Leopard seals are encountered by people hundreds of times a year along New Zealand’s coastline. They likely utilize New Zealand’s coastline for rest and recuperation. Human activity could disturb leopard seals’ rest and their subsequent responses could endanger human safety. This research aimed to determine whether leopard seals changed their behavior in response to human activity and whether these responses endangered human safety. This research utilized video recordings of twenty-nine individuals hauled out on the Otago coastline in New Zealand. The behavior of leopard seals under control conditions was compared to that expressed when people and/or dogs were present, and natural stimuli such as rain. Leopard seals rested for most of their time budget under all conditions but did so significantly less under the natural stimuli conditions compared to control conditions (p = <0.001, p = <0.001). Leopard seals lifted their heads significantly more when dogs and/or people were present (p = 0.003, p = 0.02) than under the control condition. They also moved significantly more when being measured (p = 0.041) than was observed under the control condition. Leopard seals did not express any behavior which could threaten the safety of a person or dog during this study. These results suggest that leopard seals can be disturbed by human activity when hauled out on shore but are unlikely to endanger human safety. It is recommended that wildlife managers maintain an exclusion zone of 20 m to ensure the welfare of hauled out leopard seals and human safety. Further research is required to assess to what extent the observed disturbances impact the seals’ fitness and whether there is a cumulative impact.

A document by Rachel Winter. Click on the document to view its contents.

Inflammation is a protective response from our body to an injury in the form of five cardinal signs. It is divided into acute and chronic.Additionally, practically every autoimmune disease, from gout to inflammatory bowel disease, has it as one of the primary causes. For reducing inflammation steroidal as well as non-steroidal anti-inflammatory drugs are used. There are three important types of inflammatory mediators. In this review, we will discuss inflammation, drugs and their mechanism and some inflammatory diseases.

Rabies is a lethal infectious disease caused by rabies virus (RABV). The mortality rate is very high after the appearance of clinical symptoms, with a survival rate of almost 0%. There is presently no cure for rabies. In the present study, we investigated whether the extract of Shougong powder-a calcium powder prepared from gecko that has demonstrated immunomodulatory properties in mice-is an effective treatment for rabies. The antiviral effects of the extract were evaluated both in vitro and in vivo with the cytotoxicity and antiviral assays and by immunofluorescence analysis, quantitative real-time (qRT)-PCR, and western blotting. The results showed that Shougong powder and its extract increased survival rate in RABV-infected mice is up to 60% and 50% respectively, even in 20 times of LD50. Whereas the control groups treated with Isoprinosine (IPS) or saline are only 20% and 0% survival (P=0.011). qRT-PCR and western blot analyses showed that the extract strongly inhibited viral mRNA expression and protein synthesis in vitro: expression of the N, P, M, G, and L genes of RABV was decreased by 28.8%–45.0% in the IPS group (P<0.05) and by 50.1%–59.0% in the extract group (P<0.05) relative to the control group. These results demonstrate that Shougong powder has antiviral effects against RABV and can potentially be used for the treatment for rabies.

Background: The impact of non-vitamin K antagonist oral anticoagulants (NOACs) on platelet function is still unclear. We conducted a comprehensive ex-vivo study aimed at assessing the effect of the four currently marketed NOACs on platelet function. Methods: We incubated blood samples from healthy donors with concentrations of NOACs (50, 150 and 250 ng/mL), in the range of those achieved in the plasma of patients during therapy. We evaluated: generation of thrombin; light transmittance platelet aggregation (LTA) in response to adenosine diphosphate (ADP), thrombin receptor-activating peptide (TRAP), human γ-thrombin (THR) and tissue factor (TF); generation of thromboxane (TX)B2; expression of protease-activated receptor (PAR)-1 and P-selectin on the platelet surface. Results: All NOACs concentration-dependently reduced thrombin generation compared with control. THR-induced LTA was suppressed by the addition of dabigatran at any concentration, while TF-induced LTA was reduced by factor-Xa inhibitors. ADP- and TRAP-induced LTA was not modified by NOACs. TXB2 generation was reduced by dabigatran, rivaroxaban and apixaban compared with control, particularly at the highest concentrations, but not by edoxaban. We found a concentration-dependent increase of PAR-1 expression after incubation with dabigatran, particularly at the highest concentrations, but not with FXa inhibitors; P-selectin expression was not changed by any drugs. Conclusions: Treatment with the NOACs is associated with measurable ex-vivo changes in platelet function, arguing for antiplatelet effects beyond the well-known anticoagulant activities of these drugs. There are differences, however, among the NOACs, and especially between dabigatran and the FXa inhibitors.

