Electrophoretic Deposition of 58S Bioactive Glass- Polymer Composite Coatings on 316L Stainless Steel: An Optimization for Corrosion, Bioactivity, and Cytocompatibility.

This study presents a facile fabrication of 58S bioactive glass (BG)-polymer composite coatings on a 316L stainless steel (SS) substrate using the electrophoretic deposition technique. The suspension characteristics and deposition kinetics of BG, along with three different polymers, namely ethylcellulose (EC), poly(acrylic acid) (PAA), and polyvinylpyrrolidone (PVP), have been utilized to fabricate the coatings. Among all coatings, 58S BG and EC polymers are selected as the final composite coating (EC6) owing to their homogeneity and good adhesion. EC6 coating exhibits a thickness of ∼18 µm and an average roughness of ∼2.5 µm. Herein, EC6 demonstrates better hydroxyapatite formation compared to PAA and PVP coatings in simulated body fluid-based mineralization studies for a period of 28 days. Corrosion studies of EC6 in phosphate-buffered saline further confirm the higher corrosion resistance properties after 14 days. In vitro cytocompatibility studies using human placental mesenchymal stem cells demonstrate an increase in cellular viability, attachment, and higher proliferation compared to the bare SS substrate. EC6 coatings promote osteogenic differentiation, which is confirmed via the upregulation of the OPN and OCN genes. Moreover, the EC6 sample exhibits improved antibacterial properties against Escherichia coli and Staphylococcus aureus compared to the uncoated ones. The findings of this work emphasize the potential of electrophoretically fabricated BG-EC composite coatings on SS substrates for orthopedic applications.

An Interesting Case of Balloon-Assisted Deployment of a Dislodged Coronary Stent.

We report a first and interesting case of balloon-assisted deployment of a dislodged coronary stent. While performing a calcified left circumflex coronary artery (LCX) intervention, the drug-eluting coronary stent was dislodged in the osteoproximal segment of the calcified and tortuous LCX. The dislodged stent was rewired, progressively dilated with multiple balloons and, finally, a larger, balloon-mounted stent was pushed forward, positioned across the coronary lesion and deployed, resulting in distal thrombolysis in myocardial infarction (TIMI) III flow with good angiographic results. Rewiring the dislodged stent with subsequent balloon-assisted deployment in the lesion can be a solution for a dislodged coronary stent in the proximal vessel.

The Closure of Grade 1 Coronary Perforation by the Snowplow Phenomenon.

We report an extremely rare case of spontaneous closure of grade 1 coronary perforation by the snowplow phenomenon during the revascularization of a subtotal occlusion in the left anterior descending coronary artery. Coronary artery perforation is usually a nightmare during coronary intervention in the cardiac catheterization laboratory. While large coronary perforation requires the deployment of a covered stent, small perforations require heparin reversal, prolonged balloon inflation, deployment of small coils, or gel foam closure. The coronary segment with a small perforation was stented with a drug-eluting stent (DES), which might have resulted in the shifting of the fatty plaque toward the perforation and subsequently sealing the coronary perforation.

Unveiling a Rare Side Effect: A Report of a Unique Case of Second-Degree Type 2 Sinoatrial Node Exit Block Induced by Adenosine Infusion.

Adenosine is a widely used pharmacologic agent in the field of cardiology, predominantly for the termination of supraventricular tachycardias and diagnostic purposes. Most of the side effects are short-lasting due to its very short half-life. Fatal complications of adenosine are rare but can include ventricular fibrillation, ventricular tachycardia, and asystole. Proper medical supervision and monitoring are crucial to minimize risks. We report a unique case of a second-degree type 2 sinoatrial node exit block following intravenous adenosine administration in a 25-year-old male presenting with palpitations.

Polymorphic Ventricular Tachycardia in Acute Cervical Spinal Cord Injury: A Rare Occurrence in the Setting of Normal QTc.

Cardiovascular manifestations like bradycardia, hypotension, fluctuation of blood pressure, and supraventricular arrhythmia are common in acute spinal cervical injury above the C6 level and are the major cause of mortality and morbidity in them. Ventricular tachycardia (VT) and fibrillation have only been reported in a few cases, but polymorphic VT (PMVT) has not been reported. We report a very rare case of acute cervical spinal cord injury patient who developed PMVT in the setting of normal QT interval degenerating to ventricular fibrillation, causing cardiac arrest before surgery.

A Rare Case of Radial Arteriovenous Fistula (AVF) Post-Transradial Percutaneous Coronary Intervention.

