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In the present study, genetic screening of Sahiwal and Holstein Friesian (HF) cattle and its crosses was conducted using the PCR-RFLP technique to detect the presence of CVM and DUMPS disorders. Genomic DNA was extracted from 50 Sahiwal and 100 HF animals and its crosses using commercially available kits. Gene-specific primers were utilized for in vitro amplification of SLC35A3 and UMPS genes by PCR, followed by RFLP analysis using PstI and AvaI restriction endonucleases for CVM and DUMPS, respectively. Subsequently, the PCR products were purified and sequenced to confirm any mutations in the DNA target sequences. Notably, no affected or carrier animals for CVM and DUMPS disorders were identified among the screened animals. Thus, the gene and genotype frequency of CVM and DUMPS carriers was zero, indicating a 100% frequency of normal animals. The study underscores the importance of continued screening for these genetic disorders, involving a larger sample size across the state, and advocates for mandatory screening before utilizing animals for breeding purposes, in adherence to minimum standard protocols.

Good quality of single droplet image acquisition in imaging flow cytometry (IFC) is crucial for a wide range of biological analyses. Recently, there have been significant advances in droplet microfluidic data analysis; however, acquiring blur-free single object images is still a great challenge because of the tradeoff between high flow rate and hardware setup complexity and cost. State-of-the-art hardware setups for blur-free single image acquisition are often complex, cumbersome, and not portable, limiting their suitability for point-of-care diagnostics. Moreover, motion blur and duplicate droplet image acquisition can occur with flow rate variation. To address these issues, this paper proposes a lightweight imaging pipeline for acquiring blur-free single droplet images for portable applications; this pipeline is capable of acquiring every single droplet image. While most of the existing literature focuses on complex hardware setups, utilizing high frame rate cameras that are not cost effective and complex optical solutions for droplet focusing, our pipeline utilizes minimum hardware and a lightweight algorithm for detecting, counting, and acquiring single object images from the video stream. The proposed pipeline was evaluated experimentally using videos of fast-moving droplets in which the input fluid flow rate was as high as $67.7~\mu $ L/min. The proposed pipeline achieves 100% counting accuracy on the tested videos and 2 ms, 25 ms and 10 ms processing time for each droplet on a desktop PC, single-board computer Raspberry Pi-4, and Nvidia Jetson Nano, respectively. This yields a maximum of 500, 40, and 100 blur free detected droplets per second (DPS), respectively. The Jetson Nano implementation, achieving 100 DPS with processing time of 10 ms, is faster than existing similar studies and fast enough for the target application. The results suggest that the proposed lightweight pipeline is suitable for efficient single object image acquisition in IFC on an embedded portable platform.

Droplet microfluidics enables studying large cell populations in chemical isolation, at a single-cell resolution. Applications include studying cellular response to drugs, cell-to-cell interaction studies. Such applications need a reliable and repeatable droplet generation with high monodispersity. Most systems used in research rely on manual tuning of flow parameters on off-the-shelf instruments. Setups are highly customized, limiting reproduction of experimental results. We propose an integrated, modular system for automated aqueous droplet generation with high monodispersity. The system provides dynamic feedback control of droplet size and input pressure. Input pressure is generated by two piezoelectric micropumps. Droplet sizes are determined via light intensity measurement in an LED-photodiode setup. The system is capable of wireless communication and has a low enough power consumption for battery-powered operation. We report on the assembly and the underlying working principle, as well as an in-depth experimental evaluation of the performance of the proof-of-concept prototype in aqueous droplet generation. Evaluation was performed on a modular as well as on a system level. During module-level evaluations, aqueous droplets were generated in a light mineral oil + Span 80 surfactant carrier medium, using 3 different flow-focusing junction geometries. The presented prototype had a significantly faster pressure stabilization time (10 s) compared to a syringe pump-based reference setup (120 s). During system-level evaluation, deionized water droplets were generated in a carrier medium of HFE7500 + PEG-PFPE triblock surfactant. Resultant droplet sizes were benchmarked with microscopy. The system was able to repeatedly generate mono- and polydisperse droplets on demand, with CVs between 5-10% in the $\sim $ 50- $200 \mu \text{m}$ droplet diameter range.

