Community Practices, Published Guidelines, and Evidence Base Surrounding Breast Milk Handling and Storage: A Qualitative Study

Background: Expressed breast milk (EBM) is the best alternative to direct breastfeeding. However, expressing breast milk requires good milk handling and storage practices to preserve EBM safety and integrity. Mothers require handling and storage guidance, and many seek this from the internet and online support groups. Aim: This study aimed at exploring EBM handling and storage practices within an online exclusively expressing community and comparing these with both internet resources and evidence-based research. Methods: A naturalistic observational design was used. Content analysis was undertaken on 10,000 posts from an Australian Facebook peer-support community for women who exclusively express breast milk. Women's questions, reported practices, and advice for EBM handling and storage were analyzed thematically and compared with both guidelines and evidence-based research. Findings: There were 460 posts on EBM handling and storage. Three key themes emerged: "How should I store my EBM?," "How long can I store my EBM?," and "How do I use my EBM?" The greatest consistency and agreement between recommendations and community practices were found for storage methods, whereas the least was found for storage times. EBM handling and storage practices were influenced by factors such as EBM value, convenience, and cost, leading to occasional deviations from consistent practice recommendations. Conclusion: To facilitate safe EBM handling and continuation of expression, guidelines should be updated so they are consistent, align with current evidence, and cater to mothers' cost, convenience, and milk wastage concerns. Health care providers can partner with women to evaluate online information to empower mothers in their decision making.

Does REACH provide sufficient information to regulate substances toxic to reproduction?

Hazard classification and risk assessment of substances, is essential to protect workers and consumers from hazardous substances including reproductive toxicants. The ability to classify substances for reproductive toxicity under the current REACH information requirements has been assessed. For low tonnage substances (<10 ton per annum (tpa)) information for classification is insufficient. When only a reproductive screening study is available (10-100 tpa), substances are mostly not classified in Category 1B as developmental and non-potent fertility effects may be missed. The information requirements could be improved by automatic triggering of follow-up studies in case of a Category 2 classification based on a screening study. Additionally, a study could be added to the information requirements for substances produced at 1-10 tpa. Performing a risk assessment is often problematic due to the limited study requirements at low tonnage levels. Only for substances produced at more than 100 tpa, there is a high likelihood to detect reproductive effects and perform accurate risk assessment provided that the extended-one-generation-reproductive-toxicity-study and/or extra cohorts are triggered where required. Regardless of the tonnage level, no specific studies on lactation are required. With this paper we intend to contribute to the discussion on the information requirements for reproductive toxicity in view of the REACH revision.

Ambient Hydrocarbon Detection with an Ultra-Low-Loss Cavity Raman Analyzer

The detection of ambient outdoor trace hydrocarbons was investigated with a multipass Raman analyzer. It relies on a multimode blue laser diode receiving optical feedback from a retroreflecting multipass optical cavity, effectively creating an external cavity diode laser within which spontaneous Raman scattering enhancement occurs. When implemented with ultra-low-loss mirrors, a more than 20-fold increase in signal-to-background ratio was obtained, enabling proximity detection of trace motor vehicle exhaust gases such as H₂, CO, NO, CH₄, C₂H₂, C₂H₄, and C₂H₆. In a 10-min-long measurement at double atmospheric pressure, the limits of detection obtained were near or below 100 ppb for most analytes.

Caregiver experiences in administering subcutaneous medications to community palliative care patients: Integrative review

As many as 70% of Australian patients report they would prefer to die at home, yet only 14% achieve this goal and this hospitalization adds to overall healthcare expenditure. Providing caregivers with practical means for managing symptoms at home facilitates home deaths for palliative care patients and reduces the financial healthcare burden. The aim of this paper is to understand the experience of caregivers administering subcutaneous medications at home to palliative care patients. An integrative review search of the literature revealed five common themes: positive caregiver experiences and caregiver concerns, symptom management, specialist palliative care support needs, educational requirements, and supporting patients to remain at home. Evidence strongly suggests that with support and education from a palliative care team, caregivers find their experience is empowering and positive. Without support and education, patients are more likely to present to hospital leading to admission and subsequent death not in their place of preference.

The Use of Digital Technologies in the Inpatient Setting to Promote Communication During the Early Stage of an Infectious Disease Outbreak: A Scoping Review

Background: Infectious disease outbreaks disrupt inpatient clinical care and have an impact on staff and patients' ability to communicate with each other and with the wider community. Digital technology may offer opportunities for communication in the inpatient setting during infectious disease outbreaks. Aim: This scoping review aimed to investigate the use of digital technology in the inpatient setting to promote communication in the early stages of an infectious disease outbreak. Methods: There were three aspects to this scoping review: (1) a database search of Ovid MEDLINE (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Association for Computing Machinery Digital Library (ACM) and IEEE Xplore (IEEE) exploring peer-reviewed articles, (2) a gray literature search, and (3) a media search. Results: Results focused on the early stages of the COVID-19 pandemic. Thirty-eight peer-reviewed articles were extracted from the database search. There were three main areas of investigation: study characteristics, technology features, and benefits and barriers. Forty-four websites were searched for the gray literature search focusing on policy and guidance. Eighteen media articles were retrieved focusing on patients' use of technology and community involvement. Conclusion: Results demonstrate the diverse use of digital technology in the inpatient setting to facilitate communication during the early stages of the COVID-19 pandemic. However, the articles provide limited data to allow readers to fully understand and reproduce described actions. Furthermore, there was limited guidance to support clinicians to communicate using digital technology to create trusting therapeutic relationships. Areas for future development include standard reporting process for technology hardware, software, and content; and structured reporting and evaluation of the implementation of technologies.

The mental health impact of COVID-19 on pre-registration nursing students in Australia: Findings from a national cross-sectional study

AIM

The study aimed to measure and describe the mental health impact of COVID-19 on Australian pre-registration nursing students.

BACKGROUND

The COVID -19 pandemic has had a swift and significant impact on nursing students across the globe. The pandemic was the catalyst for the closure of schools and universities across many countries. This necessary measure caused additional stressors for many students, including nursing students, leading to uncertainty and anxiety. There is limited evidence available to identify the mental health impact of COVID-19 on Australian pre-registration nursing students currently.

DESIGN

A cross-sectional study was conducted across 12 Australian universities.

