Integrated breeding approaches to enhance the nutritional quality of food legumes

Global food security, both in terms of quantity and quality remains as a challenge with the increasing population. In parallel, micronutrient deficiency in the human diet leads to malnutrition and several health-related problems collectively known as "hidden hunger" more prominent in developing countries around the globe. Biofortification is a potential tool to fortify grain legumes with micronutrients to mitigate the food and nutritional security of the ever-increasing population. Anti-nutritional factors like phytates, raffinose (RFO's), oxalates, tannin, etc. have adverse effects on human health upon consumption. Reduction of the anti-nutritional factors or preventing their accumulation offers opportunity for enhancing the intake of legumes in diet besides increasing the bioavailability of micronutrients. Integrated breeding methods are routinely being used to exploit the available genetic variability for micronutrients through modern "omic" technologies such as genomics, transcriptomics, ionomics, and metabolomics for developing biofortified grain legumes. Molecular mechanism of Fe/Zn uptake, phytate, and raffinose family oligosaccharides (RFOs) biosynthesis pathways have been elucidated. Transgenic, microRNAs and genome editing tools hold great promise for designing nutrient-dense and anti-nutrient-free grain legumes. In this review, we present the recent efforts toward manipulation of genes/QTLs regulating biofortification and Anti-nutrient accumulation in legumes using genetics-, genomics-, microRNA-, and genome editing-based approaches. We also discuss the success stories in legumes enrichment and recent advances in development of low Anti-nutrient lines. We hope that these emerging tools and techniques will expedite the efforts to develop micronutrient dense legume crop varieties devoid of Anti-nutritional factors that will serve to address the challenges like malnutrition and hidden hunger.

Phase Ib study of eprenetapopt (APR-246) in combination with pembrolizumab in patients with advanced or metastatic solid tumors

Background

We conducted a phase I, multicenter, open-label, dose-finding, and expansion study to determine the safety and preliminary efficacy of eprenetapopt (APR-246) combined with pembrolizumab in patients with advanced/metastatic solid tumors (ClinicalTrials.gov NCT04383938).

Patients and methods

For dose-finding, requirements were non-central nervous system primary solid tumor, intolerant to/progressed after ≥1 line of treatment, and eligible for pembrolizumab; for expansion: (i) gastric/gastroesophageal junction tumor, intolerant to/progressed after first-line treatment, and no prior anti-programmed cell death receptor-1 (PD-1)/programmed death-ligand 1 (PD-L1) therapy; (ii) bladder/urothelial tumor, intolerant to/progressed after first-line cisplatin-based chemotherapy, and no prior anti-PD-1/PD-L1 therapy; (iii) non-small-cell lung cancer (NSCLC) with previous anti-PD-1/PD-L1 therapy. Patients received eprenetapopt 4.5 g/day intravenously (IV) on days 1-4 with pembrolizumab 200 mg IV on day 3 in each 21-day cycle. Primary endpoints were dose-limiting toxicity (DLT), adverse events (AEs), and recommended phase II dose (RP2D) of eprenetapopt.

Results

Forty patients were enrolled (median age 66 years; range 27-85) and 37 received eprenetapopt plus pembrolizumab. No DLTs were reported and the RP2D for eprenetapopt in combination was 4.5 g/day IV on days 1-4. The most common eprenetapopt-related AEs were dizziness (35.1%), nausea (32.4%), and vomiting (29.7%). AEs leading to eprenetapopt discontinuation occurred in 2/37 patients (5.4%). In efficacy-assessable patients (n = 29), one achieved complete response (urothelial cancer), two achieved partial responses (NSCLC, urothelial cancer), and six patients had stable disease.

Conclusions

The eprenetapopt plus pembrolizumab combination was well tolerated with an acceptable safety profile and showed clinical activity in patients with solid tumors.

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Eprenetapopt in combination with pembrolizumab was well tolerated with an acceptable safety profile.

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Eprenetapopt plus pembrolizumab demonstrated clinical activity in heavily pre-treated patients with solid tumors.

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This is the first clinical trial evaluating the combination of a p53 reactivator with immuno-oncology therapy.

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This work informs the development of treatment combining immunotherapy with agents targeting specific pathways such as p53.

The influence of anastomotic techniques on postoperative anastomotic complications: Results of the Oesophago-Gastric Anastomosis Audit

BACKGROUND

The optimal anastomotic techniques in esophagectomy to minimize rates of anastomotic leakage and conduit necrosis are not known. The aim of this study was to assess whether the anastomotic technique was associated with anastomotic failure after esophagectomy in the international Oesophago-Gastric Anastomosis Audit cohort.

METHODS

This prospective observational multicenter cohort study included patients undergoing esophagectomy for esophageal cancer over 9 months during 2018. The primary exposure was the anastomotic technique, classified as handsewn, linear stapled, or circular stapled. The primary outcome was anastomotic failure, namely a composite of anastomotic leakage and conduit necrosis, as defined by the Esophageal Complications Consensus Group. Multivariable logistic regression modeling was used to identify the association between anastomotic techniques and anastomotic failure, after adjustment for confounders.

