Engineering Trienoic Fatty Acids into Cottonseed Oil Improves Low-Temperature Seed Germination, Plant Photosynthesis and Cotton Fiber Quality

Alpha-linolenic acid (ALA, 18:3Δ9,12,15) and γ-linolenic acid \ (GLA, 18:3Δ6,9,12) are important trienoic fatty acids, which are beneficial for human health in their own right, or as precursors for the biosynthesis of long-chain polyunsaturated fatty acids. ALA and GLA in seed oil are synthesized from linoleic acid (LA, 18:2Δ9,12) by the microsomal ω-3 fatty acid desaturase (FAD3) and Δ6 desaturase (D6D), respectively. Cotton (Gossypium hirsutum L.) seed oil composition was modified by transforming with an FAD3 gene from Brassica napus and a D6D gene from Echium plantagineum, resulting in approximately 30% ALA and 20% GLA, respectively. The total oil content in transgenic seeds remained unaltered relative to parental seeds. Despite the use of a seed-specific promoter for transgene expression, low levels of GLA and increased levels of ALA were found in non-seed cotton tissues. At low temperature, the germinating cottonseeds containing the linolenic acid isomers elongated faster than the untransformed controls. ALA-producing lines also showed higher photosynthetic rates at cooler temperature and better fiber quality compared to both untransformed controls and GLA-producing lines. The oxidative stability of the novel cottonseed oils was assessed, providing guidance for potential food, pharmaceutical and industrial applications of these oils.

SAT0399 RISK OF OSTEOARTHRITIS IN AN INCIDENT COHORT OF PEOPLE WITH PSORIATIC ARTHRITIS: A POPULATION-BASED COHORT STUDY

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory arthritis that causes pain, stiffness and swelling around the joints. PsA is reported to affect between 10 and 40% of individuals with psoriasis1and in the majority of patients presents after, or synchronously with, psoriasis onset.2Osteoarthritis (OA) is a common form of non-inflammatory arthritis related to joint degeneration and typically commences late in the fifth decade. PsA and OA have long been considered two distinct arthropathies, however they do have some overlapping features and symptoms and in certain circumstances it can be difficult to differentiate between them, particularly in the small joints of the hands or spine.3

Objectives:

To determine the risk of a diagnosis of osteoarthritis in psoriatic arthritis patients compared to patients with psoriasis and a general population cohort.

Methods:

Incident PsA patients aged 18-89 years at diagnosis were identified from the UK Clinical Practice Research Datalink between 1998 and 2014. All PsA patients were matched to a cohort of patients with psoriasis and a general population cohort (with no psoriasis or PsA) at a 1:4 ratio based on index date, year of birth, sex and general practice. The baseline prevalence of OA of any site was calculated as a percentage for each study cohort and then those prevalent cases were excluded from the numerators and denominators of the incident calculations. The incidence of OA was calculated and relative risks (RRadj), adjusting for body mass index (BMI), were calculated using conditional Poisson regression.

Results:

In total, 6,783 incident PsA patients were identified. The baseline prevalence of OA ranged from 22.1% (CI9521.1-23.1) in the PsA cohort to 12.6% (CI9512.2-13.0) and 11.0% (CI9510.6-11.3) in the psoriasis and general population cohorts respectively. The incidence of OA was significantly higher in the PsA cohort compared to the psoriasis and general population cohorts after adjusting for BMI (RRadj1.68 CI951.46-1.93 and RRadj1.86 CI951.62-2.14 respectively) (Tables 1 and 2).

Conclusion:

An increased risk of OA was observed in patients with PsA compared to patients with psoriasis alone and those in the general population. Further work is needed to determine whether this reflects a true increase in OA risk or misdiagnosed PsA and the extent to which it can be explained by differences in the opportunity for OA diagnosis between cohorts.

Table 1.