METHODS

Using an anonymous, online survey students provided demographic data and self-reported their stress, anxiety, resilience, coping strategies, mental health and exposure to COVID-19. Students' stress, anxiety, resilience, coping strategies and mental health were assessed using the Impact of Event Scale-Revised, the Coronavirus Anxiety Scale, the Brief Resilience Scale, the Brief Cope and the DASS-21. Descriptive and regression analyses were conducted to investigate whether stress, anxiety, resilience and coping strategies explained variance in mental health impact. Ethical Approval was obtained from the University of New England Human Research Ethics Committee (No: HE20-188). All participating universities obtained reciprocal approval.

RESULTS

Of the 516 students who completed the survey over half (n = 300, 58.1%) reported mental health concerns and most students (n = 469, 90.9%) reported being impacted by COVID-19. Close to half of students (n = 255, 49.4%) reported signs of post-traumatic stress disorder. Mental health impact was influenced by students' year level and history of mental health issues, where a history of mental health and a higher year level were both associated with greater mental health impacts. Students experienced considerable disruption to their learning due to COVID-19 restrictions which exacerbated students' distress and anxiety. Students coped with COVID-19 through focusing on their problems and using strategies to regulate their emotions and adapt to stressors.

CONCLUSION

The COVID-19 pandemic has considerably impacted pre-registration nursing students' mental health. Strategies to support nursing students manage their mental health are vital to assist them through the ongoing pandemic and safeguard the recruitment and retention of the future nursing workforce.

IMPACT STATEMENT

This study adds an Australian understanding to the international evidence that indicates student nurses experienced a range of negative psychosocial outcomes during COVID-19. In this study, we found that students with a pre-existing mental health issue and final-year students were most affected. The changes to education in Australian universities related to COVID-19 has caused distress for many nursing students. Australian nursing academics/educators and health service staff need to take heed of these results as these students prepare for entry into the nursing workforce.

PATIENT OR PUBLIC INVOLVEMENT

The study was designed to explore the impact of COVID-19 on the mental health of undergraduate nursing students in Australia. Educators from several universities were involved in the design and conduct of the study. However, the study did not include input from the public or the intended participants.

Assessing feasibility, construct validity, and reliability of a new aged care-specific preference-based quality of life instrument: evidence from older Australians in residential aged care

BACKGROUND

Quality of Life-Aged Care Consumers (QOL-ACC) is a new older-person-specific quality of life instrument designed for application in quality assessment and economic evaluation in aged care. The QOL-ACC was designed from its inception with older people receiving aged care services ensuring its strong content validity. Given that the QOL-ACC has already been validated in home care settings and a preference-weighted value set developed, we aimed to assess feasibility, construct validity and reliability of the QOL-ACC in residential aged care settings.  METHODS: Individuals living in residential aged care facilities participated in an interviewer-facilitated survey. The survey included the QOL-ACC, QCE-ACC (quality of aged care experience measure) and two other preference-based quality of life instruments (ASCOT and EQ-5D-5L). Feasibility was assessed using missing data and ceiling/floor effects. Construct validity was assessed by exploring the relationship between the QOL-ACC and other instruments (convergent validity) and the QOL-ACC's ability to discriminate varying levels of self-rated health and quality of life. Internal consistency reliability was assessed using Cronbach's alpha (α).

RESULTS

Of the 200 residents (mean age, 85 ± 7.7 years) who completed the survey, 60% were female and 69% were born in Australia. One in three participating residents self-rated their health as fair/poor. The QOL-ACC had no missing data but had small floor effects (0.5%) and acceptable ceiling effects (7.5%). It demonstrated moderate correlation with ASCOT (r = 0.51, p < 0.001) and EQ-5D-5L (r = 0.52, p < 0.001) and a stronger correlation with the QCE-ACC (r = 0.57, p < 0.001). Residents with poor self-rated health and quality of life had significantly lower scores on the QOL-ACC. The internal consistency reliability of the QOL-ACC and its dimensions was good (α = 0.70-0.77).

CONCLUSIONS

The QOL-ACC demonstrated good feasibility, construct validity and internal consistency reliability to assess aged care-related quality of life. Moderate correlations of the QOL-ACC and other instruments provide evidence of its construct validity and signifies that the QOL-ACC adds non-redundant and non-interchangeable information beyond the existing instruments. A stronger correlation with the QCE-ACC than other instruments may indicate that quality of life is more intimately connected with the care experience than either health- or social-related quality of life in residential aged care settings.

Pulmonary arterial hypertension associated with congenital heart disease: real-world analysis of clinical characteristics, treatment patterns and outcomes from EXPOSURE

Background

Treatment patterns for patients with pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) are currently not well described.

Purpose

To use real-world data from the EXPOSURE study to describe clinical characteristics, treatment patterns and outcomes of PAH-CHD patients in current clinical practice.

Methods

EXPOSURE (EUPAS19085) is an ongoing, multicentre, prospective, observational study of PAH patients initiating a PAH-specific therapy in Europe and Canada. Clinical characteristics, treatment patterns, hospitalisation and mortality are described for PAH-CHD patients classified into four clinical subgroups. Baseline was considered to be within 30 days of PAH-specific treatment initiation.

Results

Between September 2017 and November 2021, there were 1588 PAH patients with follow-up data in EXPOSURE, of whom 168 (11%) had PAH-CHD. Of these, 40% (N=67) had Eisenmenger's Syndrome (ES), 25% (N=42) had PAH with coincidental CHD, 21% (N=35) had PAH with left-to-right shunts, and 14% (N=24) had PAH after CHD corrective surgery. Baseline characteristics are summarised in the Table. Across the subgroups, the median age was 46–53 years. Compared to the other subgroups, at baseline, ES patients had a substantially longer time from diagnosis (median [Q1, Q3]: 12.6 [3.3, 31.5] years), a lower 6MWD (median [Q1, Q3]: 400 [309, 480] m) and were more likely to be in WHO FC III/IV (Table). The majority of patients across all subgroups initiated a new PAH-specific therapy as part of combination therapy at enrolment (Table). Treatment patterns over time for ES patients are shown in the Figure. The majority of ES patients received double or triple combination therapy at baseline. Overall, most ES patients remained on the same treatment regimen 6 months after baseline, with limited treatment escalation (Figure). The median observation period ranged between 15.0 and 23.0 months for all subgroups (Table). Incidence of all-cause hospitalisation during this time was generally comparable across subgroups (Table). All-cause mortality incidence rates (95% CI) were higher in patients with ES (6.3 [2.3, 13.7]) and PAH after CHD corrective surgery (8.1 [1.7, 23.8]) compared to the other two subgroups (Table).