RESULTS

Of the 2238 esophagectomies, the anastomosis was handsewn in 27.1%, linear stapled in 21.0%, and circular stapled in 51.9%. Anastomotic techniques differed significantly by the anastomosis sites (P < .001), with the majority of neck anastomoses being handsewn (69.9%), whereas most chest anastomoses were stapled (66.3% circular stapled and 19.3% linear stapled). Rates of anastomotic failure differed significantly among the anastomotic techniques (P < .001), from 19.3% in handsewn anastomoses, to 14.0% in linear stapled anastomoses, and 12.1% in circular stapled anastomoses. This effect remained significant after adjustment for confounding factors on multivariable analysis, with an odds ratio of 0.63 (95% CI, 0.46-0.86; P = .004) for circular stapled versus handsewn anastomosis. However, subgroup analysis by anastomosis site suggested that this effect was predominantly present in neck anastomoses, with anastomotic failure rates of 23.2% versus 14.6% versus 5.9% for handsewn versus linear stapled anastomoses versus circular stapled neck anastomoses, compared with 13.7% versus 13.8% versus 12.2% for chest anastomoses.

CONCLUSIONS

Handsewn anastomoses appear to be independently associated with higher rates of anastomotic failure compared with stapled anastomoses. However, this effect seems to be largely confined to neck anastomoses, with minimal differences between techniques observed for chest anastomoses. Further research into standardization of anastomotic approach and techniques may further improve outcomes.

Spatio-temporal dynamics of water quality in river sources of drinking water in Uttarakhand with reference to human health

Any contamination in potable water leads to high risk on human health. Hence, it is inevitable to characterize water quality and assess temporal change with reference to human health. In this paper, nineteen water quality parameters from 50 sources of drinking water supply operated by state agency Uttarakhand Jal Sansthan (UJS) were analysed. The water samples were collected for pre-monsoon (May) and post-monsoon (November) seasons for the year 2010, 2011, 2018 and 2019. Multivariate analysis such as Pearson's correlation coefficient (r), K-mean, hierarchical clustering and principle component analysis (PCA) were applied to examine the drinking water quality at source sites. The strength of correlation among the parameters is reduced over the time. Cluster analysis provides six major hydro-chemical clusters in the study region. Clusters were compact during 2010-2011 and converted to overlapping structure in later period. The size of clusters was change from two clusters to six clusters during 2018-2019. These hydro-chemical clusters were examined through PCA and established six major hydro-chemical components of water quality. The physico-chemical parameters, namely, pH, alkalinity, TH, TDS, Na, K, Ca, Mg, Cl and SO₄, were in PC-1, the heavy metals in PC-3, turbidity in PC-4, TC in PC-5 and PC-6 is combination of turbidity, NO₃ and TC, whereas PC-2 was a mix of pH and Na and K salts. Study highlighted that the water quality has changed over the time due to runoff of plant debris, erosion, agricultural fertilizer, development activities and local geology hosts. Each PCs was mapped with associated human health issues. Result reveals that structures and pattern of PCs indicate several human health diseases over the later period with seasonal effects.

Cutaneous Ureterostomy or Ileal Conduit Urinary Diversion: Can We Spare the Bowel Following Radical Cystectomy in Patients with Solitary Functioning Kidney?

To compare the outcomes between cutaneous ureterostomy and ileal conduit urinary diversion in patients with solitary functioning kidney, undergoing radical cystectomy. This study was a retrospective analysis of the patients, with solitary functioning kidney, who underwent radical cystectomy with either cutaneous ureterostomy or ileal conduit from January 2014 to May 2019. Baseline characteristics, perioperative outcomes, and follow-up renal function were evaluated and compared. For renal function outcomes, we assessed the estimated glomerular filtration rate (eGFR) and included patients with a follow-up of at least 2 years. A total of 43 patients were included in the study, 23 of them underwent cutaneous ureterostomy and 20 underwent ileal conduit urinary diversion. The two groups were similar with respect to their baseline demographic and clinical characteristics. Operative time (p < 0.001), time to drain removal (p = 0.016), postoperative length of hospital stay (p = 0.018), and bowel-related complications (p = 0.047) were significantly lower in patients who underwent cutaneous ureterostomy. The eGFR was comparable at baseline, and till 1 year of follow-up. But, there was a greater decline in eGFR over 2 years, in patients who received cutaneous ureterostomy (p = 0.039). The present study shows that cutaneous ureterostomy has better perioperative, and comparable short-term renal function outcomes over ileal conduit urinary diversion. However, over 2 years of follow-up, there was an increased likelihood, and greater degree of decline in eGFR in patients who received cutaneous ureterostomy.

Who to screen and how to screen for celiac disease

Celiac disease (CeD) is a chronic gluten-induced enteropathy with plethoric manifestations. The typical manifestations of CeD such as chronic diarrhea and malabsorption are widely recognized, however, many patients have atypical manifestations like iron deficiency anemia, idiopathic short stature, hypertransaminesemia or infertility, etc. These patients often present to the primary care physicians and/or non-gastrointestinal specialties. However, due to a lack of awareness among the healthcare professionals about the various atypical manifestations, many patients are not screened for CeD. In this review, we have summarized the available literature about the prevalence of CeD in various gastrointestinal (chronic diarrhea) and non-gastrointestinal conditions (iron deficiency anemia, short stature, cryptogenic hypertransaminesemia, cryptogenic cirrhosis or idiopathic ataxia etc.) where the diagnosis of CeD should be con-sidered. In addition, we also discuss special scenarios where screening for CeD should be considered even in absence of symptoms such as patients with type 1 diabetes, Down’s syndrome, and first-degree relatives of patients with CeD. Further, we discuss the diagnostic performance and limitations of various screening tests for CeD such as IgA anti-tissue transglutaminase antibodies, anti-endomysial antibodies and anti-deamidated gliadin antibodies. Based on the current recommendations, we propose a diagnostic algorithm for patients with suspected CeD.

