NCPbook: a comprehensive database of non-canonical peptides.

Non-canonical peptides (NCPs) are a class of peptides generated from regions previously thought of as non-coding, such as introns, 5' untranslated regions (UTRs), 3' UTRs, and intergenic regions. In recent years, the significance and diverse functions of NCPs have come to light, yet a systematic and comprehensive NCP database remains absent. Here, we developed NCPbook (https://ncp.wiki/ncpbook/), a database of evidence-supported NCPs, which aims to provide a resource for efficient exploration, analysis, and manipulation of NCPs. NCPbook incorporates data from diverse public databases and scientific literature. The current version of NCPbook includes 180,676 NCPs across 29 different species, evidenced by mass spectrometry (MS), ribosome profiling (Ribo-seq), or molecular experiments (ME). These NCPs are distributed across kingdoms, comprising 123,408 from 14 plant species, 56,999 from seven animal species, and 269 from eight microbial species. Furthermore, NCPbook encompasses 9,166 functionally characterized NCPs playing important roles in immunity, stress resistance, growth, and development. Equipped with a user-friendly interface, NCPbook allows users to search, browse, visualize, and retrieve data, making it an indispensable platform for researching NCPs in various plant, animal, and microbial species.

Heavy metal sequestration from wastewater by metal-organic frameworks: a state-of-the-art review of recent progress.

Metal-organic frameworks (MOFs) have emerged as highly promising adsorbents for removing heavy metals from wastewater due to their tunable structures, high surface areas, and exceptional adsorption capacities. This review meticulously examines and summarizes recent advancements in producing and utilizing MOF-based adsorbents for sequestering heavy metal ions from water. It begins by outlining and contrasting commonly employed methods for synthesizing MOFs, such as solvothermal, microwave, electrochemical, ultrasonic, and mechanochemical. Rather than delving into the specifics of adsorption process parameters, the focus shifts to analyzing the adsorption capabilities and underlying mechanisms against critical metal(loid) ions like chromium, arsenic, lead, cadmium, and mercury under various environmental conditions. Additionally, this article discusses strategies to optimize MOF performance, scale-up production, and address environmental implications. The comprehensive review aims to enhance the understanding of MOF-based adsorption for heavy metal remediation and stimulate further research in this critical field. In brief, this review article presents a comprehensive overview of the contemporary information on MOFs as an effective adsorbent and the challenges being faced by these adsorbents for heavy metal mitigation (including stability, cost, environmental issues, and optimization), targeting to develop a vital reference for future MOF research.

Amine-Decorated Methacrylic Acid-based Inverse Vulcanized Polysulfide for Effective Mercury Removal from Wastewater.

Mercury [Hg(II)] contamination is an indefatigable global hazard that causes severe permanent damage to human health. Extensive research has been carried out to produce mercury adsorbents; however, they still face certain challenges, limiting their upscaling. Herein, we report the synthesis of a novel amine-impregnated inverse vulcanized copolymer for effective mercury removal. Poly(S-MA) was prepared using sulfur and methacrylic acid employing the inverse vulcanization method, followed by functionalization. The polyethylenimine (PEI) was impregnated on poly(S-MA) to increase the adsorption active sites. The adsorbent was then characterized byusing Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy (SEM). FTIR spectroscopy confirmed the formation of the copolymer, and successful impregnation of PEI and SEM revealed the composite porous morphology of the copolymer. Amine-impregnated copolymer [amine@poly(S-MA)] outperformed poly(S-MA) in mercury as it showed 20% superior performance with 44.7 mg/g of mercury adsorption capacity. The adsorption data best fit the pseudo-second-order, indicating that chemisorption is the most effective mechanism, in this case, indicating the involvement of NH2 in mercury removal. The adsorption is mainly a monolayer on a homogeneous surface as indicated by the 0.76 value of Redlich-Peterson exponent (g), which describes the adsorption nature advent from the R2 value of 0.99.

Readthrough events in plants reveal plasticity of stop codons.

Stop codon readthrough (SCR) has important biological implications but remains largely uncharacterized. Here, we identify 1,009 SCR events in plants using a proteogenomic strategy. Plant SCR candidates tend to have shorter transcript lengths and fewer exons and splice variants than non-SCR transcripts. Mass spectrometry evidence shows that stop codons involved in SCR events can be recoded as 20 standard amino acids, some of which are also supported by suppressor tRNA analysis. We also observe multiple functional signals in 34 maize extended proteins and characterize the structural and subcellular localization changes in the extended protein of basic transcription factor 3. Furthermore, the SCR events exhibit non-conserved signature, and the extensions likely undergo protein-coding selection. Overall, our study not only characterizes that SCR events are commonly present in plants but also identifies the recoding plasticity of stop codons, which provides important insights into the flexibility of genetic decoding.

