In Vitro Biofilm-Mediated Biodegradation of Pesticides and Dye-Contaminated Effluents Using Bacterial Biofilms.

Overuse of pesticides in agricultural soil and dye-polluted effluents severely contaminates the environment and is toxic to animals and humans making their removal from the environment essential. The present study aimed to assess the biodegradation of pesticides (cypermethrin (CYP) and imidacloprid (IMI)), and dyes (malachite green (MG) and Congo red (CR)) using biofilms of bacteria isolated from pesticide-contaminated soil and dye effluents. Biofilms of indigenous bacteria, i.e., Bacillus thuringiensis 2A (OP554568), Enterobacter hormaechei 4A (OP723332), Bacillus sp. 5A (OP586601), and Bacillus cereus 6B (OP586602) individually and in mixed culture were tested against CYP and IMI. Biofilms of indigenous bacteria i.e., Lysinibacillus sphaericus AF1 (OP589134), Bacillus sp. CF3 (OP589135) and Bacillus sp. DF4 (OP589136) individually and in mixed culture were tested for their ability to degrade dyes. The biofilm of a mixed culture of B. thuringiensis + Bacillus sp. (P7) showed 46.2% degradation of CYP compared to the biofilm of a mixed culture of B. thuringiensis + E. hormaechei + Bacillus sp. + B. cereus (P11), which showed significantly high degradation (70.0%) of IMI. Regarding dye biodegradation, a mixed culture biofilm of Bacillus sp. + Bacillus sp. (D6) showed 86.76% degradation of MG, which was significantly high compared to a mixed culture biofilm of L. sphaericus + Bacillus sp. (D4) that degraded only 30.78% of CR. UV-VIS spectroscopy revealed major peaks at 224 nm, 263 nm, 581 nm and 436 nm for CYP, IMI, MG and CR, respectively, which completely disappeared after treatment with bacterial biofilms. Fourier transform infrared (FTIR) analysis showed the appearance of new peaks in degraded metabolites and disappearance of a peak in the control spectrum after biofilm treatment. Thin layer chromatography (TLC) analysis also confirmed the degradation of CYP, IMI, MG and CR into several metabolites compared to the control. The present study demonstrates the biodegradation potential of biofilm-forming bacteria isolated from pesticide-polluted soil and dye effluents against pesticides and dyes. This is the first report demonstrating biofilm-mediated bio-degradation of CYP, IMI, MG and CR utilizing soil and effluent bacterial flora from Multan and Sheikhupura, Punjab, Pakistan.

Machine learning assisted and smartphone integrated homogeneous electrochemiluminescence biosensor platform for sample to answer detection of various human metabolites.

The sensitive and accurate detection of glucose and lactate is essential for early diagnosis and effective management of diabetes complications. Herein, a 3D Printed ECL imaging system integrated with a Smartphone has been demonstrated to advance the traditional ECL to make a portable, affordable, and turnkey point-of-care solution to detect various human metabolites. A universal cross-platform application was introduced for analyzing ECL emitted signals to automate the whole detection process for real-time monitoring and rapid diagnostics. The developed ECL system was successfully applied and validated for detecting glucose and lactate using a single-electrode ECL biosensing platform. For glucose and lactate detection, the device showed a linear range from 0.1 mM to 1 mM and 0.1 mM-4 mM with a detection limit (LoD) of 0.04 mM and 0.1 mM, and a quantification limit (LoQ) of 0.142 mM and 0.342 mM, respectively. The developed method was evaluated for device stability, accuracy, interference, and real sample analysis. Furthermore, to assist in selecting the accurate and economic ECL sensing platform, SE-ECL devices fabricated via different fabrication approaches such as Laser-Induced Graphene, Screen Printing, and 3D Printing are studied for the conductivity of electrode and its significance on ECL signal. It was observed that emitted ECL signal is independent of the electrical conductivity for the same concentration of analytes. The findings suggested that the developed miniaturized point-of-care ECL platform would be a comprehensive and integrated solution for detecting other human metabolites and have the potential to be used in clinical applications.

A protocol to execute a lab-on-chip platform for simultaneous culture and electrochemical detection of bacteria.

Here, we present a protocol for a miniaturized microfluidic device that enables quantitative tracking of bacterial growth. We describe steps for fabricating a screen-printed electrode, a laser-induced graphene heater, and a microfluidic device with its integrations. We then detail the electrochemical detection of bacteria using a microfluidic fuel cell. The laser-induced graphene heater provides the temperature for the bacterial culture, and metabolic activity is recognized using a bacterial fuel cell. Please see Srikanth et al.1 for comprehensive information on the application and execution of this protocol.