951 Boerhaave's Outcome in a Single Tertiary Oesophago-Gastric Centre Over 5-Years

Aim

To present modern day outcomes for Boerhaave's in a single tertiary oesophago-gastric centre.

Method

This study retrospectively analysed the records of consecutive patients diagnosed with Boerhaave's between June 2016 and June 2021.

Results

In this case series (n=18) patients were included, male (n=14) and female (n=4), with a mean age of 61. Treatment was commenced within 24 hours of symptom onset in (n= 7;38.8%), and after (n=11; 61.1%).

All Patients had an OGD performed on arrival in theatre to plan operative management. The site of the oesophageal perforation was identified as: distal third (n=14;77.8%); middle third (n=4;22.2%). Majority of patients were treated surgically (61.11%), with only seven non operatively. Within the surgical group the most common operative technique was primary repair over T-tube with intercostal drains via Thoracotomy (n=8;72.72%), followed by a trans-hiatal primary repair via a laparotomy (n=2;18.18%) or laparoscopy (n=1;9.1%).

There were three major complications requiring unplanned return to theatre. One patient required a redo-thoracotomy, decortication, and evacuation of an empyema. One patient had a consistent leak post primary repair from oesophageal perforation requiring Eso-sponge vacuum therapy for further healing and closure of the tear. Another patient required a revision of feeding Jejunostomy.

There was zero mortality both in hospital and in 30- and 90-days following admission. The average hospital stay was 34 days, of which 11 days was in Intensive care.

Conclusion

With this data, we can conclude that aggressive medical management coupled with surgical management as well as mediastinal debridement and washout resulted in no mortality.

Longitudinal single-cell transcriptomics reveals distinct patterns of recurrence in acute myeloid leukemia

Background

Acute myeloid leukemia (AML) is a heterogeneous and aggressive blood cancer that results from diverse genetic aberrations in the hematopoietic stem or progenitor cells (HSPCs) leading to the expansion of blasts in the hematopoietic system. The heterogeneity and evolution of cancer blasts can render therapeutic interventions ineffective in a yet poorly understood patient-specific manner. In this study, we investigated the clonal heterogeneity of diagnosis (Dx) and relapse (Re) pairs at genetic and transcriptional levels, and unveiled the underlying pathways and genes contributing to recurrence.

Methods

Whole-exome sequencing was used to detect somatic mutations and large copy number variations (CNVs). Single cell RNA-seq was performed to investigate the clonal heterogeneity between Dx-Re pairs and amongst patients.

Results

scRNA-seq analysis revealed extensive expression differences between patients and Dx-Re pairs, even for those with the same -presumed- initiating events. Transcriptional differences between and within patients are associated with clonal composition and evolution, with the most striking differences in patients that gained large-scale copy number variations at relapse. These differences appear to have significant molecular implications, exemplified by a DNMT3A/FLT3-ITD patient where the leukemia switched from an AP-1 regulated clone at Dx to a mTOR signaling driven clone at Re. The two distinct AML1-ETO pairs share genes related to hematopoietic stem cell maintenance and cell migration suggesting that the Re leukemic stem cell-like (LSC-like) cells evolved from the Dx cells.

Conclusions

In summary, the single cell RNA data underpinned the tumor heterogeneity not only amongst patient blasts with similar initiating mutations but also between each Dx-Re pair. Our results suggest alternatively and currently unappreciated and unexplored mechanisms leading to therapeutic resistance and AML recurrence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12943-022-01635-4.

Longitudinal single-cell transcriptomics reveals distinct patterns of recurrence in acute myeloid leukemia

BACKGROUND

Acute myeloid leukemia (AML) is a heterogeneous and aggressive blood cancer that results from diverse genetic aberrations in the hematopoietic stem or progenitor cells (HSPCs) leading to the expansion of blasts in the hematopoietic system. The heterogeneity and evolution of cancer blasts can render therapeutic interventions ineffective in a yet poorly understood patient-specific manner. In this study, we investigated the clonal heterogeneity of diagnosis (Dx) and relapse (Re) pairs at genetic and transcriptional levels, and unveiled the underlying pathways and genes contributing to recurrence.

METHODS

Whole-exome sequencing was used to detect somatic mutations and large copy number variations (CNVs). Single cell RNA-seq was performed to investigate the clonal heterogeneity between Dx-Re pairs and amongst patients.

RESULTS

scRNA-seq analysis revealed extensive expression differences between patients and Dx-Re pairs, even for those with the same -presumed- initiating events. Transcriptional differences between and within patients are associated with clonal composition and evolution, with the most striking differences in patients that gained large-scale copy number variations at relapse. These differences appear to have significant molecular implications, exemplified by a DNMT3A/FLT3-ITD patient where the leukemia switched from an AP-1 regulated clone at Dx to a mTOR signaling driven clone at Re. The two distinct AML1-ETO pairs share genes related to hematopoietic stem cell maintenance and cell migration suggesting that the Re leukemic stem cell-like (LSC-like) cells evolved from the Dx cells.

CONCLUSIONS

In summary, the single cell RNA data underpinned the tumor heterogeneity not only amongst patient blasts with similar initiating mutations but also between each Dx-Re pair. Our results suggest alternatively and currently unappreciated and unexplored mechanisms leading to therapeutic resistance and AML recurrence.

