Exploring the potential of virtual reality for the self-management of chronic pain: A scoping review of its use to address health literacy

BACKGROUND

Individuals with low health literacy struggle to manage long-term conditions. Addressing pain-related health competencies is important in the management of chronic pain. Virtual reality may be a useful tool for empowering sustainable health-related stratgies due to its unique ability to engage users in artificial environments.

OBJECTIVES

The aim of this scoping review was to explore existing research on the use of virtual reality as a tool to promote health literacy in people with chronic pain.

DESIGN

Scoping Review guided by framework proposed by Arksey & O'Malley.

METHOD

Articles related to "pain", "virtual reality" and "health literacy" were searched in four electronic databases: CINAHL, PubMed, Embase and PsycINFO using a formal search strategy. Studies were categorised based on intervention content using the Health Literacy Pathway Model which encompasses health knowledge, self-management skills, health communication and information seeking.

RESULTS

Thirteen studies met the inclusion criteria. Several elements of pain related health literacy were not addressed in the research. Interventions addressed health knowledge, self-management skills, decision making and featured content aiming to address emotional barriers to pain-related health literacy. Other components including active information seeking and use, actively communicating with health professionals and seeking and negotiating treatment options, were not explicitly addressed.

CONCLUSION

There is heterogeneity in existing research exploring the use of VR to support people with chronic pain. Existing VR tools to address pain-related health literacy do not cover several key components of health literacy. More research is required before a robust assessment of efficacy can be undertaken.

Prefoldin-5 Expression Is Elevated in Eutopic and Ectopic Endometriotic Epithelium and Modulates Endometriotic Epithelial Cell Proliferation and Migration In Vitro

Endometriosis is a common disease among women of reproductive age in which endometrial tissue grows in ectopic localizations, primarily within the pelvic cavity. These ectopic "lesions" grow as well as migrate and invade underlying tissues. Despite the prevalence of the disease, an understanding of factors that contribute to these cellular attributes remains poorly understood. Prefoldin-5 (PFDN5) has been associated with both aberrant cell proliferation and migration, but a potential role in endometriosis is unknown. As such, the purpose of this study was to examine PFDN5 expression in endometriotic tissue. PFDN5 mRNA and protein were examined in ectopic (lesion) and eutopic endometrial tissue from women with endometriosis and in eutopic endometrium from those without endometriosis using qRT-PCR and immunohistochemistry, respectively, while function of PFDN5 in vitro was evaluated using cell count and migration assays. PFDN5 mRNA and protein were expressed in eutopic and ectopic endometrial tissue, predominantly in the glandular epithelium, but not in endometrium from control subjects. Expression of both mRNA and protein was variable among endometriotic eutopic and ectopic endometrial tissue but showed an overall net increase. Knockdown of PFDN5 by siRNA transfection of endometriotic epithelial 12Z cells was associated with reduced cell proliferation/survival and migration. PFDN5 is expressed in eutopic and ectopic glandular epithelium and may play a role in proliferation and migration of these cells contributing to disease pathophysiology.

Prevalence and associated factors of post-traumatic stress disorder in parents whose infants have single ventricle heart disease

INTRODUCTION

Post-traumatic stress disorder occurs in parents of infants with CHD, contributing to psychological distress with detrimental effects on family functioning and well-being. We sought to determine the prevalence and factors associated with post-traumatic stress disorder symptoms in parents whose infants underwent staged palliation for single ventricle heart disease.

MATERIALS AND METHODS

A large longitudinal multi-centre cohort study evaluated 215 mothers and fathers for symptoms of post-traumatic stress disorder at three timepoints, including post-Norwood, post-Stage II, and a final study timepoint when the child reached approximately 16 months of age, using the self-report questionnaire Impact of Event Scale - Revised.

RESULTS

The prevalence of probable post-traumatic stress disorder post-Norwood surgery was 50% of mothers and 39% of fathers, decreasing to 27% of mothers and 24% of fathers by final follow-up. Intrusive symptoms such as flashbacks and nightmares and hyperarousal symptoms such as poor concentration, irritability, and sudden physical symptoms of racing heart and difficulty breathing were particularly elevated in parents. Higher levels of anxiety, reduced coping, and decreased satisfaction with parenting were significantly associated with symptoms of post-traumatic stress disorder in parents. Demographic and clinical variables such as parent education, pre-natal diagnosis, medical complications, and length of hospital stay(s) were not significantly associated with symptoms of post-traumatic stress disorder.

DISCUSSION

Parents whose infants underwent staged palliation for single ventricle heart disease often reported symptoms of post-traumatic stress disorder. Symptoms persisted over time and routine screening might help identify parents at-risk and prompt referral to appropriate supports.

Aerosol Particle Size Influences the Infectious Dose and Disease Severity in a Golden Syrian Hamster Model of Inhalational COVID-19

Background: Significant evidence suggests that SARS-CoV-2 can be transmitted via respiratory aerosols, which are known to vary as a function of respiratory activity. Most animal models examine disease presentation following inhalation of small-particle aerosols similar to those generated during quiet breathing or speaking. However, despite evidence that particle size can influence dose-infectivity relationships and disease presentation for other microorganisms, no studies have examined the infectivity of SARS-CoV-2 contained in larger particle aerosols similar to those produced during coughing, singing, or talking. Therefore, the aim of the present study was to assess the influence of aerodynamic diameter on the infectivity and virulence of aerosols containing SARS-CoV-2 in a hamster model of inhalational COVID-19. Methods: Dose-response relationships were assessed for two different aerosol particle size distributions, with mass median aerodynamic diameters (MMADs) of 1.3 and 5.2 μm in groups of Syrian hamsters exposed to aerosols containing SARS-CoV-2. Results: Disease was characterized by viral shedding in oropharyngeal swabs, increased respiratory rate, decreased activity, and decreased weight gain. Aerosol particle size significantly influenced the median doses to induce seroconversion and viral shedding, with both increasing ∼30-fold when the MMAD was increased. In addition, disease presentation was dose-dependent, with seroconversion and viral shedding occurring at lower doses than symptomatic disease characterized by increased respiratory rate and decreased activity. Conclusions: These results suggest that aerosol particle size may be an important factor influencing the risk of COVID-19 transmission and needs to be considered when developing animal models of disease. This result agrees with numerous previous studies with other microorganisms and animal species, suggesting that it would be generally translatable across different species. However, it should be noted that the absolute magnitude of the observed shifts in the median doses obtained with the specific particle sizes utilized herein may not be directly applicable to other species.

An evaluation of a one-day pain science education event in a high school setting targeting pain related beliefs, knowledge, and behavioural intentions

BACKGROUND

Persistent pain is a common condition affecting one in four UK adults. Public understanding of pain is limited. Delivering pain education within schools may improve public understanding in the longer term.

OBJECTIVE

To evaluate the impact of a one-day Pain Science Education (PSE) event on sixth form/high school students' pain beliefs, knowledge and behavioural intention.

METHODS

Exploratory, single-site, mixed-methods, single-arm study involving secondary school students ≥16 years old attending a one-day PSE event. Outcome measures included the Pain Beliefs Questionnaire (PBQ), Concepts of Pain Inventory (COPI-ADULT), a vignette to assess pain behaviours; and thematic analysis of semi-structured interviews.