Mapping and candidate gene analysis of clustered bud on the main inflorescence in Brassica napus L.

Breeding rapeseed varieties with more main inflorescence siliques is an idea for developing rapeseed varieties that are suitable for light and simplified cultivation. The Brassica napus exhibited cluster bud of the main inflorescence (Bnclib) gene. At the fruiting stage, the main inflorescence had more siliques, higher density, and more main inflorescences. Moreover, the top of the main inflorescence bifurcated. Genetic analysis showed that the separation ratio between Bnclib and the wild type in the F2 generation was 3:1, which indicated that the trait was a single-gene-dominant inheritance. Among the 24 candidate genes, only one gene, BnaA03g53930D, showed differential expression between the groups (False discovery rate, FDR ≤ 0.05, |log2FC|≤ 1). qPCR verification of the BnaA03g53930D gene between Huyou 17 and its Bnclib near-isogenic line showed that BnaA03g53930D was significantly differentially expressed in the stem tissue of Huyou 17 and its Bnclib near-isogenic line (Bnclib NIL). The determination of gibberellin (GA), brassinolide (BR), cytokinin (CTK), jasmonic acid (JA), growth hormone (IAA), and strigolactone (SL) content in the shoot apex of Huyou 17 by Bnclib NIL and wild type showed that all six hormones significantly differed between the Bnclib NIL and Huyou 17. It is necessary to conduct further research on the interactions between JA and the other five hormones and the main inflorescence bud clustering in B. napus.

Synthesis and performance evaluation of slow-release fertilizers produced from inverse vulcanized copolymers obtained from industrial waste.

To improve crop nutrient uptake efficacy (NUE) and better manage fertilization, slow-release fertilizers (SRFs) are developed by either coating the urea granules or making a composite. Several materials have already been developed, nevertheless, scalability of those materials is still a challenge due to their inherit drawbacks (such as hydrophilicity, crystallinity, non-biodegradability, etc.). Herein, we utilized a biodegradable, green and sustainable copolymer produced from industrial waste (sulfur-petroleum industry waste and myrcene-citrus industry waste) to coat the urea using a facile coating method to develop novel SRFs and achieve better agronomic and environmental advantages. The copolymer was first synthesized using a facile, solvent-free one-pot method called inverse vulcanization followed by Fourier transform infrared spectroscopy (FTIR) analysis to confirm the successful reaction between myrcene and sulfur subsequently coating the copolymer on urea granule. The morphology and coating thickness of coated fertilizers were analysed using scanning electron microscopy (SEM), followed by a nitrogen release test in distilled water and a soil burial test to confirm the biodegradability. The nitrogen release test revealed that the SRF with the maximum coating thickness of 1733 µm releases only 16% of its total nitrogen after 4 days of incubation compared to the pristine urea which releases all its nutrient within 1 day. The soil burial test confirms the biodegradability of the copolymer, as after 50 days of incubation in soil the copolymer loses almost 18.25% of its total weight indicating that the copolymer is degrading.

Echocardiography- versus intracardiac electrocardiogram-based optimization of cardiac resynchronization therapy: A systematic review.

OBJECTIVE: This systematic review aimed to evaluate the performance of echocardiography-based programming in comparison with the intracardiac electrocardiogram (IEGM)-based method for the optimization of cardiac resynchronization therapy (CRT). METHODS: A literature review was conducted using digital databases to systematically identify the studies reporting CRT optimization through echocardiography compared with IEGM. Detailed patient-level study characteristics including the type of study, sample size, therapy, the New York Heart Classification (NYHA) status, lead placement, and other parameters were abstracted. Finally, postprogramming outcomes were extracted for each article. RESULTS: In a total of 11 studies, 919 patients were recruited for the final analysis. Overall, 692 (75.29%) were males. The mean duration of the QRS complex in our study population ranged from 145.2 ± 21.8 ms to 183 ± 19.9 ms. There was an equal improvement in the NYHA class between the two methods while the left ventricular ejection fraction (LVEF) demonstrated an improvement by IEGM. Many studies supported IEGM to increase the 6-minute walk test and left ventricular outflow tract velocity time interval (LVOT VTI) when compared to echocardiography. The mean time for echocardiography-based optimization was 60.15 min while that of IEGM-based optimization was 6.65 min. CONCLUSION: IEGM is an alternative method for CRT optimization in improving the NYHA class, LVEF, and LVOT VTI, and is less time-consuming when compared to the echocardiography-based methods.

