Comparison of the Petrifilm Dry Rehydratable Film and Conventional Culture Methods for Enumeration of Yeasts and Molds in Foods: Collaborative Study

A collaborative study was performed involving 18 laboratories and 6 food types to compare 3M Petrifilm yeast and mold count plates with the method described in the U.S. Food and Drug Administration’s Bacteriological Analytical Manual. Four species of mold and 2 species of yeast were used to inoculate the following foods: hot dogs, corn meal, ketchup, orange juice, yogurt, and cake mix. Each collaborator received 15 samples of each food type: 5 low-level inoculations, 5 high- level inoculations, and 5 uninoculated samples. There was no significant difference between the means of the 2 methods for any product or inoculation level. The Petrifilm yeast and mold count plate method for enumeration of yeasts and molds in foods has been adopted first action by AOAC INTERNATIONAL.

Haematobia irritans parasitism of F1 yak × beef cattle (Bos grunniens × Bos taurus) hybrids

The horn fly Haematobia irritans (Diptera: Muscidae) is a blood obligate ectoparasite of bovids that causes annual losses to the U.S. beef cattle industry of over US$1.75 billion. Climate warming, the anthropogenic dispersion of bovids and the cross-breeding of beef cattle with other bovid species may facilitate novel horn fly-host interactions. In particular, hybridizing yaks [Bos grunniens (Artiodactyla: Bovidae)] with beef cows (Bos taurus) for heterosis and carcass improvements may increase the exposure of yak × beef hybrids to horn flies. The present paper reports on the collection of digital images of commingled beef heifers (n = 12) and F1 yak × beef hybrid bovids (heifers, n = 7; steers, n = 5) near Laramie, Wyoming (∼ 2200 m a.s.l.) in 2018. The total numbers of horn flies on beef heifers and F1 yak × beef heifers [mean ± standard error (SE): 88 ± 13 and 70 ± 17, respectively] did not differ significantly; however, F1 yak × beef steers had greater total horn fly abundance (mean ± SE: 159 ± 39) than female bovids. The present report of this experiment is the first such report in the literature and suggests that F1 yak × beef bovids are as susceptible as cattle to horn fly parasitism. Therefore, similar monitoring and treatment practices should be adopted by veterinarians, entomologists and producers.

Impact of dietary protein on postprandial glycaemic control and insulin requirements in Type 1 diabetes: a systematic review

AIM

Postprandial hyperglycaemia is a challenge for people living with Type 1 diabetes. In addition to carbohydrate, dietary protein has been shown to contribute to postprandial glycaemic excursions with recommendations to consider protein when calculating mealtime insulin doses. The aim of this review is to identify and synthesize evidence about the glycaemic impact of dietary protein and insulin requirements for individuals with Type 1 diabetes.

METHODS

A systematic literature search of relevant biomedical databases was performed to identify research on the glycaemic impact of dietary protein when consumed alone, and in combination with other macronutrients in individuals with Type 1 diabetes.

RESULTS

The review included 14 published studies dated from 1992 to 2018, and included studies that researched the impact of protein alone (n = 2) and protein in a mixed meal (n = 12). When protein was consumed alone a glycaemic effect was not seen until ≥ 75 g. In a carbohydrate-containing meal ≥ 12.5 g of protein impacted the postprandial glucose. Inclusion of fat in a high-protein meal enhanced the glycaemic response and further increased insulin requirements. The timing of the glycaemic effect from dietary protein ranged from 90 to 240 min. Studies indicate that the postprandial glycaemic response and insulin requirements for protein are different when protein is consumed alone or with carbohydrate and/or fat.

CONCLUSIONS

This systematic review provides evidence that dietary protein contributes to postprandial glycaemic excursions and insulin requirements. These insights have important implications for the education of people with Type 1 diabetes and highlights the need for more effective insulin dosing strategies for mixed macronutrient meals.

