Trace-Level Screening of Chemicals Related to Clandestine Desomorphine Production with Ambient Sampling, Portable Mass Spectrometry

Desomorphine is a semisynthetic opioid that is responsible for the psychoactive effects of a dangerous homemade injectable mixture that goes by street name “Krokodil.” Desorption electrospray ionization (DESI) and paper spray ionization (PSI) are implemented on a portable mass spectrometer for the direct analysis of desomorphine and precursor reagent codeine from multiple substrates of potential relevance to clandestine drug laboratory synthesis and paraphernalia seizure. Minimal sample preparation required for analysis and portability of the instrument suggest the potential for rapid, on-site analysis of evidence, a highly desired benefit for forensic science and law enforcement practitioners. Both DESI-MS and PSI-MS can generate spectra consistent with preceding data obtained using traditional ionization methods, while demonstrating detection limits in the low- to sub-ng levels

A Low-Cost, Simplified Platform of Interchangeable, Ambient Ionization Sources for Rapid, Forensic Evidence Screening on Portable Mass Spectrometric Instrumentation

Portable mass spectrometers (MS) are becoming more prevalent due to improved instrumentation, commercialization, and the robustness of new ionization methodologies. To increase utility towards diverse field-based applications, there is an inherent need for rugged ionization source platforms that are simple, yet robust towards analytical scenarios that may arise. Ambient ionization methodologies have evolved to target specific real-world problems and fulfill requirements of the analysis at hand. Ambient ionization techniques continue to advance towards higher performance, with specific sources showing variable proficiency depending on application area. To realize the full potential and applicability of ambient ionization methods, a selection of sources may be more prudent, showing a need for a low-cost, flexible ionization source platform. This manuscript describes a centralized system that was developed for portable MS systems that incorporates modular, rapidly-interchangeable ionization sources comprised of low-cost, commercially-available parts. Herein, design considerations are reported for a suite of ambient ionization sources that can be crafted with minimal machining or customization. Representative spectral data is included to demonstrate applicability towards field processing of forensic evidence. While this platform is demonstrated on portable instrumentation, retrofitting to lab-scale MS systems is anticipated

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Structure: Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Supplemental Digital Content is available in the text

2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: Executive Summary

The executive summary of the American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions coronary artery revascularization guideline provides the top 10 items readers should know about the guideline. In the full guideline, the recommendations replace the 2011 coronary artery bypass graft surgery guideline and the 2011 and 2015 percutaneous coronary intervention guidelines. This summary offers a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization, as well as the supporting documentation to encourage their use. A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. Recommendations from the earlier percutaneous coronary intervention and coronary artery bypass graft surgery guidelines have been updated with new evidence to guide clinicians in caring for patients undergoing coronary revascularization. This summary includes recommendations, tables, and figures from the full guideline that relate to the top 10 take-home messages. The reader is referred to the full guideline for graphical flow charts, supportive text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in the development of this guideline