Anomalous right coronary artery from distal left circumflex coronary artery:a rare case report

Coronary artery anomalies (CAAs) being a group of congenital disorders, present with highly variable manifestations andhave diverse pathophysiological manifestations. In middle aged to elderly patients, a coronary anomaly is often an incidental finding.We presenteda case of 65-year-old female with history of diabetes for past 9 years who presented to our emergency department with history of exertional chest pain for past 4 weeks. Anomalous origin of right coronary artery (RCA) from distal left circumflex artery (LCX) was observed on coronary angiography. Patient was managed with optimised medical therapy (OMT).

INCIDENTALLY DETECTED MALIGNANT RIGHT CORONARY ARTERY ORIGINATING FROM LEFT CORONARY SINUS: A RARE CASE REPORT

BACKGROUND: Congenital coronary artery anomalies are rare and are usually an incidental ?nding. The incidence of coronary anomalies was reported as 1.3% in a large number of patients undergoing coronary angiogram1. In this report we present a patient with a malignant right coronary artery (RCA) originating from left coronary sinus CASE REPORT:A 52 year old male came to cardiac OPD in view of ?tness for cataract surgery. He does not have any signi?cant cardiac history or symptoms. Coronary angiogram revealed Anomalous coronary artery arising from left coronary sinus with critical 99% lesion in the Mid RCA. The patient was taken up for Percutaneous transluminal coronary angioplasty and the Mid RCA lesion was addressed. CONCLUSION:The treatment plan for people with Malignant RCA should be based on an interdisciplinary decision made between the treating physician, patient, cardiovascular imaging experts, cardiologists and heart surgeons depending on symptoms, age, anatomic features of ACAOS and ischaemic testing.

Hemodynamic Analysis on Anomalous Origin of the Right Coronary Artery from the Left Coronary Artery Sinus / 医用生物力学

Objective To analyze the hemodynamic parameters of anomalous origin of the right coronary artery from the left coronary artery sinus (AORL) based on computational fluid dynamics (CFD), so as to make an evaluation of the disease. Methods A normal right coronary artery (RCA) case and an AORL case were selected. Two models were reconstructed in Mimics software and imported into ANSYS CFX software for hemodynamics simulation. The hemodynamics of normal RCA model and AORL model were compared. Results AORL model had a smaller volume flow (9.35 cm3/s), which might lead to insufficient blood supply downstream of the RCA; the pressure at the acute corner of AORL model (13.78 kPa) was lower than normal RCA model (14.9 kPa); the wall shear stress (WSS) of AORL model (12.83 Pa) was larger than that of normal RCA model (9.74 Pa); the total deformation of AORL model was relatively large. Conclusions The entrance velocity and pressure of AORL were lower than those of normal RCA, which might lead to ischemic symptoms. The research findings are of theoretical significance for the effective evaluation of ischemia and other diseases in clinic.

Análisis causa-raíz sobre evento adverso producido en la Clínica Odontológica Docente Asistencial, Facultad de Odontología, Universidad de La Frontera, Chile / Cause-root analysis on an adverse event generated at the Dental Clinic, Faculty of Dentistry, Universidad de La Frontera, Chile

El Análisis de Causa-Raíz (ACR) es una forma de estudio retrospectivo de eventos adversos destinado a detectar las causas subyacentes de los mismos para proteger a los pacientes mediante la modificación de los factores dentro del sistema de salud que los provocaron y prevenir sus recurrencias. Si bien esta concepción centrada en la seguridad del paciente ha visto un importante auge en la atención médica, la odontología no ha sido llevada de igual manera probablemente por presentar daños más leves, procedimientos ambulatorios (con la consiguiente falta de seguimiento de muchos eventos adversos) y prácticas fundamentalmente privadas (cuyos conflictos afectarían potencialmente los resultados comerciales). Dado que no hay precedentes en Chile, se presenta un evento adverso producido en la Clínica Odontológica Docente Asistencial de la Facultad de Odontología de la Universidad de La Frontera y su ACR, desarrollado como primera intervención del Centro Chileno para la Observación y Gestión del Riesgo Sanitario de esa institución. Se plantean las necesidades de implementar un sistema explícito de categorización de eventos adversos en esa disciplina y de apoyar políticas de cultura en seguridad para el paciente odontológico, y se discute el papel de las instituciones universitarias para reconocer las áreas de vulnerabilidad en sus clínicas y así reforzar y mejorar la calidad de sus prácticas sanitarias.