Conclusions

In EXPOSURE, 11% of patients were PAH-CHD patients, with ES being the most common PAH-CHD aetiology. The majority of PAH-CHD patients were enrolled on combination therapy. ES patients had a longer time from diagnosis compared to other subgroups and their treatment patterns followed a stepwise approach. At 6 months post-baseline, the majority of ES patients were on double or triple combination therapy. Hospitalisation was comparable between subgroups and mortality was higher in ES and PAH after CHD corrective surgery patients.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson

Characterisation of pulmonary arterial hypertension patients with cardiovascular comorbidities treated with selexipag: real-world evidence from the EXPOSURE study

Background

A recent post-hoc analysis of the GRIPHON randomised controlled trial [1] showed that selexipag reduces the risk of a morbidity/mortality event versus placebo in pulmonary arterial hypertension (PAH) patients, irrespective of comorbidity burden. Real-world evidence is needed on the management of PAH patients with cardiovascular comorbidities receiving selexipag.

Purpose

To describe characteristics, treatment patterns and outcomes of PAH patients with cardiovascular comorbidities receiving selexipag in the real world.

Methods

EXPOSURE is an ongoing, multicentre, prospective, observational study of PAH patients initiating a PAH-specific therapy in Europe and Canada. Patients initiating selexipag were grouped by number of cardiovascular comorbidities present prior to or at therapy initiation: BMI ≥30 kg/m2, systemic hypertension, diabetes mellitus, and coronary artery disease.

Results

As of November 2020, 382 selexipag-treated patients had follow-up and comorbidity data available: 44% (n=169) had 0, 30% (n=114) had 1, 18% (n=70) had 2, and 8% (n=29) had ≥3 comorbidities. At selexipag initiation, patients with comorbidities were older, more likely to have idiopathic/heritable PAH and had worse functional capacity (lower median 6-minute walk distance, higher proportion in WHO functional class III/IV) vs those without comorbidities (Table 1). Overall, haemodynamic parameters were similar across groups (Table 1). Patients with a higher comorbidity burden were more likely to be at high-risk of 1-year mortality (COMPERA method) vs those with a lower comorbidity burden (Table 1). Patients predominantly initiated selexipag as part of triple combination therapy (mainly in addition to an endothelin receptor antagonist and phosphodiesterase type 5 inhibitor), regardless of comorbidity burden (76–79% across groups). The duration of exposure and the median selexipag maintenance dose were similar across groups (Table 2). The proportion of patients hospitalised and the proportion who discontinued selexipag during the exposure period are shown in Table 2. 5% (n=8) of patients in the 0 comorbidities group, 12% (n=14) in the 1 comorbidity group, 0% in the 2 comorbidities group, and 10% (n=3) in the ≥3 comorbidities group died during the exposure period.

Conclusions

These real-world data from Europe and Canada suggest that more than 50% of patients who initiated selexipag had ≥1 cardiovascular comorbidity. Patients with comorbidities had more severe functional impairment vs those without. Overall haemodynamic profiles reflected Group 1 Pulmonary Hypertension and were similar across groups. Selexipag was initiated predominantly as part of triple combination therapy in all groups and most patients remained on selexipag, regardless of comorbidity burden.

Funding Acknowledgement

Type of funding sources: Other. Main funding source(s): Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson

Physiotherapy & Psychosocial Rehabilitation in Postcovid & Postconflict Era: New Roles with same Staff? (dispatch)

Waves of COVID-19 have been managed successfully within US, EU, Southeast Asia and Latin America, however, South Asia and Sub-saharan Africa still suffer new variants and EU fights with UK and United States of ,,new waves of old disease“, postcovide or long covide syndrome. The aim of this communication and research is to prepare our auditors for the size and extent of postcovid systems and the importance of non-doctors and non-medicine experts in management of its consequences.

Predictors and impact of women's breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand

OBJECTIVE

To investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic.

DESIGN

A cross-sectional online survey collected data between August and October 2020 with recruitment via social media. Quantitative data were analyzed using descriptive analyses, and linear and logistic regression analysis related to the Breastfeeding Self-Efficacy Scale-Short Form findings. Open text responses were analyzed using content analysis.

FINDINGS

There were 1001 complete responses. Visitor restrictions impacted the woman's early parenting experience in both positive and negative ways. One third of participants stated their postnatal needs were not met with 82 stating that they had no postnatal care at all. During the first six weeks postnatal, 48.1% felt not very or not at all confident caring for their baby. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score.

DISCUSSION/CONCLUSION

Sub-optimal postnatal care and support negatively influence breastfeeding self-efficacy. Women desired additional help during the COVID-19 pandemic inclusive of support and education to meet their postnatal needs and exclusively breastfeed.

IMPLICATIONS FOR PRACTICE

Women require appropriate and timely postnatal care and support to promote confidence in caring for baby and achieve their breastfeeding goals. Preferably this care should be provided face-to-face.

Consumer strategies towards a more sustainable food system: insights from Switzerland

BACKGROUND

To improve the sustainability performance of food systems, both consumption- and production-side changes are needed.

OBJECTIVES

To this end, we assessed multiple sustainability impacts of 6 consumer strategies together with production-side aspects such as organic and circularity principles for Switzerland.

METHODS

Two strategies encompassed dietary changes: following a pescetarian diet and adhering to the national dietary guidelines. Two strategies employed alternative farming systems: increasing the share of organic production and, in addition, applying the circularity principle of avoiding feed-food competition by limiting livestock feed to low-opportunity-cost biomass. A fifth strategy reduced food waste. The sixth strategy increased the share of domestic produce. For all strategies, we assessed greenhouse gas emissions, land use, nitrogen surplus, social risks, diet quality, and diet costs.