Association of Epicardial Fat Volume with Coronary Artery Ectasia and Coronary Artery Disease.

Epicardial fat may play an important role in the pathogenesis of coronary artery disease (CAD). We investigated the relationship between coronary artery ectasia (CAE) and epicardial fat volume (EFV). This retrospective study included 506 patients with CAE (group 1), 500 with CAD (group 2), and 500 patients with normal coronaries as controls (group 3). The pericardium was traced manually from the edge of the pulmonary trunk to the last measured by computed tomography slice containing images of the heart to obtain a region of interest. EFV was significantly higher in patients with CAD than in those with CAE (87.94 ± 22.18 vs 61.33 ± 12.75 mL; P < .001). Patients with normal coronaries had EFV of 56.62 ± 9.82 mL. Multivariate logistic regression analysis showed that male gender [Odds ratio (OR) (95% confidence interval (CI)): 1.220 (1.015-1.682), P = .042], diabetes [OR (95% CI): 1.036 (1.008-1.057); P = .002], and smoking [OR (95% CI): 3.043 (1.022-9.462); P = .005] were significantly associated with CAE. The receiver operating characteristic (ROC) curve showed that EFV had strongest diagnostic value for detecting CAD rather than CAE [AUC .502 P = .074 (95% CI: .311-.784)]. This study demonstrated that EFV is an independent predictor for CAE and CAD. However, sensitivity and specificity for detecting CAE is low when compared with CAD.

Tricuspid regurgitation in His bundle pacing: A systematic review.

OBJECTIVE: This systematic review aimed to explore an association of new TR and its quantification in patients undergoing His bundle pacing (HBP). METHODS: A literature review was conducted using Mesh terms (His bundle pacing, tricuspid regurgitation, tricuspid valve incompetence, etc.) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library till October 2021. Relevant studies evaluating tricuspid regurgitation in HBP were included and information regarding TR and its related factors (ejection fraction (EF) and New York Heart Association (NYHA) class) were retrieved from the eligible studies. RESULTS: Out of 196 articles, 10 studies met the inclusion criteria, which consisted of 546 patients with HBP. The mean age of the patients ranged between 61.2 ± 12.3 and 75.1 ± 7.9 years with 54.1% males. The overall implant success rate was 79.2%. Only one study reported a 5% incidence of TR, while 9 studies reported no new TR after HBP. Four studies reported overall decrease in TR by 1 grade and 3 studies demonstrated increased TR from baseline. Two studies showed no change from baseline TR. CONCLUSION: HBP causes improvement in TR grade after HBP for cardiac resynchronization therapy (CRT) as well as atrioventricular block (AVB). Further studies in the form of randomized controlled trials are required to further evaluate the effect of HBP on tricuspid valve functioning.

Effects of microscopic testa color and morphologyon the water uptake ability and drought tolerance of germination-stage rapeseed (Brassica napus L.).

Drought is one of the most important abiotic stressors that affect crop yield. Therefore, the aim of the present study was to investigate correlations between germination-stage drought tolerance and the microscopic testa (i.e., seed coat) characteristics (color and papilla morphology) and imbibition abilities of 35 rapeseed (Brassica napus L.) accessions. After 2 h imbibition, seed water uptake (fresh weight increase) was significantly positively correlated with testa hue (HHSB), brightness (BHSB,), blue (BRGB), and lightness (L*), with correlation coefficients of 0.38, 0.34, 0.53, and 0.36, respectively, and significantly negatively correlated with saturation (SHSB), greenness-redness (a*), blueness-yellowness (b*), magenta (M), and yellow components (Y), with correlation coefficients of -0.53, -0.40, -0.53, -0.39, and -0.55, respectively. Furthermore, 5-h seed water uptake was significantly positively correlated with number of papillae (No.P), mean papillae area (APA), the papillae area ratio (PAR), gray value of red channel of papillae, with correlation coefficients of 33, 0.36, 0.43, and 0.43, respectively. Under drought conditions, genotypes with more rapid water absorption exhibited higher germination rates and stronger drought tolerance, and the germination rate and drought tolerance of black-seeded accessions were highest, followed by red-seeded accessions and then yellow-seeded accessions, which exhibited the lowest germination rate and drought tolerance. Germination rate was significantly negatively correlated with BRGB, HHSB, L*, Dg, and Db and significantly positively correlated with SHSB and Y, regardless of drought conditions. At the germination stage, DbTP was negatively correlated with drought tolerance.