The protozoan parasite Toxoplasma gondii infects approximately 2.5 billion people worldwide. Infection induces a rapid dissemination of parasites throughout the body followed by the formation of lifelong cysts within neurons of the host brain. Both stages require a dynamic immune response comprised of both innate and adaptive cells. Neutrophils are a primary responding cell to acute infection and have been observed in the brain during murine chronic infection. Previous studies investigating human neutrophils found that invasion by Toxoplasma tachyzoites inhibits apoptosis of neutrophils, prolonging their survival under inflammatory conditions. Here, we demonstrate the differentiation of two distinct subsets following exposure of human neutrophil-like-cells (HNLC) to Toxoplasma cysts. In vitro stimulation and imaging studies show cyst-specific induction of cytokines and cyst clearance by HNLCs. Further testing demonstrates that aged HNLCs perform less phagocytosis of cysts compared to non-aged HNLCs. In conclusion, this study identifies a novel response of HNLCs to Toxoplasma cysts and may indicate a role for neutrophils in the clearance of cysts during human infection with Toxoplasma.

A document by Badran Salim. Click on the document to view its contents.

A document by Imran Saeed. Click on the document to view its contents.

The present study aimed to increase the content of minor ginsenosides and enhance the anti-colorectal cancer activity of ginsenosides via biotransformation by Lactiplantibacillus plantarum MB11 screened from fermented foods. A subcutaneous transplantation tumor model of murine colorectal cancer CT26 cells was established in mice to study the anticarcinogenic activities and mechanism of fermented total ginsenosides (FTGs). The results showed that L. plantarum MB11 fermentation increased the content of minor ginsenosides and decreased that of major ginsenosides. FTGs reduced the tumor weight and size compared to the model group. Immunofluorescence and TUNEL analysis showed that FTGs significantly increase the number of caspase-3 cells in tumor tissue and induce cell apoptosis. Mechanically, FTGs activate AMPK/ mTOR autophagy pathway and regulate JAK2/ STAT3 and Bax/ Bcl-2/ caspase-3 apoptosis pathway. Overall, fermentation with L. plantarum MB11 enhanced minor ginsenosides in total ginsenosides, and FTGs induced subcutaneous transplantation tumor autophagy and apoptosis in mice.

The combination of single-cell RNA sequencing and microdissection techniques that preserves positional information has become a major tool for spatial transcriptome analyses. However, high costs and time requirements, especially for experiments at the single cell scale, make it challenging for this approach to meet the demand for increased throughput. Therefore, we proposed combinational DNA barcode (CDB)-seq as a medium-throughput, multiplexed approach combining Smart-3SEQ and CDB magnetic microbeads for transcriptome analyses of microdissected tissue samples. We conducted a comprehensive comparison of conditions for CDB microbead preparation and related factors and then applied CDB-seq to RNA extracts, fresh frozen (FF) and formalin-fixed paraffin-embedded (FFPE) mouse brain tissue samples. CDB-seq transcriptomic profiles of tens of microdissected samples could be obtained in a simple, cost-effective way, providing a promising method for future spatial transcriptomics.