RESULTS

Ninety (mean age 16.5 years, 74% female) of the 114 attendees, agreed to participate in the evaluation. PBQ scores improved on the Organic beliefs subscale [mean difference -5.9 (95% CI -6.8, -5.0), P < 0.01] and Psychosocial Beliefs subscale [1.6 (1.0, 2.2) P < 0.01]. The COPI-Adult revealed an improvement [7.1 (6.0-8.1) points, P < 0.01] between baseline and post intervention. Pain behavioural intentions improved post education for work, exercise, and bed rest related activities (p < 0.05). Thematic analysis of interviews (n = 3) identified increased awareness of chronic pain and its underpinning biology, beliefs that pain education should be widely available, and that pain management should be holistic.

CONCLUSIONS

A one-day PSE public health event can improve pain beliefs, knowledge and behavioural intentions in high school students and increase openness to holistic management. Future controlled studies are needed to confirm these results and investigate potential long-term impacts.

Development of an international glossary for clinical guidelines collaboration

OBJECTIVES

Clinical practice guidelines (CPGs) are often created through collaboration among organizations. The use of inconsistent terminology may cause poor communication and delays. This study aimed to develop a glossary of terms related to collaboration in guideline development.

STUDY DESIGN AND SETTING

A literature review of collaborative guidelines was performed to develop an initial list of terms related to guideline collaboration. The list of terms was presented to the members of the Guideline International Network Guidelines Collaboration Working Group, who provided presumptive definitions for each term and proposed additional terms to be included. The revised list was subsequently reviewed by an international, multidisciplinary panel of expert stakeholders. Recommendations received during this pre-Delphi review were implemented to augment an initial draft glossary. The glossary was then critically evaluated and refined through two rounds of Delphi surveys and a virtual consensus meeting with all panel members as Delphi participants.

RESULTS

Forty-nine experts participated in the pre-Delphi survey, and 44 participated in the two-round Delphi process. Consensus was reached for 37 terms and definitions.

CONCLUSION

Uptake and utilization of this guideline collaboration glossary by key organizations and stakeholder groups may facilitate collaboration among guideline-producing organizations by improving communication, minimizing conflicts, and increasing guideline development efficiency.

The Application of Bystander Intervention Scripts: Implications for Guardianship in Action

Responding to high rates of interpersonal victimization and perpetration among adolescents, schools have implemented bystander intervention (BI) training to educate students to intervene to prevent or stop violence. These trainings function much like an application of scripts for guardianship in action. The current study builds on the overlapping and complementary bodies of BI and routine activities research by testing whether participation in BI training, namely Green Dot (GD), influences individuals' underlying ability to intervene. Using four years of survey data collected from high school students (N = 2,374-3,443), we use item response theory to model the difficulty of engaging in different BI behaviors. We then estimate multivariate ordinary least squares regression models, one for each year, to estimate the effect of GD training on students' ability to intervene. The item response theory results show that BI behaviors differ in terms of how "difficult" they are for respondents to engage in. Findings show that in each year, GD training increased students' underlying ability to intervene. Our findings suggest BI training and guardianship in action scripts should take into account this varying difficulty of intervention behaviors to best train individuals for successful intervention to prevent victimization.

RPLP1 Is Up-Regulated in Human Adenomyosis and Endometrial Adenocarcinoma Epithelial Cells and Is Essential for Cell Survival and Migration In Vitro

Adenomyosis is defined as the development of endometrial epithelial glands and stroma within the myometrial layer of the uterus. These "ectopic" lesions share many cellular characteristics with endometriotic epithelial cells as well as endometrial adenocarcinoma cells, including enhanced proliferation, migration, invasion and progesterone resistance. We recently reported that the 60S acidic ribosomal protein P1, RPLP1, is up-regulated in endometriotic epithelial cells and lesion tissue where it plays a role in cell survival. To evaluate if a similar pattern of expression and function for RPLP1 exists in adenomyosis and endometrial cancer, we examined RPLP1 expression in adenomyosis and endometrial cancer tissue specimens and assessed its function in vitro using well-characterized cell lines. A total of 12 control endometrial biopsies and 20 eutopic endometrial and matched adenomyosis biopsies as well as 103 endometrial adenocarcinoma biopsies were evaluated for RPLP1 localization by immunohistochemistry. Endometrial adenocarcinoma cell lines, Ishikawa, HEC1A, HEC1B and AN3 were evaluated for RPLP1 protein and transcript expression, while in vitro function was evaluated by knocking down RPLP1 expression and assessing cell survival and migration. RPLP1 protein was up-regulated in eutopic epithelia as well as in adenomyosis lesions compared to eutopic endometria from control subjects. RPLP1 was also significantly up-regulated in endometrial adenocarcinoma tissue. Knockdown of RPLP1 in endometrial adenocarcinoma cell lines was associated with reduced cell survival and migration. RPLP1 expression is up-regulated in eutopic and ectopic adenomyotic epithelia as well as in the epithelia of endometrial cancer specimens. In vitro studies support an essential role for RPLP1 in mediating cell survival and migration, processes which are all involved in pathophysiology associated with both diseases.

1348 A QUALITY IMPROVEMENT PROJECT TO IMPROVE ASSESSMENT AND DOCUMENTATION FOLLOWING INPATIENT FALLS

Introduction

Inpatient falls are a major cause of avoidable harm in patients on elderly care wards. Delays in identification of fall precipitants and recognition of sustained injuries increases morbidity, mortality and length of stay (Cameron et al, Cochrane Database Syst Rev. 2018 Sep; 2018(9)). Patients sustaining falls are often initially assessed by postgraduate year 1 and 2 doctors independently. We aimed to improve patient outcomes following inpatient falls through standardisation of the assessment and documentation following a fall in hospital.

Methods

Using PDSA methodology, incident reports and documentation of inpatient falls were reviewed retrospectively over three 28-bedded elderly care wards. A post-falls proforma was devised that covered various domains of the post-fall assessment and was distributed to doctors throughout the hospital. Following the intervention, a repeat PDSA cycle was performed prospectively over the same wards and the proportion of assessments fulfilling each domain was compared between the cycles.

Results

Medical assessment of 27 falls from November 2020 to January 2021 was compared to 31 falls occurring between February and May 2022. Use of the proforma in cycle 2 was limited to 8/31 falls following intervention. Post-intervention, the proportion of assessments fulfilling medication review (19% vs 35%, p=0.14) and anticoagulation status (41% vs 55%, p=0.28) was improved. The proportion fulfilling fall circumstances (89% vs 90%, p=0.85), medical precipitant (70% vs 61%, p=0.46) and ordering of appropriate imaging (93% vs 97%, p=0.47) remained high.

Conclusion

Standardisation of post-falls assessment and documentation can improve patient safety outcomes through reducing delay in recognition of medical precipitants of falls and identification and management of sustained injuries. Improved integration of a post-falls proforma into electronic systems is needed to maximise its clinical benefit and would be the target of a further PDSA cycle.