CRISPR-Cas9-based genetic engineering for crop improvement under drought stress.

In several parts of the world, the prevalence and severity of drought are predicted to increase, creating considerable pressure on global agricultural yield. Among all abiotic stresses, drought is anticipated to produce the most substantial impact on soil biota and plants, along with complex environmental impacts on other ecological systems. Being sessile, plants tend to be the least resilient to drought-induced osmotic stress, which reduces nutrient accessibility due to soil heterogeneity and limits nutrient access to the root system. Drought tolerance is a complex quantitative trait regulated by multiple genes, and it is one of the most challenging characteristics to study and classify. Fortunately, the clustered regularly interspaced short palindromic repeat (CRISPR) technology has paved the way as a new frontier in crop improvement, thereby revolutionizing plant breeding. The application of CRISPER systems has proven groundbreaking across numerous biological fields, particularly in biomedicine and agriculture. The present review highlights the principle and optimization of CRISPR systems and their implementation for crop improvement, particularly in terms of drought tolerance, yield, and domestication. Furthermore, we address the ways in which innovative genome editing tools can help recognize and modify novel genes coffering drought tolerance. We anticipate the establishment of effective strategies of crop yield improvement in water-limited regions through collaborative efforts in the near future.

Effects of seed priming treatments on the germination and development of two rapeseed (Brassica napus L.) varieties under the co-influence of low temperature and drought.

The present study was performed to evaluate the effects of seed priming. This was done by soaking the seeds of two rapeseed cultivars, namely, ZY15 (tolerant to low temperature and drought) and HY49 (sensitive to low temperature and drought), for 12 h in varying solutions: distilled water, 138 mg/L salicylic acid (SA), 300 mg/L gibberellic acid (GA), 89.4 mg/L sodium nitroprusside (SNP), 3000 mg/L calcium chloride (CaCl2), and 30 mg/L abscisic acid (ABA). Primed and non-primed seeds were left to germinate at 15°C and -0.15 MPa (T15W15) and at 25°C and 0 MPa (T25W0), respectively. The results showed that SA, GA, SNP, CaCl2, and ABA significantly improved the germination potential (GP), germination rate (GR), germination index (GI), stem fresh weight (SFW), stem dry weight (SDW), root length (RL), stem length (SL), and seed vigor index (SVI) under T15W15. For ZY15 seeds under T25W0, GA, SNP, CaCl2, and ABA priming reduced the average germination time (96% after 5 days) compared to that of the control (88% after 5 days). For ZY15 seeds under T15W15, SA, SNP, CaCl2, and ABA priming, with respect to the control and water-treated groups, shortened the average germination time (92% after 5 days) compared to that of the control (80% after 5 days). For HY49 seeds under T25W0, GA, SNP, CaCl2, and ABA priming reduced the average germination time (92% after 5 days) compared to that of the control (85% after 5 days). Similarly, for HY49 seeds under T15W15, GA priming shortened the average germination time (89% after 5 days) compared to that of the control (83% after 5 days). These priming agents increased the net photosynthesis, stomatal conductivity, and transpiration rate of rape seedlings under conditions of low temperature and drought stress, while also decreasing intercellular carbon dioxide (CO2) concentrations. Additionally, SA, GA, SNP, CaCl2, and ABA increased superoxide dismutase concentrations (SOD) and ascorbic peroxidase (APX) activities of rape seedlings under stress conditions, while decreasing catalase (CAT) and peroxidase (POD) activities in ZY15 seedlings. In HY49, which is sensitive to low temperature and drought, all priming solutions, except for SNP, led to an increase in SOD activity levels and a decrease in CAT activity levels. Overall, SA, GA, SNP, and CaCl2 increased the concentrations of indoleacetic acid (IAA), GA, ABA, and cytokinin (CTK) in seedlings under stress conditions. Moreover, compared to SA, CaCl2, and ABA, GA (300 mg/L) and SNP (300 mol/L) showed improved priming effects for ZY15 and HY49 under stress conditions.

Genetic Risk of Autism Spectrum Disorder in a Pakistani Population.