Evaluate clinical effectiveness of Azvudine with data rather than speculationDaishi Li, MD1,2,3*, Yihuang Liu, MD1,2,3*, Minxue Shen, MD1,2,3,4#, Guangtong Deng, MD1,2,3#1 Department of Dermatology, Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China2 National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China3 Furong Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.4 Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, ChinaDaishi Li and Yihuang Liu contributed equally to this study.#Correspondence to Guangtong Deng, Minxue Shen, MD, Department of Dermatology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China. E-mail: dengguangtong@outlook.com; shenmx1988@csu.edu.cn.To the Editor,We appreciate the interest in our article entitled “Real-world effectiveness of Azvudine versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19: A retrospective cohort study”.In their study, Ma et al. stated that antiviral therapies must be administered within five days of symptom onset to be effective. However, our study population included approximately 90% of patients beyond this treatment window. Moreover, we were unable to provide virological results, leading to Ma et al.’s speculation that treatment was unlikely to benefit patients in our study. They further praised the benefits of nirmatrelvir-ritonavir in COVID-19 patients and demonstrated their results supporting a faster time to nucleic acid negative conversion compared to patients receiving Azvudine. In a phase III trial, patients treated with Azvudine only showed a 50% reduction in viral load on the fifth day of treatment, making it difficult to achieve significant clinical efficacy. Ma et al. also concluded that the dose of Azvudine was insufficient for its antiviral effects, using data from drug experimental and pharmacokinetic studies. Finally, they called for the time to make more effective drugs available to COVID-19 patients.1As a retrospective study, we sought to collect more information, particularly on cycle thresholds in COVID-19 patients. However, as we previously reported, the cycle threshold value was no longer used as a discharge criterion during the period and was not regularly checked.2 Moreover, most electronic health records of COVID-19 patients only recorded quantitative results (positive or negative) upon admission, hence virological data was lacking. Nevertheless, it was not necessary for our study, which aimed to evaluate the real-world clinical effectiveness (composite outcomes and mortality). 3Azvudine and nirmatrelvir-ritonavir were recommended for the treatment of COVID-19 patients as early as possible, but these drugs were not strictly used according to the instructions during the special period. We acknowledged several limitations in our retrospective study, including the possibility of selection bias and confounding by indication. We also emphasized that our conclusions were solely based on data from our hospital and that the generalization of our findings required more high-quality and multi-center clinical trials.3 As clinicians, with limited knowledge about drug experimental and pharmacokinetics studies, we refrain from making any response on the topic of its antiviral effect. If there are any questions concerning the antiviral effect, we suggest contacting the corresponding authors of these studies.4,5 We can, however, discuss the clinical effectiveness of the drugs.We agree that numerous studies from other countries support the benefits of nirmatrelvir-ritonavir in treating COVID-19 patients.6 However, a multi-center randomized controlled study based on Chinese patients failed to detect a significant reduction in the risk of all-cause mortality on day 28 and the duration of virus clearance in severe adult COVID-19 patients.7 As our study mainly included severe COVID-19 patients in China, the limited efficacy of nirmatrelvir-ritonavir is not surprising.3,8 While Ma et al. found a faster time to nucleic acid negative conversion in patients receiving nirmatrelvir-ritonavir compared to those receiving Azvudine,1 it did not entirely negate our findings that support the better clinical benefit of Azvudine.3Evaluating a drug’s effectiveness requires clinical data, rather than piecing together several basic articles to make a speculation solely based on its antiviral effect. For instance, remdesivir can effectively inhibit COVID-19 infection in vitro but has no significant effect on COVID-19 patients who are already being ventilated.9Similarly, metformin, the most commonly used oral type 2 diabetic drug, functions in many diseases, including avoiding long COVID.10 Nowadays, compared with other anti-COVID-19 drugs, there is limited clinical study on Azvudine. Therefore, we call for more real-world studies to evaluate the effectiveness of Azvudine in COVID-19 patients.Finally, we appreciate the feedback from some readers regarding the flowchart of patient screening in Figure 1. To avoid any confusion, we would like to clarify that patients were repeatedly counted if they met individual exclusion criteria in the study. Additionally, pregnant patients were mistakenly classified to patients with history diseases. After matching, none of pregnant patients were included in Azudine and nirmatrelvir-ritonavir group. Therefore, our conclusions were still consistent.Declaration of Competing Interest: None.Acknowledgement: This work was supported by the National Natural Science Foundation of China (Grant Nos. 82102803, 82272849 to G. D.), National Natural Science Foundation of Hunan Province (Grant Nos. 2021JJ40976 to G. D.) and Natural Science Fund for Outstanding Youths in Hunan Province (2023JJ20093 to G.D.).Role of the funding source: The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the article for publication. All the authors had full access to all the data in the study and agree to submit the manuscript for publication.