Microfluidic Device Integrated With PDMS Microchannel and Unmodified ITO Glass Electrodes for Highly Sensitive, Specific, and Point-of-Care Detection of Copper and Mercury.

This work delves upon developing a two-layer plasma-bonded microfluidic device with a microchannel layer and electrodes for electroanalytical detection of heavy metal ions. The three-electrode system was realized on an ITO-glass slide by suitably etching the ITO layer with the help of CO2 laser. The microchannel layer was fabricated using a PDMS soft-lithography method wherein the mold created by maskless lithography. The optimized dimensions opted to develop a microfluidic device with length of 20 mm, width of 0.5 mm and gap of 1 mm. The device, with bare unmodified ITO electrodes, was tested to detect Cu and Hg by a portable potentiostat connected with a smartphone. The analytes were introduced in the microfluidic device with a peristaltic pump at an optimal flow rate of [Formula: see text]/min. The device exhibited sensitive electro-catalytic sensing of both the metals by achieving an oxidation peak at -0.4 V and 0.1 V for Cu and Hg respectively. Furthermore, square wave voltammetry (SWV) approach was used to analyze the scan rate effect and concentration effect. The device also used to simultaneously detect both the analytes. During simultaneous sensing of Hg and Cu, the linear range was observed between [Formula: see text] to [Formula: see text], the limit of detection (LOD) was found to be [Formula: see text] and [Formula: see text] for Cu and Hg respectively. Further, no interference with other co-existing metal ions was found manifesting the specificity of the device to Cu and Hg. Finally, the device was successfully tested with real samples like tap water, lake water, and serum with remarkable recovery percentages. Such portable devices pave way for detecting various heavy metal ions in a point-of-care environment. The developed device can also be used for detection of other heavy metals like cadmium, lead, zinc etc., by modifying the working electrode with the various nanocomposites.

Three Different Rapidly Prototyped Polymeric Substrates With Interdigitated Electrodes for Escherichia coli Sensing: A Comparative Study.

This work delves upon the development of different types of miniaturized and 3D printed devices having interdigitated electrodes (IDEs) for the detection of Escherichia coli (E. coli) bacteria. The IDEs were fabricated using different approaches including laser-induced graphene (LIG) on polyamide, direct laser writing on glass, and polymeric 3D printing technique, and their suitability for bacteria detection has been compared. The electrochemical impedance spectroscopy (EIS) technique was employed to detect the E. coli bacteria in the prepared miniaturized devices, and the sensory response was compared. EIS was performed in the frequency range between 1 Hz to 1 MHz to record the bacterial growth and activities as a function of change in electrical impedance, and detection performance of the different miniaturized devices with IDEs were compared. It was observed that the LIG-based IDE sensor provided better sensitivity compared to that of the other two approaches. The obtained results indicate that the magnitude of impedance changes by around 2.5 [Formula: see text] per doubling of E.coli cells. With fast and flexible fabrication process capabilities, such microdevices may be used as suitable IDE sensors for microscale pathogenic detection for biomedical and clinical analysis.

A lab-on-chip platform for simultaneous culture and electrochemical detection of bacteria.

A simple, cost-effective and miniaturized lab-on-a-chip platform has been developed amenable to perform simultaneous cultivation and detection of bacteria. A microfluidic chamber was integrated to screen-printed electrodes for electrochemical detection of bacteria. The temperature required for the bacterial culture was provided through the optimized laser-induced graphene heaters. The concentration of bacteria was quantified accurately with the three-electrode system in the range of 2 × 104 to 1.1 × 109 CFU/mL without any need of biological modifications to the electrodes. The viability of cultured bacteria in the microfluidic device was also confirmed through fluorescent imaging. Furthermore, the metabolic activity of the cultured bacteria was validated through a miniaturized microbial fuel cell. Furthermore, the specificity of electrodes was also performed through electrochemical technique. Finally, a handheld and portable lab-on-a-chip platform was realized by 3D packaging, integrated with a portable potentiostat for real-time and on-field applications.

Miniaturized 3D printed electrochemical platform with optimized Fibrous carbon electrode for non-interfering hypochlorite sensing.