Autism spectrum disorder (ASD) is a group of complex multifactorial neurodevelopmental and neuropsychiatric disorders in children characterized by impairment of communication and social interaction. Several genes with associated single nucleotide polymorphisms (SNPs) have been identified for ASD in different genetic association studies, meta-analyses, and genome-wide association studies (GWAS). However, associations between different SNPs and ASD vary from population to population. Four SNPs in genes CNTNAP2, EIF4E, ATP2B2, CACNA1C, and SNP rs4307059 (which is found between CDH9 and CDH10 genes) have been identified and reported as candidate risk factors for ASD. The aim of the present study was, for the first time, to assess the association of SNPs in these genes with ASD in the Pakistani population. PCR-based genotyping was performed using allele-specific primers in 93 ASD and 93 control Pakistani individuals. All genetic associations, genotype frequencies, and allele frequencies were computed as odds' ratios (ORs) using logistic regression with a threshold of p ≤ 0.01 to determine statistical significance. We found that the homozygous genotypes of mutant T alleles of CNTNAP2 and ATP2B2 were significantly associated with Pakistani ASD patients in unadjusted ORs (p < 0.01), but their significance score was lost in the adjusted model. Other SNPs such as rs4307059, rs17850950 of EIF4E, and rs1006737 of CACNA1C were not statistically significant. Based on this, we conclude that SNPs are not associated with, or are not the main cause of, autism in the Pakistani population, indicating the involvement of additional players, which need to be investigated in future studies in a large population size. One of the limitations of present study is its small sample size. However, this study, being the first on Pakistani ASD patients, may lay the foundations for future studies in larger samples.

Calcium based siRNA coating: a novel approach for knockdown of HER2 gene in MCF-7 cells using gold nanoparticles.

Surface functionalization of nanoparticles (NPs) for therapeutic siRNA delivery into cancer cells has gained interest. The present study was designed for surface functionalization of gold nanoparticles (AuNPs) for efficient siRNA delivery and knockdown in cancer cells. In order to achieve this objective, AuNPs were coated with HER2-siRNA in the presence of 11-mercaptoundecanoic acid (11-MUA), calcium chloride (CaCl2) and polyethyleneimine (PEI) in alternate charge bearing successive layers. MCF-7 cells were cultured and transfected with fabricated assembly of AuNPs. Cytotoxicity analysis revealed that the half inhibitory concentration (IC50) for the formulation was 45.35 nM  . Total RNA was isolated from transfected cells, reverse transcribed into complementary DNA (cDNA) and real-time polymerase chain reaction (RT-PCR) was performed. The RT-PCR based delta-delta Ct analysis in treated cells revealed a significant 18.94 times decrease (p<0.001) in the expression of HER2 gene standardized with ACTB housekeeping gene as compared to untreated cells, which makes this formulation a potent approach for siRNA delivery and  gene knockout.

The Effect of Enhanced External Counterpulsation (EECP) on Quality of life in Patient with Coronary Artery Disease not Amenable to PCI or CABG.

Enhanced External Counterpulsation (EECP) is a non-invasive FDA approved therapy for patients with refractory angina pectoris. The EECP mechanism of action is similar to that of an intra-aortic balloon pump (IABP) by administering a vigorous pressure pulse via external blood pressure cuffs during the diastole. The benefit of EECP includes improvement in angina severity, angina stability, maximal walking capacity and generalized improvement in overall health. Seatle Angina Questionnaire (SAQ) is a valid, reliable and sensitive measure of health-related quality of life. It is also a sensitive and reproducible evaluation tool to measure the response to an intervention. We did a pre-test post-test designed prospective study to evaluate the effect of EECP on the quality of life in patients with CAD. There was a significant difference between SAQ-7 health-related quality of life between the pre-EECP and post-EECP groups (P value= <0.01). Moreover, a positive correlation was reported between the New York Heart Association (NYHA) Functional Classification before treatment and post-EECP SAQ-7 health-related quality of life (P value=0.015).

Formulation and evaluation of antioxidant and antityrosinase activity of Polygonum amplexicaule herbal gel.

Medicinal plants are long been used for pharmaceutical and cosmetic industry. Among medicinal plants, Polygonum amplexicaule of family polygonaceae has traditional use in medicines and skin care. P. amplexicaule belongs to genus Polygonum that contains several important phytochemicals and considered as a rich source of antioxidants. The present study was designed to formulate herbal gel containing P. amplexicaule extract and evaluate its different physical properties as well as antioxidants and antityrosinase activities. Chitosan gel base was used as gelling agent and different gel formulations were prepared by different concentrations of extracts and polymers. Physical properties like pH, colour, odour, appearance and homogeneity, spreadability, extrudability and stability were optimized and analysed. A stable gel formulation containing 1% chitosan gel base and 5% plant extract was prepared that showed good appearance and homogeneity, easily spread ability and excellent extrudability. This gel formulation was tested for antioxidant and skin whitening properties by DPPH free radical scavenging assay and tyrosinase inhibition assay respectively and ascorbic acid was used as reference standard. DPPH scavenging activity with an IC50 value of 0.446 mg/mL and tyrosinase inhibition activity with an IC50 value of 0.805 mg/mL was observed and results indicated that this herbal gel formulation has a good potential for cosmetic use.