Incidence of osteoarthritis in the PsA, psoriasis and general population cohorts

CasesMedian age (years) at diagnosis (IQR)Person yearsIncidence rate per10,000 person yearsCI95Any OAϮGeneral population137459 (51 - 66)125,798109.2(103.5 - 115.0)Psoriasis143259 (53 - 67)122,279117.1(111.0 - 123.2)PsA46459 (51 - 66)28,574162.4(147.6 - 177.2)

Ϯincluding spondylosis

References:

[1]Ogdie A, Weiss P. Rheum Dis Clin North Am. 2015;41(4):545-568.

[2]Tillett Wet al.Rheumatol. 2017;56(12):2109-2113.

[3]McGonagle Det al. Rheumatology. 2015;54(1):29-38.

Table 2.

Risk of osteoarthritis in patients with PsA compared with patients in the general population and patients with psoriasis

PsA compared with a general population cohortPsA compared with a psoriasis cohortUnadjustedAdjusted†UnadjustedAdjusted†RRCI95PRRCI95PRRCI95PRRCI95POA1.871.67-2.10<0.00011.861.62-2.14<0.00011.681.50-1.88<0.00011.681.46-1.93<0.0001

†adjusted for BMI taken as the closest entry within 3 years of the index date

Acknowledgments:

This report is independent research funded by the National Institute for Health Research, Programme Grants for Applied Research [Early detection to improve outcome in patients with undiagnosed PsA (‘PROMPT’), RP-PG-1212-20007]. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Disclosure of Interests:

None declared

0167 The Effect of Nocturnal Dinner Type “Light” Versus “Heavy” on Sleep, Attention and Microbial Composition

Introduction

Nutrition and sleep are two essential functions for the physiological existence of the organism. Furthermore, both have an acquired cultural, educational and social behavioral component. This study examined the effect of nocturnal dinner type (“light” vs. “heavy”) on the quality and quantity of sleep, attention abilities, fatigue, and mood in the following morning. In addition, the microbial composition was examined.

Methods

Twenty healthy subjects (10 men and 10 women), aged 25–33, were invited to two non-consecutive nights at the Sleep Institute for polysomnography test and filling out questionnaires: KSS; ESS; and Brief Symptom Inventory (BSI), attention abilities assessed with CPT-III. In one evening, the subjects consumed two hours before bedtime a “light” dinner based on vegetable ingredients (vegetables and vegetable proteins) with 342 calories that contained lentils, feta cheese, beet, and other vegetables. On the other evening, the subjects consumed two hours before bedtime a “heavy” dinner based on carbohydrates, fats, and animal protein with 501 calories that contained hamburger and French fries. In addition, subjects were required to give a microbial test before and after meals.

Results

There was no significant difference in the various sleep parameters between the two nights after each meal type: efficacy (t=-1.51,p=0.15); sleep latency stage 1 (t=1.81,p=0.08); sleep latency stage 2 (t=1.00,p=0.33); REM latency (t=0.57,p=0.57); total sleep time (t=-1.57,p=0.13); number of awakenings (t=0.30, p=0.76). No significant differences were found for: fatigue (KSS) (t=-0.30,p =0.77); sleepiness (ESS) (t=0.76,p =0.45); mood (BSI) (t=0.87,p =0.39); and attention deficit (CPT-III) (t=-0.68,p =0.50). The type of night meal did not show a significant effect on the microbial composition (H=0.059,p= 0.81).

Conclusion

The findings of this study show that, contrary to popular belief, “heavy” dinner did not affect the quality of sleep and functions measured in the study compared to a “light” dinner. In the current research, the population that was examined included only young and healthy subjects, therefore, the results may differ if the research in this field will extend and include other populations such as adults and subjects with different disorders. Future studies are needed to examine the relationships between sleep and nutrtion.

Support

No support

0029 Light Emitted from Media Devices at Night is Associated with Decline in Sperm Quality

Introduction

The last several decades have been characterized by the widespread usage of digital devices, especially smartphones. At the same time, there have been reports of male fertility decline. The aim of this study was to assess the relationship between evening exposure to the light-emitting screens of digital media devices and sperm quality.

Methods

Semen samples were obtained from 116 men adults aged between 21 and 59 (35.2 ±7.2) undergoing fertility evaluation for the following sperm variables: volume (mL), pH, sperm concentration (n/mL), motility percentage (progressive% + non-progressive motility%) and total sperm count. Exposure to the screens of electronic devices and sleep habits were obtained by means of a questionnaire.