ICRP Publication 141: Occupational Intakes of Radionuclides: Part 4

The 2007 Recommendations (ICRP, 2007) introduced changes that affect the calculation of effective dose, and implied a revision of the dose coefficients for internal exposure, published previously in the Publication 30 series (ICRP, 1979a,b, 1980a, 1981, 1988) and Publication 68 (ICRP, 1994b). In addition, new data are now available that support an update of the radionuclide-specific information given in Publications 54 and 78 (ICRP, 1989a, 1997) for the design of monitoring programmes and retrospective assessment of occupational internal doses. Provision of new biokinetic models, dose coefficients, monitoring methods, and bioassay data was performed by Committee 2 and its task groups. A new series, the Occupational Intakes of Radionuclides (OIR) series, will replace the Publication 30 series and Publications 54, 68, and 78. OIR Part 1 (ICRP, 2015) describes the assessment of internal occupational exposure to radionuclides, biokinetic and dosimetric models, methods of individual and workplace monitoring, and general aspects of retrospective dose assessment. OIR Part 2 (ICRP, 2016), OIR Part 3 (ICRP, 2017), this current publication, and the final publication in the OIR series (OIR Part 5) provide data on individual elements and their radioisotopes, including information on chemical forms encountered in the workplace; a list of principal radioisotopes and their physical half-lives and decay modes; the parameter values of the reference biokinetic models; and data on monitoring techniques for the radioisotopes most commonly encountered in workplaces. Reviews of data on inhalation, ingestion, and systemic biokinetics are also provided for most of the elements. Dosimetric data provided in the printed publications of the OIR series include tables of committed effective dose per intake (Sv per Bq intake) for inhalation and ingestion, tables of committed effective dose per content (Sv per Bq measurement) for inhalation, and graphs of retention and excretion data per Bq intake for inhalation. These data are provided for all absorption types and for the most common isotope(s) of each element. The online electronic files that accompany the OIR series of publications contains a comprehensive set of committed effective and equivalent dose coefficients, committed effective dose per content functions, and reference bioassay functions. Data are provided for inhalation, ingestion, and direct input to blood. This fourth publication in the OIR series provides the above data for the following elements: lanthanum (La), cerium (Ce), praseodymium (Pr), neodymium (Nd), promethium (Pm), samarium (Sm), europium (Eu), gadolinium (Gd), terbium (Tb), dysprosium (Dy), holmium (Ho), erbium (Er), thulium (Tm), ytterbium (Yb), lutetium (Lu), actinium (Ac), protactinium (Pa), neptunium (Np), plutonium (Pu), americium (Am), curium (Cm), berkelium (Bk), californium (Cf), einsteinium (Es), and fermium (Fm).

Optogenetically-Induced Population Discharge Threshold as a Sensitive Measure of Network Excitability

Network excitability is governed by synaptic efficacy, intrinsic excitability, and the circuitry in which these factors are expressed. The complex interplay between these factors determines how circuits function and, at the extreme, their susceptibility to seizure. We have developed a sensitive, quantitative estimate of network excitability in freely behaving mice using a novel optogenetic intensity-response procedure. Synchronous activation of deep sublayer CA1 pyramidal cells produces abnormal network-wide epileptiform population discharges (PDs) that are nearly indistinguishable from spontaneously-occurring interictal spikes (IISs). By systematically varying light intensity, and therefore the magnitude of the optogenetically-mediated current, we generated intensity-response curves using the probability of PD as the dependent variable. Manipulations known to increase excitability, such as sub-convulsive doses (20 mg/kg) of the chemoconvulsant pentylenetetrazol (PTZ), produced a leftward shift in the curve compared to baseline. The anti-epileptic drug levetiracetam (LEV; 40 mk/kg), in combination with PTZ, produced a rightward shift. Optogenetically-induced PD threshold (oPDT) baselines were stable over time, suggesting the metric is appropriate for within-subject experimental designs with multiple pharmacological manipulations.

P680The clinical value of CMR in the management of Cardio-Oncology patients - a tertiary centre experience

Background

There is increasing awareness of cardiotoxicity arising from cancer treatments. Early diagnosis and treatment is key, to ensure patients receive optimal oncological management. Cardiovascular magnetic resonance (CMR) offers gold standard measurement of cardiac function, alongside tissue characterisation and myocardial perfusion, thereby potentially providing additive value in the context of cardio-oncology.

Purpose

We sought to understand the clinical value of CMR in cardio-oncology at a tertiary cardio-oncology centre.

Methods

We retrospectively reviewed CMR scans requested in cardio-oncology patients at our institution within a ten-month period. We categorised clinical indications and assessed the impact on clinical management using previously-published criteria.

Results

102 CMR studies were requested in 93 cardio-oncology patients (mean age 56 (range 18 to 82), 49% male) between (March to December 2018). 41% of patients had haematological malignancies, 59% solid tumours.

15% of requests were for risk stratification prior to initiation of cancer therapy, 21% for screening for cardio-toxicity in patients currently receiving cardiotoxic agents (3% anthracyclines, 13% HER2 monoclonal antibodies, 4% fluoropyrimidines), 15% for investigation of patients with cardiac complications during cancer treatment, 35% assessment for late effects post cancer treatment, and 14% for cardiac malignancies/ infiltration.