Examining the Effect of Perceived Responsibility on Online Bystander Intervention, Target Hardening, and Inaction

Failure to take responsibility for intervening has been identified as a primary barrier to bystander intervention. Building on these findings, we examine how perceptions of responsibility affect responses to witnessing victimization in the online realm-a topic that has received limited attention. Using a maximum-likelihood selection model, we analyze data from the Pew American Trends Panel (N = 3709) to estimate the effects of respondents' perceptions of the role different groups should play in addressing online harassment on their likelihood to engage in intervention, target hardening, or inaction in response to witnessing online harassment, conditioned upon their likelihood of having witnessed such behavior. Findings indicate that the greater role respondents believe online users should have in addressing online harassment, the more likely they are to intervene. (b = .310). The greater role respondents believe law enforcement or elected officials should have in addressing online harassment, the less likely they are to intervene (b = -.135 and -.072, respectively). These findings have implications for future efforts to curb online harassment through users' crime prevention efforts.

ECG-I Phenotyping of Persistent AF Based on Driver Burden and Distribution to Predict Response to Pulmonary Vein Isolation (PHENOTYPE-AF)

BACKGROUND

This prospective trial sought to phenotype persistent AF based on AF mechanisms using ECGI mapping to determine whether this would predict long term freedom from arrhythmia after pulmonary vein isolation (PVI).

METHODS

Patients with persistent AF of < 2 years duration underwent cryoballoon PVI. ECGI mapping was performed prior to PVI to determine potential drivers (PDs) defined as rotational activations completing ≥ 1.5 revolutions or focal activations. The co-primary end point was the association between (1) PD burden (defined as the number of PD occurrences) and (2) PD distribution (defined as the number of segments on an 18 segment model of the atria harbouring PDs) with freedom from arrhythmia at 1 year follow up.

RESULTS

Of 100 patients, 97 completed follow up and 52 (53.6%) remained in sinus rhythm off antiarrhythmic drugs. Neither PD burden nor PD distribution predicted freedom from arrhythmia (HR 1.01, 95% CI 0.99 - 1.03, p = 0.164; and HR 1.04, 95% CI 0.91 - 1.17, p = 0.591 respectively). Otherwise, the burden of rotational PDs, rotational stability, and the burden of PDs occurring at the pulmonary veins and posterior wall all failed to predict arrhythmia recurrence (all p > 0.10).

CONCLUSIONS

AF mechanisms as determined using ECGI mapping do not predict outcome after PVI for persistent AF. Further studies using different methodologies to characterise AF mechanisms are warranted. (NCT03394404) This article is protected by copyright. All rights reserved.

The uterine natural killer cell, cytotoxic T lymphocyte, and granulysin levels are elevated in the endometrium of women with nonstructural abnormal uterine bleeding

OBJECTIVE

To examine the expression of uterine natural killer (uNK) cells and cytotoxic T lymphocytes (CTLs) in endometrial biopsies from reproductive-age women with and without nonstructural abnormal uterine bleeding (AUB) and evaluate the expression of granulysin within these cell populations and potential modulation of matrix metalloproteinase (MMP) expression.

DESIGN

Experimental study, retrospective design.

SETTING

Academic research laboratory.

PATIENT(S)

Patients with nonstructural AUB with no other gynecological pathologies and control patients without AUB.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Immunohistochemical analysis of granulysin, CD56 (uNK cell marker), and CD8 (CTL marker) expression as well as granulysin messenger ribonucleic acid (mRNA) expression levels in endometrial biopsy samples. Assessment of granulysin regulation of human endometrial stromal cell MMP-1 and MMP-3 mRNA expression.

RESULT(S)

The numbers of uNK cells and CTLs were significantly greater in endometrial biopsy tissue from women with AUB than those from controls. In accord with the increased expression of uNK cells and CTLs, granulysin expression was significantly greater in endometrial biopsies from patients with AUB than in from controls and colocalized to both cell types but not endometrial stromal or epithelial cells. The increased granulysin protein expression was associated with the increased granulysin mRNA expression in adjacent serial sections from these same samples. The treatment of the human endometrial stromal cell line t-HESC with granulysin resulted in a significant increase in MMP-1 and MMP-3 mRNA expression.

CONCLUSION(S)

In the current study, immunohistochemistry showed an increased expression of uNK cells, CTLs, and granulysin among subjects with AUB compared with that of subjects without AUB, leading to conclusions that disturbances in the balance of immune cells and an increase in granulysin expression may have implications in the pathophysiology of AUB and include enhanced MMP-1 and MMP-3 expression.

Ransomware and the Robin Hood effect?: Experimental evidence on Americans' willingness to support cyber-extortion

Objectives

Ransomware attacks have become a critical security threat worldwide. However, existing research on ransomware has largely ignored public opinion. This initial study identifies patterns in the American public's support for the use of ransomware, specifically when it is framed to provide benefits to others (i.e., in-group members). Drawing on the Robin Hood decision-making literature and Moral Foundations Theory, we offer theoretical predictions regarding ransomware support.

Methods

In a survey of 1013 Americans, we embedded a split-ballot experiment in which respondents were randomly assigned to indicate their level of support or opposition to one of two sets of six ransomware scenarios. We manipulated the nationality, authority level, and political affiliation of the actors.

Results

We find that people are more supportive of ransomware use when the actors are from their own in-group, and the outcomes benefit their in-group members. Also, the more strongly participants endorsed the moral foundations of authority and harm/care, the more supportive they were of the use of ransomware that may benefit others from their in-group.

Conclusions

These findings suggest political actors may be able to generate public support for morally questionable actions by emphasizing in-group benefits and the Robin Hood nature of an attack (e.g., outcome-based morality).

The Relationship and Expression of miR-451a, miR-25-3p and PTEN in Early Peritoneal Endometriotic Lesions and Their Modulation In Vitro

Background: miR-451a can function as a tumor suppresser and has been shown to be elevated in both endometriotic lesion tissue and serum from women with endometriosis. To further explore the role of miR-451a in the pathophysiology of endometriosis, specifically, further evaluating its association with the tumor suppressor, phosphatase and tensin homolog (PTEN), we examined their expression in individual endometriotic lesion tissue to gain insight into their relationship and further explore if miR-451a regulates PTEN expression. Methods: A total of 55 red, peritoneal endometriotic lesions and matched eutopic endometrial specimens were obtained from 46 patients with endometriosis. miR-451a, miR-25-3p and PTEN mRNA levels were assessed by qRT-PCR and reported for each matched eutopic and ectopic sample. To evaluate miR-451a and miR-25-3p expression of miR-25-3p and PTEN, respectively, 12Z cells (endometriotic epithelial cell line) were transfected and miR-25-3p expression was assessed by qRT-PCR, while PTEN protein expression was assessed by Western blotting. Results: PTEN and miR-25-3p expression exhibited an inverse relationship, as did miR-25-3p and miR-451a in individual lesions. Over-expression of miR-451a in 12Z cells resulted in down-regulation of miR-25-3p, while up-regulation of miR-25-3p resulted in down-regulation of PTEN protein expression. Conclusions: By assessing individual endometriotic lesion expression, we discovered an inverse relationship between miR-451a, miR-25-3p and PTEN, while in vitro cell transfection studies suggest that miR-451a may regulate PTEN expression via modulating miR-25-3p.