Results

Smartphone and tablet usage in the evening and after bedtime was negatively correlated (p&lt;0.05) with sperm motility, sperm progressive motility, and sperm concentration, and positively correlated with the percentage of immotile sperm. In addition, sleep duration was positively correlated with sperm total and progressive motility and negatively correlated with semen pH (p&lt;0.05). A significant negative correlation was observed between subjective sleepiness and total and progressive motility as well as total motile sperm number (p&lt;0.05).

Conclusion

The results of this study revealed a link between evening and post-bedtime exposure to light-emitting digital media screens and sperm quality. To the best of our knowledge, this is the first study to report these types of correlations between sperm quality and exposure time to SWL emitted from digital media, especially smartphones and tablets, in the evening and after bedtime.

Support

No Support

Patient deprivation and perceived scan burden negatively impact the quality of whole-body MRI

AIM

To evaluate the association between the image quality of cancer staging whole-body magnetic resonance imaging (WB-MRI) and patient demographics, distress, and perceived scan burden.

MATERIALS AND METHODS

A sample of patients recruited prospectively to multicentre trials comparing WB-MRI with standard scans for staging lung and colorectal cancer were invited to complete two questionnaires. The baseline questionnaire, administered at recruitment, collated data on demographics, distress and co-morbidity. The follow-up questionnaire, completed after staging investigations, measured perceived WB-MRI scan burden (scored 1 low to 7 high). WB-MRI anatomical coverage, and technical quality was graded by a radiographic technician and grading combined to categorise the scan as "optimal", "sub-optimal" or "degraded". A radiologist categorised 30 scans to test interobserver agreement. Data were analysed using the chi-square, Fisher's exact, t-tests, and multinomial regression.

RESULTS

One hundred and fourteen patients were included in the study (53 lung, 61 colorectal; average age 65.3 years, SD=11.8; 66 men [57.9%]). Overall, 45.6% (n=52), scans were classified as "optimal" quality, 39.5% (n=45) "sub-optimal", and 14.9% (n=17) as "degraded". In adjusted analyses, greater deprivation level and higher patient-reported scan burden were both associated with a higher likelihood of having a sub-optimal versus an optimal scan (odds ratio [OR]: 4.465, 95% confidence interval [CI]: 1.454 to 13.709, p=0.009; OR: 1.987, CI: 1.153 to 3.425, p=0.013, respectively). None of the variables predicted the likelihood of having a degraded scan.

CONCLUSIONS

Deprivation and patients' perceived experience of the WB-MRI are related to image quality. Tailored protocols and individualised patient management before and during WB-MRI may improve image quality.

PL3.5 Efficacy and safety of selinexor in recurrent glioblastoma

BACKGROUND

New treatment modalities are needed for recurrent glioblastoma (rGBM). Selinexor is a novel, oral selective inhibitor of nuclear export which forces nuclear retention of tumor suppressor proteins including p53 and p27, leading to apoptosis. We previously reported interim results showing tolerability, preliminary efficacy, and blood-brain barrier penetration in a surgical cohort (N=8). We now report updated results following completion of accrual to non-surgical cohorts (N=68).

MATERIALS AND METHODS

This is an open-label, multicenter, phase 2 study of selinexor monotherapy. Patients (pts) not undergoing surgery for measurable rGBM per response assessment neuro-oncology criteria (RANO) were enrolled in one of 3 arms encompassing different dosing schedules of selinexor (50 mg/m2 [~ 85 mg] BIW, 60 mg BIW, and 80 mg QW). Treatment was continuous, although cycles were defined as 28 days and response was assessed every other cycle by MRI. Prior treatment with radiotherapy and temozolomide was required and prior bevacizumab was exclusionary. The primary endpoint was 6-month progression free survival (6mPFS) rate, calculated by the Kaplan-Meier method.