RESULTS

The strategies revealed trade-offs between impact categories, unless combined in a synergistic way. Whereas dietary changes towards more plant-based diets reduced environmental impacts (≤51%) and increased diet quality (≤57%), they increased social risks due to increased sourcing from contexts with potentially bad labor conditions (≤19%). Further, when the share of organic produce was increased, land use and dietary costs were increased (≤33% and ≤42%, respectively). The effect on land use could, however, be reversed when circularity principles were introduced in addition to the organic production standard, resulting in reductions for all environmental indicators (≤75%). Reducing food waste and increasing the share of domestic produce led to better sustainability performance as well, but at lower orders of magnitude.

CONCLUSIONS

Combining all proposed strategies could lead to substantial favorable changes on all impact categories assessed, but would require a thorough transformation of the current food system. However, the sum of individual consumers each following only 1 of the strategies proposed would make an important contribution towards improving the sustainability performance of the Swiss food system.

Australian nurses' perceptions about workplace violence management, strategies and support services

AIMS

This study ascertained nurses' perceptions about workplace violence management, strategies and support services.

BACKGROUND

Nurses regularly encounter verbal and physical violence in their workplace. Workplace violence has long-term consequences on nurses' personal lives and professional work ability. However, more needs to be known about nurses' perceptions of violence management and interventions used.

METHODS

Ninety-eight nurses from a regional public hospital in Queensland, Australia, completed a survey about workplace violence. Nurses worked in the Emergency Department, Intensive Care Unit or Mental Health Department.

RESULTS

Ninety-five per cent of nurses stated that all violence should be reported, but 18% would take no action, and 22% would not complete an incident from. Perceptions and preferred responses differed for verbal and physical violence. Low-level interventions and aggression management training were preferred by nurses. Nearly all nurses felt that they should be involved in the development of workplace violence policies.

CONCLUSIONS

Nurses rate aggression management training highly, and they desire more input into violence policies. The under-reporting of violent incidents remains an issue for future management.

IMPLICATIONS FOR NURSING MANAGEMENT

Understanding nurses' perceptions of workplace violence management enables the identification of gaps when applying policy and adopting practical approaches to reduce the incidence and severity of workplace violence.

Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice

OBJECTIVE

To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion.

PATIENTS AND METHODS

In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication.

RESULTS

The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P = 0.03).

CONCLUSIONS

UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections.

CLINICAL TRIAL REGISTRATION NUMBER (ISRCTN REGISTRY NUMBER)

55546280.

Absconding: A qualitative perspective of patients leaving inpatient psychiatric care

Absconding from inpatient psychiatric care is a complex problem with significant and broad ranging effects for patients, staff, family/carers, and the broader community. Absconding includes leaving the ward without permission and failing to return from leave at an agreed time. This study is a retrospective chart audit of a data set of absconding events from 11 psychiatric wards in a metropolitan Australian city. The data set included both quantitative and qualitative data. The focus of this study is analysis of the qualitative data documenting what happened during events, with quantitative data provided to contextualize the qualitative analysis. A total of 995 absconding events by 488 patients were reported between January 2016 and June 2018, representing a rate of 1.6 per 100 admissions. Two themes were identified in the qualitative analysis. 'Having things to do' encompassed opportunistic absconding and volitional absconding. 'Something changed' represented predisposing events that affected the absconding behaviour, such as being stepped down in care (moving from a more acute to a less acute psychiatric unit), receiving bad news, or interpersonal conflict either between patients or between nursing staff and patients. Results highlight the importance of harm minimization strategies to reduce the incidence of absconding.

KS01.5.A Allergic airway inflammation impacts tumor take and delays experimental glioblastoma progression

BACKGROUND

Numerous epidemiological studies have highlighted the protective role of immunoglobulin E-mediated allergic diseases on glioblastoma (GBM) susceptibility and prognosis. However, the mechanistic explanations behind these phenomena remain unexplored. Our objective was to set up a preclinical model and investigate the mechanisms underlying such protection to improve our understanding of the crosstalk between immune system and brain tumor development.

MATERIAL AND METHODS

A mouse model of allergic airway inflammation (AAI) induced by repeated nasal instillation of House Dust Mite extract was initiated before intracranial implantation of GL261 glioma cells, in both immunocompetent (C57BL/6) and immunodeficient (RAG-KO) mice. Tumor take and tumor growth were monitored by MRI. Central (microglia) and peripheral (spleen, bone marrow) immune cells were characterized by flow cytometry. The response of microglia was further assessed by RNA sequencing. Impact of candidate genes on patient survival was characterized by Cox regression analysis using data from TCGA and CGGA.

RESULTS

Following AAI induction in C57BL/6 mice, engraftment of GL261 cells in the brain was delayed and tumor growth rate was reduced. This correlated with an increase in survival of the mice and was accompanied by increased effector memory T-cells in the circulation. Of note, the survival benefit was lost in RAG-KO mice devoid of adaptive immunity. At the level of the brain, we observed enhanced secretion of TNFα and IL6 in microglia ex vivo. AAI induced a transcriptional reprogramming of microglia towards a pro-inflammatory-like state. We identified an allergy-related microglia gene signature that is associated with improved prognosis of glioma patients.

CONCLUSION

Our results demonstrate that AAI limits both tumor take and GBM progression in mice, providing a preclinical model to study the role of allergic inflammation in GBM susceptibility and prognosis, respectively. At the functional level, we identify a potentiation of microglial and adaptive anti-tumoral immunity. Further investigations are warranted to shed light on the reciprocal crosstalk between microglial reprogramming and peripheral immunity in the context of allergies and brain tumors.

Ureteral access sheath-related injuries vs. post-operative infections. Is sheath insertion always needed? A prospective randomized study to understand the lights and shadows of this practice

OBJECTIVE

To compare intraoperative ureteral injuries in RIRS with UAS insertion with the rate of postoperative infections after RIRS without UAS insertion.

PATIENTS AND METHODS

In this randomized trial, patients who received an indication for RIRS between January 2017 and December 2017 were divided into two groups. Group A had no UAS insertion and Group B had UAS insertion. Post-Ureteroscopic Lesion Scale (PULS) grading was performed after UAS or flexible ureteroscope removal. Proximal, middle and distal ureteral lesions were evaluated and compared according to the PULS scale. Additionally, patients in both groups were followed postoperatively to assess any infective complication.