We report a rare case of radial arteriovenous fistula in a middle-aged person after a successful transradial percutaneous coronary intervention. Early release of manual radial compression was the culprit behind the development of radial arteriovenous fistula. Early surgical repair of the radial arteriovenous fistula resulted in the complete resolution of distal forearm symptoms in the abovementioned patient. It is advised for young interventional cardiologists to apply a compressive bandage over the radial artery for a minimum period of one hour to get rid of this extremely rare complication.

An Unusual Case of Right Anterior Descending Coronary Artery.

The left anterior descending coronary artery (LAD) arises from the left coronary sinus about 10-12 mm above the annular plane and traverses down the interventricular groove. With deep septal and diagonal branches, it supplies the left side of the heart. Here, we describe an extremely rare case of anomalous origin of the LAD from the right coronary artery, which courses epicardially over the right side of the heart with its ramifying branches, which can be described as the "right anterior descending coronary artery (RAD)."

Supracardiac Total Anomalous Pulmonary Venous Connection in Adolescence.

Background Supracardiac total anomalous pulmonary communication (TAPVC) constitutes a rare congenital cardiac anomaly. Most babies with supracardiac TAPVC are diagnosed in infancy and undergo complete surgical repair during infancy. Delayed presentation of supracardiac TAPVC is rare, and the surgical outcomes are not well known. This retrospective study was conducted to determine the presentation and surgical outcome of supracardiac TAPVC among adolescents, which constitutes an extremely rare subgroup of TAPVC. Methodology This retrospective analysis was conducted among 15 adolescent patients with supracardiac TAPVC who underwent surgical repair in the cardiothoracic surgery department of a tertiary care center in India. This study aimed to assess the intraoperative, postoperative, immediate, early, and late outcomes of adolescent patients with supracardiac TAPVC who had undergone surgical repair between 2010 and 2014 in a tertiary care center in India. Results The study included 15 patients with a diagnosis of isolated supracardiac TAPVC. A mild degree of cyanosis was present in eight patients, recurrent episodes of lower respiratory tract infections were present in five patients, and dyspnea (New York Heart Association I/II) was noted in 12 patients. Mean oxygen saturation was 92% (range = 85-93%), and mean pulmonary artery pressure was 24 mmHg (range = 15-50 mmHg). After median stenotomy, a wide anastomosis was made between the common pulmonary venous chamber and the posterior wall of the left atrium. A fenestration was made in the Dacron patch in three patients who had raised pulmonary vascular resistance (PVR) preoperatively. Twelve patients were weaned off cardiopulmonary bypass (CPB) with minimal inotropic support. Three patients who had high preoperative PVR had difficulty in weaning from CPB. The mean CPB and cross-clamp time was 75 ± 12 minutes and 58 ± 9 minutes, respectively. Atrial fibrillation was noted in five (33.3%) patients in the early postoperative period, and three (20%) patients had pulmonary artery hypertensive crises postoperatively. There was no superficial or deep sternal wound infection in the postoperative period. Mild and moderate right ventricular dysfunction was present in four (26.67%) and two (13.3%) patients, respectively, in the postoperative period. On two-dimensional echocardiography during follow-up at the end of one year, there was no gradient across the anastomosis, and pulmonary artery pressure was normal in all patients. Conclusions Surgical repair of supracardiac TAPVC in adolescence has an excellent outcome. Survival of patients with supracardiac TAPVC until adolescence depends on the presence of a dilated vertical vein and a large atrial septal defect facilitating unobstructed pulmonary venous flow. The aim of the surgical repair should be to create a wide anastomosis between the left atrium and the pulmonary venous chamber which should be bigger than the size of the mitral valve orifice indexed to the body surface area as it would amount to no or negligible anastomotic gradient postoperatively.

U-shaped and L-shaped Left Main Coronary Artery: Rare Congenital Anomalies.

Congenital anomalies in the shape of the coronary arteries are extremely uncommon to encounter in routine clinical practice in interventional cardiology. In this study, we describe two uncommon shape anomalies of the left main coronary artery, that is, U-shaped left main coronary artery and L-shaped left main coronary artery. These anomalies were observed in two consecutive patients who presented with atypical chest pain and exertional shortness of breath. These uncommon shape anomalies of the left main coronary artery hold their clinical significance during intervention as those require robust guide catheter support during the difficult passage of the routine coronary hardwires.

The Rescuing Role of Aggressive Thrombosuction in Elective Coronary Angioplasty.