Root cause analysis (RCA) is a retrospective study of adverse events performed to detect the underlying causes of these events to protect patients by modifying the factors within the health system that caused them and preventing their recurrences. Although this paradigm focused on patient safety has seen a significant increase in medical care, dentistry has not been carried out in the same way, probably because of milder injuries, outpatient procedures (with the consequent lack of follow-up of many adverse events) and basically private practices (whose conflicts would potentially affect commercial outcomes). Since there is no precedent in Chile, we present an adverse event produced at the Dental Clinic of the Faculty of Dentistry of the University of La Frontera and its RCA, performed as the first intervention of the Chilean Center for the Observation and Management of Health Risk of that institution. The needs to implement an explicit system of categorization of adverse events in this discipline and to provide support for cultural safety policies for the dental patient are discussed. The role of university institutions in recognizing areas of vulnerability in their clinics and to strengthen and improve the quality of their health practices is also discussed.

A Case Report on Percutaneous Coronary Intervention in Chronic Total Occlusion by Retrograde Visualization.

As bilateral approach is paramount in chronic total occlusions with retrograde flow, the use of two radial arteries,two femoral arteries or combination technique using one radial and one femoral artery will probably be increasingly reported in the near future. After puncture of opposite groin, a diagnostic 6 Fr catheter is used to intubate the ostium of the contralateral artery. By visualizing the distal vessel in multiple projections, contralateral injections help to direct the progression of the wire in the occluded segment towards the distal true lumen. and confirm the intraluminal position of the wire after the occluded segment. We are reporting a case with chronic total occlusion where we used bilateral femoral access and simultaneous contrast injection to visualize retrograde flow in LAD while opening CTO through ante-grade pathway.

Severe Aortic Regurgitation Caused by Double-Folded Right Coronary Cusp / 日本心臓血管外科学会雑誌

<p>We report a case of severe aortic regurgitation due to deformation of the right coronary cusp which remained in a double-folded shape. A 76-year-old woman was admitted in August 2015 for the evaluation and treatment of dyspnea. She had no history of rheumatic fever, syphilis, endocarditis, or chest trauma. During physical examination, a grade IV/VI diastolic murmur was noted along the left sternal border. Her chest x-ray film showed marked cardiomegaly with interlobular pleural effusion (Vanishing tumor). An aortography revealed abnormally dilated proximal part of right coronary artery as well as severe aortic regurgitation. At operation, the ascending aorta was exposed through median sternotomy with the patient on total cardiopulmonary bypass. The left and non-coronary cusps were easily identified and noted to be normal. The right coronary cusp was recognized to be turned inside out and stayed in a double-folded shape, which made mal-coaptation of cusps and caused aortic regurgitation. The size of the right coronary cusp was larger than other two cusps. A very large right coronary ostium which occupied almost all of the sinus of Valsalva was confirmed. The aortic valve was excised and reconstructed with glutaraldehyde-treated autologous pericardium. She had an uneventful recovery and was discharged on POD 32. The mechanism of how right coronary cusp became disfigured was discussed. We think that the lesions of the sinus of Valsalva and proximal part of the RCA may have caused the double-folded right coronary cusp abnormality.</p>

Detection of Streptococcus mutans using padlock probe based on Rolling Circle Amplification (RCA)

The aim of this study was to develop and evaluate a padlock probe based on the Rolling Circle Amplification (RCA), which targeted to 16S-23S rDNA region of S. mutans. The specificity of developed padlock probe was tested for DNA within a panel strains, including S. mutans isolated from the saliva and reference strains of the genus Streptococcus, as well as total DNA samples of biofilm and saliva. The results were positive either for DNA samples of S. mutans or DNA samples recovered from the biofilm and saliva revealing the specificity of designed padlock probe. The padlock probe based on the RCA was proved to be an effective, reproducible method for S. mutans detection and demonstrated the possibility of a rapid detection and accurate identification of S. mutans infection.