RESULTS

The evaluation comprised 181 patients, 89 for group A and 92 for group B. Overall stone-free rate, clinically insignificant residual fragments, and final stone-free rate were 41.4%, 53.5%, and 95%, respectively. There were 33 (37.1%) patients with ureteral lesions in group A while 42 (45.6%) patients had ureteral lesions in group B, with no significant difference. On the other hand, the overall presence of postoperative infection rate was much higher for Group A (37.1% vs 16.3% P=.03).

CONCLUSIONS

UAS insertion does not result in a higher number of ureteral injuries. UAS insertion during RIRS allows a lower rate of postoperative infections. Clinical Trial Registration Number (ISRCTN registry number): 55546280.

Role of the community pharmacist in detecting frailty and spatio-temporal disorientation among community-dwelling older people in France

BACKGROUND

Many older community-dwelling subjects may be frail and/or disoriented, putting them at risk of adverse outcomes. We investigated the prevalence of frailty and spatiotemporal disorientation among patients aged > 65 years collecting regular medication at a community pharmacy.

METHODS

Prospective, cross-sectional study of geriatric evaluation in 218 community pharmacies in France. Regular customers aged > 65 years attending the pharmacy to receive ≥ 1 prescription drug were eligible. Spatio-temporal disorientation was assessed using a 4-item screening test; subjects were considered disoriented if they had ≥ 1 incorrect answers. Frailty was evaluated using the Short Emergency Geriatric Assessment (SEGA) grid. Subjects were considered as not frail (score < 8), or frail/very frail (score of 8 or more).

RESULTS

4090 subjects were included, average age 77.5 ± 7.6 years, 60.1% females. Overall, 1025 (25%) were frail/very frail, and 384 (9.4%) were disoriented in space or time. On average, subjects were taking 5.4 ± 3.5 medications per day. Among non-frail patients, 116/3065 (3.8%) were disoriented, of whom 87 (87/116, 75%) managed their medication alone. Among frail/very frail patients, 268/1025 (26.1%) were disoriented, of whom 46 (46/268, 16.8%) managed their medication alone. The majority of patients (77.9%) collected their medication alone at the pharmacy, but significantly fewer frail patients came to collect their drugs alone (p < 0.001).

CONCLUSION

It is feasible for community pharmacists to detect disorientation and frailty among older patients. A quarter of subjects were frail/very frail, and 3.2% were disoriented yet managing their drugs alone. Additional social support should be envisaged for these subjects.

Australian nurses' suggestions for the management of violence in the workplace: 'The people who make the policy are not the people on the floor'

AIM(S)

To ascertain nurses' perceptions about, and suggestions for, management solutions to workplace violence perpetrated by patients.

BACKGROUND

Violence towards nurses from patients in the workplace is high in Australia. There is a need for good management responses, and experienced nurses can provide logistical suggestions about effective strategies.

METHOD(S)

This study uses an exploratory qualitative design. Focus group interviews were undertaken with 23 nurses working in a regional public hospital in Queensland, Australia. The COREQ research reporting checklist was followed, and the qualitative data were transcribed and thematically analysed manually and by NVivo.

RESULTS

Policy implementation, training, staff movement, seclusion, debriefing and a full reporting cycle were identified as central themes. Workplace violence management happens before, during and after a violent event.

CONCLUSION(S)

Weak processes undermine management; staff training on de-escalation is needed. Affected staff need freedom to move from the ward. Better medical orders should be in place before an event. A full debriefing and feedback cycle are required, along with easier reporting processes.

IMPLICATIONS FOR NURSING MANAGEMENT

Nursing management can reduce violence by ensuring better institutional support, consistent follow-up and complete feedback procedures. Legal support, follow-up mechanisms and staff training in de-escalation are key points.

La présence simulée comme outil de gestion des troubles du comportement pour les résidents atteints de démence en institution : recommandations

En milieu institutionnel, les troubles du comportement des résidents atteints de démence restent essentiellement abordés via des approches pharmacologiques alors que de nombreuses solutions non médicamenteuses existent. Parmi celles-ci, la présence simulée consiste en un enregistrement sonore ou vidéo réalisé par des proches dans le but d’apaiser un résident présentant un trouble du comportement. La présence simulée est encore peu reconnue du fait, notamment, d’un manque d’information théorique et pratique. Le but de cet article est de proposer des recommandations pratiques et méthodologiques quant à la mise en place et à l’utilisation de la présence simulée. Ces recommandations se basent, d’une part, sur la littérature scientifique et, d’autre part, sur notre propre expérience clinique d’application de cet outil en institution pour résidents atteints de démence.

[Asthma and scuba diving: Creation and evaluation of a website (For doctors, asthmatics and diving instructors)]

INTRODUCTION

Scuba diving has long been strictly contraindicated for asthmatics; this contraindication has been questioned in recent years. Our objective was to provide a website, evaluated by its users, for doctors, diving instructors and asthmatics.

MATERIALS AND METHODS

Creation of the site Asthme-Plongee.com based on a peer-reviewed literature review, then distribution of a questionnaire in summer 2018 to diving clubs, general practitioner groups, pulmonologists and FFESSM federal offices, and via social networks.

RESULTS

Our sample consisted of 413 assessors, including 264 health professionals (63.9%), 74 asthmatics (17.9%) and 92 diving instructors (22.3%), spread over the entire territory of France. The structure of the website, the clarity of the information written and its relevance were generally appreciated by the entire population with a median score of 8/10. The site was found useful: 72.9% of respondents thought they would visit it later.

CONCLUSION

Faced with a growing number of amateur divers, it seems essential to raise awareness of current recommendations and good diving practices.

A qualitative study of expectations and experiences of women using a social media support group when exclusively expressing breastmilk to feed their infant

BACKGROUND

Global recommendations are that mothers exclusively breastfeed their infants for the first six months of life to achieve optimal growth, development, and health outcomes. When infants are unable to feed at the breast, giving expressed breastmilk is the preferred alternative. Mothers who exclusively express breastmilk are poorly supported in mainstream healthcare, and are increasingly using social media groups for assistance.

AIM

To understand the expectations and experiences of women who access social media groups when exclusively expressing breastmilk.

METHODS

A qualitative descriptive approach was used. Participants were recruited online using purposive sampling. The data was collected using semi-structured in-depth interviews with ten women. Audio data were transcribed and subjected to a thematic analysis.