The most common indications for CMR were monitoring of left ventricular ejection fraction (LVEF) in patients where quantification by echocardiography was non-diagnostic or significantly different between imaging studies (39%) and ischaemia assessment including for patients due to receive fluoropyrimidines (26%). Others were aetiology of LV dysfunction/cardiomyopathy (13%) and tissue characterisation (23%), including assessment for cardiac AL amyloid (11 patients), myocarditis (2), cardiac metastases (1), cardiac masses (6), and cardiac iron loading (1).

CMR findings had clinical impact in 61% of patients and assisted in adjudicating a new diagnosis in 29% of patients. 88% of patients were able to continue anthracycline/anti-HER2 therapies based on CMR findings of stable LVEF (93% of whose echocardiograms had suggested reductions). LVEF had reduced significantly in 12% of patients meaning chemotherapy was held/discontinued. 3 patients were recommended to receive non-fluoropyrimidine chemotherapy based on perfusion CMR (pCMR) findings, with one patient permitted to receive capecitabine following normal pCMR.

Conclusion

CMR provides a comprehensive assessment of myocardial structure and function with utility within the context of cardio-oncology for risk stratification pre-chemotherapy, screening for cardiotoxicity during treatment and investigation of cardiac complications of cancer treatment. The additional information derived from CMR generally provides reassurance enabling administration of optimal cancer therapies.

Effect of walking surface, late-cueing, physiological characteristics of aging, and gait parameters on turn style preference in healthy, older adults

Turning while walking is a crucial component of locomotion, often performed on irregular surfaces with little planning time. Turns can be difficult for some older adults due to physiological age-related changes. Two different turning strategies have been identified in the literature. During step turns, which are biomechanically stable, the body rotates about the outside limb, while for spin turns, generally performed with closer foot-to-foot distance, the inside limb is the main pivot point. Turning strategy preferences of older adults under challenging conditions remains unclear. The aim of this study was to determine how turning strategy preference in healthy older adults is modulated by surface features, cueing time, physiological characteristics of aging, and gait parameters. Seventeen healthy older adults (71.5 ± 4.2 years) performed 90° turns for two surfaces (flat, uneven) and two cue conditions (pre-planned, late-cue). Gait parameters were identified from kinematic data. Measures of lower-limb strength, balance, and reaction-time were also recorded. Generalized linear (logistic) regression mixed-effects models examined the effect of (1) surface and cuing, (2) physiological characteristics of ageing, and (3) gait parameters on turn strategy preference. Step turns were preferred when the condition was pre-planned (p < 0.001) (model 1) and when the gait parameters of stride regularity and maximum acceleration decreased (p = 0.010 and p = 0.039, respectively) (model 3). Differences in turn strategy selection under dynamic conditions ought to be evaluated in future fall-risk research and rehabilitation utilizing real-world activity monitoring.

SAT-554 Teprotumumab in Graves' Orbitopathy: Extended Outcome Analyses

Objective A multicenter, double-masked, randomized, placebo-controlled, phase two trial of 88 patients with active, moderate-to-severe Graves’ orbitopathy (GO) has demonstrated a significant and rapid response to teprotumumab, an insulin-like growth factor 1 receptor inhibitory monoclonal antibody, when compared with placebo after 24 weeks (N Engl J Med 2017; 376:1748). We now report extended primary and secondary outcome analyses. Methods Seven weeks after final dose of study medication (week 28), the primary and secondary endpoints were analyzed in teprotumumab intent-to-treat patients as compared with placebo to assess possible relapse. This included the primary composite endpoint of percentage patients with ≥2 points reduction in clinical activity score (CAS, seven-point scale) and a reduction of ≥2 mm in proptosis, secondary endpoints of proptosis, CAS, diplopia grade, specific GO quality of life questionnaire (GO-QoL), and exploratory analyses of clinical severity, all in the study (more severely affected) eye. Results Thirty-one of 42 (74%) teprotumumab- and six of 45 (13%) placebo- treated patients reached the primary outcome at treatment week 28 (p<0.001). Response was maintained from end of treatment period (week 24) in 93% of those teprotumumab-treated patients who responded. Proptosis response was similar to the primary outcome, with 55% of those receiving teprotumumab having a high response (≥3mm decrease). Gender, race, smoking or baseline proptosis values did not impact proptosis response. At week 28, 37/42 (88%) of those receiving teprotumumab and 27/45 (60%) getting placebo reached the CAS outcome (p=0.003). All individual CAS components were different from placebo (p≤0.04) except eyelid erythema (p=0.06). Assessment of CAS and severity of GO favored teprotumumab: chemosis (percent of patients ≥1 grade reduction; p=0.11), swelling of eyelid (percent of patients ≥1 grade reduction; p=0.01) and lid aperture (percent of patients ≥2 mm reduction; p=0.09). From baseline there was a reduction in constant diplopia (36% vs 9.5%) and increase in those with no diplopia (9.5% vs. 50%) in the teprotumumab group. At week 24, significantly more teprotumumab-receiving patients had improved by ≥one grade than placebo (62% vs. 22%, p<0.001). Improvement of diplopia grade remained significant at week 28 off drug. Overall GO-QoL was higher in those receiving teprotumumab than in patients getting placebo (p<0.001). Teprotumumab did not affect thyroid function, which was stable in both study groups through the treatment phase and follow-up. Conclusions Teprotumumab reduced the composite primary outcome of proptosis and CAS, as well as improved diplopia and GO-QoL significantly at seven weeks following study treatment discontinuation. This analysis also indicates that proptosis can serve as a primary and sensitive outcome for future trials of therapeutic response in GO.