This study describes the construction of a droplet generation speed compact empirical mathematical model for a flow-focusing microfluidic droplet generator. The application case is a portable, low-cost flow cytometry system for microbiological applications, with water droplet sizes of 50-70 micrometer range and droplet generation rates of 500-1500 per second. In this study, we demonstrate that for the design of reliable microfluidic systems, the availability of an empirical model of droplet generation is a mandatory precondition that cannot be achieved by time-consuming simulations based on detailed physical models. When introducing the concept of a compact empirical model, we refer to a mathematical model that considers general theoretical estimates and describes experimental behavioral trends with a minimal set of easily measurable parameters. By interpreting the experimental results for different water- and oil-phase flow rates, we constructed a minimal 3-parameter droplet generation rate model for every fixed water flow rate by relying on submodels of the water droplet diameter and effective ellipticity. As a result, we obtained a compact model with an estimated 5-10% accuracy for the planned typical application modes. The main novelties of this study are the demonstration of the applicability of the linear approximation model for droplet diameter suppression by the oil flow rate, introduction of an effective ellipticity parameter to describe the droplet form transformation from a bullet-like shape to a spherical shape, and introduction of a machine learning correction function that could be used to fine-tune the model during the real-time operation of the system.

Present study includes the effect of inbreeding on expected genetic gain and estimation of regression with respect to first lactation production, reproduction and lifetime traits in Karan Fries crossbred cattle maintained at ICAR-NDRI, Karnal. Out of total, only 36.97% were found to be inbred with an average inbreeding coefficient 3.68%. Overall least squares mean for reproduction traits (days) AFC, SP, DP and CI were 1020.41 ± 5.49, 141.42± 3.86, 74.54 ± 2.04 and 421.20 ± 3.81 respectively. For production traits (kg) were 305MY, LL, LTMY, FY and SNFY were 3169.15 ± 37.87, 353.25 ± 4.18, 3686.10 ± 55.10, 266.19 ± 4.66 and 127.81 ± 2.26 respectively and lifetime traits like LTMY and stayability were 14588.47 ± 486.09 (kg) and 2444.69 ± 41.26 (days) respectively. Among reproduction traits (days), AFC increased by +3.70, DP +3.66 and CI +68.44 however SP decreased by -0.85 d and production traits (kg), 305MY decreased by -10.2 TMY -16.09, LL -1.23 d, 305FY -1.75, 305SNFY - 0.26, LTMY 202.02 and stayability -17.37 days per unit increase in the inbreeding coefficient. Although there was no inbreeding depression in any of the traits except AFC. The expected genetic gain of AFC increased two folds in IBL2 (Fx >5%) as compared to IBL1 (Fx

The present experiment was conducted at Bull Mother Experimental Farm (BMEF), College of Veterinary Science and Animal Husbandry, Anjora to study the relationship between skin thickness and milk yield of Sahiwal cows. The overall mean skin thickness of neck, dewlap, chest, abdomen, flank, hind quarter, udder and rump was 3.44±0.06, 3.49±0.06, 3.53±0.06, 4.53±0.08, 5.62±0.12, 4.07±0.07, 2.45±0.04 and 6.63±0.17 mm respectively. Analysis of variance showed that that the effect of skin thickness was statistically significant (P

High-throughput microflow cytometry has become a focal point of research in recent years. In particular, droplet microflow cytometry (DMFC) enables the analysis of cells reacting to different stimuli in chemical isolation due to each droplet acting as an isolated microreactor. Furthermore, at high flow rates, the droplets allow massive parallelization, further increasing the throughput of droplets. However, this novel methodology poses unique challenges related to commonly used fluorometry and fluorescent microscopy techniques. We review the optical sensor technology and light sources applicable to DMFC, as well as analyze the challenges and advantages of each option, primarily focusing on electronics. An analysis of low-cost and/or sufficiently compact systems that can be incorporated into portable devices is also presented.

