Resting Metabolic Rate and Lung Function in Wild Offshore Common Bottlenose Dolphins, Tursiops truncatus, Near Bermuda

Diving mammals have evolved a suite of physiological adaptations to manage respiratory gases during extended breath-hold dives. To test the hypothesis that offshore bottlenose dolphins have evolved physiological adaptations to improve their ability for extended deep dives and as protection for lung barotrauma, we investigated the lung function and respiratory physiology of four wild common bottlenose dolphins (Tursiops truncatus) near the island of Bermuda. We measured blood hematocrit (Hct, %), resting metabolic rate (RMR, l O₂ ⋅ min^-1), tidal volume (V_T, l), respiratory frequency (f_R, breaths ⋅ min^-1), respiratory flow (l ⋅ min^-1), and dynamic lung compliance (C_L, l ⋅ cmH₂O^-1) in air and in water, and compared measurements with published results from coastal, shallow-diving dolphins. We found that offshore dolphins had greater Hct (56 ± 2%) compared to shallow-diving bottlenose dolphins (range: 30–49%), thus resulting in a greater O₂ storage capacity and longer aerobic diving duration. Contrary to our hypothesis, the specific C_L (sC_L, 0.30 ± 0.12 cmH₂O^-1) was not different between populations. Neither the mass-specific RMR (3.0 ± 1.7 ml O₂ ⋅ min^-1 ⋅ kg^-1) nor V_T (23.0 ± 3.7 ml ⋅ kg^-1) were different from coastal ecotype bottlenose dolphins, both in the wild and under managed care, suggesting that deep-diving dolphins do not have metabolic or respiratory adaptations that differ from the shallow-diving ecotypes. The lack of respiratory adaptations for deep diving further support the recently developed hypothesis that gas management in cetaceans is not entirely passive but governed by alteration in the ventilation-perfusion matching, which allows for selective gas exchange to protect against diving related problems such as decompression sickness.

Abstract 2772: Preclinical development of a novel antibody-drug conjugate targeting “cold” tumors

The promise of immunotherapy for cancer is underscored by the recent efficacy of checkpoint inhibitors, which hinder the ability of tumors to escape attack by the immune system. Patients most likely to benefit from such therapy include those whose tumors are inflamed and who express the PD-L1 checkpoint protein. It is imperative that alternative therapies are developed for patients whose tumors do not exhibit these characteristics. Using our proprietary OGAP® system, we identified a novel membrane cancer target, OX001L. OX001L expression in certain cancers is associated with poor prognosis and reduced survival. IHC studies showed substantial prevalence of OX001L across multiple tumor types, with a majority of the OX001L positive samples scoring negative for PD-L1. In non-small cell lung cancer, OX001L expression was significantly increased in tumors lacking abundant intratumoral PD-1 positive T-cell infiltrate or PD-L1 expression compared to inflamed or PD-L1 positive tumors (p<0.00001). This finding suggests that OX001L may play a role in cancer immune escape. In order to effectively target OX001L positive tumor cells, we generated a human OX001L therapeutic antibody which exhibits target selectivity and cross-reactivity to the cynomolgus monkey OX001L orthologue, as demonstrated by FACS. Using immunofluorescence microscopy, we found that the antibody-antigen complex exhibits efficient internalization from the plasma membrane. Glycoengineering improved the antibody's ability to mediate potent antibody dependent cellular cytotoxicity (ADCC) activity in vitro and in vivo. Furthermore, when conjugated to a DNA alkylating toxin, the OX001L antibody promoted highly potent in vitro cytotoxicity of histotypically distinct cancer cell lines and also effected substantial anti-tumor activity in vivo. Importantly, the OX001L antibody and antibody-drug conjugate (ADC) were well tolerated in cynomolgus monkeys. These data indicate that OX001L ADC is a distinctive therapeutic molecule which could act on OX001L positive tumors via both ADC and ADCC mechanisms of action. The ability of the ADC to also promote recruitment and activation of cytotoxic T lymphocytes in OX001L positive tumors, similar to other cytotoxic payloads, will be further explored. This represents a unique therapeutic opportunity to target “cold”/PD-L1 negative, OX001L positive tumors which are less likely to respond to conventional checkpoint inhibitor therapy. In addition, a combination of the OX001L ADC and checkpoint inhibitors could be used to treat OX001L positive, “hot”/PD-L1 positive tumors. Targeting such tumors with both agents (and through two distinct, non-overlapping mechanisms of action) may yield a higher degree of success and/or a decreased propensity for relapse in patients than would checkpoint inhibitor monotherapy. We plan to test this exciting therapeutic opportunity in humanized in vivo models.