The investigation of incidents and accidents involving medical residents / 医学教育

1）We examined 111 cases of incidents and accidents involving medical residents which were identified in a search of the database of the Japan Council for Quality Health Care.<br>2）In each case we deduced the root causes, which were then classified into 8 categories.<br>3）To develop strategies to prevent such cases from recurring, we believe that it is essential to develop a variety of training facility systems and to establish collaborative multidisciplinary medical treatment teams. Our results also suggest that consistent undergraduate and postgraduate programs for medical safety education are necessary.

Antígenos de Plasmodium falciparum, blancos de la respuesta inmunitaria humoral en pacientes tratados con cloroquina / Antigens of Plasmodium falciparum, target of humoral immune response in patients treated with chloroquine

Se planteó identificar antígenos que pudieran ser reconocidos por los anticuerpos IgG1 e IgG3, descritos como protectores en la infección malárica, en personas con respuesta clínica adecuada (RCA) o falla al tratamiento (FT) antimalárico, provenientes de localidades con diferentes grados de endemicidad. Se evaluaron por Immunoblotting muestras de sueros de individuos provenientes de tres localidades del Edo. Amazonas (Venezuela): Puerto Ayacucho (Atures), San Juan de Manapiare (Manapiare) y Platanal (Alto Orinoco). La reactividad de IgG, IgG1 e IgG3 frente a componentes antigénicos del extracto de P. falciparum (FCB2), permitió identificar un mayor número de moléculas específicas en los pacientes con RCA que en los pacientes con FT. La frecuencia de reconocimiento de polipéptidos fue baja en las tres localidades, algunas moléculas con una frecuencia de reconocimiento igual o mayor al 20% pertenecían a sueros de individuos de las localidades de Puerto Ayacucho y Platanal, ambas con exposición permanente a P. falciparum. Dado el reconocimiento de polipéptidos por IgG, IgG1 e IgG3 en sueros de pacientes con RCA, estos podrían ser considerados como posibles blancos relevantes de la respuesta inmunológica protectora que coadyuven con el tratamiento antimalárico. Esto contribuiría al desarrollo y diseño de vacunas más efectivas, que prevengan la infección malárica y/o potencien la eficacia a la quimioterapia.

Here we studied the presence of antigens recognized by IgG1 and IgG3 antibodies, thought as protective, in patients with adequate clinical response (RCA) or treatment failure (FT), living in areas of different degrees of endemicity. Immunoblotting was evaluated from serum samples of individuals from three locations in the State Amazonas (Venezuela): Puerto Ayacucho (Atures), San Juan de Manapiare (Manapiare) and Pantanal (Alto Orinoco). The reactivity of IgG, IgG1 and IgG3 against antigenic components of the extract of P. falciparum (FCB2) identified a greater number of specific molecules in patients with RCA in patients with AFT. The frequency of recognition of polypeptides was low in all three locations, with some molecules having a recognition rate of greater than or equal to 20% sera of individuals belonging to the towns of Puerto Ayacucho and Platanal, both with cases of P. falciparum. Given the recognition of polypeptides by IgG, IgG1 and IgG3 in sera of patients with RCA, they could be considered as possible targets for relevant protective immune responses that contribute to malaria treatment. This would contribute to the development and design of more effective vaccines that prevent malaria infection and/or enhance the efficacy of chemotherapy.