There are 23 descript breeds of goat in India. However there is no recognized breed of goat registered by Chhattisgarh state hence requires systematic study for their characterization. The present study was undertaken to establish the norms of different physical characteristics, reproductive and productive performance traits and haematological profile of local goats of Chhattisgarh plains. Information was collected from Raipur, Durg, Rajnandgaon and Kanker districts of Chhattisgarh plain region. The average measurement for body weight, body length, height, ear length, face length, horn length and tail length for adult male were 31.05±0.49kg, 71.26±0.6, 74.44±0.91, 45.35±0.71, 16.14±0.21, 19.47± 0.18, 15.85±0.43 and 16.05 cm respectively. The corresponding values in adult female were 24.55±0.47 kg, 61.13±0.90, 64.74±0.73, 37.37±0.52, 15.74±0.24, 18.41±0.18, 11.72±0.57, and 14.58±0.22 cm respectively. The mean values for the reproductive performance traits i.e. age at first mating in male, age at first mating in female, age at first kidding and kidding interval were observed as 184±0.05, 216±0.04, 370±0.4 and 184±0.03 days, respectively, and average litter size 1.5. The mean values for the productive performance traits daily milk yield, total lactation milk yield and lactation length were recorded as 307.25±13.16 ml, 32.29±2.65 litres, and 105.75±2.48 days, respectively. Different haematological parameters such as haemoglobin, packed cell volume, total erythrocytes count, total leukocytes count, mean corpuscular haemoglobin, mean corpuscular volume and mean corpuscular haemoglobin concentration were considered and value estimated as 9.35±0.20 (g%), 28.9±0.66 (%), 8.45+0.17 (million/μl), 9,660±256.33 (thousand/μl), 9.1± 0.22 (pg), 27.79±0.0 (fl), and 32.39±0.27(%) respectively. Hence this study was aimed to phenotypically characterize the local goat in view of establishing a database for the breed and undertaking conservation programme for preserving rich indigenous genetic resources biodiversity.

Background: Clinical decision making in oncology is based on both inter- and multidisciplinary approach. Hence teaching future doctors involved in oncology or general health practice is crucial. The aim of the Vienna Summer School on Oncology (VSSO) as an international, integrated, undergraduate oncology course is to teach medical students interdisciplinary team communication and application of treatment concepts/algorithms in a multidisciplinary setting., Method: The teaching is based on an inter- and multidisciplinary faculty and a multimodal education approach to address different learning styles. The participants rated their satisfaction of the program voluntarily after finishing the course according to a grading scale from one (not good) to five (very good). The learning success was assessed by a compulsory pre-VSSO and post-VSSO single choice questionnaire., Results: Program organisation was rated with a mean score of 4.47 out of 5.0 (SD 0.51), composition of the program and range of topics with a mean score of 4.68 (SD 0.58) and all teachers with a mean score of 4.36 (SD 0.40) points. Student evaluation at the beginning and end of the program indicated significant knowledge acquisition -i.e., general aspects of cancer: median 8.75 points (IQR 7.5-9.4) vs.10.0 points (IQR 9.4-10.0) p = 0.005; specific aspects of cancer: median 4.87 points (IQR 3.33-5.71) vs. 8.72 points (IQR 6.78-9.49) p ≤ 0.001, respectively., Conclusion: Even though the participants represent a selection of students with special interest in cancer, the results of the VSSO indicate the benefit of an inter- and multidisciplinary teaching approach within an oncology module.

