Effect of 'Procumbenase' a serine protease from Tridax procumbens aqueous extract on wound healing: A scar free healing of full thickness wounds.

Wound healing involves several cellular and molecular pathways. Tridax procumbens activates genetic pathways with antibacterial, antioxidant, anticancer, and anti-inflammatory properties, aiding wound healing. This study purified Procumbenase, a serine protease from T. procumbens extract, using gel filtration (Sephadex G-75) and ion exchange (CM-Sephadex C-50) chromatography. Characterization involved analyses of protease activity, RP-HPLC, SDS-PAGE, gelatin zymogram, PAS staining, mass spectrometry, and circular dichroism. Optimal pH and temperature were determined. Protease type was identified using inhibitors. Wound-healing potential was evaluated through tensile strength, wound models, hydroxyproline estimation, and NIH 3T3 cell scratch analysis. In incision wound rat models, Procumbenase increased tensile strength on day 14 more than saline and Povidone­iodine. It increased wound contraction by 89 % after 10 days in excision wound models, attaining full contraction by day 15 and closure by day 21. Scarless wound healing was enhanced by 18 days of epithelialization against 22 and 21 days for saline and povidone­iodine. Procumbenase increased hydroxyproline concentration 2.53-fold (59.93 ± 2.89 mg/g) compared to saline (23.67 ± 1.86 mg/g). In NIH 3 T3 cell scratch assay, Procumbenase increased migration by 60.93 % (50 µg) and 60.57 % (150 µg) after 48 h. Thus, Procumbenase is the primary bioactive molecule in T. procumbens, demonstrates scar-free wound healing properties.

TiO2 nanoparticles derived from egg shell waste: Eco synthesis, characterization, biological and photocatalytic applications.

Biosynthesis of metal oxide nanoparticles has attracted much attention in recent years owing to the increasing impact for improving hygienic substances, cost effective approaches, environment friendly solvents and reusable resources. The present study has shown the eco synthesis of TiO2 nanoparticles using the aqueous extract of egg shell waste. UV, XRD, FT-IR, and FE-SEM with EDX methods were implied for TiO2 nanoparticles. The agar well approach was used to investigate the antimicrobial properties of biosynthesized nanoparticles against pathogenic organisms. The cytotoxicity analysis was investigated by MTT assay method and photocatalytic activity was studied using methylene blue, methyl orange and Congo red dye. X-ray diffraction studies showed that the presence of tetragonal structure. The crystallite size of synthesized TiO2 nanoparticles is 27.3 nm. FE-SEM analysis indicates that the average grain size of the prepared sample was found to be in the range of 30-40 nm. Eco synthesis of TiO2 nanoparticles displayed amazing antimicrobial efficacies against human pathogenic organisms and obtained excellent cytotoxicity investigation was performed against Osteosarcoma cell lines (MG-63). Further it was also found that the expression of impressive catalytic efficiency, 91.1 percent decreased in 60 min for methylene blue. From the results, we found that eco synthesized TiO2 nanoparticles has promising utility in multidisciplinary like antimicrobial, anticancer and photocatalytic applications.

Experimental and Computational Investigations of the Tropospheric Photooxidation Reactions of 1,1,1,3,3,3-Hexafluoro-2-Methyl-2-Propanol Initiated by OH Radicals and Cl Atoms.

The gas-phase kinetics for the reactions of OH radicals and Cl atoms with 1,1,1,3,3,3-hexafluoro-2-methyl-2-propanol (HF2M2P) were measured at temperatures between 268 and 363 K using the relative rate experimental technique. Methane and acetonitrile were used as reference compounds to measure the rate coefficients of the title reactions. For the reactions of HF2M2P with OH radicals and Cl atoms, the rate coefficients were measured to be (7.07 ± 1.21) × 10-15 and (2.85 ± 0.54) × 10-14 cm3 molecule-1 s-1, respectively, at 298 K. The obtained Arrhenius expressions for the reactions of HF2M2P with OH radicals and Cl atoms are kHF2M2P + OHExp - (268 - 363 K) = (7.84 ± 0.75) × 10-14 exp [-(717 ± 59)/T] and kHF2M2P + ClExp - (268 - 363 K) = (3.21 ± 0.45) × 10-12 exp [-(1395 ± 83)/T] cm3 molecule-1 s-1. In addition to the experimental measurements, computational kinetic calculations were also performed for the title reactions at the M06-2X/MG3S//M06-2X/6-31 + G(d,p) level of theory using advanced methods such as the canonical variational transition-state theory coupled with small curvature tunneling corrections at temperatures between 200 and 400 K. Theoretical calculations reveal that the H-abstraction from the CH3 group is a more favorable reaction channel than that from the OH group. Thermochemistry, branching ratios, cumulative atmospheric lifetime, global warming potential, acidification potential, and photochemical ozone creation potential of HF2M2P were calculated in the present investigation.

