Coronary bypass grafting is probably the most extensively studied surgical technique; however, the reported data on its outcome in the younger population are relatively scarce. We present our 10-year experience with young patients undergoing coronary revascularisation.

Patients and method

Fifty-one patients, 40 years or younger, underwent coronary bypass surgery in our institution, between January 2003 and December 2012. Relevant preoperative and intraoperative clinical data were retrieved from the patient’s medical records. Follow-up data was obtained by personal or telephonic interview of the patients or relatives.

Results

Out of 51 patients (4 females, 47 males), with a mean age of 37.35?±?3.25 years (range 27–40 years), 47 patients underwent off-pump coronary artery bypass and the rest underwent on-pump beating heart coronary artery bypass. Indication for surgery was triple-vessel disease (TVD) in 24 patients (47 %), double-vessel disease (DVD) in 9 patients (17.7 %) and single-vessel disease (SVD) in 18 patients (35.3 %). A total of 104 grafts (51 with left internal thoracic artery, 10 with radial artery and 43 with saphenous vein) were constructed, with a mean of 2.04?±?0.94 grafts per patient. There was no in-hospital or 30-day mortality. Mean ICU stay was 2.33?±?0.76 days and mean hospital stay was 7.2?±?1.6 days (range 5–13 days). Cumulative follow-up was 256.53 years (mean 5.03?±?3.19 years); follow-up was 90.2 % complete. Actuarial probability of survival at 10 years was estimated to be 91.1 %.

Conclusion

Early and midterm results of coronary artery bypass surgery in young patients are excellent.     

Evaluation of developmental toxicity of guaifenesin using pregnant female rats

Objectives:Guaifenesin possesses expectorant, muscle relaxant, and anticonvulsive properties. To the best of our knowledge, the promising data regarding the developmental toxicity of guaifenesin are scarce. The current study investigates the developmental toxic effects of guaifenesin in detail using female rats.Results:A significant reduction in maternal weight, and food/water intake, was observed, however, no mortality and morbidity were observed. About 14 dead fetuses were found in Group-3 and -4 each, while 26 in Group 5. Morphological analysis revealed 21.2%, 45.4%, 67.2%, and 86.9% of total fetuses having hemorrhagic spots in Group-2, -3, -4, and -5, respectively. Dropping wrist/ankle and kinky tail were found in Group-4 and -5 only. Morphometric analysis showed a significant decline in fetal weight, full body length, skull length, forelimb length, hindlimb length, and tail length in all guaifenesin treated groups. Skeletal examination displayed that only Group 5 fetuses had increased intercostal space between 7^th and 8^th rib. We also observed improper development of carpals, metacarpals, tarsals, and metatarsals of the Group 5 fetuses.Conclusion:Guaifenesin showed a significant developmental toxicity at selected test doses; therefore, a careful use is suggested during pregnancy.KEY WORDS: Developmental toxicity, embryotoxicity, fetotoxicity, guaifenesin, teratogen, toxicology     

Potential risk of esophageal squamous cell carcinoma due to nucleotide excision repair <Emphasis Type="Italic">XPA</Emphasis> and <Emphasis Type="Italic">XPC</Emphasis> gene variants and their interaction among themselves and with environmental factors

The association of nucleotide excision repair (NER) gene polymorphisms with esophageal squamous cell carcinoma (ESCC) is inconclusive. The aim of the current study was to assess the association of repair gene xeroderma pigmentosum A (XPA) (rs-1800975) and xeroderma pigmentosum C (XPC) (rs-2228000) polymorphisms with ESCC risk as well as modifying effects of environmental factors. The genotyping was done in 450 confirmed ESCC cases and equal number of individually matched controls by the polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) and direct sequencing methods. Conditional logistic regression models were used to assess the genotypic associations and interactions. A high ESCC risk was found in subjects who carried the homozygous minor allele of XPA (odds ratio (OR)?=?3.57; 95 % confidence interval (CI)?=?1.76–7.23), and the risk was higher when analysis was limited to participants who were ever smokers (OR?=?4.22; 95 % CI?=?2.01–8.88), lived in adobe houses (OR?=?8.42; 95 % CI?=?3.74–18.95), consumed large volumes of salt tea (OR?=?7.42; 95 % CI?=?3.30–16.69), or had a positive family history of cancer (FHC) (OR?=?9.47; 95 % CI?=?4.67–19.20). In case of XPC, a homozygous minor allele also showed strong association with ESCC risk (OR?=?4.43; 95 % CI?=?2.41–8.16). We again observed a very strong effect of the above environmental factors in elevating the risk of ESCC. Further, the variant genotypes of both genes in combination showed an increased risk towards ESCC (OR?=?7.01; 95 % CI?=?3.14–15.64) and such association was synergistically significant. Salt tea consumption showed an interaction with genotypes of XPA and XPC. However, an interaction with FHC was significant in the case of XPA genotype only. XPA and XPC genotypes are associated with an increased risk of ESCC, and such association was reasonably modulated by different exposures.