Lawson Criterion for Ignition Exceeded in an Inertial Fusion Experiment

For more than half a century, researchers around the world have been engaged in attempts to achieve fusion ignition as a proof of principle of various fusion concepts. Following the Lawson criterion, an ignited plasma is one where the fusion heating power is high enough to overcome all the physical processes that cool the fusion plasma, creating a positive thermodynamic feedback loop with rapidly increasing temperature. In inertially confined fusion, ignition is a state where the fusion plasma can begin "burn propagation" into surrounding cold fuel, enabling the possibility of high energy gain. While "scientific breakeven" (i.e., unity target gain) has not yet been achieved (here target gain is 0.72, 1.37 MJ of fusion for 1.92 MJ of laser energy), this Letter reports the first controlled fusion experiment, using laser indirect drive, on the National Ignition Facility to produce capsule gain (here 5.8) and reach ignition by nine different formulations of the Lawson criterion.

Digging deeper into the taxonomy of Cylindrospermum and description of Johanseniella tripurensis gen. et sp. nov. from India

The wet soil-inhabiting cyanobacterium URH-6-PS was collected from the state of Tripura, India, and characterized using a polyphasic approach. Initial microscopic analysis indicated the strain to be a member of the genus Cylindrospermum, however, the 16S rRNA gene phylogenetic analysis showed some interesting results. The strain URH-6-PS clustered in the Clade I which positioned itself outside the Cylindrospermum sensu stricto clade with strong probability/bootstrap support, indicating that the strain may not belong to the genus Cylindrospermum. Further, analysis of the 16S-23S ITS region using the folded secondary structures of the D1-D1', Box-B and V3 helices and the 16S-23S ITS percentage dissimilarity values clearly indicated the distinctiveness of strain URH-6-PS from other members of the Clade I. The detailed investigations conducted in this study provided sufficient evidence that the taxonomic status of the members of Clade I need to be revised. Interestingly, all members of the clade I originated from tropical and sub-tropical habitats while members of the Cylindrospermum sensu stricto clade have been reported from temperate conditions. Previous studies had also indicated the possibility of the formation of tropical and subtropical Cylindrospermum-like genera and thus, this comes across as a much-awaited study to resolve the taxonomic complexities around the genus Cylindrospermum. Based on the results obtained in this study and the trends observed in the earlier studies, we describe a novel Cylindrospermum-like genus Johanseniella gen. nov., with the type species Johanseniella tripurensis sp. nov. in accordance with the International Code of Nomenclature of algae, fungi and plants.

Roholtiella volcanica sp. nov., a New Species of Cyanobacteria from Kamchatkan Volcanic Soils

During a study of biodiversity of cyanobacteria in Gorely volcano soils (Kamchatka Peninsula), a strain of heterocytous, a false branching cyanobacterium with gradually tapered filaments, was isolated. Prominent features of the strain were purplish-grey trichomes and firm, distinct multilayered sheaths. Based on the results obtained from the morphological, ecological, and phylogenetic analysis using the 16S rRNA and 16S–23S ITS region, 16S–23S ITS secondary structure analysis, comparison of flanking regions of BoxB and V3 helices, and the p-distance between the 16S–23S ITS region, we describe our strain K7 as a novel species of the genus Roholtiella with the name Roholtiella volcanica sp. nov., in accordance with the International Code of Nomenclature for algae, fungi, and plants. This work continues the rapid expansion of the description of new taxa of cyanobacteria, and particularly demonstrates a coming phase in cyanobacterial taxonomy in which the discovery of new species in recently described genera rapidly increases our understanding of the diversity in this phylum.

Induction of Iron Stress in Hepatocellular Carcinoma Cell Lines by Siderophore of Aspergillus nidulans Towards Promising Anticancer Effect

Hepatocellular carcinoma is among the leading causes of cancer-related deaths worldwide and needs efficient and feasible approach of treatment. Present study focuses on exploring the anticancer activity of a secondary metabolite called siderophore of Aspergillus nidulans against hepatocellular carcinoma cell line HepG2. These small peptides are produced by microorganisms including fungi for scavenging iron from its surroundings. Fungi including Aspergillus spp. are known to produce siderophores under iron-limited conditions. Siderophores have high affinity towards iron and are classified into various types. In the present study, siderophore isolated and purified from fungal cultures was confirmed to be of hydroxamate type by chrome azurol sulfonate and Atkin's assay. HPLC analysis confirmed purity while LC-ESI-MS revealed that the siderophore is triacetyl fusigen. Cancerous cells, HepG2, grown under siderophore treatment showed inhibition in growth and proliferation in a dose- and time-dependent manner. Reduction in viability and metabolic activity was evident upon treatment as seen in trypan blue, MTT and WST assay. Fluorescent staining using PI and DAPI confirmed the same while DCFDA staining revealed increased reactive oxygen species production which might have led to cell death and deterioration. Such increase in ROS has been correlated with iron accumulation by assessing intracellular iron level through ICP-MS. To assess the effect of siderophore treatment on normal cells, WRL-68, same assays were carried out but the effect was mostly non-significant up to 48 h. Thus, present work suggests that an optimum dose of siderophore purified from A. nidulans culture might prove a useful anticancer agent.