Structural insights into the anti-cancer activity of quercetin on G-tetrad, mixed G-tetrad, and G-quadruplex DNA using quantum chemical and molecular dynamics simulations.

Human telomerase referred as 'terminal transferase' is a nucleoprotein enzyme which inhibits the disintegration of telomere length and act as a drug target for the anticancer therapy. The tandem repeating structure of telomere sequence forms the guanine-rich quadruplex structures that stabilize stacked tetrads. In our present work, we have investigated the interaction of quercetin with DNA tetrads using DFT. Geometrical analysis revealed that the influence of quercetin drug induces the structural changes into the DNA tetrads. Among DNA tetrads, the quercetin stacked with GCGC tetrad has the highest interaction energy of -88.08 kcal/mol. The binding mode and the structural stability are verified by the absorption spectroscopy method. The longer wavelength was found at 380 nm and it exhibits bathochromic shift. The findings help us to understand the binding nature of quercetin drug with DNA tetrads and it also inhibits the telomerase activity. Further, the quercetin drug interacted with G-quadruplex DNA by using molecular dynamics (MD) simulation studies for 100 ns simulation at different temperatures and different pH levels (T = 298 K, 320 K and pH = 7.4, 5.4). The structural stability of the quercetin with G-quadruplex structure is confirmed by RMSD. For the acidic condition (pH = 5.4), the binding affinity is higher toward G-quadruplex DNA, this result resembles that the quercetin drug is well interacted with G-quadruplex DNA at acidic condition (pH = 7.4) than the neutral condition. The obtained results show that quercetin drug stabilizes the G-quadruplex DNA, which regulates telomerase enzyme and it potentially acts as a novel anti-cancer agent.Communicated by Ramaswamy H. Sarma.

Role of 6-Mercaptopurine in the potential therapeutic targets DNA base pairs and G-quadruplex DNA: insights from quantum chemical and molecular dynamics simulations.

The theoretical studies on DNA with the anticancer drug 6-Mercaptopurine (6-MP) are investigated using theoretical methods to shed light on drug designing. Among the DNA base pairs considered, 6-MP is stacked with GC with the highest interaction energy of -46.19 kcal/mol. Structural parameters revealed that structure of the DNA base pairs is deviated from the planarity of the equilibrium position due to the formation of hydrogen bonds and stacking interactions with 6-MP. These deviations are verified through the systematic comparison between X-H bond contraction and elongation and the associated blue shift and red shift values by both NBO analysis and vibrational analysis. Bent's rule is verified for the C-H bond contraction in the 6-MP interacted base pairs. The AIM results disclose that the higher values of electron density (ρ) and Laplacian of electron density (∇2ρ) indicate the increased overlap between the orbitals that represent the strong interaction and positive values of the total electron density show the closed-shell interaction. The relative sensitivity of the chemical shift values for the DNA base pairs with 6-MP is investigated to confirm the hydrogen bond strength. Molecular dynamics simulation studies of G-quadruplex DNA d(TGGGGT)4 with 6-MP revealed that the incorporation of 6-MP appears to cause local distortions and destabilize the G-quadruplex DNA.

Use of Exfoliative Specimens and Fine-Needle Aspiration Smears for Mutation Testing in Lung Adenocarcinoma.