Future development in vehicle design only becomes necessary if environmental concerns take priority and an electric powertrain is feasible. The Hybrid Vehicle is introduced in this work to meet the vehicle's never-ending fuel requirement. A hybrid car, in general, has both an internal combustion engine and an electric power system. The electrical system's accuracy and efficiency significantly impact the vehicle's performance. This researcher focused on the hybrid electric vehicle's powertrain electrical system, which included a fuel cell, a battery, and a solar panel. The Simulink model has been developed and simulated successfully. The Simulink model employs a permanent magnet synchronous motor drive mechanism. The simulation results are compared to state-of-the-art approaches in terms of rotor speed, electromagnetic torque, current, DC-DC converter current and voltage, state of charge, grid charger performance, solar panel performance, and mechanical torque. Furthermore, the performance of the energy storage system was compared to a standard commonly used in hybrid electric car electrical systems in this study.

Objective -The objective of this study was to systematically assess the meta-analyes to determine the lacunae in the literature for PCF following laryngectomy. Methods – Bibliometric analysis on Meta-analyses on PCF after total laryngectomy for laryngeal cancer in PubMed Database. Results – twenty-four meta-analyses were considered eligible and chosen for analysis, Six meta-analyses (25%) focused on the risk factors for PCF in TL. Four meta-analyses (16.6%) on the role of onlay flap. Four meta-analyses (16.6%) focused on the timing of feed initiation. Three meta-analyses (12.5%) on using stapler for pharyngeal closure. Two meta-analyses on types of pharyngeal reconstruction. Other meta-analysis analysed the use of salivary bypass tubes, the method of pharyngeal closure, organ preservation protocols on PCF, primary and secondary TEP and the effect of non-surgical treatment on PCF. Conclusion - Despite the plenty of published meta-analysis, there is a lack of scrutiny on some critical aspects of PCF.

Case: A 41-year-old man with no prior cardiac history and a history of regular narrow QRS tachycardia, presenting with frequent paroxysmal palpitations, was referred to our institution. The tachycardia was adenosine-sensitive, leading to the acute termination of the tachycardia. The baseline electrocardiogram was unremarkable. During an electrophysiology study (EPS), supraventricular tachycardia (SVT) was easily induced by ventricular extrastimuli. Figure [1](#fig-cap-0003) shows a single ventricular extrastimulus applied from the right ventricular apex (RVa) during the tachycardia, and this finding was reproducible. Questions: What is the mechanism of the observed response? What are the clinical implications?

This paper presents two novel mixed-uncertainty state estimators for discrete-time descriptor linear systems, namely linear time-varying mixed-uncertainty filter (LTVMF) and linear time-invariant mixed-uncertainty filter (LTIMF). The former estimator is based on the minimum-variance approach, from which quadratic and explicit formulations are derived and addressed to LTI and LTV systems. Both formulations incorporate the knowledge of state linear constraints, such as equality (in the descriptor form) and inequality, to mitigate precision and accuracy issues related to initialization and evolution of the state estimates. The explicit version is developed to reduce the computational burden of quadratic solvers, which is based on a particularity of the state inequality constraints. The LTIMF algorithm is based on the mixed H 2 / H ∞ criterion motivated by performing low-cost computations. This speed benefit is originated from a reachability analysis involving constant design matrices. Both LTVMF and LTIMF algorithms solve state-estimation problems in which the uncertainties are combined to yield the so-called mixed-uncertainty vector, which is composed by set-bounded uncertainties, characterized by constrained zonotopes, and stochastic uncertainties, characterized by Gaussian random vectors. As mixed-uncertainty vectors imply biobjective optimization problems, we innovatively present multiobjective arguments to justify the choice of the solution on the Pareto-optimal front. According to these arguments, LTVMF is introduced with a cost normalization, which enables the combination of beyond minimum-variance approaches. Likewise, the mixed H 2 / H ∞ criterion of LTIMF is introduced with slack variables to improve the quality of the state estimates. In order to discuss the advantages and drawbacks, the state estimators are tested in two numerical examples.