FINDINGS

The first theme was expecting and experiencing emotional support; sub-themes include: coping with grief through emotional support and shared experiences; providing emotional support in the absence of in-person social support; providing emotional support through being non-judgemental; and the ability to access emotional support and engagement 24/7. The second theme was receiving information to manage exclusive expressing; sub-themes include: expression schedules and the let-down reflex; managing exclusive expression; and resolving lactation and breast-related issues.

DISCUSSION

Ajzen's 'Theory of Planned Behaviour' is used to better understand the women's expectations and experiences of belonging to an online peer support group while exclusive expressing.

CONCLUSION

The study highlights the importance of both antenatal and postnatal education and support, the need for reliable information, and the impact of the inability to breastfeed on mothers' emotional health.

Hospital admissions among people who inject opioids following syringe services program implementation

Background

Syringe services programs (SSPs) are an evidence-based harm reduction strategy that reduces dangerous sequelae of injection drug use among people who inject drugs (PWID) such as overdose. SSP services include safer injection education and community-based naloxone distribution programs. This study evaluates differences in overdose-associated hospital admissions following the implementation of the first legal SSP in Florida, based in Miami-Dade County.

Methods

We performed a retrospective analysis of hospitalizations for injection drug-related sequelae at a county hospital before and after the implementation of the SSP. An algorithm utilizing ICD-10 codes for opioid use and sequelae was used to identify people who inject opioids (PWIO). Florida Department of Law Enforcement Medical Examiners Commission Report data was used to analyze concurrent overdose death trends in Florida counties.

Results

Over the 25-month study period, 302 PWIO admissions were identified: 146 in the pre-index period vs. 156 in the post-index period. A total of 26 admissions with PWIO overdose were found: 20 pre-index and 6 post-index (p = 0.0034).

Conclusions

Declining overdose-associated admissions among PWIO suggests early impacts following SSP implementation. These results indicate a potential early benefit of SSP that should be further explored for its effects on future hospital admission and mortality.

Role of security guards in Code Black events in medical and surgical settings: A retrospective chart audit

The prevalence of security guards in health care settings is growing worldwide. There is a need to explore and understand their role and actions to inform policy and training and support least restrictive practices in health care. The aim of this study was to conduct a retrospective chart audit of security guard logs to investigate security guard involvement in Code Blacks, called in emergency situations of personal threats including patient and/or visitor violence, in medical and surgical wards in a large metropolitan health network in South Australia. Security guards attended 1664 Code Blacks (0.63% of admissions) over the 2.5-year study period. Events were more frequently reported in medical than surgical wards. The most common reasons for security guard attendance were patients threatening/harming staff and patients threatening/harming themselves. The most frequent security guard actions were "Attend only/standby," "Physical restraint," and "Patient located and returned to the ward." The most frequent outcomes were physical restraint, chemical restraint, and de-escalation respectively. Results highlight the imperative that health services maintain and increase efforts to support least restrictive practice through policy directives and staff training.

Motion-based prediction of external forces and moments and back loading during manual material handling tasks

This paper evaluates a method for motion-based prediction of external forces and moments on manual material handling (MMH) tasks. From a set of hypothesized contact points between the subject and the environment (ground and load), external forces were calculated as the minimal forces at each contact point while ensuring the dynamics equilibrium. Ground reaction forces and moments (GRF&M) and load contact forces and moments (LCF&M) were computed from motion data alone. With an inverse dynamics method, the predicted data were then used to compute kinetic variables such as back loading. On a cohort of 65 subjects performing MMH tasks, the mean correlation coefficients between predicted and experimentally measured GRF for the vertical, antero-posterior and medio-lateral components were 0.91 (0.08), 0.95 (0.03) and 0.94 (0.08), respectively. The associated RMSE were 0.51 N/kg, 0.22 N/kg and 0.19 N/kg. The correlation coefficient between L5/S1 joint moments computed from predicted and measured data was 0.95 with a RMSE of 14 Nm for the flexion/extension component. In conclusion, this method allows the assessment of MMH tasks without force platforms, which increases the ecological aspect of the tasks studied and enables performance of dynamic analyses in real settings outside the laboratory.

Accuracy and kinematics consistency of marker-based scaling approaches on a lower limb model: a comparative study with imagery data

Medical images are not typically included in protocol of motion laboratories. Thus, accurate scaling of musculoskeletal models from optoelectronic data are important for any biomechanical analysis. The aim of the current study was to identify a scaling method based on optoelectronic data, inspired from literature, which could offer the best trade-off between accurate geometrical parameters (segment lengths, orientation of joint axes, marker coordinates) and consistent inverse kinematics outputs (kinematic error, joint angles). The methods were applied on 26 subjects and assessed with medical imagery building EOS-based models, considered as a reference. The main contribution of this paper is to show that the marker-based scaling followed by an optimisation of orientation joint axes and markers local coordinates, gives the most consistent scaling and joint angles with EOS-based models. Thus, when a non-invasive mean with an optoelectronic system is considered, a marker-based scaling is preliminary needed to get accurate segment lengths and to optimise joint axes and marker local coordinates to reduce kinematic errors.AbbrevationsAJCAnkle joint centreCKEcumulative kinematic errorDoFdegree of freedomEBEOS-basedHBheight-basedHJChip joint centreKJCknee joint centreMBmarker-basedMSMmusculoskeletal modelsSPMstatistical parametric mappingSTAsoft tissue artifactEB_a.m∗EOS-based with optimised joint axes, and all model markers coordinatesMB_a.m∗marker-based with optimised joint axes, and all model markers coordinatesMB_l.a.mmarker-based with optimised segment lengths, joint axes, and selected model markers coordinatesASISanterior superior illiac spinePSISposterior superior illiac spine.

A machine-learning method for classifying and analyzing foot placement: Application to manual material handling

Foot placement strategy is an essential aspect in the study of movement involving full body displacement. To get beyond a qualitative analysis, this paper provides a foot placement classification and analysis method that can be used in sports, rehabilitation or ergonomics. The method is based on machine learning using a weighted k-nearest neighbors algorithm. The learning phase is performed by an observer who classifies a set of trials. The algorithm then automatically reproduces this classification on subsequent sets. The method also provides detailed analysis of foot placement strategy, such as estimating the average foot placements for each class or visualizing the variability of strategies. An example of applying the method to a manual material handling task demonstrates its usefulness. During the lifting phase, the foot placements were classified into four groups: front, contralateral foot behind, ipsilateral foot behind, and parallel. The accuracy of the classification, assessed with a holdout method, is about 97%. In this example, the classification method makes it possible to observe and analyze the handler's foot placement strategies with regards to the performed task.