RESULTS

76 pts were enrolled; 24, 14 and 30 pts on doses of ~85 mg BIW, 60 mg BIW, and 80 mg QW, respectively. Median age was 56 years (range 21–78). Median number of prior treatments was 2 (range 1–7)

At the end of the 6 cycles, 30.2% pts on 80 mg QW were free from progression. The 6mPFS rate on 80 mg QW was 18.9%. Best RANO-defined responses (assessed locally) among 26 evaluable pts on 80 mg QW included 1 complete response, 2 partial responses, 7 stable disease, and 16 with progressive disease. Complete and partial responses were durable: the complete and a partial responder remain on selinexor for 393 and 1093 days respectively, as of the cut-off date. Median duration of response was 10.8 months. The most common related adverse events (all grades) in pts on ~85 mg BIW/60 mg BIW/80 mg QW were nausea (42%/64%/63%), leukopenia (38%/7%/43%), fatigue (71%/71%/47%), neutropenia (29%/14%/33%), decreased appetite (46%/71%/27%), and thrombocytopenia (67%/29%/23%).

CONCLUSION

Selinexor demonstrated efficacy, with durable responses and disease stabilization in rGBM. Based on the favorable efficacy and safety profile, selinexor at a dose of 80 mg QW is recommended for further development in rGBM.

Pharmacological treatment for Type 2 diabetes integrating findings from cardiovascular outcome trials: an expert consensus in the UK

In people with Type 2 diabetes, cardiovascular disease is a leading cause of morbidity and mortality. Thus, as well as controlling glucose, reducing the risk of cardiovascular events is a key goal. The results of cardiovascular outcome trials have led to updates for many national and international guidelines. England, Wales and Northern Ireland remain exceptions, with the most recent update to the National Institute for Health and Care Excellence (NICE) guidelines published in 2015. We reviewed current national and international guidelines and recommendations on the management of people with Type 2 diabetes. This article shares our consensus on clinical recommendations for the use of sodium-glucose co-transporter 2 inhibitors (SGLT-2is) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) in people with Type 2 diabetes and established or at very high risk of cardiovascular disease in the UK. We also consider cost-effectiveness for these therapies. We recommend considering each person's cardiovascular risk and using diabetes therapies with proven cardiovascular benefits when appropriate to improve long-term outcomes and cost-effectiveness.

An observational cohort study of exercise and education for people with chronic obstructive pulmonary disease not meeting criteria for formal pulmonary rehabilitation programmes

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality. Pulmonary rehabilitation (PR) is offered to patients with functional breathlessness. However, access to PR is limited. The objective of this study was to evaluate whether a 4-week education and exercise programme offered to COPD patients with Medical Research Council (MRC) dyspnoea 1-2 improves disease self-management. Patients were recruited by their GP to attend four weekly 2-h sessions provided by a multidisciplinary team. Patients completed outcome measures before and after the program. Forty-two patients entered the programme and 26 out of 42 (61.9%) completed all sessions. The Bristol COPD Knowledge Questionnaire and Patient Activation Measure improved (both p ≤ 0.001). Disease burden was not reduced according to the COPD assessment test. All patients accepted a referral for ongoing exercise. Fourteen current smokers (81.3%) accepted a referral for smoking cessation, three patients with anxiety or depression (37.5%) accepted a psychological therapies referral. The programme improved COPD disease knowledge, patient activation and stimulated referrals to further services supporting disease management. Randomised controlled trials are warranted for similar interventions for COPD patients with early stage disease.

Abstract GS3-06: Dynamics of breast cancer relapse reveal molecularly defined late recurring ER-positive subgroups: Results from the METABRIC study

Background: Recent studies have demonstrated that women with early stage ER-positive (ER+) and HER2-negative (HER2-) breast cancer have a persistent risk of recurrence and cancer related death up to 20 years post diagnosis, highlighting the chronic nature of ER+ breast cancer and critical need to identify tumor characteristics that are more predictive of risk of recurrence than standard clinical covariates. However, progress in delineating the dynamics of breast cancer relapse and biomarkers of late recurrence has been hindered by the lack of large cohorts with long-term clinical follow-up and molecular information.