Sirolimus is used in cardiac transplant recipients to prevent rejection, progression of cardiac allograft vasculopathy, and renal dysfunction. However, sirolimus has many potential side effects and its tolerability when used outside of clinical trials is not well established. We describe a decade of experience with sirolimus in cardiac transplant recipients at our institution. We retrospectively reviewed records of all adult cardiac transplant recipients living between September 1999 and February 2010 (n = 329) and identified 67 patients (20%) who received sirolimus. The indications for sirolimus were cardiac allograft vasculopathy (67%), renal dysfunction (25%), rejection (4%), and intolerability of tacrolimus (3%). One-third of patients discontinued sirolimus at a median (25th, 75th percentiles) of 0.9 (0.2, 1.6) yr of duration. Over 70% of subjects experienced an adverse event attributed to sirolimus. Adverse events were associated with higher average sirolimus levels (9.1 ng/mL vs. 7.1 ng/mL, p = 0.004). We conclude that sirolimus is frequently used in cardiac transplant recipients (20%) and commonly causes side effects, often necessitating discontinuation. Higher average sirolimus levels were associated with adverse events, suggesting that tolerability may improve if levels are maintained within the lower end of the current therapeutic range; however, the improvement in tolerability would need to be balanced with the potential for decreased efficacy., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Sirolimus is an immunosuppressive agent increasingly used in cardiac transplant recipients in the setting of allograft vasculopathy or worsening renal function. Recently, sirolimus has been associated with increased risk of venous thromboembolism (VTE) in lung transplant recipients. To investigate whether this association is also present in cardiac transplant recipients, we retrospectively reviewed the charts of 67 cardiac transplant recipients whose immunosuppressive regimen included sirolimus and 134 matched cardiac transplant recipients whose regimen did not include sirolimus. Rates of VTE were compared. Multivariable Cox proportional hazards models tested the association of sirolimus use with VTE. A higher incidence of VTE was seen in patients treated with vs. without sirolimus (8/67 [12%] vs. 9/134 [7%], log-rank statistic: 4.66, p=0.03). Lower body mass index (BMI) and total cholesterol levels were also associated with VTE (p<0.05). The association of sirolimus with VTE persisted when adjusting for BMI (hazard ratio [95% confidence interval]: 2.96 [1.13, 7.75], p=0.03) but not when adjusting for total cholesterol (p=0.08). These data suggest that sirolimus is associated with an increased risk of VTE in cardiac transplant recipients, a risk possibly mediated through comorbid conditions. Larger, more conclusive studies are needed. Until such studies are completed, a heightened level of awareness for VTE in cardiac transplant recipients treated with sirolimus appears warranted., (© 2012 John Wiley & Sons A/S.)

Background: Jugular venous pressure (JVP) is assessed to estimate volume status in patients with heart failure because right atrial pressure (RAP) reflects pulmonary capillary wedge pressure (PCWP). In a large cohort of heart failure patients spanning 14 years, we sought to further characterize the relationship between RAP and PCWP, including identifying temporal trends, to optimize estimates of PCWP by JVP. We also sought to determine whether the RAP to PCWP relationship impacts post-transplant mortality., Methods: Hemodynamic data were obtained from 4,079 patients before cardiac transplantation. Elevated RAP was defined as ≥10 mm Hg and elevated PCWP ≥22 mm Hg. Hemodynamics were "concordant" when both RAP and PCWP were elevated or when both were not elevated. The frequency of concordant hemodynamics was assessed over 3 eras (1993 to 1997, 1998 to 2002, 2003 to 2007). Baseline characteristics were compared among quartiles of the ratio (RAP+1)/PCWP. The association of (RAP+1)/PCWP with 2-year mortality after cardiac transplantation was assessed using multivariate models., Results: The frequency of concordant hemodynamics over time was stable (74%, 72%, 73%; p = 0.4). Increasing (RAP+1)/PCWP was associated with the following variables: female gender; cardiomyopathy etiology besides ischemic or non-ischemic; prior sternotomies; and lower creatinine clearance (p < 0.01 for all). Elevated (RAP+1)/PCWP was associated with post-transplant mortality (relative risk 1.2, 95% confidence interval 1.02 to 1.37, p = 0.02)., Conclusions: [corrected] RAP and PCWP remain concordant in most heart failure patients, supporting the ongoing use of JVP to estimate PCWP. Easily identifiable patient characteristics were associated with an increased RAP/PCWP ratio, and their presence should alert clinicians that PCWP may be overestimated by JVP assessment. A higher RAP/PCWP ratio was an adverse risk factor for post-cardiac transplant survival., (Copyright © 2012 International Society for Heart and Lung Transplantation. All rights reserved.)