OBJECTIVE: Cytology specimens are considered to be a promising alternative for detecting driver mutations in lung cancer patients. We aimed to explore the suitability and utility of various cytology samples of non-small-cell lung cancer (NSCLC) patients for mutation testing. In addition to mutation detection, the importance of preanalytic factors was discussed. DESIGN: A total of 116 cytology samples including 32 controls comprising pleural effusions, bronchial washings, and direct fine-needle aspiration (FNA) smears were included in the study for the detection of EGFR, KRAS, and Her-2/neu gene mutations. Tumor content was checked by microscopic evaluation. Tumor enrichment was done by scraping direct smears. DNA yield was assessed before selecting the method of mutation detection. Sanger sequencing and real-time PCR-based methods were used. RESULTS: Overall, 20.23% EGFR mutations and 2.74% KRAS mutations were observed in this study. Nondriver genetic polymorphisms were observed in EGFR exon 20 in 37% cases. The coexistence of the EGFR mutation and EGFR polymorphism was seen in 7 cases. DNA yield was better in pleural effusions and bronchial washings. Real-time PCR was used in specimens of low DNA yield. CONCLUSIONS: Cytology samples are useful in ascertaining molecular diagnostic information for treatment purposes if they are optimized judiciously in their preanalytic phase.

An Exprimental and Computational Study on the Cl Atom Initiated Photo-Oxidization Reactions of Butenes in the Gas Phase.

Temperature-dependent rate coefficients for the reactions of Cl atoms with trans-2-butene and isobutene were measured over the temperature range of 263-363 K using relative rate technique with reference to 1,3-butadiene, isoprene, and 1-pentene. The measured rate coefficients for the reactions of Cl atoms with isobutene and trans-2-butene are kR1298K= (3.43 ± 0.11) × 10-10 and kR2298K = (3.20 ± 0.04) × 10-10 cm3 molecule-1 s-1, respectively, at 298 K and 760 torr. Measured rate coefficients were used to fit the Arrhenius equations, which are obtained to be kR1-Exp269-363K = (4.99 ± 0.42) × 10-11 exp[(584 ± 26)/T] and kR2-Exp269-363K = (1.11 ± 0.3) × 10-10 exp[(291 ± 88)/T] cm3 molecule-1 s-1 for isobutene and trans-2-butene, respectively. To understand the reaction mechanism, estimate the contribution of each reaction site, and to complement our experimental results, computational studies were also performed. Canonical variational transition state theory with small curvature tunneling in combination with MP2/6-31G(d), MP2/6-31G(d,p), MP2/6-31+G(d,p), CCSD(T)/cc-pvdz, and QCISD(T)/cc-pvdz level of theories were used to calculate the temperature-dependent rate coefficients over the temperature range of 200-400 K. The effective lifetimes, thermodynamic parameters, and atmospheric implications of the test molecules were also estimated.

Experimental and Theoretical Investigations on the Reaction of 1,3-Butadiene with Cl Atom in the Gas Phase.

Temperature dependent rate coefficients for the reaction of Cl atom with 1,3-butadiene were measured over the temperature range 269-363 K relative to its reaction with isoprene and 1-pentene. Theoretical calculations were performed for the title reaction using CVT/SCT in combination with CCSD(T)/6-31+G (d,p)//MP2/6-311+G(2df,2p) level of theory, to complement our experimental measurements. The test molecule would survive for 1 h in the atmosphere, and therefore, it can be considered as a very short-lived compound. 1,3-Butadience cannot contribute to global warming as it is very short-lived. However, 4 ppm of ozone is estimated to be formed by the test molecule, which can be considered to be reasonably significant.

Therapeutic effects of gold nanoparticles synthesized using Musa paradisiaca peel extract against multiple antibiotic resistant Enterococcus faecalis biofilms and human lung cancer cells (A549).

Botanical-mediated synthesis of nanomaterials is currently emerging as a cheap and eco-friendly nanotechnology, since it does not involve the use of toxic chemicals. In the present study, we focused on the synthesis of gold nanoparticles using the aqueous peel extract of Musa paradisiaca (MPPE-AuNPs) following a facile and cheap fabrication process. The green synthesized MPPE-AuNPs were bio-physically characterized by UV-Vis spectroscopy, FTIR, XRD, TEM, Zeta potential analysis and EDX. MPPE-AuNPs were crystalline in nature, spherical to triangular in shape, with particle size ranging within 50 nm. The biofilm inhibition activity of MPPE-AuNPs was higher against multiple antibiotic resistant (MARS) Gram-positive Enterococcus faecalis. Light and confocal laser scanning microscopic observations evidenced that the MPPE-AuNPs effectively inhibited the biofilm of E. faecalis when tested at 100 µg mL-1. Cytotoxicity studies demonstrated that MPPE-AuNPs were effective in inhibiting the viability of human A549 lung cancer cells at higher concentrations of 100 µg mL-1. The morphological changes in the MPPE-AuNPs treated A549 lung cancer cells were visualized under phase-contrast microscopy. Furthermore, the ecotoxicity of MPPE-AuNPs on the freshwater micro crustacean Ceriodaphnia cornuta were evaluated. Notably, no mortality was recorded in MPPE-AuNPs treated C. cornuta at 250 µg mL-1. This study concludes that MPPE-AuNPs are non-toxic, eco-friendly and act as a multipurpose potential biomaterial for biomedical applications.