Percutaneous biliary stone clearance: is there still a need? A 10-year single-centre experience

AIM

To evaluate the safety and efficacy of percutaneous biliary stone clearance in a single hepatopancreaticobiliary (HPB) centre.

MATERIALS AND METHODS

All patients who underwent percutaneous biliary stone clearance between 2010 and 2020 at a HPB centre were identified from the radiology information system. Their demographic data, presentation, previous surgery, number/size of biliary calculi, success and complications were collected from patient records. Unpaired student's t-test was used to compare numerical variables and the Chi-square test was used to compare categorical data.

RESULTS

Sixty-eight patients aged between 58.5-91.1 years underwent the procedure, and 42.6% (29/68) had the procedure due to surgically altered anatomy precluding endoscopic retrograde cholangiopancreatography (ERCP). The most common presentation was cholangitis (62%). The success rate of percutaneous stone clearance was 92.7%. The average number of calculi was two (range 1-412). Of the patients included, 4.4% developed pancreatitis, 4.4% developed cholangitis, and 1.5% had hepatic artery branch pseudoaneurysm successfully treated with transarterial embolisation. There was no significant difference in success or complication rates between the different access sites (right lobe, left lobe, roux-loop, T-tube, p=0.7767).

CONCLUSION

Percutaneous biliary stone clearance is safe and effective and will continue to play an important role where ERCP fails or is impossible due surgically altered anatomy.

Sexual and reproductive health education for women in a migrant camp in Belgrade, Serbia

 

Serbia borders the European Union (EU). It hosts 18 migrant camps for migrants/refugees blocked from entering the EU. A camp in Belgrade, houses 450 people, most residing there for over a year. The women are vulnerable due to no/low education, early marriage, multiple children, perilous journeys travelled, shared basic accommodation, and uncertain status/futures. The UN sustainable development goal 3 highlights the importance of improving sexual and reproductive health (SRH) in humanitarian settings. SRH education empowers women to plan/prevent pregnancies, prevent spread of sexually transmitted infections, and to know when to see a doctor. Many migrant camps exist across Europe housing similarly vulnerable women who would benefit from SRH education. The objectives were to 1. Create a safe space for sharing SRH concerns; 2. Assess knowledge and needs; 3. Develop and deliver a bespoke SRH programme in collaboration with the women; 4. Assess impact on knowledge. I facilitated SRH discussions and built rapport, the women then completed an anonymous questionnaire assessing knowledge/needs. I developed a series of monthly SRH workshops delivered over a year. The questions posed were 1. Was SRH education needed/desired? 2. Would women attend? 3. Would SRH knowledge improve?

The discussions and questionnaire demonstrated the need and desire for SRH education. 4-10 women (average 8) attended each workshop, with open discussions generated. The women's knowledge increased, extrapolated from workshop activities and qualitative feedback. These migrant women had an unmet need for SRH education, which was addressed via this programme. It demonstrated an increase in SRH knowledge, enabling informed SRH decision making and ultimately improving public health. Migrant women reside in camps across Europe, and would benefit from this programme. Creating a collaborative, bespoke SRH programme with migrant women in transit across Europe is both innovative and important.

Key messages

Vulnerable female migrants residing in a migrant camp in Belgrade had an unmet need/desire for sexual and reproductive health education which was addressed via a bespoke programme of SRH workshops. Migrant camps exist across Europe housing vulnerable women who urgently require access to good quality sexual and reproductive health education and care in order to improve overall public health.

Digital sexual and reproductive health resources for women living in a migrant camp in Serbia

 

Prior to Covid-19 (C19), I delivered sexual and reproductive health (SRH) educational workshops to refugee/migrant women in a migrant camp in Belgrade, Serbia. SRH education and access are key to the public health for all but specifically this vulnerable population. C19 and a national lockdown meant an alternative, none face to face delivery method was required. Migrant camps exist throughout Europe, and restrictions due to C19 continue across the world increasing the applicability of this practice in many settings. My previous experience informed my knowledge for course content, however not suitable delivery methods. Most women had mobile phones, however barriers to accessing online content included intermittent internet access, low computer literacy, inadequate privacy, and need for translation. Following research into alternative formats, over a number of months we piloted; texts +/- attachments, voice messages, video streaming, online videos to download. The questions posed were 1. Which format was the most accessible/acceptable to the women? 2. When the format was decided, how many women would access the content and was this number comparable to the workshops? The feedback showed texts with links to unlisted YouTube videos with burned subtitles were best, enabling download when internet access/privacy allowed and requiring minimal computer skills. We created an SRH programme of 5-minute videos with feedback obtained via text. Each video has 4-21 views (averaging 8 and continuing to increase) at time of submission, comparable or more than the workshops. This innovative practice delivers SRH information to women in this migrant camp. It doesn't replace workshops but when access is restricted it can be used independently, or ordinarily as a supplementary tool to workshops. It is applicable in any setting when access is restricted. Benefits include; choice of when/where/how to access; repeat views; potential for wider reach/scaling to reach larger populations.

Key messages

These carefully designed digital resources have allowed non-English speaking migrant women in a migrant camp to continue accessing sexual and reproductive health education during Covid-19 lockdowns. This innovative practice of delivering information to vulnerable, hard to reach groups is applicable in many settings when face to face access is restricted.

Long-term outcomes of catheter ablation for ventricular arrhythmias in post- myocarditis patients; Insights from a meta-analysis of current datv

Background

In the past decade, catheter ablation (CA) has become a rapidly expanding treatment option for ventricular tachycardia (VT), however it is not commonly utilized for patients with post-myocarditis VT. We aimed to systematically review up-to-date evidence regarding feasibility, effectiveness, and safety of CA, with a specific focus on long-term relapse rate and procedural complications.

Methods

A structured electronic database search (PubMed, Embase, Cochrane) of the scientific literature was performed for studies describing outcomes at up to 7.3 years after CA. The primary outcome measured was VT recurrence post-ablation. Procedural success was defined as freedom of ventricular arrhythmias (at the end of follow-up after an ablation procedure). The secondary outcome was significant procedural complications which included procedural death, stroke, cardiac tamponade, acute myocardial infarction, major vascular complications, and major bleeding, assessed on a study-by-study basis.

Results

A total of 186 patients were included in analysis with most patients (88%) being male.

Over the follow up period there was a 18% relapse rate (n=34) (Confidence Interval (CI); 0.12–0.24, I2≈0, p=0.77) with the majority of patients remaining VT free for the duration of follow up. Only one study recorded the percentage of re-do procedures. The overall procedural complication rate was 3.0% (n=7, (CI; 0.01–0.07, I2≈0, p=0.44) and of note, there were no peri-procedural deaths or heart transplant surgeries reported. However, a single study reported a mortality of 10% (n=2) during the follow up period.

Conclusions

CA is an effective and durable long-term therapeutic strategy for post myocarditis VT patients with limited relapse rate and very low complication rates based on these non-randomised data. Larger randomised-controlled trials with standardised treatment and long follow-up are required to compare CA versus conventional treatment in the post-acute myocardial phase.

