Clinical Outcomes of physiologically-guided revascularisation

Objective: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR).Study design: Descriptive study.Place and duration of study: Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020.Methodology: A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and considering p-value ≤0.05 as statistically significant.Results: The frequency of major adverse cardiac event (MACE) and target vessel revascularisation was 8.4% and 3.2% in the revascularisation-performed group as compared to 6.4% and 3.2% in the revascularisation-deferred group. In adjusted models, no statistically significant difference was noted in MACE when comparing the revascularisation-performed group with a deferred group.Conclusion: Revascularisation guided by invasive physiological assessment with FFR or iFR is clinically safe and led to better resource utilisation. Key Words: Fractional flow reserve, Instantaneous wave-free ratio, Invasive physiological assessment, Low-middle income country

Comparison of Low – Versus Medium-Pressure Shunts in Pediatric Hydrocephalus – A Study of the Children Hospitals, Lahore

Objective:  This prospective cross-sectional study was aimed to assess the effectiveness of low-pressure vs. medium-pressure shunts in children with hydrocephalus. Material and Methods: 52 children with different types of hydrocephalus were admitted through OPD and Surgical emergency at The Children Hospital, Lahore. All Children were gone through Ultrasonography and CT Brain plain after admission. The pediatric hydrocephalus was resolved into two groups. All patients treated with Chhabra differential pressure VP (ventriculoperitoneal) shunt in either low pressure or medium pressure. CT scans were used to assess the postoperative clinical and radiological outcomes to monitor the ventricle hemispheric ratio (VHR). Results:  A low-pressure shunt was implanted in 26 individuals, whereas a medium-pressure shunt was implanted in 26 individuals. Patients varied in age from one day to thirteen years old. In group A, the average VHR was 57.58% preoperatively, but it dropped to 42.88% after surgery. Similarly, in group B, the pre-and postoperative VHR was 59.35% and 42.81%, respectively, which was statistically significant. In both groups, the incidence of shunt complications and redo shunt operation were not statistically significant. Conclusion:  In this study, individuals with pediatric hydrocephalus who had a low-pressure shunt or a medium-pressure shunt had similar outcomes

Effects of Veratrilla baillonii Extract on Hepatic Gene Expression Profiles in Response to Aconitum brachypodum-Induced Liver Toxicity in Mice

This manuscript was aimed to explore the hepato-protective effect of water extract of Veratrilla baillonii Franch. (Gentianaceae) (WVBF) on serious hepatic toxicity induced in mice treated with Aconitum brachypodum Diels (Ranunculaceae) at transcriptome level. The physiological and pathological symptoms were evaluated as the markers for hepato toxicity induced by A. brachypodum Diels (CFA) extracted compounds. Moreover, gene chip method was used to compare and investigate the gene expression level of WVBF on CFA induced-liver toxicity to identify the potential target of WVBF and CFA on liver. The results showed that WVBF had a significant detoxification effect on CFA-induced acute hepatic toxicity. There were 130 genes with lower expression and 124 genes expressed at higher rate in CFA treated group as compared with normal control group, while there are 67 genes down-regulated and 74 genes up-regulated in WVBF treated group in comparison with CFA treated group. WVBF could attenuate CFA-induced liver damage in mice through regulating oxidative stress, inflammatory injury and cell apoptosis/necrosis pathways. On the other hand, WVBF and CFA may have potential synergetic effects on the target genes of certain diseases such as inflammation, cancer and diabetes

Sweroside Alleviated Aconitine-Induced Cardiac Toxicity in H9c2 Cardiomyoblast Cell Line

Aconitine is the main bioactive ingredient of Aconitum plants, which are well-known botanical herbs in China. Aconitine is also notorious for its high cardiotoxicity, as it can induce life-threatening ventricular arrhythmias. Unfortunately, there are few effective antidotes to aconitine toxicity. This study aimed to evaluate the potent protective effects of the ingredients from V. baillonii on aconitine toxicity on H9c2 cell line. Cell viability was assessed by methylthiazoltetrazolium bromide (MTT). Intracellular Ca2+ concentration alteration and reactive oxygen species (ROS) generation were observed by confocal microscopy and flow cytometry, respectively. Cellular oxidative stress was analyzed by measuring malondialdehyde (MDA) and superoxide dismutase (SOD) levels. Mitochondrial membrane potential (ΔΨ) was determined using JC-1 kit. RT-PCR and Hoechst staining techniques were conducted to determine the levels of autophagy/apoptosis. The mRNA levels of dihydropyridine receptor (DHPR), ryanodine receptors (RyR2) and sarcoplasmic reticulum Ca2+-ATPase (SERCA) were measured by RT-PCR. We screened six components from V. baillonii, among which, sweroside exhibited the strongest protective effects on aconitine-induced cardiac toxicity. Sweroside suppressed the aconitine-induced mRNA expressions of NaV1.5 (encoded by SCN5A), RyR2 and DHPR, and reversed the aconitine-induced decrease in mRNA level of SERCA, thus preventing the aconitine-induced persistent intracellular Ca2+ accumulation and avoiding intracellular Ca2+ overload. We further found that sweroside restabilized the aconitine-disrupted mitochondrial membrane potential (ΔΨ) and reversed the aconitine-induced increase in the mRNA levels of cell autophagy-related factors (Beclin-1, Caspase-3, and LC3- II) in H9c2 cells. In the whole-animal experiments, we observed that sweroside (50 mg/kg) alleviated effectively aconitine-induced arrhythmias by analysis of electrocardiogram (ECG) recording in rats. Our results demonstrate that sweroside may protect cardiomyocytes from aconitine toxicity by maintaining intracellular Ca2+ homeostasis, restabilizing mitochondrial membrane potential (ΔΨ) and avoiding cell autophagy/apoptosis