Successful management of severe generalized tetanus in a 23-year man with Phenobarbital adjuvant: a case reportArezoo Ahmadi1, Elahe Karimpour-Razkenari2, Ramin Ansari2, Mahforouzalsadat Marashi3, Hamidreza Sharifnia1, Atabak Najafi1, Mojtaba Mojtahedzadeh2*1 Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran2 Department of Anesthesiology and Critical Care, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.3 Department of Infectious Disease and Tropical Medicine, School of Medicine, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.Corresponding author: Mojtaba Mojtahedzadeh; Pharmacist; Board Certified of Pharmacotherapy Specialty; Fellowship of Critical Care Pharmacotherapy; Department of Clinical Pharmacy, Tehran University of Medical Sciencesmojtahed@tums.ac.irSina Hospital, Imam Khomeini St, Hasanabad Square, Tehran, IranTel: +982164120Postal code: 1136746911Fax number: 00982166348587Abstract With a mortality rate of up to 50%, generalized tetanus is still a global concern, especially in low and middle-income countries. A 23-year-old man from Afghanistan was admitted to Sina Hospital, affiliated with Tehran University of Medical Sciences, with the chief complaint of generalized severe spasms and lockjaw. The patient had a history of skin lesions and had never been vaccinated against tetanus. He admitted to the intensive care unit after intubation in emergency room, with diagnose of severe generalized tetanus. After receiving tetanus immunoglobulin and intravenous metronidazole, a combination therapy of midazolam, propofol, atracurium and morphine was administered. Due to the refractory muscular spasms intravenous phenobarbital started and little by little recovery was achieved. With no symptom recurrence, after receiving the first 2 doses of the Td vaccine, the patient was discharged on day 42.Keywords: Tetanus, phenobarbital, Intensive care

Objective: To investigate the hypothesis that maternal haemoglobin (Hb) levels in twin pregnancy fall between the first and second trimesters, and that the size of the fall is associated with gestational age at birth and birthweight (BW). Design: Retrospective study. Setting: Inner London Maternity Unit. Population: Pregnant women with twin pregnancies delivering two live, phenotypically normal neonates, after 24 +0 weeks of gestation, between October 2009 and September 2021. Methods: Measurement of Hb, at ≤14 +0 weeks of gestation, (Hb1) and again at 20 +0-30 +0 weeks gestation (Hb2). Hb drop was defined as Hb1-Hb2. Small for gestational age was defined as BW <10th percentile for gestation. The association of Hb drop with gestational age at birth, BW, SGA and intertwin BW discrepancy of ˃25%, was evaluated. Main outcome Measures: Gestational age at birth , incidence of SGA neonates and/or intertwin BW discrepancy >25%. Results: 925 women with twin pregnancies. Maternal Hb1 did not correlate with gestational age or SGA or twins with BW discrepancy >25%. However, a larger Hb drop was associated with a higher gestational age at birth (p<0.001), a larger BW of both twin 1 and 2 (p<0.001) and a trend towards reduction in the incidence of delivering one or two SGA neonates (p=0.005 and p=0.003, respectively) or twins with BW discrepancy of >25% (p=0.005). Conclusions: The study has shown that a larger maternal Hb drop from the first to the second trimester is associated with a higher gestational age at birth, a larger BW and smaller BW discrepancy in twin pregnancies.

A document by Ilya N. Sorokin. Click on the document to view its contents.

Reply by Casella et al to Letter Regarding Article,

A document by Pradip Jana. Click on the document to view its contents.

Objective: To study the adverse maternal and perinatal outcomes in women with severe features of preeclampsia among different ranges of proteinuria. Design: Prospective Cohort Study. Setting: Department of Obstetrics and Gynaecology, Jawaharlal Institute of Post-graduate Medical Education and Research (JIPMER), Puducherry, India. Population: 202 singleton women with severe features of preeclampsia. Methods: Women satisfying the inclusion criteria were managed based on department protocol, assessed based on delivery outcomes, adverse maternal and perinatal outcomes. These women were followed up till 12 weeks postpartum. Main Outcome Measures: Composite adverse maternal and perinatal outcomes were recorded using ROC curves. Sensitivity, specificity, positive and negative predictive values of proteinuria were used in predicting adverse outcomes. Results: There was a significant association between the values of antepartum 24-proteinuria and urine PCR (p<0.001). There were 33 stillbirths (16.34%) and 19 neonatal deaths (11.24%). 24-hour proteinuria was found to have a significant correlation with composite adverse perinatal outcome (p=0.002) and individual outcomes of NICU admission for >48 hours (p=0.01) and neonatal sepsis (p=0.02) but not adverse maternal outcomes (p=0.998). The optimum cut-off adverse neonatal outcomes was 905 mg proteinuria/day (sensitivity-74.2%; specificity-51%). 15% of the women had a persistently elevated urine PCR at 3 months postpartum. Conclusion: In women with severe features of preeclampsia, severe and massive proteinuria were related to composite adverse perinatal outcome, but not composite adverse maternal outcome. 24-hour urine protein, but not Urine PCR was significantly associated with persistent proteinuria. The women with persistent postpartum proteinuria (15%) require long term follow up to assess the development of chronic renal diseases. Funding: No external funding was utilized for this study. Keywords: hypertension, preeclampsia; proteinuria Tweetable abstract: Proteinuria is associated with adverse perinatal outcomes and persistent proteinuria in women with severe features of preeclampsia.