3D printing technology based electrochemical device can provide ease of fabrication, cost effectiveness, rapid detection and lower limit of detection. Herein, a novel, customized, portable and inexpensive 3D printed electrochemical device, has been presented. Fibrous carbon Toray paper, deposited with gold nanoparticles through electrodeposition, used as a working electrode which Further device was tested with 1 mM sodium hypochlorite using cyclic voltammetry (CV) and square wave voltammetry (SWV) in 0.1 M PBS. Hypochlorite has a pivotal role in supporting the growing chemical and paper industries and finds diverse uses in several clinical applications. It is primarily used for disinfecting food, water and surfaces. The scan rate study was carried out from 20 mVs-1 to 250 mVs-1 using cyclic voltammetry technique. The diffusion coefficient obtained from scan rate effect was 1.39 × 10-6 cm2s-1. The concentration range was evaluated with SWV technique, in a linear range of 0.6 µM-40 µM, with a detection limit of 0.7 µM. The device was further analyzed to ensure non-interference from co-existing chemicals like sodium chloride, potassium nitrate, sodium carbonate, sodium nitrite. Real sample analysis was done with sea, artificial sea and tap water with impressive recovery values. In summary, the developed working electrode can be customized and modified based on testing analyte; thus, the proposed device can be used for various other biochemical analytes.

Electrochemical Mini-Platform With Thread- Based Electrodes for Interference Free Arsenic Detection.

Herein, a fully integrated thread/textile-based electrochemical sensing device has been demonstrated. A hydrophilic conductive carbon thread, chemically modified with gold nanoparticles through an electrodeposition process, was used as a working electrode (WE). The hydrophilic thread coated with Ag/AgCl and an unmodified bare hydrophilic thread were used as reference electrode (RE) and counter electrode (CE) respectively. The device was fabricated with hydrophilic conductive carbon threads supported by capillary tubes and these integrated electrodes were placed in a 2 mL glass vial. The physico-chemical characterization of the working electrode was carried out using SEM (scanning electron microscopy) and X-ray photoelectron spectroscopy (XPS). Furthermore, the fabricated sensing platform, was tested for electrochemical sensing of arsenic. The electrocatalytic oxidation activity of arsenic in the designed platform was investigated via cyclic voltammetry (CV) and square wave Voltammetry (SWV). An oxidation peak at -0.4 V corresponding to the oxidation of arsenic was obtained. Scan rate effect was performed using CV analysis and the diffusion coefficient was found to be 2.478×10-10 with a regression coefficient of R2 = 0.9647. Further, concentration effect was accomplished in the linear range 0.4 µ M to 60 µ M. The limit of detection was obtained as 0.416 µ M. For the practical application, effect of interference from other chemicals and real sample analysis from the tap water and blood serum sample was carried out which gave remarkable recovery values.

Rapid Inkjet-Printed Miniaturized Interdigitated Electrodes for Electrochemical Sensing of Nitrite and Taste Stimuli.

This paper reports on single step and rapid fabrication of interdigitated electrodes (IDEs) using an inkjet printing-based approach. A commercial inkjet-printed circuit board (PCB) printer was used to fabricate the IDEs on a glass substrate. The inkjet printer was optimized for printing IDEs on a glass substrate using a carbon ink with a specified viscosity. Electrochemical impedance spectroscopy in the frequency range of 1 Hz to 1 MHz was employed for chemical sensing applications using an electrochemical workstation. The IDE sensors demonstrated good nitrite quantification abilities, detecting a low concentration of 1 ppm. Taste simulating chemicals were used to experimentally analyze the ability of the developed sensor to detect and quantify tastes as perceived by humans. The performance of the inkjet-printed IDE sensor was compared with that of the IDEs fabricated using maskless direct laser writing (DLW)-based photolithography. The DLW-photolithography-based fabrication approach produces IDE sensors with excellent geometric tolerances and better sensing performance. However, inkjet printing provides IDE sensors at a fraction of the cost and time. The inkjet printing-based IDE sensor, fabricated in under 2 min and costing less than USD 0.3, can be adapted as a suitable IDE sensor with rapid and scalable fabrication process capabilities.

Optimized ink jetted paper device for electroanalytical detection of picric acid.