Background: Although risk factors for left ventricular (LV) hypertrophy in the native heart are well known, as is its association with increased risk of adverse outcomes, such information is poorly defined in heart transplant (HTx) recipients. We determined whether increased LV mass and concentricity (mass/volume) were associated with death in patients after HTx., Methods: Between May 2003 and May 2006, 140 HTx recipients underwent cardiac magnetic resonance imaging (MRI). Clinical characteristics associated with increased LV mass were determined. Cox proportional hazard models were constructed to assess the relationship of LV mass and concentricity with death., Results: MRIs were acquired a median of 6.0 years after transplant. The top quartile of indexed LV mass and concentricity were 35.8 g/m(2.7) or higher and 1.5 g/ml or higher, respectively. History of rejection (odds ratio [OR], 5.9; 95% confidence interval [CI], 2.1-16.4; p < 0.01), diabetes (OR, 3.3; 95% CI, 1.3-8.2; p = 0.01), and post-transplant year of MRI acquisition (OR, 1.2; 95% CI, 1.1-1.4; p < 0.01) were associated with the top quartile of LV mass in multivariable models. LV mass and concentricity were independently associated with cardiovascular death (hazard risk [HR], 1.11 per g/m;(2.7) HR, 10.1 per g/ml, p ≤ 0.01, respectively). LV concentricity was independently associated with all-cause mortality (HR, 4.4 per g/ml, p < 0.01)., Conclusion: A history of rejection and diabetes are associated with increased LV mass. Increased LV mass, particularly of a concentric phenotype, is an independent risk factor for cardiovascular and all-cause mortality after HTx., (Copyright © 2010 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)

Objective: Left ventricular assist devices (LVADs) are commonly used for critically ill patients awaiting heart transplantation, although their effect on long-term outcomes, relative to inotropic support alone, is still debated., Method: Data from Status 1 patients who underwent heart transplantation at our institution between 1990 and 2005 were reviewed (n = 180). They were divided into two groups: those who underwent LVAD implantation as a bridge to transplant (n = 31) and those treated with inotropic agents without the support of LVAD (n = 149). They were compared in terms of demographics and clinical outcome., Results: Both groups were similar in terms of patient and donor demographics. Relative to the inotrope group, the LVAD group did have a longer ischemic time (p = 0.032), a greater incidence of pretransplant transfusion (p < 0.00001), and a greater maximum level of pretransplant panel reactive antibodies (p < 0.001). Creatinine at listing significantly improved in LVAD patients awaiting transplantation (p < 0.0001). Comparisons of 5-year survival in addition to freedom from posttransplant infection, malignancy, revascularization, and acute rejection did not show significant difference between the two groups. The LVAD group did benefit from increased freedom from chronic rejection compared to the inotrope group (p = 0.049). Stepwise Cox Regression did not identify any independent factors affecting patient survival during the first 5 years after transplant., Conclusions: Status 1 patients successfully bridged to heart transplantation with LVADs had similar long-term clinical outcomes compared to those treated with inotropic agents.

Background: Immunofluorescence staining of endomyocardial biopsy (EMB) specimens to detect the complement fragment C4d is used to diagnose antibody-mediated rejection. However, data are limited regarding the utility of routine staining for C4d in clinical care., Methods: This study retrospectively reviewed the clinical course of adult cardiac transplant recipients who underwent > or = 2 EMBs with immunofluorescence C4d staining at the University of Texas Southwestern Medical Center since September 2006. C4d staining was performed by the immunohistochemistry laboratory and interpreted by the members of the surgical pathology department, in conjunction with interpretation of the routine hematoxylin and eosin staining. Donor-specific antibodies (DSA) were routinely assessed at the time of clinical rejection., Results: Of 67 patients, specimens were positive for C4d (C4d+) in 14 and negative for C4d (C4d-) in 53. The frequency of acute cellular rejection (ACR) in these 2 groups was 57% (8 of 14, designated C4d+/ACR+) vs 11% (6 of 53, designated C4d-/ACR+; p < 0.001). Significantly more patients with a positive C4d specimen had a positive retrospective donor specific crossmatch, presence of DSA after transplantation, and depressed graft function (p < 0.01 for each)., Conclusions: Positive C4d immunofluorescence staining on EMB specimens was associated with ACR, reduced allograft function, a positive retrospective crossmatch, and the presence of DSA after transplantation. The latter 2 observations support the contention that C4d deposition is a marker of antibody-mediated rejection. Routine evaluation of C4d staining is feasible in the clinical setting and may identify variable patterns of rejection.

