Management of Lost Atherectomy Devices in the Coronary Arteries

\ua9 2025 The Author(s). Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC. Rotational and orbital atherectomy are important tools to treat calcific coronary disease. Entrapment of an atherectomy device, that is, rotational atherectomy burr or orbital atherectomy crown, is a serious complication during atherectomy. Loss of an atherectomy device is a more challenging complication that usually follows device entrapment. Although uncommon, given the increased adoption of atherectomy, it is important for interventional cardiologist to understand the mechanisms and principles for prevention and management of lost atherectomy devices. Given the paucity of reported cases, there is no clear consensus or defined approach as to how this complication is best managed. The current recommendations for burr/crown entrapment are generally to remove everything from the coronary vasculature and range from different percutaneous strategies and ultimately cardiac surgery. Conservative treatment with leaving the burr within the coronary vasculature has not been recommended. This article serves to review and provide a contemporary update on the management of lost atherectomy devices in the coronary arteries. We review the management and techniques centered around cases of lost atherectomy devices including a unique cohort of patients with lost burrs/crowns that were left in the coronary arteries. Finally, we provide an algorithmic approach to the contemporary management of lost atherectomy devices, incorporating a conservative strategy arm, and discuss situations where this may be considered

Escaping the cohort of concern: in vitro experimental evidence supports non-mutagenicity of N-nitroso-hydrochlorothiazide

In recent years, nitrosamine impurities in pharmaceuticals have been subject to intense regulatory scrutiny, with nitrosamine drug substance-related impurities (NDSRIs) treated as cohort of concern impurities, regardless of predicted mutagenic potential. Here, we describe a case study of the NDSRI N-nitroso-hydrochlorothiazide (NO-HCTZ), which was positive in the bacterial reverse mutation (Ames) test but is unstable under the test conditions, generating formaldehyde among other products. The mutagenic profile of NO-HCTZ was inconsistent with that expected of a mutagenic nitrosamine, exhibiting mutagenicity in the absence of metabolic activation, and instead aligned well with that of formaldehyde. To assess further, a modified Ames system including glutathione (3.3 mg/plate) to remove formaldehyde was developed. Strains used were S. typhimurium TA98, TA100, TA1535, and TA1537, and E. coli WP2 uvrA/pKM101. In this system, formaldehyde levels were considerably lower, with a concomitant increase in levels of S-(hydroxymethyl)glutathione (the adduct formed between glutathione and formaldehyde). Upon retesting NO-HCTZ in the modified system (1.6-5000 µg/plate), a clear decrease in the mutagenic response was observed in the strains in which NO-HCTZ was mutagenic in the original system (TA98, TA100, and WP2 uvrA/pKM101), indicating that formaldehyde drives the response, not NO-HCTZ. In strain TA1535, an increase in revertant colonies was observed in the modified system, likely due to a thiatriazine degradation product formed from NO-HCTZ under Ames test conditions. Overall, these data support a non-mutagenic designation for NO-HCTZ and demonstrate the value of further investigation when a positive Ames result does not align with the expected profile

Can Machines Design? An Artificial General Intelligence Approach

International audienceCan machines design? Can they come up with creative solutions to problems and build tools and artifacts across a wide range of domains? Recent advances in the field of computational creativity and formal Artificial General Intelligence (AGI) provide frameworks for machines with the general ability to design. In this paper we propose to integrate a formal computational creativity framework into the Gödel machine framework. We call the resulting framework design Gödel machine. Such a machine could solve a variety of design problems by generating novel concepts. In addition, it could change the way these concepts are generated by modifying itself. The design Gödel machine is able to improve its initial design program, once it has proven that a modification would increase its return on the utility function. Finally, we sketch out a specific version of the design Gödel machine which specifically addresses the design of complex software and hardware systems. Future work aims at the development of a more formal version of the design Gödel machine and a proof of concept implementation

Los desafíos a la reunificación de China y Taiwán: la Ley Antisecesión (2005) y el Acuerdo Marco de Cooperación Económica (2010)

El presente artículo tiene por objetivo analizar el problema de la reunificación entre la República Popular China y Taiwán en la última década, en el marco de dos hitos: por un lado, la promulgación de la Ley Antisecesión del 14 de marzo de 2005 y, por otro, la firma del Acuerdo Marco de Cooperación Económica el 30 de junio de 2010