Two Cases of Postinfarction Ventricular Septal Perforation due to Obstruction of the Right Coronary Artery / 日本心臓血管外科学会雑誌

We report 2 cases of postinfarction ventricular septal perforation (VSP) attributable to obstruction of the right coronary artery. Case 1 was a 63-year-old man in whom VSP developed after percutaneous coronary angioplasty for complete obstruction of the right coronary artery. He developed papillary muscle rupture intraoperatively, requiring mitral valve replacement and subsequent treatment for right-side heart failure. He was discharged l7 weeks after surgery. Case 2 was a 77-year-old man. During catheterization following the detection of 99% obstruction of the #2 segment of the right coronary artery, VSP was found and the patient underwent emergency surgery. Postoperative echocardiography and ventriculography did not reveal a residual shunt or mitral regurgitation (MR). However, he suddenly developed acute MR in the 4th postoperative week and died of acute heart failure. VSP attributable to obstruction of the right coronary artery is difficult to repair surgically because of its anatomical location, among other reasons, and mitral valve replacement is sometimes needed if VSP is accompanied by necrosis of the mitral valve papillary muscle. Appropriate care is therefore needed in this case.

The Effective Use of Redo of Off-Pump Coronary Artery Bypass Grafting through a Left Thoracotomy with a Patent Left Internal Thoracic Artery Graft / 日本心臓血管外科学会雑誌

Redo of off-pump coronary artery bypass grafting (CABG) through a left thoracotomy with a patent left internal thoracic artery graft was very effective. A 62-year-old man was admitted because of unstable angina for whom CABG had been performed 6 years earlier (LITA-LAD, Ao-SVG-OM1), the saphenous vein graft soon become occluded. Coronary angiography revealed total occlusion of the right coronary artery (RCA)#1. For vasoconstruction of the left circumflex artery (LCx) and RCA, off-pump coronary artery bypass (OPCAB) was performed through a left thoracotomy. During normal cardiac contraction, a radial artery graft (RAG) was anastomosed sequentially from the descending aorta to the obtuse margin (OM) 1, OM2, RCA#4PL (postero-lateral branch). The postoperative course was uneventful and he was discharged on the 26th post-operative day. In patients with patent grafts, re-median sternotomy has a high risk of injury to already patent grafts and adhesions make the dissection difficult. Alternatively, as in this case, off-pump coronary artery bypass through a left thoracotomy can be very effective. Total arterial vasoconstruction was performed and postoperatively there was no early graft occlusion.

EXPRESSION OF GAL?-1,4-GlcNAc GROUP IN ASTROCYTOMA / 解剖学报

Objective To study the expression of Gal?-1,4-GlcNAc group in human normal brains and astrocytomas. Methods The protein extracts from human normal brains and astrocytomas were subjected to sodium dodecyl sulfate polyacrylamide gel electropheresis(SDS-PAGE),then were stained with Coomassie Brilliant blue(CBB).In addition,the expression of Gal?-1,4-GlcNAc group was studied by ricinus communis agglutinin-I(RCA-I) lectin blot and lectin histochemistry with RCA-I respectively. Results By comparison,CBB staining showed that the protein components from normal brains were similar to those from astrocytomas.However,by RCA-I lectin blot and histochemistry assay,it was found that the expression of Gal?-1,4-GlcNAc was more extensive in astrocytomas than normal brains.It was surprising that a major 61?kD protein was galactosylated in astrocytomas but not in normal brains.Ratio of RCA-I stained cells was 8% in human normal brains,while 15%,21%,28% and 41% in astrocytomas Ⅰ,Ⅱ,Ⅲ and Ⅳ respectively.Conclusion The expressions of Gal?-1,4-GlcNAc groups in astrocytomas were more than those in normal brains,which suggested that Gal?-1,4-GlcNAc group might be related to the malignant degree of astrocytomas.

CD226(PTA1) monoclonal antibody induced the cytotoxicity of NK cell clone in redirected cytotoxicity assay / 中国免疫学杂志

Objective:To investigate the expression and function of CD226 on NK cell clone Methods:NK cell clone was established by limited dilution, and identified by FCM The function of CD226 on the cytotoxicity of NK cell clone was detected by RCA and the NK cell clone secreted cytokines in the supernatants during the killing phase were measured by ELISA Results:One NK cell clone was obtained by limited dilution The cytotoxicity of this clone was upregulated markedly by CD226 mAb, and the secretion levels of IFN ? and GM CSF by NK cell clone increased obviously in RCA Conclusion:CD226 is a novel NK cell activation receptor, and the elevated IFN ? and GM CSF levels may be related to CD226 mAb enhanced NK function