Citation Format: Angelo Kaplan, Nickolas Attanasio, To Uyen T Do, Sudha Swaminathan, Arnima Bisht, San Lin Lou, Jason Allen, Robert Boyd, James E. Ackroyd, Gleb Feldman, Christian Rohlff, Rachel L. Dusek. Preclinical development of a novel antibody-drug conjugate targeting “cold” tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2772.

Systematic review of the cost-effectiveness of preoperative antibiotic prophylaxis in reducing surgical-site infection

BACKGROUND

Surgical-site infections (SSIs) increase the length of hospital admission and costs. SSI prevention guidelines include preoperative antibiotic prophylaxis. This review assessed the reporting quality and cost-effectiveness of preoperative antibiotics used to prevent SSI.

METHODS

PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Index of Economic Articles (EconLit), Database of Abstracts of Reviews of Effect (including the National Health Service Economic Evaluation Database) and Cochrane Central databases were searched systematically from 1970 to 2017 for articles that included costs, preoperative antibiotic prophylaxis and SSI. Included were RCTs and quasi-experimental studies conducted in Organisation for Economic Co-operation and Development countries with participants aged at least 18 years and published in English. Two reviewers assessed eligibility, with inter-rater reliability determined by Cohen's κ statistic. The Consolidated Health Economic Evaluation and Reporting Standards (CHEERS) and modified Drummond checklists were used to assess reporting and economic quality. Study outcomes and characteristics were extracted, and incremental cost-effectiveness ratios were calculated, with costs adjusted to euros (2016) (€1 = US $1·25; £1 sterling = €1·28).

RESULTS

Twelve studies published between 1988 and 2014 were included from 646 records identified; nine were RCTs, two were nested within RCTs and one was a retrospective chart review. Study quality was highest in the nested studies. Cephalosporins (first, second and third generation) were the most frequent prophylactic interventions. Eleven studies demonstrated clinically effective interventions; ten were cost-effective (the intervention was dominant); in one the intervention was dominated by the control; and in one the intervention was more effective and more expensive than the control.

CONCLUSION

Preoperative antibiotic prophylaxis does reduce SSI, costs to hospitals and health providers, but the reporting of economic methods in RCTs is not standardized. Routinely nesting economic methods in RCTs would improve economic evaluations and ensure appropriate selection of prophylactic antibiotics.

Effects of non-steroidal growth implant and dietary zilpaterol hydrochloride on growth and carcass characteristics of feedlot lambs