Thrombosuction plays a controversial role during primary percutaneous intervention (PCI). Landmark trials have demonstrated no additional role of thrombosuction during primary percutaneous intervention towards improving mortality and outcome during primary percutaneous intervention. We describe a rare elective coronary angioplasty where only aggressive thrombosuction (almost 150-200 mL) of blood from the coronary artery established the antegrade coronary flow and saved an octogenarian from impending sudden cardiac death (SCD). The present case describes the promising role of aggressive thrombosuction even during elective coronary intervention when a large dissection ends in acute total thrombotic occlusion of a coronary artery jeopardizing the antegrade coronary perfusion.

Exercise-Induced Ventricular Tachycardia: A Case Report.

Exercise-induced ventricular tachycardia (EIVT) is a very rare condition that can occur in both structurally normal and abnormal hearts. It is important to recognize and understand the triggers, symptoms, and implications of this condition. In this report, we present a case of a young patient who experienced symptoms of palpitation, presyncope, and syncope during exertion. We also review the pathophysiology, clinical presentation, diagnosis, and management of exercise-induced ventricular arrhythmia. This information is particularly important in the context of sports medicine and cardiovascular health.

A Case of Bradycardia-Induced Torsades De Pointes in a Patient Presenting to the Emergency Room With Cardiac Arrest.

Torsades de pointes (TdP) is a less common type of ventricular tachycardia (VT) characterized by polymorphic VT of changing amplitude and characteristic twists around the isoelectric baseline. It is almost always associated with QT interval prolongation. Unless immediately intervened, it can lead to ventricular fibrillation followed by cardiac arrest. We report a case of a patient with bradycardia-induced TdP who presented to the emergency room with cardiac arrest.

An Unusual Case of Long-Segment Dissection of the Left Anterior Descending Coronary Artery During Osteoproximal Chronic Total Occlusion Intervention.

Coronary artery dissection can occur after post-balloon inflation; however, a very long-segment coronary dissection (>50 mm) is a rare occurrence during routine coronary interventions. Here, we report an extremely rare case of long-segment coronary dissection in the left anterior descending coronary artery (LAD) induced during antegrade revascularization of chronic total occlusion of osteoproximal LAD with stiffer Gaia II wire. The patient had excruciating angina with hemodynamic collapse and acute pulmonary edema; the patient was rescued with long-segment coronary revascularization.

Primary Percutaneous Coronary Intervention of Acute Thrombotic Occlusion of a Low-Lying Tortuous Right Coronary Artery With a Multipurpose Catheter in an Octogenarian.

Right coronary artery intervention is usually accomplished with a Judkins right (JR) coronary guide catheter. Abnormal right coronary artery take-off from the right coronary sinus poses difficulty in engaging the right coronary artery with a conventional JR guide catheter. We report a rare case of primary percutaneous intervention of the right coronary artery which was performed with a multipurpose catheter as the patient had an extremely low-lying coronary artery from the coronary sinus where conventional catheters could not engage the right coronary artery in an octogenarian with acute inferior wall ST-elevation myocardial infarction in cardiogenic shock.

Recent advances in methanol production from methanotrophs.

Methanol, the simplest aliphatic molecule of the alcohol family, finds diverse range of applications as an industrial solvent, a precursor for producing other chemicals (e.g., dimethyl ether, acetic acid and formaldehyde), and a potential fuel. There are conventional chemical routes for methanol production such as, steam reforming of natural gas to form syngas, followed by catalytic conversion into methanol; direct catalytic oxidation of methane, or hydrogenation of carbon dioxide. However, these chemical routes are limited by the requirement for expensive catalysts and extreme process conditions, and plausible environmental implications. Alternatively, methanotrophic microorganisms are being explored as biological alternative for methanol production, under milder process conditions, bypassing the requirement for chemical catalysts, and without imposing any adverse environmental impact. Methanotrophs possess inherent metabolic pathways for methanol production via biological methane oxidation or carbon dioxide reduction, thus offering a surplus advantage pertaining to the sequestration of two major greenhouse gases. This review sheds light on the recent advances in methanotrophic methanol production including metabolic pathways, feedstocks, metabolic engineering, and bioprocess engineering approaches. Furthermore, various reactor configurations are discussed in view of the challenges associated with solubility and mass transfer limitations in methanotrophic gas fermentation systems.

A Single Coronary Artery From the Left Coronary Sinus: The Continuing Conundrum.