Methods: We report the results of a cohort of 3,240 breast cancer patients from the United Kingdom and Canada with 20 years of follow-up (median 9.75 years), including 1,980 with accompanying molecular data from the primary breast tumor. Information for each patient on loco-regional recurrence (LR), distant recurrence (DR), and site(s) of metastases was collected. We developed a non-homogenous Markov chain model that accounted for different clinical endpoints and timescales, as well as competing risks of mortality and the distinct baseline hazards that characterize different molecular subgroups. This approach enabled robust analysis of the spatio-temporal dynamics of breast cancer recurrence across the clinical subgroups, PAM50 subgroups and the integrative clusters, while also enabling individual risk of relapse predictions.

Results: We employed our multistate model to compute the probability of experiencing a LR or DR, as well as the baseline transition probabilities from surgery, LR or DR at various time intervals for average individuals in each of the clinical/molecular subgroups. These analyses reveal four late-recurring ER+ (predominantly HER2-) subgroups, together accounting for 26% of all ER+ tumors, with high (median 42-55%) risk of recurrence up to 20 years post-diagnosis. Each of these four subgroups maps to one of the Integrative Clusters, defined based on genomic copy number alterations and gene expression, and is enriched for a characteristic copy number amplification events: 11q13 (CCND1, RSF1), 8p12 (FGFR1, ZNF703), 17q23 (RPS6KB1) and 8q24 (MYC). These four molecular subgroups are superior in predicting late DR than standard clinical variables.

Conclusions: A detailed understanding of the rates and routes of metastasis and their variability across the distinct molecular subtypes is essential for devising personalized approaches to breast cancer care. We describe a molecularly characterized breast cancer cohort with long-term clinical follow-up and a statistical modeling framework, enabling delineation of the dynamics of breast cancer recurrence at unprecedented resolution. These analyses reveal four late recurring ER+ subgroups and accompanying biomarkers that collectively define the quarter of ER+ cases at highest risk of recurrence. Our findings highlight opportunities for improved patient stratification and biomarker-driven clinical trials directed at the subset of breast cancer patients with persistent risk of recurrence.

Citation Format: Curtis C, Rueda OM, Sammut S-J, Chin S-F, Caswell-Jin JL, Seoane JA, Callari M, Batra R, Pereira B, Bruna A, Ali HR, Provenzano E, Liu B, Parisien M, Gillett C, McKinney S, Green A, Murphy L, Purushotham A, Ellis I, Pharoah P, Rueda C, Aparicio S, Caldas C. Dynamics of breast cancer relapse reveal molecularly defined late recurring ER-positive subgroups: Results from the METABRIC study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr GS3-06.

A review of the biomechanical determinants of rugby scrummaging performance

Background

The scrum is a physical contest unique to the game of rugby union, important for determining match outcomes.

Objective

This review will describe the current understanding of the kinetic and kinematic determinants of successful scrum performance to support coaching interventions and inform on future research.

Methods

Literature review.

Results

Individual and combined scrumming forces increase with playing level but there is no concurrent increase in body mass or player strength. There is very little variation in individual kinematics between individuals and across levels of play, suggesting that there are limited possible techniques for successful scrummaging. Live scrum contests are dynamic and require constant adjustments to body positions in response to increased compressive force and exaggerated lateral and vertical force components. Skilled performers are able to exert high levels of horizontal force while maintaining effective body positions within this dynamic environment.

Conclusion

Success in scrummaging depends on the optimisation of joint angles and force production at the individual level, and the coordination of effort at a team level. The analysis presented here demonstrates that producing large scrum-specific forces and achieving the optimal 'body shape' are essential for successful scrum performance.

'Test n Treat' (TnT): a cluster randomized feasibility trial of on-site rapid Chlamydia trachomatis tests and treatment in ethnically diverse, sexually active teenagers attending technical colleges

OBJECTIVES

We conducted a cluster-randomized feasibility trial of 90-minute Chlamydia trachomatis tests and same day on-site treatment ('Test n Treat/TnT') in six technical colleges in London, England, to assess TnT uptake rates; follow-up rates; prevalence of C. trachomatis at baseline and 7 months; time to treatment; acceptability of TnT.