Background: Although the Cylex immune assay has been proposed as a means of tailoring immunosuppression after organ transplantation, there are limited data regarding its utility in cardiac transplant recipients. Therefore, we sought to determine the utility of the Cylex assay in assessing the risk of infection or rejection in cardiac transplant recipients., Methods: This study is a retrospective review of the clinical course of all adult cardiac transplant recipients who underwent a Cylex assay at UT Southwestern Medical Center between January 2004 and September 2007., Results: One hundred eleven patients were free of significant rejection or infection at the time of the first Cylex assay. Most patients (92%) were >1 year post-transplant. Over the next 157 +/- 41 (mean +/- SD) days, 2 patients had 3 episodes of rejection requiring therapy and 7 patients had 8 infections requiring therapy. The Cylex responses ranged from 17 to 894 ng/ml. No correlation was observed between the baseline Cylex response and subsequent risk of either infection or rejection within 6 months. Lower white blood cell count and African American ethnicity were correlated with a lower Cylex response., Conclusions: In this study, the Cylex assay had limited utility as an adjunct to routine clinical evaluation in assessing risk of infection or rejection in cardiac transplant recipients.

Background: The prognostic implications of low QRS voltage on the electrocardiogram (ECG) in heart failure (HF) are not well characterized., Methods: We manually measured and summed the QRS voltage in all 12 leads of the ECG (sumQRS) in two cohorts: (1) 415 patients with a low left ventricular ejection fraction followed up in a HF clinic ("clinic cohort") and (2) 100 subjects with advanced HF who had an ECG within 1 year preceding cardiac transplantation ("pretransplant cohort"). Low voltage was defined as the lowest quartile of the clinic cohort (sumQRS <12 mV) and its prevalence was compared in the two cohorts. The associations of low voltage with 1-year outcomes were assessed in the clinic cohort., Results: In the clinic cohort, the frequency of low voltage was higher in New York Heart Association class 4 versus class 1-3 patients (34% vs 22% respectively, P = .04). The frequency of low voltage in the pretransplant cohort (47%) was twice that of the clinic cohort (24%, P < .001). After 1 year of follow-up in the clinic cohort, low ECG voltage was associated with a higher rate of death (14% vs 5%, P = .008) and the composite end point of death or HF hospitalization (35% vs 20%, P = .004). These associations persisted in multivariable analyses adjusting for important confounders., Conclusions: Low ECG voltage is a marker of the severity of HF and is a risk factor for adverse outcomes in patients with systolic HF at 1 year.

Background: Managing immunosuppression is a significant aspect of posttransplantation patient care. Previously, our institution reported that prednisone could be withdrawn in cardiac allograft recipients without jeopardizing midterm survival. We returned to this group of patients to investigate the long-term effects of our steroid taper protocol., Methods: We reviewed the records of 162 consecutive cardiac transplant recipients from our institution. Patients who underwent transplantation between 1988 and 1990 were treated with traditional triple-therapy immunosuppression (cyclosporine, azathioprine, and prednisone). Beginning June 1990, we instituted a protocol of early steroid taper with discontinuation by 6 months after transplant. The two groups were comparable with respect to age, sex, ethnicity, cause of heart failure, ischemic time, body mass index, and creatinine at the time of transplantation., Results: Fifty-seven percent of the patients in the early steroid taper group were successfully withdrawn from steroids at 6 months after transplantation. This group had a decreased freedom from and increased frequency of acute rejection (p < 0.01 for each) when compared with the traditional therapy group. There was, however, no difference in freedom from posttransplant coronary artery disease (p = 0.53). The early steroid taper group enjoyed an increased freedom from malignancy (p = 0.01) and trended toward a decreased frequency of infection (p = 0.10) and improved survival (p = 0.06)., Conclusions: Steroid withdrawal is possible in 57% of patients at 6 months after transplantation. The institution of an early steroid taper protocol improves the overall freedom from malignancies and may decrease the frequency of infection and prolong overall survival without increasing the risk of posttransplant coronary artery disease.

