Short communication: Molecular markers for epithelial cells across gastrointestinal tissues and fecal RNA in preweaning dairy calves

The objective of this study was to compare the transcription of gene markers for gastrointestinal (GI) epithelial cells, including fatty acid binding protein 2 (FABP2) and cytokeratin 8 (KRT8), and tight junction complex genes (TJP1, CLDN1, CLDN4) in fecal RNA against several GI tract tissue sections in dairy calves. Eight healthy Jersey calves were euthanized at 5 wk of age, and postmortem samples were collected from rumen, duodenum, jejunum, ileum, large intestine, cecum, and feces for total RNA isolation. Tissues and fecal samples were immediately frozen in liquid nitrogen until RNA isolation. A real-time quantitative PCR analysis was performed using a single standard curve composited of equal amounts of all samples, including cDNA from fecal and GI tract tissues. The mRNA expression of the tight junctions TJP1, CLDN1, and CLDN4 was greater in fecal RNA compared with lower GI tract tissues (i.e., duodenum, jejunum, ileum, large intestine, and cecum). Similar to fecal RNA, rumen tissue had greater expression of tight junctions CLDN1 and CLDN4 than lower GI tract tissues. Similarly, rumen tissue had greater expression of TPJ1 than all lower GI tract tissues except duodenum. The expression of TJP1 and CLDN4 was greater in fecal RNA than in rumen tissue; in contrast, CLDN1 mRNA expression was greater in rumen tissue than in the fecal RNA. The expression of FABP2 was greater in duodenum in comparison to all tissue except ileum. The mRNA expression of FABP2 in fecal samples was similar to jejunum and ileum. The expression of KRT8 in fecal samples was similar to duodenum, large intestine, and cecum. The fecal RNA had a greater expression of KRT8 in comparison to jejunum and ileum. The rumen tissue had the lowest mRNA expression of KRT8. The expression levels of FABP2, KRT8, and tight junction genes observed in fecal transcripts suggest that a considerable amount of RNA derived from GI tract epithelial cells can be detected in fecal RNA, which is in agreement with previous data in neonatal dairy calves and other biological models including humans, rodents, and primates. The greater expression of tight junctions in fecal RNA in comparison to sections of the low GI remains to be understood, and due to the importance of tight junctions in GI physiology, further clarification of this effect is warranted. The similarities in mRNA expression of FABP2 and KRT8 between fecal RNA and intestinal sections add up to the accumulating evidence that fecal RNA can be used to investigate molecular alterations in the GI tract of neonatal dairy calves. Further research in this area should include high-throughput transcriptomic analysis via RNA-seq to uncover novel molecular markers for specific sections of the GI tract of neonates.

Medium term results following heart transplantation for end stage heart failure: A single center experience of 257 patients

OBJECTIVE

End stage heart failure is a lethal disease with a dismal 5 year survival. Heart transplantation has proven to be a highly effective modality of treatment in appropriately selected group of such patients. This is a retrospective analysis of medium term outcomes of heart transplantation in the setting of a private health facility in India. The objective of this study was two fold.

METHODS

The outcome of 257 heart transplants done at a single centre from October 2012 to October 2019 was analyzed. Patients with combined Heart and lung transplants and those whose complete medical records were unavailable were excluded from the study. Survival was tracked at 60 days, 90 days, one year and beyond for a maximum of 7 years. Preoperative patient risk profiles were characterized on the basis of INTERMACS category.

RESULTS

There were 176 male and 81 female patients. The age range was from 8 months to 78 years with a mean of 32.9 years. Survival at 2 months was 87%, at 90 days was 83%, at one year was 81%, 2 years was 75%, at 3 years was 72% and at 5 years and beyond was 62% for the whole series. Strong predictors of 90 day mortality included INTERMACS category (odd's ratio 0.289, p = 0.000) and creatinine more than 1.5 mg/dl (odd's ratio 2.48, p = 0.056). Recipient pulmonary vascular resistance and donor organ ischemic times were not found to be statistically significant factors affecting outcome. Medium term survival was influenced by INTERMACS category (Hazard ratio > 3 for INTERMACS category 1 compared to INTERMACS 4 or 5, p < 0.0001) and creatinine > 1.5 mg/dl (Hazard ratio 2.15, p = 0.003). This effect of creatinine was related to the age of the recipient. Hazard ratio 1.4, p = 0.524 if age <30 and Hazard ratio 4.78, p = 0.006, if age was >50.