A quantitative ethnozoological study of traditionally used animals in Pachamalai hills of Tamil Nadu, India.

ETHNOPHARMACOLOGICAL RELEVANCE: The purpose of this study was designed to gather primary folk knowledge on different animal based therapies used by Malayalis in Pachamalai hills. This is the first ethnozoological study in Pachamalai hills; the data regarding the medicinal animals/animal products were documented and their usages were analyzed quantitatively. METHODS: Data was collected following the interviews from key informants (N=89) and reported diseases and health complications were classified in 18 categories. Seven quantitative indexes such as informant consensus factor (FIC), fidelity level (FL), relative frequency of citation (RFC), relative importance (RI), cultural importance index (CII), index of agreement on remedies (IAR) and cultural agreement index (CAI) were used to analyze the reported animal species. RESULTS: A total of 46 animal species belonging to 8 taxonomic groups were documented to be used in traditional medicine by Malayalis in Pachamalai hills. Animal based medicines were prepared from whole animals or their body parts or products extracted from them such as: butter, meat, milk, bones, horn, musk, skin, fin, honey, mucus, eggs, urine, excreta, hair and legs. The most encountered taxonomic group was Mammalia having 14 species. Aphrodisiac ailments (AA) (0.99), Dental care ailments (DCA) (0.99), Endocrinal disorders ailments (EDA) (0.99), Hair care ailments (HCA) (0.99), Oncology ailments (OA) (0.99) and Ortho ailments (ORTA) (0.99) gained the highest FIC value. Sus scrofa domesticus scored the highest FL (100%) for the Skeleto-muscular ailments for external cause; Lissemys punctata had the highest RI value (2.00) due to its versatility and the highest frequency of citation (RFC=1.000). Gallus domesticus had the highest cultural importance (CII=8.538) and the highest CAI value (CAI=8.427). According to IAR, Plexippus paykulli (IAR=1.00), Equus ferrus caballus (IAR=1.00), Trachypithecus johnii (IAR=1.00), Oecophylla samaragdina (IAR=1.00) and Apis indica (0.990) had the highest agreement among the informants for being used for the same medicinal purpose. Furthermore, no side effects have been reported from the use of ABT. CONCLUSIONS: Our study revealed that Malayalis (Pachamalai hills) possess valuable knowledge on Malayalis׳ animal based therapies. It is believed that the present documentation will serve to record this vanishing knowledge before it is eroded completely from the island and to the scientific community. It is also anticipated that the present documentation will be fundamental to protect traditional knowledge, for the conservation and sustainable use of the rich biodiversity of Pachamalai hills for future generations and to ensure Pachamalai hills׳ sovereign rights over its genetic resources and utilization by first documenting them. In addition, further experimental investigations are required to elucidate the pharmacological properties of the reported medicinal fauna of Pachmalai hills.

Reasons for low quality of life in South Indian cancer patient population: a prospective observational study.

Over the last decade, quality of life investigations of cancer patients' have became a critical evaluation parameter in the clinical cancer research and treatment evaluation programs. This study was carried out in a 1200 bed tertiary care teaching hospital, MGM Hospital, located at Warangal, India. Present study assessed the overall quality of life, symptoms of patients affected by breast, head and neck, cervical and stomach cancers by using guidelines and modules of The European Organisation for Research and Treatment of Cancer. The assessment was carried out in two phases, as review I at ≤2 cycles and review II at ≥5 cycles of treatment. Data were analyzed for 104 individuals with the mean age of 46.1±11.2 years. The evaluation was characterised as functional scale and symptom scale. In the functional scale physical, and role functions were significant (P<0.05) in all the 4 types of cancers studied. Additional, future perspective, social and emotional functions were observed to be significant in breast cancer, head and neck cancer and cervical cancer, respectively. Where as in symptom scale pain was observed to be significant for all cancers studied. Individually, breast cancer patient also showed significant parameters like fatigue, arm symptoms, and upset by hair loss. Head and neck cancer patients had insomnia and diarrhoea as additional significant symptom scale parameters. In cervical cancer patients, fatigue, insomnia, menopausal symptoms, and in stomach cancer patients, nausea and vomiting, dysphagia, reflex symptoms and eating restrictions were significantly affected. Most of the findings are similar to past studies in the respective type of cancer patients which shows that, quality of life was mostly influenced by the above mentioned factors and have some interesting implications for management and treatment of cancer.