Validation of a low-cost inertial motion capture system for whole-body motion analysis

While some low-cost inertial motion capture (IMC) systems are now commercially available, generally, they have not been evaluated against gold standard optical motion capture (OMC). The objective was to validate the low-cost Neuron IMC system with OMC. Whole-body kinematics were recorded on five healthy subjects during manual handling of boxes for about 32 min while wearing 17 magnetic and inertial measurement units with Optotrak clusters serving as a reference. The kinematical model was calibrated anatomically for OMC and with poses for IMC. Local coordinate systems were aligned with angular velocities to dissociate differences due to technology or kinematical model. Descriptive statistics including the root mean square error (RMSE), coefficient of multiple correlation (CMC) and limits of agreement (LoA) were applied to the joint angle curves. The average technological error yielded 5.8° and 4.9° for RMSE, 0.87 and 0.96 for CMC and 0.4 ± 8.6° and -0.3 ± 6.0° for LoA about the frontal and transverse axes respectively, whereas the longitudinal axis yielded 10.5° for RMSE, 0.78 for CMC and 3.3 ± 13.1° for LoA. Differences due to technology and to the model contributed similarly to the total difference between IMC and OMC. For many joints and axes, RMSE stayed under 5°, CMC over 0.9 and LoA under 10°, especially for the transverse axis and lower limb. The Neuron low-cost IMC system showed potential for tracking complex human movements of long duration in a normal laboratory environment with a certain error level that may be suitable for many applications involving large IMC distribution.

P11.26 Genome-wide shRNA screen identifies candidate genes driving glioblastoma invasion

BACKGROUND

A major hallmark of glioblastoma (GBM) is its highly invasive capacity, contributing to its aggressive behaviour. Since invasive cells cannot be easily removed by surgery or irradiation, they are left behind and eventually result in lethal recurrence. Therefore, a better understanding of the invasion process and of the key molecular players underlying the invasive capacities of GBM may lead to the identification of new therapeutic targets for GBM patients.

MATERIAL AND METHODS

To identify candidate genes responsible for invasion, a genome-wide shRNA screen was performed in patient-derived GBM sphere cultures. The phenotype of the most promising candidate was validated in in vitro invasion assays, ex vivo brain slice cultures and in vivo orthotopic xenografts in mice. Gene knockdown in invasive GBM cell lines was compared with overexpression in non-invasive cells. RNA sequencing of knockdown cells, along with the generation of deletion constructs were applied to uncover the mechanisms regulating invasion.

RESULTS

Through a whole genome shRNA screen, a zinc-finger containing protein was identified as an invasion essential candidate gene. Knockdown of this gene confirmed a strong decrease in invasion capacity in two highly invasive GBM cell lines. In contrast, gene overexpression switched non-invasive GBM cells to an invasive phenotype. Deletion of either one or both zinc-finger motifs led to decreased invasion indicating that the two zinc-finger motifs are essential for regulating invasion. Mutation of the nuclear localisation signal resulted in retention of the protein in the cytoplasm and loss of the invasion phenotype demonstrating that the protein activity is required in the nucleus. Gene expression analyses revealed that invasion-related genes are significantly regulated by the candidate gene once it is localized in the nucleus.

CONCLUSION

We identified a zinc-finger containing protein as a novel driver of GBM invasion, presumably through a transcription factor activity resulting in the induction of an invasive transcriptional program. This protein and its downstream pathway may represent a novel promising target to overcome invasive capacities in GBM.

PL3.4 Intrinsic tumor plasticity in Glioblastoma allows for recreation of stem like-states and efficient tumor cell adaptation to new microenvironments

BACKGROUND

Cellular heterogeneity has been well established within numerous cancer types, including malignant brain tumours. Initially, cancer stem cells (CSC) have been accounted for formation of phenotypic heterogeneity and tumor progression in glioblastoma (GBM). Recent data, however, suggest that CSCs may not represent a stable entity and intrinsic plasticity plays a key role in tumor adaptation to changing microenvironments. The question arises whether CSCs are a defined subpopulation of tumor cells or whether they represent a changing entity that any cancer cell can adopt depending on the environmental conditions.

MATERIAL AND METHODS

Intra-tumoral phenotypic heterogeneity was interrogated at the single cell transcriptomic and proteomic level in GBM patient-derived orthotopic xenografts (PDOXs) and stem-like cultures. Tumor cell subpopulations were further classified based on expression of four stem cell-associated membrane markers (CD133, CD15, A2B5 and CD44). The resulting 16 subpopulations were FACS isolated and functionally analyzed. Mathematical Markov modelling was applied to calculate state transitions between cell states.

RESULTS

GBM patient biopsies, PDOXs and stem-like cell cultures display remarkable stem cell-associated intra-tumoral heterogeneity. Independent of marker expression, all analysed tumor subpopulations carried stem-cell properties and had the capacity to recreate phenotypic heterogeneity. Mathematical modeling revealed a different propensity in reforming the original heterogeneity over time, which was independent of the proliferation index but linked to tumorigenic potential. Although subpopulations varied in their potential to adapt to new environments, all were able to reach a steady state microenvironment-specific equilibrium.

CONCLUSION

Our results suggest that phenotypic heterogeneity in GBM results from intrinsic plasticity allowing tumor cells to effectively adapt to new microenvironments. Cellular states are non-hierarchical, reversible and occur via stochastic state transitions of existing populations, striving towards an equilibrium instructed by the microenvironment. Our data provides evidence that CSCs do not represent a clonal entity defined by distinct functional properties and transcriptomic signatures, but rather a cellular state that is determined by environmental conditions, which has implications for the design of treatment strategies targeting CSC-like states.

