Role of Cardiopulmonary Exercise Testing in Predicting Perioperative Outcomes in Cancer Patients Undergoing Thoracoabdominal Surgeries; an Observational Cohort Study

Introduction: The cancer patients are at a high risk of developing perioperative complications. Cardiopulmonary exercise testing (CPET) is a non-invasive, perioperative risk stratification tool that predicts perioperative morbidity and mortality. Prior literature has concluded that CPET has a valuable role in predicting post-operative complications in major surgical procedures. However, the data on the effectiveness of CPET in evaluating the perioperative risk in cancer-specific populations are limited. This study assessed the usefulness of CPET in perioperative risk stratification of patients with thoracoabdominal cancer who underwent elective major thoracoabdominal surgeries. Materials and Methods: A retrospective observational cohort study was conducted on cancer patients that underwent pre-operative CPET at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan, from September 2017 to September 2019. All adult male and female patients with a significant medical history for cancer of the thoracoabdominal region who underwent CPET before a major thoracoabdominal surgery were included in the study. Results: A total of 32 patients were included in the present investigation. The mean age of the sample was 62.75 ± 10.18 years, and the majority of the participants were female. Following surgery, 53% of the participants had post-operative complications in terms of morbidity and mortality. Fifteen participants had an anaerobic threshold (AT) of ≥11.0 ml/ kg/min. Among these, 12 participants had an uneventful surgery. On the contrary, among 17 participants that were considered to have a high risk (<11.0 ml/kg/min) for surgery, 14 subjects (82%) had at least one complication (including mortality). The sensitivity and specificity of CPET to anticipate complications during oncological surgery were calculated to be 82% and 80%, respectively. The mean AT of participants with uneventful surgery was calculated to be 11.83 ± 1.01 ml/kg/min. This was statistically greater than the AT of subjects that had morbidity (9.86 ± 1.20 ml/kg/min) or mortality (8.95 ± 0.35 ml/kg/min) (P < 0.001). Conclusion: CPET, when using AT alone as an indicator, can provide a good-excellent prediction of perioperative outcome among oncology patients undergoing major thoracoabdominal surgical procedures

Genetic Improvement of Sorghum for Biomass Traits Using Genomics Approaches

Nonrenewable energy resources deplete with the passage of time due to rapid increase in industrialization and population. Hence, countries worldwide are investing dearly in substitute energy resources like biofuel from miscellaneous set of feedstocks. Among the energy crops, sorghum serves as a model crop due to its drought tolerance, small genome size (730 Mb), high biomass, dry matter contents, quick growth, wide adaptability to diverse climatic and soil conditions and C4 photosynthesis. Sweet sorghum with high sugar content in stalk is an efficient feedstock for advanced biofuels and other bio-based products from sugars. However, high biomass sorghum has the utility as a feedstock for cellulosic biofuels. The enhanced yield of monomeric carbohydrates is a key to cheap and efficient biofuel production. The efficiency of lignocellulosic biofuels is compromised by recalcitrance to cell wall digestion, a trait that cannot be efficiently improved by traditional breeding. Therefore, scientists are looking for solutions to such problems in biomass crop genomes. Sorghum genome has been completely sequenced and hence this crop qualifies for functional genomics analysis by fast forward genetic approaches. This chapter documents the latest efforts on advancement of sorghum for biomass potential at morphological and molecular level by exploiting genomics approaches

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Performance of Epoxy-Injection and Microorganism-Based Crack-Healing Techniques on Cracked Flexural Members

Reinforced concrete (RC) members are designed to crack and the crack width usually remains within the service limit; however, these micro-cracks make structures susceptible to the infiltration of aggressive substances, especially near the coastline. Thus, the healing of these cracks is necessary before they further widen and spread. This study focused on the development and application of a crack-healing solution using microorganisms of the class bacillus; healing was observed through a crack-sensing camera. The aim was to regain the load-carrying capacity of the concrete member to meet the serviceability limit state requirements after healing the crack. The performance of the crack-healing solution was compared with the epoxy-injection method. Five full-scale RC beams of 100 × 200 × 1800 mm in dimension were cast using concrete designed with a cylindrical compressive strength of 21 MPa. After curing for up to 28 days, the beam specimens were tested and subjected to four-point bending to produce a flexural crack of width 1–3 mm. One of the beams was treated to fill the crack by injecting epoxy, while the three other similar beams were treated using a crack-healing solution consisting of bacteria (Bacillus subtilis), nutrient (calcium nitrate), and transporting agents. The healing solution was applied directly to the opened crack with silica gel and with cement slurry in three similar beams cracked under flexural load. The cracks in the beam treated with the crack-healing solution were sealed and kept moist for a further 14 days. After curing, all of the beams including the control (without treatment) were tested again and were subjected to four-point bending until failure to observe the effect of the crack repairs on the flexural response. It was observed that both systems were equally good at enhancing the serviceability limit state and improving the load-carrying capacity