COVID-19: Pathophysiology, transmission, and drug development for therapeutic treatment and vaccination strategies

COVID-19, a dreaded and highly contagious pandemic, is flagrantly known for its rapid prevalence across the world. Till date, none of the treatments are distinctly accessible for this life-threatening disease. Under the prevailing conditions of medical emergency, one creative strategy for the identification of novel and potential antiviral agents gaining momentum in research institutions and progressively being leveraged by pharmaceutical companies is target-based drug repositioning/repurposing. A continuous monitoring and recording of results offer an anticipation that this strategy may help to reveal new medications for viral infections. This review recapitulates the neoteric illation of COVID-19, its genomic dispensation, molecular evolution via phylogenetic assessment, drug targets, the most frequently worldwide used repurposed drugs and their therapeutic applications, and a recent update on vaccine management strategies. The available data from solidarity trials exposed that the treatment with several known drugs, viz. lopinavir-ritonavir, chloroquine, hydroxychloroquine, etc had displayed various antagonistic effects along with no impactful result in diminution of mortality rate. The drugs like remdesivir, favipiravir, and ribavirin proved to be quite safer therapeutic options for treatment against COVID-19. Similarly, dexamethasone, convalescent plasma therapy and oral administration of 2DG are expected to reduce the mortality rate of COVID-19 patients.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

Prospects of Biosensors Based on Functionalized and Nanostructured Solitary Materials: Detection of Viral Infections and Other Risks

Advances in nanotechnology over the past decade have emerged as a substitute for conventional therapies and have facilitated the development of economically viable biosensors. Next-generation biosensors can play a significant role in curbing the spread of various viruses, including HCoV-2, and controlling morbidity and mortality. Pertaining to the impact of the current pandemic, there is a need for point-of-care biosensor-based testing as a detection method to accelerate the detection process. Integrating biosensors with nanostructures could be a substitute for ultrasensitive label-free biosensors to amplify sensing and miniaturization. Notably, next-generation biosensors could expedite the detection process. An elaborate description of various types of functionalized nanomaterials and their synthetic aspects is presented. The utility of the functionalized nanostructured materials for fabricating nanobiosensors to detect several types of viral infections is described in this review. This review also discusses the choice of appropriate nanomaterials, as well as challenges and opportunities in the field of nanobiosensors.

Ferroelectric Field-Effect-Transistor Integrated with Ferroelectrics Heterostructure

To address the demands of emerging data-centric computing applications, ferroelectric field-effect transistors (Fe-FETs) are considered the forefront of semiconductor electronics owing to their energy and area efficiency and merged logic-memory functionalities. Herein, the fabrication and application of an Fe-FET, which is integrated with a van der Waals ferroelectrics heterostructure (CuInP₂ S₆ /α-In₂ Se₃ ), is reported. Leveraging enhanced polarization originating from the dipole coupling of CIPS and α-In₂ Se₃ , the fabricated Fe-FET exhibits a large memory window of 14.5 V at V_GS = ±10 V, reaching a memory window to sweep range of ≈72%. Piezoelectric force microscopy measurements confirm the enhanced polarization-induced wider hysteresis loop of the double-stacked ferroelectrics compared to single ferroelectric layers. The Landau-Khalatnikov theory is extended to analyze the ferroelectric characteristics of a ferroelectric heterostructure, providing detailed explanations of the hysteresis behaviors and enhanced memory window formation. The fabricated Fe-FET shows nonvolatile memory characteristics, with a high on/off current ratio of over 10⁶ , long retention time (>10⁴ s), and stable cyclic endurance (>10⁴ cycles). Furthermore, the applicability of the ferroelectrics heterostructure is investigated for artificial synapses and for hardware neural networks through training and inference simulation. These results provide a promising pathway for exploring low-dimensional ferroelectronics.

Review article: Epidemiology of coeliac disease

Coeliac disease is an immune-mediated disease caused by ingestion of gluten in genetically susceptible individuals. Coeliac disease has been thought to affect mainly people of European origin but subsequently many studies revealed that it affects people living in North America, Oceania, South America, Asia as well as Africa. The global pooled seroprevalence and prevalence of biopsy-confirmed coeliac disease are 1.4% and 0.7% respectively. The pooled incidence rates in women and men are 17.4 (95% CI: 13.7-21.1) and 7.8 (95% CI: 6.3-9.2) per 100 000 person-years respectively. The systematic reviews, based on many population-based data, suggest that both the prevalence and the incidence of coeliac disease has increased over past three decades, which may be attributable not only to an increase in the detection rate (improvement in diagnostic tests, simplification of diagnostic criteria and increase in awareness about the disease) but also because of modernisation and globalisation related changes in the dietary practices including increase in the use of convenience food and dietary gluten. In addition to genetic factors, while there are many environmental risk factors, including age at the first introduction of gluten, breastfeeding, caesarean section, exposure to antibiotics and gut microbiome; the amount of gluten ingestion during early part of life, however, has been shown to increase the risk of coeliac disease, and this is relevant from the point of view of primary prevention. In this review, we have reviewed and summarised the literature, up till year 2021, related to the global and continent-wise epidemiology and risk factors associated with coeliac disease.

The Prevalence of the Celiac Disease in Patients with Dyspepsia: A Systematic Review and Meta-Analysis

BACKGROUND

Patients with celiac disease (CeD) can commonly present with symptoms of dyspepsia. We conducted a systematic review and meta-analysis of the present literature to assess the prevalence of CeD in patients diagnosed with dyspepsia.