Alleviating dormancy in Brassica oleracea seeds using NO and KAR1 with ethylene biosynthetic pathway, ROS and antioxidant enzymes modifications.

BACKGROUND: Seed dormancy is a prevailing condition in which seeds are unable to germinate, even under favorable environmental conditions. Harvested Brassica oleracea (Chinese cabbage) seeds are dormant and normally germinate (poorly) at 21 °C. This study investigated the connections between ethylene, nitric oxide (NO), and karrikin 1 (KAR1) in the dormancy release of secondary dormant Brassica oleracea seeds. RESULTS: NO and KAR1 were found to induce seed germination, and stimulated the production of ethylene and 1-aminocyclopropane-1-carboxylic acid (ACC), and both ethylene biosynthesis enzyme ACC oxidase (ACO) [1] and ACC synthase (ACS) [2]. In the presence of NO and KAR1, ACS and ACO activity reached maximum levels after 36 and 48 h, respectively. The inhibitor of ethylene 2,5-norbornadiene (NBD) had an adverse effect on Brassica oleracea seed germination (inhibiting nearly 50% of germination) in the presence of NO and KAR1. The benefits from NO and KAR1 in the germination of secondary dormant Brassica oleracea seeds were also associated with a marked increase in reactive oxygen species (ROS) (H2O2 and O2˙-) and antioxidant enzyme activity at early germination stages. Catalase (CAT) and glutathione reductase (GR) activity increased 2 d and 4 d, respectively, after treatment, while no significant changes were observed in superoxide dismutase (SOD) activity under NO and KAR1 applications. An increase in H2O2 and O2˙- levels were observed during the entire incubation period, which increasing ethylene production in the presence of NO and KAR1. Abscisic acid (ABA) contents decreased and glutathione reductase (GA) contents increased in the presence of NO and KAR1. Gene expression studies were carried out with seven ethylene biosynthesis ACC synthases (ACS) genes, two ethylene receptors (ETR) genes and one ACO gene. Our results provide more evidence for the involvement of ethylene in inducing seed germination in the presence of NO and KAR1. Three out of seven ethylene biosynthesis genes (BOACS7, BOACS9 and BOACS11), two ethylene receptors (BOETR1 and BOETR2) and one ACO gene (BOACO1) were up-regulated in the presence of NO and KAR1. CONCLUSION: Consequently, ACS activity, ACO activity and the expression of different ethylene related genes increased, modified the ROS level, antioxidant enzyme activity, and ethylene biosynthesis pathway and successfully removed (nearly 98%) of the seed dormancy of secondary dormant Brassica olereace seeds after 7 days of NO and KAR1 application.

Boerhaave's Syndrome: Delayed Management Using Over-the-Scope Clip.

BACKGROUND The diagnosis of Boerhaave's syndrome is often missed or delayed. This subsequently leads to a high mortality rate, which could be greatly reduced if treatment is instituted early, within 24 hours of perforation. Treatment ranges from conservative management to operative intervention depending on the time of presentation and the patient's clinical condition. Endoscopic intervention in the form of over-the-scope clip (OTSC) application is gaining popularity with very promising results. CASE REPORT A 43-year-old male was diagnosed with Boerhaave's syndrome and treated initially by insertion of bilateral chest drainage, intravenous broad-spectrum antibiotics, and total parenteral nutrition. He was transferred to our facility 9 days later. Upper gastrointestinal endoscopy revealed a 1.5 cm deep longitudinal ulcer involving the distal esophagus and extending to the Z-line. Due to the perforation site, a size 12 OTSC clip was used. Application of a second clip was needed to achieve complete closure of the perforation site. Contrast swallow was done 4 days later showed no leak. The patient was started on oral intake and was discharged home in good general condition after a hospital stay of 16 days. CONCLUSIONS Delayed presentation of Boerhaave's syndrome can be treated safely by an over-the-scope clip. This endoscopic method hastens recovery and shortens the hospital stay.