Enterovirus D68 (EV-D68) is a respiratory virus that primarily affects children and has been associated with sporadic outbreaks of respiratory illness worldwide. This study aimed to carry out a literature review considering several aspects involving EV-D68 infection: epidemiology, molecular evolution, prevention, diagnosis, and treatment of this infection. Data from 976 whole genome sequences (WGS) of EV-D68 collected between September 1977 to September 2022 showed substitution rates of 4.06E10‐3 nucleotides per site per year (s/s/y). Phylogenetic tree of EV-D68 by clades (A1, A2, B, B1, B2, B3, and C) was performed. The time to the most recent common ancestor (tMRCA) of A1 was 2005-04-17 in the USA, A2 was 2003-12-23 in China, B was 2003-07-06 in China, B1 was 2010-03-21 in Vietnam, B2 was 2006-11-25 in Vietnam, B3 was 2011-01-15 in China, and C was 2000-06-27 in the USA. The molecular origin of the EV-D68 was in Canada in 1995, later it was disseminated in France in 1997, the USA in 1999, Asia in 2008, the Netherlands in 2009, New Zealand in 2010, Mexico in 2014, Kenya in 2015, Sweden in 2016, Switzerland in 2018, Spain in 2018, Belgium in 2018, Australia in 2018, and Denmark in 2019. Recently, in 2022 this virus circulated in the USA. The immune response to EV-D68 involves both innate and adaptive immunity, with the production of neutralizing antibodies and activation of T cells playing crucial roles. Prevention strategies for EV-D68 include practicing good hand hygiene, respiratory etiquette, and avoiding close contact with infected individuals. In conclusion, EV-D68 was originated in Canada in 1995 and spread to Europe, Asia, Oceania, Latin America, and Africa.

Angiomyofibroblastoma is a rare tumor that originates from mesenchymal tissue and is most frequently found in women of childbearing age. Angiomyofibroblastoma often grows in the female external genitalia,and there have been occasional reports in the scrotum and inguinal region of males.Due to the lack of specificity in the clinical symptoms and signs of Angiomyofibroblastoma,diagnosis has been challenging,particularly when it comes to intracardiac angiomyofibroblastoma.Ultrasound is typically the preferred method of examination for detecting intracardiac masses. This report presents a case study of a 47-year-old woman with intracardiac angiomyofibroblastoma.The preoperative diagnosis of Angiomyofibroblastoma can be further improved by analyzing ultrasound images in combination with other imaging features.

A giant coronary artery aneurysm (GCAA) concurrent with coronary artery fistula is a rare condition, and it becomes even more unusual when combined with a single coronary artery (SCA) anomaly. Here we report such an extremely rare case, who is a 35-year-old woman presenting with severe chest distress. A GCAA with fistula to the right ventricle was noted, occurring in a single coronary artery, diagnosed by multimodality cardiovascular imaging techniques. Both GCAA and coronary artery fistula can cause severe cardiac complications, which jeopardize life. While an SCA is mostly asymptomatic, it may also lead to sudden cardiac death as well. Therefore, surgical intervention was recommended. We chose a novel thrombus-inducing strategy to eliminate the GCAA and repair the fistula. Symptoms were relieved after the surgery, and the patient remained asymptomatic over 8 months of follow-up.