METHODS

We searched MEDLINE and EMBASE databases for the keywords: celiac disease, coeliac disease, anti-gliadin, tissue transglutaminase antibody, anti-endomysial antibody, dyspepsia and functional gastrointestinal disorder. All the studies published from January 1991 till May 2021 were included. Diagnosis of CeD was based on the European Society of Pediatric Gastroenterology, Hepatology and Nutrition guidelines. A random-effects model was used to pool the data.

RESULTS

Twenty-one studies screening 10,275 patients with dyspepsia were included. The pooled seroprevalence of CeD based on a positive anti-tissue transglutaminase antibody and/or anti-endomysial antibody was 4.8% (95% CI [2.8, 6.7%], I² = 87.7%). The pooled biopsy-confirmed CeD prevalence was 1.5% (95% CI [1.0, 1.9%]; I² = 59.8%) in these patients. Both seroprevalence (Odds ratio: 1.8; 95% CI [0.8, 4.0%]; I² = 0%) and prevalence of biopsy-confirmed CeD (Odds ratio: 1.4; 95% CI [0.8, 2.4]; I² = 0%) were not higher in patients with dyspepsia compared to controls. There was a moderate risk of selection bias and significant heterogeneity in the pooled results.

CONCLUSIONS

The pooled prevalence of CeD in patients with dyspepsia was 1.5% and it was not significantly higher than the general population. These results do not support screening of patients with dyspepsia for CeD.

Mast cell mediation of visceral sensation and permeability in irritable bowel syndrome

Abnormalities of mast cell structure or function may play prominent roles in irritable bowel syndrome (IBS) symptom genesis. Mast cells show close apposition to sensory nerves and release bioactive substances in response to varied stimuli including infection, stress, and other neuroendocrine factors. Most studies focus on patients who develop IBS after enteric infection or who report diarrhea-predominant symptoms. Three topics underlying IBS pathogenesis have been emphasized in recent investigations. Visceral hypersensitivity to luminal stimulation is found in most IBS patients and may contribute to abdominal pain. Mast cell dysfunction also may disrupt epithelial barrier function which alters mucosal permeability potentially leading to altered bowel function and pain. Mast cell products including histamine, proteases, prostaglandins, and cytokines may participate in hypersensitivity and permeability defects, especially with diarrhea-predominant IBS. Recent experimental evidence indicates that the pronociceptive effects of histamine and proteases are mediated by the generation of prostaglandins in the mast cell. Enteric microbiome interactions including increased mucosal bacterial translocation may activate mast cells to elicit inflammatory responses underlying some of these pathogenic effects. Therapies to alter mast cell activity (mast cell stabilizers) or function (histamine antagonists) have shown modest benefits in IBS. Future investigations will seek to define patient subsets with greater potential to respond to therapies that address visceral hypersensitivity, epithelial permeability defects, and microbiome alterations secondary to mast cell dysfunction in IBS.

P-574 Ovarian Revitalisation using Platelet Rich Plasma

Study question

Can we rejuvinate ovaries (with low ovarian reserve) by injecting fresh platelet rich plasma ?

Summary answer

With ovarian PRP injections, Ovarian reserve will increase and number of follicles increases in treated ovaries .

What is known already

Till date no definitive treatment is available to restore function of ovaries. Few drugs e.g. granulocyte colony stimulating factor etc tried for the same but no satisfactory result was achieved. Oral ovulogens and gonadotropins cannot produce satisfactory number of ova in these patients. So they were forced to go for donar ova. By using ovarian PRP injections couple can have a chance of their own biological child.

Study design, size, duration

we conducted the pilot study involving injection of autologous fresh platelet rich plasma injection into the ovaries of subfertile females by comparison of their fertility parameters viz. hormonal profile involving measurements of blood levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH), prostaglandin E2 levels (PGE2); antral follicular count (AFC); number of mature follicles (NMF) and number of retrieved oocytes (NRO) in both pre-PRP and post-PRP states.

Participants/materials, setting, methods

Forty-five subfertile females of more than 20 years were included in our study . All the patients underwent fresh autologous PRP injection under transvaginal ultrasonographic guidance. Besides the demographic data, each patient’s hormonal profile (including blood levels of AMH, FSH, LH, PGE2), AFC, NMF and NRO in both pre-PRP and post-PRP state were recorded in a predesigned proforma. Statistical evaluation of the recorded data was done using appropriate methods and tools.

Main results and the role of chance

Mean age, weight, height, body mass index and years of subfertility of the patients in our study was 31.27yrs, 58.38kg, 154.84cm, 24.37kg/m2 and 8.44years respectively. The mean blood levels of AMH increased significantly in post-PRP state (1.6 vs 2.4pg/ml) in contrast to significant decrease in blood level of FSH (21.4 vs 12.5mIU/ml), LH (15.1 vs 5.9mIU/ml) & PGE2 (162.7 vs 66pg/ml). The AFC, NMF & NRO also increased in post-PRP state relative to pre-PRP state. The differences in above levels and numbers were statistically significant.

Limitations, reasons for caution

Autologous PRP injection into ovaries improves hormonal profile, AFC and number of mature follicles as well as retrieved oocytes. Furthur followup is needed to know weather our patients concieve spontaneously or they will need some kind of assisted tecniques to concieve a pregnency.

Wider implications of the findings

Autologous PRP injection into ovaries improves hormonal profile, AFC and number of mature follicles as well as retrieved oocytes, it can be utilized as a revitalisation tool to boost fertility. Our study results reinforce the above concept. However, outcome-based studies are needed to further validate the results of our study.