It is extremely rare to come across a single coronary artery during routine interventional cardiology practice. The incidence of single coronary arteries increases across congenital heart diseases. We report an extremely rare case of a single coronary artery arising from the left coronary sinus in an octogenarian presenting with anterior wall non-ST elevated myocardial infarction (NSTEMI) secondary to atherosclerotic occlusion of the proximal left main coronary artery (LMCA). It is often difficult to selectively engage a single coronary artery due to anomalous origin from the sinus; nonselective coronary sinus injection often suffices in visualizing the single coronary trunk dividing into left and right coronary arteries besides demonstrating the associated route and atherosclerotic anomalies.

A Ball Valve Thrombus in a Young Obese Male With Hyperlipidemia.

A ball valve thrombus is a common entity in rheumatic mitral stenosis where a large clot forms in the left atrial appendage, the clot detaches from the left atrial appendage, swirls in the left atrium in a clockwise manner, obstructs the mitral inflow producing cyclic acute pulmonary edema, and likely causes left ventricular outflow tract obstruction producing transient syncope or embolism to the brain producing dense hemiplegia. Besides rheumatic mitral stenosis, ball valve thrombus has been described in post-mitral valve replacement patients and restrictive cardiomyopathy. Left atrial myxoma sometimes rocks across the mitral valve producing the effect of a ball valve thrombus. Right atrial ball valve thrombus has been described after prolonged parenteral nutrition through a central line in intensive care units and in carcinoma patients with cardiac metastasis. We report an extremely rare case of a ball valve thrombus in an obese individual where dyslipidemia was the sole triggering factor for the formation of a ball valve thrombus in the left atrium.

Cracking the Left Main Coronary Artery Nodular Calcium With a Scoring Balloon.

Nodular calcium in the coronary artery poses a great challenge during coronary intervention. Although rotational atherectomy is the preferred modality of treatment of nodular calcium, we treated the left main coronary artery (LMCA) nodular calcium with a scoring balloon during primary angioplasty of an octogenarian with anterior wall myocardial infarction and EKG suggestive of LMCA occlusion. During primary coronary angioplasty, the scoring balloon alone also sometimes suffices in achieving good angiographic results and thrombolysis in myocardial infarction grade III (TIMI III) flow.

On the absence of collective motion in a bulk suspension of spontaneously rotating dielectric particles.

A suspension of dielectric particles rotating spontaneously when subjected to a DC electric field in two dimensions next to a no-slip electrode has proven to be an ideal model for active matter [Bricard et al., Nature, 2013, 503, 95-98]. In this system, an electrohydrodynamic (EHD) instability called Quincke rotation was exploited to create self-propelling particles which aligned with each other due to EHD interactions, giving rise to collective motion on large length scales. It is natural to question whether a suspension of such particles in three dimensions will also display collective motion and spontaneously flow like bacterial suspensions do. Using molecular dynamics type simulations, we show that dielectrophoretic forces responsible for chaining in the direction of the applied electric field in conventional electrorheological fluids and the counter-rotation of neighboring particles in these chains prevent collective motion in suspensions undergoing spontaneous particle rotations. Our simulations discover that the fundamental microstructural unit of a suspension under Quincke rotation is a pair of counter-rotating spheres aligned in the direction of the electric field. We perform a linear stability analysis that explains this observation.

Ni6Se5, an unexplored transition metal chalcogenide of formula M(n+1)Xn(2 ≤n≤ 8), for high-performance hybrid supercapacitor and Li-ion battery application.

This work reports anin situ, one-step hydrothermal preparation procedure of a binder-free electrode growth of Ni6Se5on nickel foam (Ni6Se5/NF) with a rod-like structure. Ni6Se5is an enveloped transition metal chalcogenides of formula M(n+1)Xn(where 2 ≤n≤ 8, M is a transition metal and X is chalcogen) of the nickel selenide family. The Ni6Se5/NF electrode described here demonstrates an exceptional lifetime of 81% capacitance retention over 20000 cycles and a high specific capacitance of 473.5 Fg-1at a current density of 4 Ag-1. The Ni6Se5/NF/activated carbon asymmetric supercapacitor (SC) exhibits a remarkable 97.3 Whkg-1energy density and a 2325 Wkg-1power density. Ni6Se5served as an active electrode material in SC applications and offered exceptional power density and long cycle life. Ni6Se5/NF, used as an anode for Li-ion batteries, has a lithium storage capacity of 939.7 mAhg-1at 100 mAg-1current density. Ni6Se5's (active electrode material) excellent energy storage capability, which was previously unreported, is particularly beneficial for electrochemical energy storage device applications.