Funding Acknowledgement

Type of funding sources: None. Relapse rate during follow-upProcedural complication rate

1150 A Painless Anterior Chest Wall Mass Post Coronary Artery Bypass Grafting Surgery

Aim

We aim to present here a case of a painless anterior chest wall mass which was first noted during routine follow up post coronary artery bypass graft surgery

Case presentation

An 80-year-old male developed an asymptomatic slow growing pronounced swelling over the right anterior chest wall post CABG. His other past medical history includes chronic obstructive pulmonary disease, pulmonary fibrosis, ischaemic heart disease, an AICD for complete heart block, hypertension, hyperlipidaemia and osteoarthritis. A CT scan demonstrated a 10 x 12 x 6.5 cm subcutaneous lesion at the mid-line of the lower chest wall adjacent to the xiphisternum and the previous sternotomy site. On clinical examination there was a large non-tender cystic swelling with peripheral calcifications, but overlying skin was normal. Fluid was aspirated from the lesion and cytology showed a paucicellular specimen with features in keeping with seroma. Due to the progressive increase in size patient underwent surgical resection. A gelatinous bloody fluid was aspirated from the lesion and it was then resected enbloc. The tumour base appeared to arise from 6/7th costal cartilage and tumour was shaved away. The mass was confirmed histologically to be chondrosarcoma.

Conclusions

Given the uncommon prevalence of malignant primary chest wall tumours this case highlights the importance of high clinical suspicion even after developing post CABG.

The stability of an isolate of the SARS-CoV-2 B.1.1.7 lineage in aerosols is similar to three earlier isolates

Background

Our laboratory previously examined the influence of environmental conditions on the stability of an early isolate of SARS-CoV-2 (hCoV-19/USA/WA-1/2020) in aerosols generated from culture medium or simulated saliva. However, genetic differences have emerged among SARS-CoV-2 lineages, and it is possible that these differences may affect environmental stability and the potential for aerosol transmission.

Methods

The influence of temperature, relative humidity, and simulated sunlight on the decay of four SARS-CoV-2 isolates in aerosols, including one belonging to the recently emerged B.1.1.7 lineage, were compared in a rotating drum chamber. Aerosols were generated from simulated respiratory tract lining fluid to represent aerosols originating from the deep lung.

Results

No differences in the stability of the isolates were observed in the absence of simulated sunlight at either 20°C or 40°C. However, a small but statistically significant difference in the stability was observed between some isolates in simulated sunlight at 20°C and 20% relative humidity. .

Conclusions

The stability of SARS-CoV-2 in aerosols does not vary greatly among currently circulating lineages, including B.1.1.7, suggesting that the increased transmissibility associated with recent SARS-CoV-2 lineages is not due to enhanced survival in the environment.

Long-term outcomes of index cryoballoon ablation or point-by-point radiofrequency ablation in patients with atrial fibrillation and systolic heart failure

Catheter ablation is an established effective approach for the treatment of atrial fibrillation (AF) in patients with heart failure, however, the role of cryoablation in this setting is unclear. Procedural success and left ventricular systolic dysfunction (LVEF) improvement in patients with LVEF ≤ 45% undergoing index catheter ablation with cryoablation were evaluated. Freedom from AF recurrence was seen in 43% rising to 59% following repeat procedure. There were significant improvements in LVEF and functional status at long-term follow-up. Results were comparable to a contemporaneous cohort of heart failure patients undergoing index ablation with radiofrequency ablation. Cryoablation is an effective first-line AF ablation approach in the setting of heart failure.

60S acidic ribosomal protein P1 (RPLP1) is elevated in human endometriotic tissue and in a murine model of endometriosis and is essential for endometriotic epithelial cell survival in vitro

Endometriosis is a female disease which is defined as the presence of ectopic endometrial tissue and is dependent on estrogen for its survival in these ectopic locations. Expression of the ribosomal protein large P1 (RPLP1) is associated with cell proliferation and invasion in several pathologies, but a role in the pathophysiology of endometriosis has not been explored. In this study, we aimed to evaluate the expression and function of RPLP1 with respect to endometriosis pathophysiology. RPLP1 protein was localised by immunohistochemistry (IHC) in eutopic and ectopic tissue from 28 subjects with confirmed endometriosis and from 20 women without signs or symptoms of the disease, while transcript levels were evaluated by qRT-PCR in 77 endometriotic lesions and 55 matched eutopic endometrial biopsies, and protein expression was evaluated using western blotting in 20 of these matched samples. To evaluate the mechanism for enhanced lesion expression of RPLP1, an experimental murine model of endometriosis was used and RPLP1 expression was localized using IHC. In vitro studies using an endometriosis cell line coupled with shRNA knockdown was used to demonstrate its role in cell survival. Expression of RPLP1 mRNA and protein were significantly higher in ectopic lesion tissue compared to paired eutopic endometrium and immunohistochemical localisation revealed predominant localisation to epithelial cells. This pattern of lesion RPLP1 was recapitulated in mice with experimentally induced endometriosis. Stable knockdown of RPLP1 protein resulted in a significant decrease in cell survival in vitro. These studies reveal that RPLP1 is associated with cell proliferation and/or survival and may play a role in the pathophysiology of endometriosis.

Increased CXCL12 expression in endometrium of women with abnormal uterine bleeding is post-transcriptionally mediated via miR-23b-3p and is associated with decreased expression of the miR-23b-3p/24-3p/27b-3p cluster: a pilot study

OBJECTIVE

To study C-X-C motif chemokine 12 (CXCL12) and CXCR4 expression in endometrial tissue from both women with and without abnormal uterine bleeding (AUB) of endometrial origin and evaluate their relationship with microRNA (miRNA).

DESIGN

Retrospective and laboratory study.

SETTING

University-based research laboratory.

PATIENT(S)

Nine women with and without abnormal uterine bleeding, all of whom were in the secretory stage of their menstrual cycle, who provided endometrial biopsy tissue.

INTERVENTION(S)

Immunohistochemical localization of CXCL12 and CXCR4 as well as quantitative reverse-transcription polymerase chain reaction (qRT-PCR) assessment of mRNA expression in archived endometrial biopsy tissue and in vitro cell culture using the immortalized endometrial stromal cell line, t-HESC. Endometrial stromal cell line, t-HESC transfection with nontargeting, negative control miRNA mimics or miRNA mimics for miR-23b-3p and mRNA assessment miR-23b-3p expression confirmed by qRT-PCR and evaluation of impact on CXCL12 expression at the protein level by enzyme-linked immunosorbent assay and mRNA levels by qRT-PCR.

MAIN OUTCOME MEASURE(S)

Expression of CXCL12 and CXCR4 protein via immunohistochemistry and mRNA and miRNA levels of CXCL12 and CXCR4 as well as miR-23b-3p, miR-24b-3p, and miR-27b-3p, respectively, via qRT-PCR.