METHODS

Participants completed questionnaires and provided genitourinary samples at baseline and 7 months. Participants were informed that baseline samples would not be tested for 7 months and were advised to get screened independently. Colleges were randomly allocated 1:1 to intervention (TnT) or control (no TnT). One month and 4 months post recruitment, participants at intervention colleges were texted invitations for on-site free C. trachomatis tests. A purposive sample of students who did/did not attend for screening were interviewed (n = 26).

RESULTS

Five hundred and nine sexually active students were recruited: median age 17.9 years, 47% male, 50% black ethnicity, 55% reporting two or more sexual partners in the previous year. TnT uptake was 13% (33/259; 95% CI 8.9-17.4%) at 1 month and 10% (26/259; 6.7-14.4%) at 4 months with overall C. trachomatis positivity 5.1% (3/59; 1.1-14.2%). Follow-up at 7 months was 62% (317/509) for questionnaires and 52% (264/509) for samples. C. trachomatis prevalence was 6.2% (31/503) at baseline and 6.1% (16/264) at 7 months. Median time from test to treatment was 15 h. Interviews suggested low test uptake was associated with not feeling at risk, perceptions of stigma, and little knowledge of sexually transmitted infections (STIs).

CONCLUSIONS

Despite high C. trachomatis rates at baseline and follow-up, uptake of testing was low. Like many countries, England urgently needs better sex education, including making STI testing routine/normal. Trial registration ISRCTN58038795.

Qualitative Analysis of a Cultural Dexterity Program for Surgeons: Feasible, Impactful, and Necessary

OBJECTIVES

Ineffective cross-cultural communication contributes to adverse outcomes for minority patients. To address this, the authors developed a novel curriculum for surgical residents built on the principle of cultural dexterity, emphasizing adaptability to clinical and sociocultural circumstances to tailor care to the needs of the individual patient. This study's objective was to evaluate the feasibility, acceptability, and perception of this program upon conclusion of its first year.

DESIGN, SETTING, AND PARTICIPANTS

The curriculum was implemented at 3 general surgery programs. The flipped classroom model combined independent study via e-learning modules with interactive role-playing sessions. Sessions took place over 1 academic year. Four focus groups were held, each with 6 to 9 participants, to gain feedback on the curriculum. Focus groups were recorded and transcribed, and the data were analyzed using a grounded theory approach.

RESULTS

Five major themes emerged: (1) Role modeling from senior colleagues is integral in developing communication/interpersonal skills and attitudes toward cultural dexterity. (2) Cultural dexterity is relevant to the provision of high-quality surgical care. (3) Barriers to providing culturally dexterous care exist at the system level. (4) "Buy-in" at all levels of the institution is necessary to implement the principles of cultural dexterity. (5) The shared experience of discussing the challenges and triumphs of caring for a diverse population was engaging and impactful.

CONCLUSION

Early implementation of the curriculum revealed that the tension between surgical residents' desire to improve their cultural dexterity and systemic/practical obstacles can be resolved. Combining surgically relevant didactic materials with experiential learning activities can change the paradigm of cross-cultural training.

Effect of tele-health care on quality of life in patients with severe COPD: a randomized clinical trial

Background and objective

Telemonitoring (TM) of patients with COPD has gained much interest, but studies have produced conflicting results. We aimed to investigate the effect of TM with the option of video consultations on quality of life (QoL) in patients with severe COPD.

Patients and methods

COPD patients at high risk of exacerbations were eligible for the 6-month study and a total of 281 patients were equally randomized to either TM (n=141) or usual care (n=140). TM comprised recording of symptoms, oxygen saturation, spirometry, and video consultations. Algorithms generated alerts if readings breached thresholds. Both groups filled in a health-related QoL questionnaire (15D^©) and the COPD Assessment Test (CAT) at baseline and at 6 months. Within-group differences were analyzed by paired t-test.