Background: Multiple studies have demonstrated an increased incidence of lung cancer in the heart transplant population. We reviewed our cardiac transplantation experience with respect to the development of bronchogenic carcinoma and explored the role of routine chest computed tomography (CT) in its surveillance., Methods: We performed a review of our cardiac transplantation experience, highlighting the incidence of lung cancer, and we analyzed our recent experience with screening chest CT in lung cancer surveillance in this patient group., Results: Eighteen patients developed 20 cases of bronchogenic carcinoma for an incidence of 6.83%. In 10 cases, the patients underwent surgical resection; however, in the remaining cases, the patients were either treated with chemotherapy and/or radiation or they died before initiation of therapy. The actuarial 1-, 2- and 5-year overall survival rates were 49%, 29% and 13%, respectively. The median survival of patients who underwent surgical resection was 28 months (3 to 85 months), whereas the median survival of patients who were either ineligible for surgery or died before initiation of treatment was only 1 month (1 to 13 months). All patients diagnosed with lung cancer by chest CT underwent surgical resection; however, only 37.5% of patients diagnosed with lung cancer by chest X-ray were found at an appropriate stage for resection (p = 0.025)., Conclusions: Cardiac transplant recipients have a significant risk of developing bronchogenic carcinoma. Routine chest CT screening in high-risk patients may enable clinicians to identify disease earlier, which is essential for the option of surgical resection and, therefore, prolonged survival.

Background: Cyclosporine (CsA) is frequently initiated as induction therapy in patients undergoing orthotopic heart transplantation, but our experience has identified a significant rate of post-operative renal dysfunction. We therefore devised a renal-sparing cyclosporine-free induction regimen consisting of the early administration basiliximab, an interleukin-2 receptor monoclonal antibody, followed by the late initiation of cyclosporine on post-operative Day 4., Methods: Between September 1998 and December 1999, we treated 25 patients at risk for post-operative renal dysfunction (high-risk basiliximab group) with the new induction regimen and another 33 patients not at risk (low-risk CsA group) for renal dysfunction with our standard cyclosporine protocol. We identified a historical control group (1996 through 1998) of 32 patients at risk for renal dysfunction (high-risk CsA group) who had received our standard cyclosporine protocol., Results: The increase in serum creatinine levels after transplantation was less in the high-risk basiliximab group (-0.1 +/- 0.7) than in the high-risk CsA group (0.5 +/- 1.0, p < 0.02) and comparable to the low-risk CsA group (0.03 +/- 0.6). The basiliximab protocol did not increase rejection; the percentage of rejection episodes was high-risk basiliximab, 0; high-risk CsA, 13; and low-risk CsA, 3 (p = .13)., Conclusion: Basiliximab induction therapy allows delayed initiation of cyclosporine after cardiac transplantation without an increase in rejection and reduces the risk of post-operative renal dysfunction.

Objectives: Pericardial effusion occurs frequently after orthotopic heart transplantation, but the causes of this complication have not been well described. This study was designed to identify factors predisposing toward the development of significant postoperative pericardial effusions in a large, single-institution population of orthotopic heart transplant recipients., Methods: A retrospective review of more than 90 preoperative, intraoperative, and postoperative variables was conducted for 241 patients undergoing orthotopic heart transplantation from September 1988 to December 1999. Patients who had significant postoperative pericardial effusions develop were identified from postoperative echocardiograms by standard criteria. Factors associated with the development of significant pericardial effusions were determined by multivariate logistic regression analysis., Results: Echocardiographic data were available for 203 of 241 transplant recipients. Forty-two patients (21%) had significant effusions develop. According to multivariate analysis, pericardial effusions were less likely to occur in recipients with a history of previous cardiac surgery (odds ratio 0.13, 95% confidence interval 0.05-0.36, P <.0001) and with greater weight (odds ratio 0.96, 95% confidence interval 0.94-0.99, P <.0048). Pericardial effusions were more likely to occur in patients who had received aminocaproic acid during the operation (odds ratio 5.92, 95% confidence interval 2.23-15.72, P <.0008). Patient survival and hospital length of stay did not differ between patients with and without postoperative pericardial effusions., Conclusions: Postoperative pericardial effusions develop in approximately 20% of patients undergoing orthotopic cardiac transplantation. On the basis of the risk factors identified in this study, prevention may prove difficult, although avoidance of the intraoperative use of aminocaproic acid may be helpful.