Trial registration number

TMU/IEC/19-20/0113

An Insight of Nanomaterials in Tissue Engineering from Fabrication to Applications

Tissue engineering is a research domain that deals with the growth of various kinds of tissues with the help of synthetic composites. With the culmination of nanotechnology and bioengineering, tissue engineering has emerged as an exciting domain. Recent literature describes its various applications in biomedical and biological sciences, such as facilitating the growth of tissue and organs, gene delivery, biosensor-based detection, etc. It deals with the development of biomimetics to repair, restore, maintain and amplify or strengthen several biological functions at the level of tissue and organs. Herein, the synthesis of nanocomposites based on polymers, along with their classification as conductive hydrogels and bioscaffolds, is comprehensively discussed. Furthermore, their implementation in numerous tissue engineering and regenerative medicine applications is also described. The limitations of tissue engineering are also discussed here. The present review highlights and summarizes the latest progress in the tissue engineering domain directed at functionalized nanomaterials.

Clinical and Psychological Factors Predict Outcome in Patients With Functional Dyspepsia: A Prospective Study

BACKGROUND & AIMS

Symptoms of functional dyspepsia (FD) fluctuate over time but there are limited data on the impact of factors on change in dyspepsia symptom severity over time. We aimed to evaluate the demographic, clinical, and psychological factors associated with change in dyspepsia symptom severity.

METHODS

Consecutive patients with FD presenting to a tertiary care center completed questionnaires assessing clinical and psychological symptoms at the time of the initial visit (baseline) and 3- to 6-month follow-up evaluations. FD and irritable bowel syndrome (IBS) were diagnosed using Rome IV criteria. FD severity was measured using patient assessment of gastrointestinal symptom severity. Patient-reported outcome measures information scales were used to assess the severity of anxiety, depression, and sleep disturbance.

RESULTS

Of 128 FD patients, 64 (50%) also met Rome IV criteria for IBS. In the final multivariable model, lower baseline sleep disturbance, improvement in anxiety scores, absence of IBS, and a lower number of medications taken for gastrointestinal symptoms were associated with improvement in dyspepsia scores (P < .05 for all). Conversely, higher baseline dyspepsia severity was associated with greater improvement in dyspepsia severity at follow-up evaluation (P < .001).

CONCLUSIONS

Improvement in FD symptom severity over 3 to 6 months was associated with improvement of anxiety, lower sleep disturbance at baseline, absence of IBS, and higher baseline dyspepsia severity.

Agricultural work-related fatalities and injuries in Punjab (India)

OBJECTIVE

Analysis of data on monetary compensation and estimating the rate of injuries related to agricultural activities in the state of Punjab.

METHODS

The primary data were collected from 22 districts of Punjab state for 2012-2015 through Punjab State Agricultural Marketing Board, Mohali. Data were analysed for the nature of health hazards, type of injuries, possible causes and factors of injuries and their gender.

RESULTS

During the four consecutive years (2012-2015) an overall 5888 hazards cases related to agricultural activities were reported from the state, out of which 1993 (33.85%) were fatal and 3895 (66.15%) were non-fatal injuries. Among the fatal cases, the leading causes reported were due to electric motors (34.47%), poisoning through snake bites (21.48%), poisoning through pesticide applications with sprayers (19.62%) and crushed under/falling from the tractors and related equipment (13.50%). The annual fatality rate of the state of Punjab was estimated as 14.14 per 100 000 agricultural workers, while the overall injury incidence rate was observed as 39.57 per 100 000 agricultural workers.

CONCLUSIONS

Majority of agricultural work-related health hazards in Punjab were mainly due to negligence, lack of knowledge/experience, restlessness/sleeplessness, inadequate safety measures, over speed and wrong practices employed by the operator. There is a need for better ergonomic controls, work environments and practices for the prevention of injuries and health hazards related to agricultural activities.

Two-Dimensional CIPS-InSe van der Waal Heterostructure Ferroelectric Field Effect Transistor for Nonvolatile Memory Applications

Channel current conduction modulation with the spontaneous polarization of ferroelectric films in ferroelectric field-effect transistors (FeFETs) has been widely investigated. Low interface quality and thermodynamic instability owing to the presence of dangling bonds in the conventional ferroelectrics have limited the memory retention and endurance of FeFETs. This, in turn, prevents their commercialization. However, the atomically thin nature of 2D ferroelectric, semiconducting, and insulating films facilitate the achievement of trap-free interfaces as van der Waal heterostructures (vdWHs) to develop FeFETs with long data retention and endurance characteristics. Here, we demonstrate a 2D vdWH FeFET fabricated with ferroelectric CuInP₂S₆ (CIPS), hexagonal boron nitride (h-BN) as the dielectric, and InSe as the ferroelectric semiconductor channel. The device shows an excellent performance as nonvolatile memory (NVM) with its large memory window (4.6 V at a voltage sweep of 5 V), high drain current on/off ratio (>10⁴), high endurance, and long data retention (>10⁴ s). These results demonstrate the considerable potential of vdWHs for the development of FeFETs for logic and NVM applications.