Results

Most of the enrolled patients had severe COPD (86% with Global Initiative for Chronic Obstructive Lung Disease stage 3 or 4 and 45% with admission for COPD within the last year, respectively). No difference in drop-out rate and mortality was found between the groups, and likewise there was no difference in 15D or CAT at baseline. At 6 months, a significant improvement of 0.016 in 15D score (p=0.03; minimal clinically important difference 0.015) was observed in the TM group (compared to baseline), while there was no improvement in the control group −0.003 (p=0.68). After stratifying 15D score at baseline to <0.75 or ≥0.75, respectively, there was a significant difference in the <0.75 TM group of 0.037 (p=0.001), which is a substantial improvement. No statistically significant changes were found in CAT score.

Conclusion

Compared to the nonintervention group, TM as an add-on to usual care over a 6-month period improved QoL, as assessed by the 15D questionnaire, in patients with severe COPD, whereas no difference between groups was observed in CAT score.

Type 2 diabetes mellitus in older people: a brief statement of key principles of modern day management including the assessment of frailty. A national collaborative stakeholder initiative

Rates of population ageing are unprecedented and this, combined with the progressive urbanization of lifestyles, has led to a dramatic shift in the epidemiology of diabetes towards old age, particularly to those aged 60-79 years. Both ageing and diabetes are recognized as important risk factors for the development of functional decline and disability. In addition, diabetes is associated with a high economic, social and health burden. Traditional macrovascular and microvascular complications of diabetes appear to account for less than half of the diabetes-related disability observed in older people. Despite this, older adults are under-represented in clinical trials. Guidelines from organizations such as the National Institute for Health and Care Excellence (NICE), the European Association for the Study of Diabetes, and the American Diabetes Association acknowledge the need for individualized care, but the glycaemic targets that are suggested to constitute good control [HbA_1c 53-59 mmol/mol (7-7.5%)] are too tight for frail older individuals. We present a framework for the assessment of older adults and guidelines for the management of this population according to their frailty status, with the intention of reducing complications and improving quality of life for these people.

Research gaps in the management and prevention of cutaneous squamous cell carcinoma in organ transplant recipients

Although tremendous progress has been made in recent years in skin cancer care for organ transplant recipients, significant gaps remain in data-driven clinical guidelines, particularly for the treatment and prevention of cutaneous squamous cell carcinoma (cSCC), the most common malignancy among this population. In this review, we aim to summarize current knowledge around the management of cSCC and highlight the most significant gaps in knowledge that continue to pose challenges in the delivery of skin cancer care for organ transplant recipients. We suggest future directions for research that will bridge existing gaps and establish evidence-driven guidelines for primary prevention, screening and treatment of cSCC in this high-risk patient population.

A simulated rugby match protocol induces physiological fatigue without decreased individual scrummaging performance

Background: A rugby union game consists of 80 minutes of strenuous exertion. Forwards are required to participate in the arduous activity of scrummaging throughout a game.Objectives: The purpose of this study was to identify whether rugby-match simulated fatigue modified individual scrummaging technique and reduced performance.Methods: Twelve forwards (body mass 106.2±13.3 kg; stature 179.5±8.4 cm) had individual scrum kinetics and kinematics assessed prior to and following a protocol that simulated a rugby match. The simulated rugby match protocol required participants to run at various velocities and perform rugby specific tasks. Rating of Perceived Exertion (RPE) was assessed using a 6-20 Borg scale and Visual Analogue Scale (VAS). Blood lactate, heart rate and RPE were measured prior to, at mid-point and after the simulated game, while markers of muscle damage (blood creatine kinase activity (CK) and urea) were measured prior to and following the protocol.Results: RPE (p<0.0001) and VAS (p<0.0001) showed significant increases between the pre- and post-simulation values. Of the physiological markers, heart rate (p<0.0001) and blood urea concentration (p=0.004) increased following the match simulation. No significant differences were observed for blood CK (p=0.281), individual scrummaging forces (p=0.433) or in the kinematic variables following the protocol. While physiological fatigue and subjective ratings of physiological fatigue may develop during a rugby simulation, no differences were observed in peak forces or in body kinematics at peak force.Conclusion: Physiological fatigue does not influence individual scrummaging performance and technique.