Variation among human, veterinary and environmental Mycobacterium chelonae-abscessus complex isolates observed using core genome phylogenomic analysis, targeted gene comparison, and anti-microbial susceptibility patterns

Mycobacterium chelonae is a member of the Mycobacterium chelonae-abscessus complex and a cause of opportunistic disease in fish, reptiles, birds, and mammals including humans. Isolates in the complex are often difficult to identify and have differing antimicrobial susceptibilities. Thirty-one previously identified rapidly-growing, non-tuberculous Mycobacterium sp. isolates cultured from biofilms, fish, reptiles, mammals, including humans, and three ATCC reference strains were evaluated with nine M. chelonae-abscessus complex whole genome sequences from GenBank by phylogenomic analysis, targeted gene comparisons, and in-vitro antimicrobial susceptibility patterns to assess strain variation among isolates from different sources. Results revealed minimal genetic variation among the M. chelonae strains. However, the core genomic alignment and SNP pattern of the complete 16S rRNA sequence clearly separated the turtle type strain ATCC 35752^T from the clinical isolates and human reference strain “M. chelonae chemovar niacinogenes” ATCC 19237, providing evidence of two distinct subspecies. Concatenation of the partial rpoB (752 bp) and complete hsp65 (1,626 bp) sequence produced the same species/subspecies delineations as the core phylogeny. Partial rpoB and hsp65 sequences identified all the clinical isolates to the appropriate species level when respective cut-offs of 98% and 98.4% identity to the M. chelonae type strain ATCC 35752^T were employed. The human strain, ATCC19237, was the most representative strain for the evaluated human, veterinary, and environmental strains. Additionally, two isolates were identified as Mycobacterium saopaulense, its first identification in a non-fish or non-human host.

The stabilization effect of the conjoint tendon in reverse total shoulder arthroplasty

BACKGROUND

Numerous factors determine stability of reverse total shoulder arthroplasty. The effect of the conjoint tendon in relation to stability remains unknown. In this biomechanical study, we evaluated the influence of the conjoint tendon on the anterior stability of reverse total shoulder arthroplasty with a hemispherical glenosphere and a glenosphere with 9 mm lateralisation.

METHODS

A reverse total shoulder arthroplasty was implanted in 6 human cadaveric shoulders. The anterior stability was evaluated using a shoulder simulator. Two conditions, intact and dissected conjoint tendon, and 2 component configurations, a hemispherical glenosphere and a glenosphere with 9 mm lateralisation, were tested in each specimen. Testing of anterior stability was performed in 30° and 60° of abduction, with 0° and 30° of external rotation in the glenohumeral joint.

FINDINGS

The conjoint tendon showed a significant influence on the anterior stability with a hemispherical glenosphere in 30° and 60° with neutral rotation (p = 0.028) as well as 30° abduction with 30° (p = 0.028) external rotation. The 9 mm lateralised glenosphere stabilized significantly reverse total shoulder arthroplasty with resected conjoint tendon compared to the hemispherical glenosphere with resected conjoint tendon (p = 0.028).

INTERPRETATION

In a biomechanical setting the conjoint tendon has a stabilizing influence on the anterior stability of the reverse total shoulder arthroplasty with a hemispherical glenosphere in an abducted arm position, but this stabilizing effect was not seen with the lateralised glenosphere. The single influence of the lateralisation of the glenosphere on anterior stability was shown in cases of resected conjoint tendon.