A multidisciplinary approach to the management of atypical osseous epithelioid hemangioendothelioma.

Hemangioendothelioma is a rare vascular tumor of intermediate malignant potential. Though epithelioid hemangioendothelioma (EH) is commonly found in soft tissues, it has been known to be present in skeletal tissues. The authors present a case of a 50-year-old woman diagnosed with EH of the iliac bone and acetabulum, who experienced pathological fracture at presentation. This report describes a multidisciplinary approach to the management that includes initial incisional biopsy, curettage, and bone grafting, followed by Intensity Modulated Radiation Therapy. The patient finally underwent hemipelvic resection with allograft reconstruction after recurrence. Histopathological study revealed osseous EH of low mitotic activity that stained positively for CD31, CD34, vimentin, and Factor VIII. Herein, the authors discuss the imaging characteristics, histopathological aspects, cytogenetic findings, and the radiobiological behavior of osseous EH. After an aggressive multidisciplinary intervention, the patient is able to achieve local control with no evidence of distal metastatic disease.

An evaluation of hepatotoxicity in breast cancer patients receiving injection Doxorubicin.

BACKGROUND: Hepatic dysfunction in the cancer unit has a significant impact on patient outcomes. The therapeutic application of anthracycline antibiotics are limited by side-effects mainly myelosuppression, chronic cardiotoxicity, and hepatotoxicity. AIM: To assess the risk of Hepatotoxicity in breast cancer patients receiving Inj. Doxorubicin. SUBJECTS AND METHODS: The investigation was a prospective study that was conducted in cancer patients receiving Inj. Doxorubicin doses of 50 mg/m(2), and 75 mg/m(2) at a South Indian tertiary care hospital. Sample collection was carried out from pre-chemotherapy to 4(th) cycle. Serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), direct bilirubin and total bilirubin were assessed to determine hepatotoxicity. Data were analyzed using unpaired t-test, Pearson correlation using Graph-Pad Prism version 5.00 for Windows, Graph-Pad Software, San Diego, California, USA, www.graphpad.com. RESULTS: Breast cancer patients comprised 37% (49/132) of the total female cancer patient population, of which 46 patients with a mean age of 46.6 (13.4) years were included and 30.4% (14/46) patients were developed hepatotoxicity. The mean standard deviation of SGOT, SGPT, direct bilirubin, total bilirubin in the pre-chemotherapy cycle to fourth chemotherapy cycle were found to be 21.97 (5.798) U/L and 181.3 (103.6) U/L, 23.17 (6.237) U/L and 147.6 (90.9) U/L, 0.1351 (0.1186) mg/dL and 0.5445 (0.4587) mg/dL, 0.3094 (1.346) mg/dL and 2.7163 (1.898) mg/dL simultaneously where P < 0.05 which were statistically significant. CONCLUSION: There exist a strong correlation between the use of Inj. Doxorubicin and risk for developing hepatotoxicity. The health-care professionals dealing with breast cancer patients need to have awareness for hepatotoxicity with the use of Inj. Doxorubicin therapy.

Citrate coated iron oxide nanoparticles with enhanced relaxivity for in vivo magnetic resonance imaging of liver fibrosis.