Picric acid (PA) is one of the essential components utilized in manufacturing of explosives. Therefore, the detection of trace amount of PA is critical in forensic science, criminal investigation, military security and environmental safety. Owing to these attributes, development of a simple, rapid and point-of-care (POC) analytical method for PA detection and quantification is crucial. Herein, a low-cost, POC, ink jetted paper device has been developed for electroanalytical detection of PA. Inkjet printing is an economic fabrication process used for extruding several nanomaterials with diversified applications. By improving the ink viscosity, inkjet printers can simplify the fabrication of paper-based electrochemical sensor, and provide easy, fast, environmental friendly and viable for large scale production sensors, thereby adding its commercialization potential. In this work, a commercially available circuit board printer and an inexpensive high viscosity carbon conductive ink were used to print an electrochemical paper device. The fabricated device was used for electrochemical detection of PA using cyclic voltammetry (CV) and wave voltammetry (SWV). Various parameters like effect of potential scan rate from 10 mVs-1 to 300 mVs-1, effect of variable PA concentration effect was studied. A linear concentration range of 4 µM to 60 µM was obtained. For a working electrode of 7 mm2 surface area, the limit of detection (LOD) was 4.04 µM (922.56 ppb) which was less than the prescribed safe limit of 8 µM. Effect of interference with other chemicals was examined using SWV with the co-existing metals like zinc, lead, copper and mercury. Finally, real sample analysis for tap and lake water was successfully performed with the device. The developed cost-effective paper-based ink-jetted platform, with further fine-tuning and surface modifications, can be used for sensing various analytes as a point-of-care device.

Experimental studies on droplet characteristics in a microfluidic flow focusing droplet generator: effect of continuous phase on droplet encapsulation.

The efficacy of droplet-based microfluidic assays depends on droplet size, pattern, generation rate, etc. The size of the droplet is affected by numerous variables as flow rate ratio, viscosity ratio, microchannel geometry, surfactants, nature of fluids and other dimensionless numbers. This work reports rigorous analysis and optimization of the behavior of droplets with change in flow rate ratio and viscosity ratio in a flow-focusing device. Droplets were produced for different flow rate ratios maintaining a constant aqueous phase and varying the continuous phase, to have capillary numbers ranging from 0.01 to 0.1. It was observed that the droplet size decreased with the increase in flow rate ratio, and vice versa. It was noted that as the viscosity ratio was increased, the dispersed phase elongated before the complete breakup and long droplets were formed in the microchannel. Smaller droplets were formed for lower viscosity ratios with a combination of higher flow rate ratios. An empirical relation has been developed to predict the droplet length in terms of capillary number and flow rate ratio for different viscosity ratios. In addition, microparticle encapsulation in individual droplets was attempted to realize the effect of flow rate of the continuous phase for various flow rate ratios on encapsulation efficiency.

Droplet-based lab-on-chip platform integrated with laser ablated graphene heaters to synthesize gold nanoparticles for electrochemical sensing and fuel cell applications.

Controlled, stable and uniform temperature environment with quick response are crucial needs for many lab-on-chip (LOC) applications requiring thermal management. Laser Induced Graphene (LIG) heater is one such mechanism capable of maintaining a wide range of steady state temperature. LIG heaters are thin, flexible, and inexpensive and can be fabricated easily in different geometric configurations. In this perspective, herein, the electro-thermal performance of the LIG heater has been examined for different laser power values and scanning speeds. The experimented laser ablated patterns exhibited varying electrical conductivity corresponding to different combinations of power and speed of the laser. The conductivity of the pattern can be tailored by tuning the parameters which exhibit, a wide range of temperatures making them suitable for diverse lab-on-chip applications. A maximum temperature of 589 °C was observed for a combination of 15% laser power and 5.5% scanning speed. A LOC platform was realized by integrating the developed LIG heaters with a droplet-based microfluidic device. The performance of this LOC platform was analyzed for effective use of LIG heaters to synthesize Gold nanoparticles (GNP). Finally, the functionality of the synthesized GNPs was validated by utilizing them as catalyst in enzymatic glucose biofuel cell and in electrochemical applications.

Automated pencil electrode formation platform to realize uniform and reproducible graphite electrodes on paper for microfluidic fuel cells.

Graphite pencil stroked electrodes for paper-based Microfluidic devices are gaining immense attention due to their electrochemical properties, cost efficiency, and ease-of-use. However, their widespread use has been hindered by the challenges associated with their manual fabrication such as non-uniformity in graphite deposition, applied pressure, etc. This work presents the design and development of an automated graphite pencil stroking device for graphite electrode fabrication with high efficiency through a compact, inexpensive and automatic process, with reduced fabrication time and human intervention leading to more uniformity. The motion platform of Graphtec plotter was used to create multiple strokes with the help of the proposed device. Such inexpensive graphite electrodes (less than the US $1) have been observed to be porous in nature, acting as diffusion agents. The automated graphite electrodes were used to study the performance of microfluidic paper fuel cells (MPFCs) with formic acid, oxygen, and sulphuric acid acting as fuel, oxidising agent and electrolyte respectively. From this configuration, the maximum current density and power density were measured to be 1,305.5 µA cm-2 and 135.5 µW cm-2, respectively at 0.3 V stable OCP at 100 strokes. Overall, the study enumerates the development of an automated pencil stroke device for fabricating graphite electrodes, which can potentially be harnessed in numerous miniaturized paper based applications.