The effects of steroidal growth implants alone or in combination with β-adrenergic agonist feed additives have not been studied thoroughly in mutton sheep in South African feedlot conditions. This study investigated the effects of a non-steroidal growth implant zeranol (Ralgro®), alone or in combination with zilpaterol hydrochloride (Zilmax®), on growth performance, carcass characteristics, and selected meat quality traits in 160 SA Mutton Merino ram lambs fed in a commercial feedlot. The experimental design consisted of two Ralgro treatment groups x two Zilmax treatments x two Zilmax feeding periods x 20 animals per treatment group. Lambs were randomly allocated to eight treatment groups, of which one half were implanted with Ralgro after arrival, followed by feed supplementation with Zilmax at two Zilmax feeding periods during the finisher phase, compared with negative control treatments (e.g. no Ralgro or Zilmax; Ralgro + no Zilmax; or no Ralgro + Zilmax). All lambs were fed the grower ration traditionally used by the commercial feedlot, which contained 16.89% crude protein (CP) and 2.94 Mcal/kg dry matter (DM). Zilmax was supplemented in the feed at 40 mg per animal per day and fed for 18 days or 25 days, plus three days withdrawal. Lambs that did not receive the Zilmax treatment were fed the basal diet without Zilmax feed supplementation. Ralgro significantly increased average daily gains (ADG) and cold carcass mass (CCM) of lambs. Lambs supplemented with Zilmax during the finisher phase had higher ADG, greater CCM and increased dressing percentage by ca.1.1% compared with those in the control group. Lambs fed Zilmax for 25 days had higher CCM than those fed for 18 days. The duration of the Zilmax treatment also decreased hide weight, fat thickness and shear force values (tenderness). Zilmax increased ADG and CCM in lambs, particularly if combined with Ralgro implants during the growing phase. The results from this study indicate that the combination of Ralgro implants with Zilmax feed supplementation during the finisher phase had additive effects and increased ADG and CCM of feedlot lambs.Keywords: Growth performance, meat quality, South African Mutton Merino, sheep, Ralgro®, Zilmax®

Reliability of a novel thermal imaging system for temperature assessment of healthy feet

Background

Thermal imaging is a useful modality for identifying preulcerative lesions (“hot spots”) in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. This paper reports the reliability of this device for temperature assessment of healthy feet.

Methods

Plantar skin foot temperatures were measured with the novel thermal imaging device (Diabetic Foot Ulcer Prevention System (DFUPS), constructed by Photometrix Imaging Ltd) and also with a hand-held infrared spot thermometer (Thermofocus® 01500A3, Tecnimed, Italy) after 20 min of barefoot resting with legs supported and extended in 105 subjects (52 males and 53 females; age range 18 to 69 years) as part of a multicentre clinical trial. The temperature differences between the right and left foot at five regions of interest (ROIs), including 1st and 4th toes, 1st, 3rd and 5th metatarsal heads were calculated. The intra-instrument agreement (three repeated measures) and the inter-instrument agreement (hand-held thermometer and thermal imaging device) were quantified using intra-class correlation coefficients (ICCs) and the 95% confidence intervals (CI).

Results

Both devices showed almost perfect agreement in replication by instrument. The intra-instrument ICCs for the thermal imaging device at all five ROIs ranged from 0.95 to 0.97 and the intra-instrument ICCs for the hand-held-thermometer ranged from 0.94 to 0.97. There was substantial to perfect inter-instrument agreement between the hand-held thermometer and the thermal imaging device and the ICCs at all five ROIs ranged between 0.94 and 0.97.

Conclusions

This study reports the performance of a novel thermal imaging device in the assessment of foot temperatures in healthy volunteers in comparison with a hand-held infrared thermometer. The newly developed thermal imaging device showed very good agreement in repeated temperature assessments at defined ROIs as well as substantial to perfect agreement in temperature assessment with the hand-held infrared thermometer. In addition to the reported non-inferior performance in temperature assessment, the thermal imaging device holds the potential to provide an instantaneous thermal image of all sites of the feet (plantar, dorsal, lateral and medial views).

Trial registration

Diabetic Foot Ulcer Prevention System NCT02317835, registered December 10, 2014

Patients' and caregivers' experiences of using continuous glucose monitoring to support diabetes self-management: qualitative study

BACKGROUND

Continuous glucose monitoring (CGM) enables users to view real-time interstitial glucose readings and provides information on the direction and rate of change of blood glucose levels. Users can also access historical data to inform treatment decisions. While the clinical and psychological benefits of CGM are well established, little is known about how individuals use CGM to inform diabetes self-management. We explored participants' experiences of using CGM in order to provide recommendations for supporting individuals to make optimal use of this technology.

METHODS

In-depth interviews (n = 24) with adults, adolescents and parents who had used CGM for ≥4 weeks; data were analysed thematically.