Prebiotic Potential of Dietary Beans and Pulses and Their Resistant Starch for Aging-Associated Gut and Metabolic Health

Dietary pulses, including dry beans, lentils, chickpeas, and dry peas, have the highest proportion of fiber among different legume cultivars and are inexpensive, easily accessible, and have a long shelf-life. The inclusion of pulses in regular dietary patterns is an easy and effective solution for achieving recommended fiber intake and maintaining a healthier gut and overall health. Dietary pulses-derived resistant starch (RS) is a relatively less explored prebiotic ingredient. Several in vitro and preclinical studies have elucidated the crucial role of RS in fostering and shaping the gut microbiota composition towards homeostasis thereby improving host metabolic health. However, in humans and aged animal models, the effect of only the cereals and tubers derived RS has been studied. In this context, this review collates literature pertaining to the beneficial effects of dietary pulses and their RS on gut microbiome-metabolome signatures in preclinical and clinical studies while contemplating their potential and prospects for better aging-associated gut health. In a nutshell, the incorporation of dietary pulses and their RS in diet fosters the growth of beneficial gut bacteria and significantly enhances the production of short-chain fatty acids in the colon.

Textbook outcome following oesophagectomy for cancer: international cohort study

Background

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

Methods

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

Results

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P &lt; 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P &lt; 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

Conclusion

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Textbook outcome following oesophagectomy for cancer: international cohort study

BACKGROUND

Textbook outcome has been proposed as a tool for the assessment of oncological surgical care. However, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess textbook outcome in an international setting.

METHODS

Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 to December 2018. Textbook outcome was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with textbook outcome, and results are presented as odds ratio (OR) and 95 per cent confidence intervals (95 per cent c.i.).

RESULTS

Of 2159 patients with oesophageal cancer, 39.7 per cent achieved a textbook outcome. The outcome parameter 'no major postoperative complication' had the greatest negative impact on a textbook outcome for patients with oesophageal cancer, compared to other textbook outcome parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of textbook outcome. Presence of 24-hour on-call rota for oesophageal surgeons (OR 2.05, 95 per cent c.i. 1.30 to 3.22; P = 0.002) and radiology (OR 1.54, 95 per cent c.i. 1.05 to 2.24; P = 0.027), total minimally invasive oesophagectomies (OR 1.63, 95 per cent c.i. 1.27 to 2.08; P < 0.001), and chest anastomosis above azygous (OR 2.17, 95 per cent c.i. 1.58 to 2.98; P < 0.001) were independently associated with a significantly increased likelihood of textbook outcome.

CONCLUSION

Textbook outcome is achieved in less than 40 per cent of patients having oesophagectomy for cancer. Improvements in centralization, hospital resources, access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve textbook outcome.

Improvement in constipation and diarrhea is associated with improved abdominal pain in patients with functional bowel disorders

BACKGROUND

Abdominal pain is a bothersome and lifestyle limiting symptom in patients with functional bowel disorders. It is associated with decreased quality of life in affected individuals, as well as significant annual healthcare expenditure. Knowledge of specific factors that predict improvement in abdominal pain in those with functional bowel disorders is thus far limited.

METHODS

Consecutive patients presenting for outpatient care at a major academic medical center between October 2017 and March 2020 completed an electronic symptom survey prior to initial clinic visit, and again after 3 months. The Rome IV questionnaires for functional dyspepsia, irritable bowel syndrome, functional constipation, and functional diarrhea were all included. Additionally, all subjects completed the Patient Reported Outcomes Measurement Information System Anxiety, Depression, and sleep disturbance questionnaires. Patients with a diagnosis of a Rome IV functional gastrointestinal disorder without any organic cause for symptoms were identified based on both chart review as well as survey response data. Univariable and multivariable analysis was used to assess predictors of improved abdominal pain after 3 months.

KEY RESULTS

180 patients with a mean age of 45.3 years were included in the final analysis. 78.3% of patients were female, and 77.2% met Rome IV criteria for irritable bowel syndrome. On multivariable analysis, improvement in constipation and diarrhea were both independent predictors of improved abdominal pain after 3 months.

CONCLUSIONS AND INFERENCES

Improvement in constipation and diarrhea both predicted improvement in abdominal pain, suggesting that addressing these factors is central to the management of abdominal pain in functional gastrointestinal disorders.

INFLUENCE OF THE DURATION OF DIABETES AND VIBRATION PERCEPTION THRESHOLD ON THE SEVERITY OF ERECTILE DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

BACKGROUND

Erectile dysfunction(ED) in men is a frequent under-reported complication of diabetes mellitus, which is becoming significant health problem worldwide.

AIMS

The study aims to determine the prevalence and risk factors for development of ED in North Indian patients with type 2 diabetes mellitus.

METHODS

We used international index of erectile function (IIEF-5) for the assessment of ED in 796 patients with type 2 diabetes mellitus. We recorded the age, duration of diabetes, glycemic status, body mass index, diabetes medications, microvascular and macrovascular complications.

RESULTS

The mean age of patients in the study was 49.38 ± 9.52 years. The prevalence of ED in patients with type 2 diabetes mellitus was 79.4%. Logistic regression analysis revealed that age, body mass index, glycemic control, insulin therapy, retinopathy and nephropathy was not significantly associated with erectile dysfunction in patients with type 2 diabetes mellitus. Duration of diabetes (OR = 1.054, 95% CI 1.007 to 1.102, P=0.023) and vibration perception threshold (OR = 1.071, 95% CI 1.042 to 1.102, P=0.000) were identified as key risk factors for development of ED.

CONCLUSION

Duration of diabetes and peripheral neuropathy emerged as significant risk factors for development of severe erectile dysfunction.