A Doppler Echocardiographic Pulmonary Flow Marker of Massive or Submassive Acute Pulmonary Embolus.

BACKGROUND: To date, echocardiography has not gained acceptance as an alternative imaging modality for the detection of massive pulmonary embolism (MPE) or submassive pulmonary embolism (SMPE). The objective of this study was to explore the clinical utility of early systolic notching (ESN) of the right ventricular outflow tract (RVOT) pulsed-wave Doppler envelope in the detection of MPE or SMPE. METHODS: Two hundred seventy-seven patients (mean age, 56 ± 16 years; 52% women), without known pulmonary hypertension, who underwent contrast computed tomographic angiography for suspected pulmonary embolism (PE) and underwent echocardiography were retrospectively studied. Extent of PE was categorized using standard criteria. ESN identified from pulsed-wave spectral Doppler interrogation of the RVOT was analyzed, as were other echocardiography parameters such as McConnell's sign, the "60/60" sign, and acceleration and deceleration times of the RVOT Doppler signal. Analysis was conducted using probability statistics and receiver operating characteristic curve analysis. RESULTS: Of the 277 patients studied, 100 (44%) had MPE or SMPE, 87 (38%) had subsegmental PE, and 90 (39%) did not have PE. ESN was observed in 92% of patients with MPE or SMPE, 2% with subsegmental PE, and in no patients without PE. Interobserver assessment of early systolic notching demonstrated 97% agreement (κ = 0.93, P < .001). Compared with more widely recognized echocardiographic parameters, the area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI, 0.92-0.98) for ESN was superior to that for McConnell's sign (AUC, 0.75; 95% CI, 0.68-0.80), the 60/60 sign (AUC, 0.74; 95% CI, 0.68-0.79), and RVOT acceleration time ≤ 87 msec (AUC, 0.84; 95% CI, 0.79-0.88), as well as other study Doppler variables, in patients with computed tomography-confirmed MPE or SMPE. CONCLUSIONS: The pulmonary Doppler flow pattern of ESN appears to be a promising noninvasive sign observed frequently in patients with MPE or SMPE. Future prospective study to ascertain diagnostic utility in a broader population is warranted.

Relationships among Safety Climate, Safety Behavior, and Safety Outcomes for Ethnic Minority Construction Workers.

In many countries, it is common practice to attract and employ ethnic minority (EM) or migrant workers in the construction industry. This primarily occurs in order to alleviate the labor shortage caused by an aging workforce with a lack of new entrants. Statistics show that EM construction workers are more likely to have occupational fatal and nonfatal injuries than their local counterparts; however, the mechanism underlying accidents and injuries in this vulnerable population has been rarely examined. This study aims to investigate relationships among safety climate, safety behavior, and safety outcomes for EM construction workers. To this end, a theoretical research model was developed based on a comprehensive review of the current literature. In total, 289 valid questionnaires were collected face-to-face from 223 Nepalese construction workers and 56 Pakistani construction workers working on 15 construction sites in Hong Kong. Structural equation modelling was employed to validate the constructs and test the hypothesized model. Results show that there were significant positive relationships between safety climate and safety behaviors, and significant negative relationships between safety behaviors and safety outcomes for EM construction workers. This research contributes to the literature regarding EM workers by providing empirical evidence of the mechanisms by which safety climate affects safety behaviors and outcomes. It also provides insights in order to help the key stakeholders formulate safety strategies for EM workers in many areas where numerous EM workers are employed, such as in the U.S., the UK, Australia, Singapore, Malaysia, and the Middle East.

Meta-Analysis Comparing Patent Foramen Ovale Closure Versus Medical Therapy to Prevent Recurrent Cryptogenic Stroke.