RESULTS

Participants found CGM an empowering tool because they could access blood glucose data effortlessly, and trend arrows enabled them to see whether blood glucose was rising or dropping and at what speed. This predicative information aided short-term lifestyle planning and enabled individuals to take action to prevent hypoglycaemia and hyperglycaemia. Having easy access to blood glucose data on a continuous basis also allowed participants to develop a better understanding of how insulin, activity and food impacted on blood glucose. This understanding was described as motivating individuals to make dietary changes and break cycles of over-treating hypoglycaemia and hyperglycaemia. Participants also described how historical CGM data provided a more nuanced picture of blood glucose control than was possible with blood glucose self-monitoring and, hence, better information to inform changes to background insulin doses and mealtime ratios. However, while participants expressed confidence making immediate adjustments to insulin and lifestyle to address impending hypoglycaemia and hypoglycaemia, most described needing and expecting health professionals to interpret historical CGM data and determine changes to background insulin doses and mealtime ratios. While alarms could reinforce a sense of hypoglycaemic safety, some individuals expressed ambivalent views, especially those who perceived alarms as signalling personal failure to achieve optimal glycaemic control.

CONCLUSIONS

CGM can be an empowering and motivational tool which enables participants to fine-tune and optimize their blood glucose control. However, individuals may benefit from psycho-social education, training and/or technological support to make optimal use of CGM data and use alarms appropriately.

Building Evidence for Health: Green Buildings, Current Science, and Future Challenges

Civilizational challenges have questioned the status quo of energy and material consumption by humans. From the built environment perspective, a response to these challenges was the creation of green buildings. Although the revolutionary capacity of the green building movement has elevated the expectations of new commercial construction, its rate of implementation has secluded the majority of the population from its benefits. Beyond reductions in energy usage and increases in market value, the main strength of green buildings may be the procurement of healthier building environments. Further pursuing the right to healthy indoor environments could help the green building movement to attain its full potential as a transformational public health tool. On the basis of 40 years of research on indoor environmental quality, we present a summary of nine environment elements that are foundational to human health. We posit the role of green buildings as a critical research platform within a novel sustainability framework based on social-environmental capital assets.

Field energetics and lung function in wild bottlenose dolphins, Tursiops truncatus, in Sarasota Bay Florida

We measured respiratory flow rates, and expired O2 in 32 (2-34 years, body mass [Mb] range: 73-291 kg) common bottlenose dolphins (Tursiops truncatus) during voluntary breaths on land or in water (between 2014 and 2017). The data were used to measure the resting O2 consumption rate ([Formula: see text], range: 0.76-9.45 ml O2 min-1 kg-1) and tidal volume (VT, range: 2.2-10.4 l) during rest. For adult dolphins, the resting VT, but not [Formula: see text], correlated with body mass (Mb, range: 141-291 kg) with an allometric mass-exponent of 0.41. These data suggest that the mass-specific VT of larger dolphins decreases considerably more than that of terrestrial mammals (mass-exponent: 1.03). The average resting [Formula: see text] was similar to previously published metabolic measurements from the same species. Our data indicate that the resting metabolic rate for a 150 kg dolphin would be 3.9 ml O2 min-1 kg-1, and the metabolic rate for active animals, assuming a multiplier of 3-6, would range from 11.7 to 23.4 ml O2 min-1 kg-1.\absbreak Our measurements provide novel data for resting energy use and respiratory physiology in wild cetaceans, which may have significant value for conservation efforts and for understanding the bioenergetic requirements of this species.

Implementation of the European health interview survey (EHIS) into the German health update (GEDA)

Background

This methodological paper describes the integration of the ‘European Health Interview Survey wave 2’ (EHIS 2) into the ‘German Health Update’ 2014/2015 (GEDA 2014/2015-EHIS).