Superparamagnetic iron oxide nanoparticles are widely used for the magnetic resonance imaging (MRI) applications. The surface characteristics, magnetic properties, size and targeting efficiency of the material are crucial factors for using the same as contrast agents. We report a simple synthesis method of citrate coated iron oxide nanoparticles and its systematic characterization. The developed system is highly water dispersible with an average particle size of 12 nm. The particles in water are monodisperse and are found to be stable over long periods. The efficiency of the material to de-phase water proton has been studied for various concentrations of iron using longitudinal (T1) and transverse (T2) weighted MRI. The coating thickness of the nanoparticle was optimized so that they exhibited a high transverse to longitudinal relaxivity (r2/r1) ratio of 37.92. A clear dose-dependent contrast enhancement was observed in T2 weighted in vivo MR imaging of liver fibrosis model in rodents. The labelling efficacy of the particle and the intracellular magnetic relaxivity were also investigated and presented. The particles were also tested for blood and cellular compatibility studies. Development of fibrosis and presence of iron in the liver was confirmed by histopathological analysis. From this study, we conclude that the citrate coated ultra small superparamagnetic iron oxide nanoparticles (C-USPION) with optimized parameters like particle size and magnetic property are capable of producing good MR contrast in imaging of liver diseases.

Ionizing radiation effects on sex steroid hormone levels in serum and milt of freshwater fish Oreochromis mossambicus.

Effects of gamma rays on the sex steroid hormone levels [testosterone (T), 11-ketotestosterone (11-KT) and 17ß-estradiol (E2)] were studied in the freshwater fish Oreochromis mossambicus. Gamma radiation induced effects on hormone levels reported here for the first time in the fish. Since radionuclides released accidentally or during a nuclear disaster can contaminate inland water bodies, biomonitoring methods are required for assessing the impacts of certain dose levels of radiation that may ultimately result in ionizing radiation exposure to both humans and non-human biota. Three groups of (n=15 in each group) fishes were irradiated with a single dose of (60)Co 10Gy, 15Gy and 20Gy with a duration of .33, .50 and .66min. Significant decrease of the hormone levels was seen at higher doses of 15Gy and 20Gy. The sex steroid hormone levels in the fishes are vital for sperm production, development, differential functions related to the physiology and reproductive behavior. This study serves as biomonitoring tool to assess the ionizing radiation effects on reproductive behavior of aquatic biota.

Pathogenecity of Pseudomonas aeruginosa in Oreochromis mossambicus and treatment using lime oil nanoemulsion.

Fish diseases caused by Pseudomonas aeruginosa, a known pathogenic organism, is responsible for considerable economic losses in the commercial cultivation of Oreochromis mossambicus (Tilapia). The bacteria were injected into healthy fish through intramuscular injection, oral and immersion challenge. Infection was confirmed by histopathological investigation of the infected organs. Lime nanoemulsion was prepared and the effectiveness of the nanoemulsion was studied both in vitro and in vivo by well diffusion assay and in vivo in the artificially infected fish. Results showed that the lime nanoemulsion was effective against the P. aeruginosa infection in O. mossambicus both in vitro and in vivo.

An 11-channel radio frequency phased array coil for magnetic resonance guided high-intensity focused ultrasound of the breast.

In this study, a radio frequency phased array coil was built to image the breast in conjunction with a magnetic resonance guided high-intensity focused ultrasound (MRgHIFU) device designed specifically to treat the breast in a treatment cylinder with reduced water volume. The MRgHIFU breast coil was comprised of a 10-channel phased array coil placed around an MRgHIFU treatment cylinder where nearest-neighbor decoupling was achieved with capacitive decoupling in a shared leg. In addition a single loop coil was placed at the chest wall making a total of 11 channels. The radio frequency coil array design presented in this work was chosen based on ease of implementation, increased visualization into the treatment cylinder, image reconstruction speed, temporal resolution, and resulting signal-to-noise ratio profiles. This work presents a dedicated 11-channel coil for imaging of the breast tissue in the MRgHIFU setup without obstruction of the ultrasound beam and, specifically, compares its performance in signal-to-noise, overall imaging time, and temperature measurement accuracy to that of the standard single chest-loop coil typically used in breast MRgHIFU.

An unusual combination of coronary arterial and systemic venous anomalies-clinical implications.

A 57-year-old male underwent coronary angiography for exertional angina which showed two left anterior descending coronary arteries (LAD)--a short LAD from the left coronary sinus terminating in the proximal Anterior Inter-Ventricular Sulcus (AIVS), a long LAD from the proximal right coronary artery entering the distal AIVS and an anomalous left circumflex artery from the right coronary sinus. In addition, he also had absent right superior vena cava and a persistent left superior vena cava entering the coronary sinus.