RESULT(S)

CXCL12 and its receptor CXCR4 expression were up-regulated in the endometrial tissue of women with AUB at the protein level, but this up-regulation of expression was only associated with increased CXCR4 mRNA expression. To evaluate whether CXCL12 may be post-transcriptionally regulated, we assessed expression of miR-23b-3p, a bona fide post-transcriptional regulator of CXCL12 expression. The expression of miR-23b-3p was statistically significantly lower in AUB endometrial tissue, as were fellow cluster members miR-24-3p and miR-27-3p. Transfection of t-HESC cells with pre-miR-23b-3p mimics statistically significantly reduced the levels of CXCL12 secreted protein but not mRNA levels, suggesting that miR-23b-3p retards protein translation independent of transcript degradation.

CONCLUSION(S)

Reduced expression of the miR-23b-3p/24-3p/27b-3p cluster is associated with elevated expression of CXCL12, which may contribute to the pathophysiology of AUB.

P504VT ablation outcomes and predictors in a UK population- validating existing predictors and novel markers

Background

Radiofrequency catheter ablation (CA) can reduce ventricular tachycardia (VT) burden and registry data suggests an improvement in mortality. However, there is significant heterogeneity in patient morbidity and VT phenotype. A risk prediction model derived from observational data has suggested pre-procedural left ventricular (LV) function, age and underlying ischaemic cardiomyopathy are associated with greater post-procedural mortality. Validation of proposed factors in clinical practice is required to facilitate comprehensive pre-procedural risk stratification and inform decision making.

Purpose

To determine whether proposed pre-procedural predictors of mortality after VTCA are valid in a UK population and explore any association with other predictors.

Method

Patients undergoing VTCA at a tertiary electrophysiology centre between 06/07/16 and 31/07/19 were included. Pre-specified characteristics and mortality follow-up data were analysed from electronic health records. Cox regression analysis was undertaken to determine association with mortality.

Results

161 patients with mean age of 63 ±15.9 years underwent VTCA of whom 133 (83%) were male. During the follow-up  period (16 months, 13-24; median, 1st-3rd quartile) 16 patients died. No deaths occured in the 27 (16%) patients with structurally normal hearts. Chronic kidney disease (CKD) stage III-IV (HR 14.73 [4.9-44.4]), LV ejection fraction &lt;35% (HR 7.13 [1.59-31.88]), underlying ischaemic cardiomyopathy (HR 6.17 [1.37-27.85]), LV internal diameter (LVID) (1.08 [1.02-1.15]) and age (HR 1.08 [1.02-1.14]) were associated with significantly greater mortality risk (Table 1) (Figure 1).

Conclusion

Proposed risk stratifying factors are validated in our UK centre’s experience. Additionally, CKD and baseline LVID appear to be associated with mortality in our population and warrant further study.

Risk factor Hazard ratio Lower confidence interval Upper confidence interval P-value Atrial fibrillation (yes/no) 0.14 0.02 1.11 0.06 Age (years) 1.08 1.02 1.14 &lt;0.01 Diabetes (yes/no) 2.43 0.85 6.92 0.10 Chronic kidney disease (yes/no) 14.73 4.88 44.41 &lt;0.01 Ischaemic cardiomyopathy (yes/no) 6.17 1.37 27.85 0.02 LV EF &lt;35% (yes/no) 7.13 1.59 31.88 &lt;0.01 LV internal diameter (mm) 1.08 1.02 1.15 &lt;0.01 Procedural urgency (urgent/elective) 1.12 0.57 2.20 0.75 Table 1: Association between baseline risk factors and mortality risk after VT catheter ablation

Abstract Figure 1: Kaplan-Meier survival curves

Concurrent Immunohistochemical Localization and Western Blot Analysis of the MIF Receptor, CD74, in Formalin-Fixed, Paraffin-Embedded Tissue

Archived, formalin-fixed, paraffin-embedded tissue provides a robust resource for assessing protein expression in a variety of complex tissue types. Immunohistochemical localization techniques allow one to identify proteins of interest in the different cell populations which compose these tissues, but quantitative comparison within and between samples is semiquantitative. In contrast, Western blot analysis provides a more quantitative assessment but without the ability to identify the cellular sources of expressed protein. Here we describe a dual approach using human endometrium to assess both the localization and quantitation of the macrophage migration inhibitory factor (MIF) receptor CD74 by immunohistochemical techniques and Western blotting.

Evaluation of the optimal standardized ileal digestible threonine:lysine ratio in lactating sow diets

Camborough PIC sows (n = 291) were fed 1 of 5 dietary treatments to evaluate the standardized ileal digestible (SID) Thr:Lys requirement during lactation. Sows were blocked by parity (1, 2, and 3+) and randomly allotted to 1 of 5 SID Thr:Lys ratios (52, 60, 68, 76, and 84). SID Lys was formulated to 1.03% and SID methionine and cystine (M + C):Lys was 55%. Sows were allowed 5.45 kg feed/day starting on the day of farrowing. All other nutrients met or exceeded the NRC (2012) requirements. Sows were allowed ad libitum access to water, and piglets were cross-fostered within treatment within 24 h of birth. Data collected during the study included sow prefarrow BW, sow weaning weight, starting litter weight, weaning litter weight, piglet mortality, weaning-to-estrus interval, and subsequent total born piglets. Data were analyzed as a randomized complete block design using PROC MIXED with sow as the experimental unit and treatment and parity as fixed effects. Requirement estimation models evaluated were quadratic polynomial, broken-line linear, and broken-line quadratic (BLQ) using PROC NLMIXED. Models that differed in their Bayesian information criterion (BIC) values by at least 2 points were considered to have meaningful differences in their data fit. The best-fit model was based on the best BIC value. As the SID Thr:Lys ratio increased, there was a quadratic response on ADFI (4.73, 4.57, 4.67, 4.55, and 4.60 kg/d; P = 0.001) and percent of sow BW loss (-6.4, -7.89, -7.35, -6.19, and -5.81; P = 0.004). In addition, there was a trend for weaning-to-estrus interval to be affected by the ratio (5.4, 4.4, 4.6, 4.5, and 4.8; P = 0.07). Daily litter gain was also quadratically improved as the SID Thr:Lys ratio increased (2.67, 2.67, 2.78, 2.77, and 2.68 kg/d; P-value = 0.001). For daily litter gain, the BLQ model was determined to be the best fit with an estimated SID Thr:Lys requirement of 65%. In conclusion, the optimal SID Thr:Lys ratio for litter growth was 65.