Distal transradial artery access for coronary angiography in a patient having rheumatoid arthritis-related severe arthropathies

Conventional radial access has become the default access for coronary angiography. Sometime, it is difficult to take a conventional radial access, especially in patients having severe arthropathies leading to limited wrist joint mobility. In such scenarios, distal transradial access (dTRA) can be adopted. We describe a case of an elderly male patient having rheumatoid arthritis with arthropathies. He presented to us with unstable angina; coronary angiogram was advised for ischaemia assessment. Right dTRA was adopted due to severe joint deformity at wrist joint, limiting joint extension. A successful coronary angiogram was performed via the right dTRA without major discomfort and complications. Haemostasis was secured with TR band radial artery compression device. In this case report, we have evaluated the importance of practising dTRA in a patient with severe arthropathies

Evolutionary Trajectory for the Emergence of Novel Coronavirus SARS-CoV-2

Over the last two decades, the world experienced three outbreaks of coronaviruses with elevated morbidity rates. Currently, the global community is facing emerging virus SARS-CoV-2 belonging to Betacoronavirus, which appears to be more transmissible but less deadly than SARS-CoV. The current study aimed to track the evolutionary ancestors and different evolutionary strategies that were genetically adapted by SARS-CoV-2. Our whole-genome analysis revealed that SARS-CoV-2 was the descendant of Bat SARS/SARS-like CoVs and bats served as a natural reservoir. SARS-CoV-2 used mutations and recombination as crucial strategies in different genomic regions including the envelop, membrane, nucleocapsid, and spike glycoproteins to become a novel infectious agent. We confirmed that mutations in different genomic regions of SARS-CoV-2 have specific influence on virus reproductive adaptability, allowing for genotype adjustment and adaptations in rapidly changing environments. Moreover, for the first time we identified nine putative recombination patterns in SARS-CoV-2, which encompass spike glycoprotein, RdRp, helicase and ORF3a. Six recombination regions were spotted in the S gene and are undoubtedly important for evolutionary survival, meanwhile this permitted the virus to modify superficial antigenicity to find a way from immune reconnaissance in animals and adapt to a human host. With these combined natural selected strategies, SARS-CoV-2 emerged as a novel virus in human society

NOMA-enabled Backscatter Communications for Green Transportation in Automotive-Industry 5.0

Automotive-Industry 5.0 will use emerging 6G communication techniques such as Non-Orthogonal Multiple Access (NOMA) and backscatter communications for enhanced spectrum and energy efficiency. In this paper, we provide an introduction to green transportation and also discuss the advantages of using backscatter communications and NOMA in Automotive Industry 5.0. We also briefly review the recent work in the area of NOMA empowered backscatter communications. We discuss different use cases of backscatter communications in NOMA-enabled 6G vehicular networks. We also propose a multi-cell optimization framework to maximize the energy efficiency of the backscatter-enabled NOMA vehicular network. In particular, we jointly optimize the transmit power of the roadside unit and the reflection coefficient of the backscatter device in each cell by employing Dinkelbach method, dual theory and KKT conditions to obtain efficient solutions. Finally, we highlight some open issues and future research opportunities related to NOMA-enabled backscatter communications in 6G vehicular networks

NOMA-Enabled Backscatter Communications for Green Transportation in Automotive-Industry 5.0

Automotive-Industry 5.0 will use emerging 6G communications to provide robust, computationally intelligent, and energy-efficient data sharing among various onboard sensors, vehicles, and other intelligent transportation system entities. Nonorthogonal multiple access (NOMA) and backscatter communications are two key techniques of 6G communications for enhanced spectrum and energy efficiency. In this article, we provide an introduction to green transportation and also discuss the advantages of using backscatter communications and NOMA in Automotive Industry 5.0. We also briefly review the recent work in the area of NOMA empowered backscatter communications. We discuss different use cases of backscatter communications in NOMA-enabled 6G vehicular networks. We also propose a multicell optimization framework to maximize the energy efficiency of the backscatter-enabled NOMA vehicular network. In particular, we jointly optimize the transmit power of the roadside unit and the reflection coefficient of the backscatter device in each cell, where several practical constraints are also taken into account. The problem of energy efficiency is formulated as nonconvex, which is hard to solve directly. Thus, first, we adopt the Dinkelbach method to transform the objective function into a subtractive one, then we decouple the problem into two subproblems. Second, we employ dual theory and KKT conditions to obtain efficient solutions. Finally, we highlight some open issues and future research opportunities related to NOMA-enabled backscatter communications in 6G vehicular networks