CONCLUSION

Satisfactory medium term outcome is possible after heart transplantation even in resource constrained environment of a developing country.

Developing Surgical Oncology Services in Resource Constrained Settings: Results of a Systematic and Motivated Approach

Background: General surgeons trained in surgical oncology and working in a general service hospital can offer and provide a wide variety of oncological services although significant limitations exist compared with a true tertiary cancer care center in developed high income countries. Providing optimal and standard of care surgical oncology services is truly demanding and limitations in ancillary and support services can potentially limit the quality of care provided in resource constrained settings like ours. Aim: The aim of this study was to analyze the patterns of care, surgical outcomes in terms of morbidity and mortality, quality of resection in terms of margins and nodal yield over a period of 08 weeks in a general service hospital with resource constrained setting and with two trained and motivated surgical oncologists. Methods: Data of 22 patients with solid organ cancers who underwent major operative treatment both curative and palliative under the surgical oncology services were analyzed retrospectively. All patients were evaluated clinically, imaging as required and pathologic tissue diagnosis of cancer obtained as was possible and after adequate preoperative preparation were operated upon. Results: Four patients of carcinoma rectum underwent low anterior resection with diverting ileostomy, one patient with rectal cancer had APR with permanent end colostomy, two patients underwent total thyroidectomy for papillary thyroid cancer, eight patients underwent modified radical mastectomy for carcinoma breast, two patients had optimal cytoreductive surgery for carcinoma ovary -one patient upfront and another as interval cytoreduction, two cases of soft tissue tumor underwent limb salvage surgery, one case of carcinoma stomach underwent subtotal gastrectomy, one case of carcinoma cecum underwent classic right radical hemicolectomy. Two patients underwent emergency exploration for acute abdomen who were otherwise metastatic for palliation. All but one case received neoadjuvant therapy prior to surgery in carcinoma rectum, one case of carcinoma ovary and carcinoma breast were operated after neoadjuvant chemotherapy. Overall there was only one margin positive resection after low anterior resection who was operated upfront due to impending obstruction. The average nodal yield in all cases of colorectal carcinomas and breast cancer cases were as per current NCCN standards. Morbidities included seroma collection in 3 patients, minor surgical site infection in 2 patients, peristomal allergy in two patients, there were no deaths in elective cases. Conclusion: Providing quality surgical oncology services in a resource constrained general service hospital is challenging. Through an aggressive, well planned and motivated approach with a good surgical oncology training background and with available resources it is possible to achieve a varied spectrum, quality care and an improved and sustainable healthcare oncology systems for better outcomes even in these settings.

Selectively arranged single-wire based nanosensor array systems for gas monitoring

Gas nanosensors, comprised of arrays of nanoelectrodes with finger-widths of ∼100 nm developed by electron beam lithography and aerosol assisted chemical vapor deposited non-functionalized and Pt-functionalized tungsten oxide nanowires (<100 nm) subsequently integrated across the pairs of electrodes via the dielectrophoresis method, are developed in this work. The functionality of these devices is validated towards various concentrations of NO2 and C2H5OH. The results demonstrate reproducible and consistent responses with better sensitivity and partial selectivity for the non-functionalized systems to NO2, as opposed to the Pt-functionalized systems, which display better sensing properties towards C2H5OH with a loss of response to NO2. These results are explained on the basis of the additional chemical and electronic interactions at the Pt/tungsten oxide interface, which increase the pre-adsorption of oxygen species and make the functionalized surface rather more sensitive to C2H5OH than to NO2, in contrast to the non-functionalized surface.