180 Evaluation of soluble concentrated yeast product on sow and litter performance

Two hundred and forty sows (Camborough, PIC, Hendersonville, TN) were started on study at 35 d post-breeding through lactation to determine the effects of soluble concentrated yeast product (Celmanax SCP, Arm and Hammer, Princeton, NJ) on sow and litter performance. Sows were fed their respective dietary treatments: 1) Control diet gestation x control diet lactation; 2) 0.01% Celmanax SCP in gestation x control diet lactation; 3) Control diet gestation x 0.02% Celmanax SCP in lactation; and 4) 0.01% Celmanax SCP in gestation x 0.02% Celmanax SCP in lactation. All diets were formulated to meet or exceed NRC (2012) requirements and contained a feed disinfectant. Sows were allowed ad libitum access to feed and water in lactation. Litters were weighed after cross-fostering, 48 h post-farrow (after litter adjustments and cross-fostering) and at weaning. Sows were weighed entering farrowing and at weaning. Data were analyzed as a randomized complete parity block using PROC MIXED of SAS with sow as the experimental unit, treatment as a fixed effect, and parity as a random effect. There were detectable levels of fumonisin (2 ppm), vomitoxin (1.3 ppm) and zearalenone (243 ppb). There were no differences in sow feed intake or body weight loss (P > 0.10). There was a significant difference in treatments 1, 2, 3 and 4 for days between wean to estrus (5.99, 5.12, 4.90, 4.49; P = 0.01) and percent bred within 7 d (86.53, 97.06, 97.85, 100.00; P = 0.01), respectively. Average piglet wean weights (kg) were 5.82, 5.87, 5.93, 6.01; P = 0.02 for treatments 1, 2, 3 and 4 respectively. Furthermore, there were no responses in piglet average daily gain or mortality (P > 0.10). The feeding of the soluble yeast product to sows does appear to improve subsequent breeding and litter performance.

PSII-9 Effect of avilamycin on nursery pig performance and health

Four hundred (PIC 337 X Camborough, PIC, Hendersonville, TN) and 800 (PIC 359 X C29) barrows and gilts were used to determine the impact of avilamycin (Kavault®, Elanco, Greenfield, IN) on nursery pig performance. Upon weaning, the lightest 10% of pigs were sorted off to form one replication and the remaining pigs were sorted by sex and placed into blocks with 25 pigs/pen. Six of the 48 pens were assigned to a non-feed grade medication control treatment. Remaining blocks were assigned to 1 of 3 treatments (50 g Mecadox/ton, 73 g Kavault/ton d0 to d21, 73 g Kavault/ton d0 to d42). Diets were formulated to meet or exceed NRC (2012) recommendations. Pen weights and feed intake information were collected for calculation of ADG, ADFI, and F:G. Pigs were vaccinated against porcine circovirus, Mycoplasma hyopnuemoniae, Salmonella, and Lawsonia. Diagnostic samples showed presence of E. coli and Salmonella. Pigs were PRRSv and PEDv negative. Data were analyzed as a completely randomized design using the PROC MIXED procedure of SAS with pen as experimental unit and treatment as a fixed effect. LSMeans were considered significant at P ≤ 0.05 and considered a trend at P > 0.05 and P ≤ 0.10. Final body weight (d42) was not significantly different (P = 0.26), but there were numerical improvements in body weight for all medication treatments compared to the control (0.68, 0.68, and 1.5 kg for Mecadox, Kavault 21 d and Kavault 42 d respectively). Overall ADG (0.46, 0.45, 0.48, 0.45 kg, respectively) was greatest and F:G was lowest for the Kavault 42d treatment, although differences were not always significant (P > 0.05). Feeding medications numerically lowered the percentage of injectable medication intervention compared to controls (110.8, 12.7, 137.2, and 156.0%, respectively). Avilamycin appears to be an effective medication option for pigs in 42 d nursery programs but the anticipated response may differ depending on feeding duration.

PSII-12 The effects of lift crates on sow performance and litter survival

In modern sow farms, pre-weaning mortality (PWM) remains a key barrier to achieving peak productivity and optimizing piglet welfare. Therefore, a total of 270 sows (PIC 1050, 3.6 average parity) were used (May to July 2018) to determine the effect of lift crates in farrowing on sow and piglet performance and litter survival in a commercial setting in southwestern Ontario, Canada. Lift crates are driven by postural changes in the sow which activate a hydraulic lift system (Balance Frame; NOOYEN, Deurne, NL) which temporarily raises a movable sow slat 25 cm above the crate floor. Sows were randomly assigned to 2.44 m × 1.83 m farrowing crates that were 1) conventional or 2) lift crates. Within rooms, litters were standardized to 13 or 14 pigs within 24 h after parturition. Daily sow feed intake was measured using electronic lactation feeders (Gestal SOLO; JYGA Technologies, Inc.). Data were analyzed using the MIXED procedure of SAS (Cary, NC). Sow was the experimental unit. No differences (P > 0.22) were observed for number born alive, stillbirths or mummified fetuses. Sow backfat loss (2.2 vs. 2.5 mm), average daily feed intake (5.67 vs. 5.74 kg) and wean-to-estrus interval (5.27 vs. 5.62 d) were similar (P > 0.16) between conventional and lift crate treatments. However, from birth to cross-fostering, lift crates reduced (P < 0.01) piglet deaths by 55% when compared to conventional crates (0.58 vs. 0.32 piglets). Piglet deaths from cross-fostering to weaning did not differ (P = 0.18, 0.68 vs. 0.54 piglets). Number of pigs weaned (12.62 vs. 12.87) and suckled litter weaning weight (75.7 vs. 75.6 kg) did not differ (P > 0.11) across treatments. These results provide evidence that lift crates can reduce the number of piglet deaths and may improve PWM in sow farms.Keywords: crate, piglet, survival

Evaluation of the optimal standardized ileal digestible valine:lysine ratio in lactating sow diets1

An experiment was conducted with 430 sows to evaluate the ideal standardized ileal digestible (SID) Val:Lys on sow and litter performance during an 18.6-d lactation period. The SID Val:Lys ratios measured were based on the previously published literature and then values above and below reported values. Sows were randomly allotted within parity block (parity 1, parity 2, and parity 3+) to one of five corn-soybean meal-based lactation diets formulated to contain different levels of SID Val:Lys (0.50, 0.62, 0.75, 0.88, and 1.00, respectively). All diets were formulated to be isocaloric (3.35 ME Mcal/kg) with 0.95% SID Lys and contained vitamins and minerals that exceeded recommendations (NRC, 2012). Experimental diets were given to sows from 112 d of pregnancy throughout the 23-d lactation period. Litters were standardized within 48 h after farrowing. Sows were fed with the Howema computerized feeding system that mixed the high and low diets to create the intermediate diets, weighed the feed for each sow and then delivered the feed to each individual feeding hopper to record daily sow feed intake during lactation. Data were analyzed as a randomized complete block design using the PROC MIXED procedure of SAS with sow as the experimental unit and treatment as a fixed effect and parity as the random effect. Results were considered significant at P ≤ 0.05 and considered a trend at P > 0.05 and P ≤ 0.10. Sow ADFI was not significantly different (5.2, 5.2, 5.2, 5.0, and 5.4 ± 0.15 kg/d, respectively). On average, sows consumed ~45 g of SID Lys per day. Sow wean to estrus (5.2, 4.7, 5.3, 5.5, and 4.5 ± 0.32 d, respectively) was not different as the Val:Lys ratio changed. Increasing the Val:Lys ratio resulted in no differences (2.66, 2.64, 2.76, 2.61, and 2.62 ± 0.08 kg; P > 0.10) in average daily litter gain. There were no differences in sow weight loss or subsequent total born across the dietary treatments. Overall, increasing levels of SID Val:Lys did not change sow reproductive performance or piglet growth rate.