Methods

GEDA 2014/2015-EHIS is a cross-sectional health survey. A two-stage stratified cluster sampling approach was used to recruit persons aged 15 years and older with permanent residence in Germany. Two different modes of data collection were used, self-administered web questionnaire and self-administered paper questionnaire. The survey instrument implemented the EHIS 2 modules on health status, health care use, health determinants and social background variables and additional national questions. Data processing was conducted according to the quality and validation rules specified by Eurostat.

Results

In total, 24,824 questionnaires were completed. The response rate was 27.6%. The two-stage cluster sample method seems to have been successful in achieving a sample with high representativeness. The final micro data file was inspected, approved and certified by Eurostat. Access to micro data of the EHIS 2 can be provided by Eurostat via research contract and to the GEDA 2014/2015-EHIS public use file by the Research Data Centre of the Robert Koch Institute. First EHIS 2 results are available at the Eurostat website.

Conclusions

Integrating a multinational health survey into an existing national health monitoring system was a challenge in Germany. The national survey methodology for conducting the survey had to be further developed in order to meet the overarching goal of harmonizing the health information from national statistical offices and public health research institutes across the European Union. The harmonized EHIS 2 data source will profoundly impact international public health research in the near future. The next EHIS wave 3 will be conducted around 2019.

Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals

BACKGROUND

Infection may complicate surgical patients' hospital admission. The effect of hospital-acquired infections (HAIs) on processes of care among surgical patients who died is unknown.

AIM

To investigate the effect of HAIs on processes of care in surgical patients who died in hospital.

METHODS

Surgeon-recorded infection data extracted from a national Australian surgical mortality audit (2012-2016) were grouped into HAIs and no infection. The audit included all-age surgical patients, who died in hospital. Not all patients had surgery. Excluded from analysis were patients with community-acquired infection and those with missing timing of infection. Multivariate logistic regression was used to determine the adjusted effects of HAIs on the processes of care in these patients. Costs associated with HAIs were estimated.

FINDINGS

One-fifth of surgical patients who died did so with an HAI (2242 out of 11,681; 19.2%). HAI patients had increased processes of care compared to those who died without infection: postoperative complications [51.0% vs 30.3%; adjusted odds ratio (aOR): 2.20; 95% confidence interval (CI): 1.98-2.45; P < 0.001]; unplanned reoperations (22.6% vs 10.9%; aOR: 2.38; 95% CI: 2.09-2.71; P < 0.001) and unplanned intensive care unit admission (29.3% vs 14.8%; aOR: 2.18; 95% CI: 1.94-2.45; P < 0.001). HAI patients had longer hospital admissions and greater hospital costs than those without infection.

CONCLUSION

HAIs were associated with increased processes of care and costs in surgical patients who died; these outcomes need to be investigated in surgical patients who survive.

Vocal palsy increases the risk of lower respiratory tract infection in low-risk, low-morbidity patients undergoing thyroidectomy for benign disease: A big data analysis

OBJECTIVES

Thyroidectomy is the commonest operation that places normally functioning laryngeal nerves at risk of injury. Vocal palsy is a major risk factor for dysphonia, dysphagia, and less commonly, airway obstruction. We investigated the association between post-thyroidectomy vocal palsy and long-term risks of pneumonia and laryngeal failure.

DESIGN

An N=near-all analysis of the English administrative dataset using a previously validated informatics algorithm to identify young and otherwise low-risk patients undergoing first-time elective thyroidectomy for benign disease. Information about age, sex, morbidities, social deprivation and post-operative and late complications were derived.

MAIN OUTCOME MEASURES

Between 2004 and 2012, 43 515 patients between the ages of 20 and 69 who had no history of cancer, neurological, or respiratory disease underwent elective total or hemithyroidectomy without concomitant or late neck dissection, parathyroidectomy or laryngotracheal surgery for benign thyroid disease for the first and only time. Information about age, sex, morbidities and in-hospital and late complications was recorded.