New evidence suggests that closure of a patent foramen ovale (PFO) plus medical therapy (MT; antiplatelet or anticoagulation) is superior to MT alone to prevent recurrent cryptogenic stroke. We performed a meta-analysis of randomized controlled trials that compared PFO closure plus MT with MT alone in patients with cryptogenic stroke. The efficacy end points were recurrent stroke, transient ischemia attack, and death. The safety end points were major bleeding and newly detected atrial fibrillation. Trials were pooled using random effects and fixed effects models. A trial sequential analysis was performed to assess if the current evidence is sufficient. Risk ratios (RR) were calculated for pooled estimates of risk. Five randomized controlled trials (3,440 patients) were included. Mean follow-up was 4.1 years. PFO closure reduced the risk of recurrent stroke by 58% (RR 0.42, 95% CI 0.20 to 0.91, p = 0.03). The number needed to treat was 38. The cumulative Z-line crossed the trial sequential boundary, suggesting there is adequate evidence to conclude that PFO closure reduces the risk of recurrent stroke by 60%. PFO closure did not reduce the risk of transient ischemia attack (RR 0.78, 95% CI 0.53 to 1.15, p = 0.21), mortality (RR 0.74, 95% CI 0.35 to 1.60, p = 0.45), or major bleeding (RR 0.96, 95% CI 0.42 to 2.20, p = 0.93); it did increase the risk of atrial fibrillation (RR 4.69, 95% CI 2.17 to 10.12, p <0.0001).

Investigating ethnic minorities' perceptions of safety climate in the construction industry.

INTRODUCTION: An increasing number of ethnic minorities (EMs) have been employed in the construction industry to alleviate severe labor shortages in many countries. Unfortunately, statistics show that EMs have higher fatal and non-fatal occupational injury rates than their local counterparts. However, EMs are often underrepresented in safety climate (SC) research as they are difficult to reach and gauge their perception. A positive relationship has been widely found between SC and safety performance. Understanding the safety perceptions of EMs helps to reduce injuries and improve their safety performance. METHOD: Based on a sample of 320 EMs from 20 companies in the construction industry, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to identify the SC factors of EMs, and validate the extracted factors, respectively. Multivariate analysis of variance was undertaken to examine mean differences in perceptions of SC by personal characteristics. RESULTS: Three SC factors for EMs encapsulating 16 variables were identified through EFA. The hypothesized CFA model for a three-factor structure derived from EFA showed a satisfactory goodness-of-fit, composite reliability, and construct validity. CONCLUSIONS: Three SC factors were identified, namely: (a) safety management commitment, safety resources, and safety communication; (b) employee's involvement and workmate's influence; and (c) perception of safety rules, procedures and risks. The perceptions of SC differed significantly by nationality, marital status, the number of family members supported, and drinking habit. PRACTICAL APPLICATIONS: This study reveals the perception of EMs toward SC. The findings highlight the areas for safety improvement and provide leading indicators for safety performance of EMs. The findings are also enlightening for countries with a number of EMs, such as the United Sates, the United Kingdom, Australia, Singapore, and the Middle East.

Ultrasound Assisted Catheter Directed Thrombolysis in the Management of a Right Atrial Thrombus: A New Weapon in the Armamentarium?

Catheter related thrombosis (CRT) is a commonly encountered entity fraught with substantial risk for mortality secondary to various complications including pulmonary embolism (PE), tricuspid regurgitation, endocarditis, right sided heart failure, and cardiogenic and septic shock. CRT carries a mortality rate of 18% in hemodialysis patients and more than 40% in nonhemodialysis patients. Management strategies include systemic anticoagulation, systemic thrombolysis, surgical evacuation, and percutaneous retrieval with no established guidelines. Ultrasound assisted catheter directed thrombolysis emerges as promising modality with a relatively lower risk of hemorrhage compared to systemic thrombolysis. We report a case of a 75-year-old man with dialysis catheter related thrombosis without PE for which ultrasound assisted catheter directed thrombolysis was used successfully as an alternative therapy.

Aortic valve myxoma at the extreme age: a review of literature.

Primary cardiac tumours are a rare finding, with cardiac myxoma and fibroelastoma representing the majority of these tumours. Cardiac myxomas are most commonly found in the left atrium but are rarely found with attachment to the cardiac valves. The authors describe a case of aortic myxoma found in an 81-year-old man presented with peripheral arterial disease. CT angiogram of the thorax was performed to find the source of emboli and it showed a mass attached to the aortic valve and protruding into the aorta. Details of the location and texture were studied on transoesophageal echocardiography. Preoperative coronary angiography showed coronary artery disease and the patient underwent successful coronary artery bypass grafting and simultaneous resection of the mass. Histopathology revealed the mass as a myxoma.