Progress for research of grape and wine culture in Georgia, the South Caucasus

This communication will provide the latest information about the progress of the “Research Project for the Study of Georgian Grapes and Wine Culture”, managed by the National Wine Agency of Georgia since 2014. Local and foreign institutions continue to work together with the aim of stimulating multidisciplinary scientific research activity on Georgian viticulture and viniculture and to reconstruct their development from Neolithic civilizations to the present. The project is multidisciplinary in nature, merging contributions from archaeology, history, ethnography, molecular genetics, biomolecular archaeology, palaeobotany, ampelography, enology, climatology and other scientific fields.

106 Assessment of fecal near infrared reflectance spectroscopy to detect and monitor the reproductive status of endangered Amur and Snow leopard females

Feces from captive and wild carnivores can yield valuable information about an individuals’ physiological and reproductive status, diet, and ecology. Near infrared spectroscopy (NIRS) is a rapid, noninvasive, cost-efficient technique widely used in the agricultural, pharmaceutical, and chemical industries that has gained traction in diagnostic and ecological field applications for herbivore species, such as wild deer, antelope, and giant panda. The aim of this study was to test the transferability of NIRS to measuring reproductive status in feces from 2 endangered carnivore species, the Snow (Panthera uncia) and Amur (Panthera pardus orientalis) leopards. Fecal near infrared spectra analysed with multivariate statistics were used to generate prediction models for estrone-3-glucuronide (E1G) and progesterone (P4). In the E1G NIRS model, fecal samples (n=93) were obtained from 5 female leopards (3 Amur, 2 Snow) at 5 different zoo facilities, whereas for the P4 NIRS model fecal samples (n=51) from only 1 pregnant Amur leopard was available. The hormones were extracted with methanol and quantified by enzyme-linked immunosorbent assays (C. Munroe), where the sample range for E1G was 0.20-2.17 μg/g and the range for P4 was 0.06-61.89 μg/g. The near infrared spectra (350-2500nm) were acquired with an ASD FieldSpec®3 portable spectrometer (Malvern Panalytical, Malvern, UK), and the chemometric analysis was realised using the Unscrambler® X v.10.4 (CAMO Software AS, Oslo, Norway). Hormone reference values were log transformed before chemometric analysis to account for the heterogeneity of variance. Spectral pretreatment of standard normal variate was applied to the truncated wavelength range 700-240 0nm in order to remove interference from the visible region (350-700nm) due to individual diets that can confer colour variants that alter spectral signatures. Initial principal component analysis for the E1G and P4 datasets models showed &gt;95% of the variation was explained by 4 factors, with no separation of principal component analysis scores between species or reproductive status. Quantitative prediction models using partial least-squares regression on selected wavelength ranges yielded a coefficient of determination for E1G and P4 of 0.10-0.04 and 0.35-0.19 for calibrations and validations, respectively. These near infrared models require further mathematical processing and consideration of sample variation due to diet complexity in carnivores in order to accurately assess hormone levels and monitor reproductive cycles in these species. This work was supported by USDA-ARS Biophotonics Initiative grant #58-6402-3-018.

Effects of two feeding periods of tiamulin fed in combination with chlortetracycline for control and treatment of swine respiratory and enteric disease and subsequent growth performance of growing-finishing pigs

The objective of this study was to evaluate the effects of two dietary feeding periods of tiamulin in combination with chlortetracycline for the control and treatment of swine respiratory and enteric disease and subsequent growth performance. The study used 1,151 commercial crossbred barrows and gilts in a randomized complete block design. Pigs were housed in single-sex groups of 25 at a floor space of 0.69 m²/pig. There were two dietary treatments: 1) nonmedicated controls and 2) 39 mg/kg tiamulin + 441 mg/kg chlortetracycline (TIACTC) fed from days 7 to 20 and again days 49 to 62. There were 23 pens per treatment group. Daily observations were made throughout the study, including the number of pigs in each pen coughing, with diarrhea, or showing signs of lameness as well as the number of pigs in each pen requiring individual therapy treatment for each symptom. Pigs were weighed as a group on days 0 (for allocation purposes), 7, 21, 49, 61, 89 (start of marketing), and at time of slaughter. Within pen, animals were selected by visual appraisal and sent for slaughter over 4 wk to a commercial slaughter facility where HCW was collected and used to calculate carcass yield. There was no difference (P > 0.05) between treatments for the incidence of morbidity or mortality. Pigs fed TIACTC tended to have less coughing observations (P = 0.10) and less diarrhea observations (P = 0.08) during the study period, and had less observations of lameness (P < 0.001) and required less treatments than nonmedicated controls (P < 0.001). For the overall study period, pigs fed TIACTC had greater (P < 0.05) total BW gain (43.3 kg greater/pen) and greater (P < 0.05) ADG and ADFI than controls. There was no effect (P > 0.05) of treatment on G:F. Overall, pigs fed TIACTC weighed 1.3 kg heavier (P < 0.05) at the start of marketing and completed the study with an overall BW advantage of 1.6 kg (P < 0.05) compared to controls. The difference between treatments for live BW increased with marketing group (1.0 kg in marketing group 1 and 3.3 kg in marketing group 4). Pigs fed TIACTC had greater (P < 0.05) HCW (1.0 kg) than controls; however, there was no difference (P > 0.05) between treatments for carcass yield. The results of this study suggest that feeding TIACTC was successful at controlling respiratory and enteric disease and, consequently, improved growth performance and carcass weight of grow-finish pigs.

Long QT molecular autopsy in sudden unexplained death in the young (1-40 years old): Lessons learnt from an eight year experience in New Zealand

BACKGROUND

To review long QT syndrome molecular autopsy results in sudden unexplained death in young (SUDY) between 2006 and 2013 in New Zealand.

METHODS

Audit of the LQTS molecular autopsy results, cardiac investigations and family screening data from gene-positive families.

RESULTS

During the study period, 365 SUDY cases were referred for molecular autopsy. 128 cases (35%) underwent LQTS genetic testing. 31 likely pathogenic variants were identified in 27 cases (21%); SCN5A (14/31, 45%), KCNH2 (7/31, 22%), KCNQ1 (4/31, 13%), KCNE2 (3/31, 10%), KCNE1 (2/31, 7%), KCNJ2 (1/31, 3%). Thirteen variants (13/128, 10%) were ultimately classified as pathogenic. Most deaths (63%) occurred during sleep. Gene variant carriage was more likely with a positive medical history (mostly seizures, 63% vs 36%, p = 0.01), amongst females (36% vs 12%, p = 0.001) and whites more than Maori (31% vs 0, p = 0.0009). Children 1-12 years were more likely to be gene-positive (33% vs 14%, p = 0.02). Family screening identified 42 gene-positive relatives, 18 with definitive phenotypic expression of LQTS/Brugada. 76% of the variants were maternally inherited (p = 0.007). Further family investigations and research now support pathogenicity of the variant in 13/27 (48%) of gene-positive cases.

CONCLUSION

In New Zealand, variants in SCN5A and KCNH2, with maternal inheritance, predominate. A rare variant in LQTS genes is more likely in whites rather than Maori, females, children 1-12 years and those with a positive personal and family history of seizures, syncope or SUDY. Family screening supported the diagnosis in a third of the cases. The changing classification of variants creates a significant challenge.