RESULTS

Mean age at surgery was 46±12. There was a strong female preponderance (85%), and most patients (89%) had no recorded Charlson comorbidities Most patients (65%) underwent hemithyroidectomy. Late vocal palsy was recorded in 449 (1.03%) patients, and its occurrence was an independent risk factor for emergency hospital readmission (n=7113; Hazard Ratio 1.52; 95% confidence interval 1.21-1.91), hospitalisation for lower respiratory tract infection (n=944; HR 2.04; 95% CI 1.07-3.75), dysphagia (n=564; HR 3.47; 95% CI 1.57-7.65) and gastrostomy/tracheostomy placement (n=80; HR 20.8; 95% CI 2.5-171.2). Independent risk factors for late vocal palsy were age, burden of morbidities, total thyroidectomy, post operative bleeding, male sex, and annual surgeon volume <30.

CONCLUSIONS

There is a significant association between post-thyroidectomy vocal palsy and long-term risks of hospital readmission, dysphagia, hospitalisation for lower respiratory tract infection, and gastrostomy/tracheostomy tube placement. This adds weight to the need, from a thyroid surgical perspective, to undertake universal post-thyroidectomy laryngeal surveillance as a minimum standard of care, with a focus on post-operative dysphagia and aspiration, and from a medical/respiratory perspective, to initiate investigations to identify occult vocal palsy in patients who present with pneumonia, who have a history of thyroid surgery.

Abstract 3715: Analysis of tumor infiltrating lymphocytes and in vitro exhausted T-cell models to identify unique Immuno-Oncology targets

In cancer, T cells are exposed to persistent antigen stimulation and/or inflammatory signals. Such prolonged stimulation is often associated with deterioration of T cell effector functions resulting in a functional state termed ‘exhaustion’. Exhausted T cells are characterized by expression of multiple inhibitory receptors, loss of cytolytic function and decline in cytokine production capability. T cell exhaustion is likely associated with inefficient control of tumor progression. Identification of cell surface proteins involved in induction and maintenance of the exhausted state could inform novel immunomodulatory cancer therapies. To comprehensively investigate cell surface signature of the exhausted state and identify potential immuno-oncology (I-O) targets, we conducted in-depth expression profiling of membrane proteins from intact tumors (Colorectal, Pancreatic, Lung, Breast and Prostate cancer), different in vitro models of T cell exhaustion and primary tumor-derived lymphocytes (Colorectal, Breast and Lung cancer) by targeted proteomics for known cell type and activation markers. Using proteomic expression analysis and statistical clustering analysis methods, novel I-O targets were identified in both the in vitro models of T cell exhaustion and primary tumor-derived lymphocytes (TILs). The cancer specify of novel I-O targets was then interrogated using the expression profiling of cell membrane proteins from intact tumors. Using this approach we identified most known T cell inhibitory receptors (PD-1, CTLA-4, BTLA, TIM-3, KIRs, LAG-3 and TMIGD2) and their described ligands (B7-H1 to B7-H7). To generate more precise expression data to validate I-O targets emerging from the above discovery approaches and their known interacting partners we analyzed single tumors using an integrated evaluation methodology. Tumors were subject to multiple parallel analysis steps: (i) proteomic analysis of the tumor and TILs; (ii) TILs were subject to flow cytometry analysis for specific proteins; (iii) tumor tissue sections were subject to immuno-histochemical analysis for specific proteins. The multiple analysis platforms were integrated by key cell type and functional markers allowing the different types of information provided by each technique to be placed in an overall 3-D tumor context. We present one example of a potential I-O target identified using our integrated proteomic discovery approach which is further validated at the expression level using multiple whole tumor and TIL analyses.

Citation Format: James Ackroyd, Joanne Berry, Yaoyao Fu, Jason Allen, Martin Barnes, Alexander Patterson, Angelo Kaplan, Christian Rohlff, Haining Huang, Livija Deban, Robert Boyd. Analysis of tumor infiltrating lymphocytes and in vitro exhausted T-cell models to identify unique Immuno-Oncology targets [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3715. doi:10.1158/1538-7445.AM2017-3715