Interplay of transcription factors STAT3, STAT1 and AP-1 mediates activity of the matrix metallo-proteinase-1 promoter in colorectal carcinoma cells

Signal Transducers (STATs) 1 and 3 and Activator Protein 1 (AP-1) are transcription factors involved in the development of malignancy in colorectal carcinoma (CRC). Matrix Metalloproteinase 1 (MMP-1) is a protease frequently dysregulated in de-differentiated and invasive cancer cells. Its expression is influenced by STAT and AP-1 transcription factors. We studied their contributions to transcriptional regulation of MMP-1 in colorectal carcinoma (CRC) cells. Both STAT3 and AP-1 contribute individual expression-inducing and additive effects and interact with the MMP-1 promoter. DNA binding of AP-1 protein c-Jun is stimulation-independent but modulated by STAT3 and a STAT recognition DNA element. Activated STAT3 showed a suppressive effect on AP-1-mediated MMP-1 mRNA upregulation as shown by STAT3 knockdown. Surprisingly, activated STAT1 overcame STAT3-dependent repression of AP-1-driven MMP-1 expression. Moreover, combined STAT3, STAT1 and AP-1 activities evoked maximal MMP-1 mRNA levels in a synergistic manner. Our results suggest a dominant role of AP-1 in transcriptional upregulation of MMP-1 in CRC cells which is modulated by joint functions of STAT3 and STAT1. The individual and combinatorial activity of these factors is of diagnostic and prognostic interest.

Evaluation of a strategy using pretherapeutic fiducial marker placement to avoid missing liver metastases

Background

Hepatic surgery is appropriate for selected patients with colorectal liver metastases (CRLM). Advances in chemotherapy have led to modification of management, particularly when metastases disappear. Treatment should address all initial CRLM sites based on pretherapeutic cross-sectional imaging. This study aimed to evaluate pretherapeutic fiducial marker placement to optimize CRLM treatment.

Methods

This pilot investigation included patients with CRLM who were considered for potentially curative treatment between 2009 and 2016. According to a multidisciplinary team decision, lesions smaller than 25 mm in diameter that were more than 10 mm deep in the hepatic parenchyma and located outside the field of a planned resection were marked. Complication rates and clinicopathological data were analysed.

Results

Some 76 metastases were marked in 43 patients among 217 patients with CRLM treated with curative intent. Of these, 23 marked CRLM (30 per cent), with a mean(s.d.) size of 11·0(3·4) mm, disappeared with preoperative chemotherapy. There were four complications associated with marking: two intrahepatic haematomas, one fiducial migration and one misplacement. After a median follow-up of 47·7 (range 18·1-144·9) months, no needle-track seeding was noted. Of four disappearing CRLM that were marked and resected, two presented with persistent active disease. Other missing lesions were treated with thermoablation.

Conclusion

Pretherapeutic fiducial marker placement appears useful for the curative management of CRLM.

Success of organic and biodynamic system experiment to produce high quality wines

Reducing input use and in particular pesticide use is very important in OIV 2018 new resolutions. Also Europe and France promote research and co-design with winegrowers in more sustainable viticulture according to a combination of climate change. It is also very important to take into account soil diversity and Protected Designation Areas constraints to make sure that new wines will ensure the sustainability of the wineries. This study explores design, experiment and assess of new realistic viticulture production systems located in Protected Designation of Origin (PDO) areas and with already organic or biodynamic certification for six consecutive years, in winery production conditions. It also discusses the chosen assessment indicators and the adoption of such new production systems by winegrowers. Eleven cases were studied in a system experiment network in Alsace (France) and in six consecutive production years. Contrasted production years, PDO areas combined to organic or biodynamic certification allow testing the resilience of experimented systems over time. Combination of new practices are tested to drastically reduce input and in particular pesticide. Assessed performances of the systems deal with 14 main indicators: social acceptability (1) and economic viability (1), agronomy (yield (1), harvested berries quality (2), fungi damage (3), soil quality (1), and wine sensorial analysis (1) and environment (Frequency Treatment Index (1), Cupper rate (1), INDIGO® method (2)). Several innovations were selected by co-design with winegrowers: adding essential oil and Propolis to copper spraying; total grass cover of the vine site; new decision rules for rate and time pesticide spraying; decision aid tool; resistant grape varieties planted. The assessment results support that the performance of the 14 indicators is very good for most of the eleven systems during the six assessed years. Combinations of tested innovations are neither dangerous nor difficult to enforce in the field by the vineworkers. Innovations do not increase the cost of grape production. The yield ratios were satisfactory the 6-yeared of observation because calculated yield match with targeted yield. Harvested berries quality support that the 7 vine sites succeed in targeted total acidity and sugar rate according to the different PDO conditions every years. Wines were Alsace or Grand Cru PDO labelled and successful marketed. At least, the Treatment Frequency Index is reduced by an average of 40% for all vine sites and assessed years. TFI can be reduced at a maximum of 89% and TFI median is 38%. Cupper rate can be reduced at a maximum of 97% and Cupper rate median is 54%. I-pest from INDIGO® method indicate a minimal risk taking for groundwater, surface water, air and beneficial organisms contamination. And finally, flora richness indicator is stable or steadily increases during the 6 study years. In this study, we demonstrated that drastically monitoring reduction of pesticide and other inputs is possible. Chosen indicators allow a exhaustive assessment, but could also been aggregated all together to give a synthetic information to winegrowers and make them easier to adopt the innovative systems. Introduction of innovation combinations in highly sustainable organic and biodymanic systems are validated to produce high quality wines. Now, it is possible to serenely promote and disseminate these highly sustainable innovative systems, taking into account of course vineyard diversity.

[Diving and asthma: Literature review]

INTRODUCTION

Scuba diving has long been contraindicated for asthmatics. Recommendations are evolving towards authorisation under certain conditions. Our objective was to review the literature on the risks associated with scuba diving among asthmatics and about recommendations on this subject.

MATERIALS AND METHODS

We used the MEDLINE and LiSSa databases, until June 2018, in French, English or Spanish language, with the keywords "asthma AND diving" and "asthme plongée" respectively. References to the first degree were analyzed.

RESULTS

We have included 65 articles. Risk of bronchospasm is well documented, particularly in cold and/or deep water, or in the event of exposure to allergens (compressor without filter). Nonasthmatic atopic divers may be at greater risk of developing bronchial hyper-reactivity. Although the theoretical risk exists, epidemiological studies do not seem to show an over-risk of barotrauma, decompression sickness or arterial gas embolism in asthmatics. French, British, American, Spanish and Australian societies agreed on the exclusion of patients with moderate to severe persistent asthma, FEV1<80%, active asthma in the last 48hours, exercise/cold asthma and poor physical fitness.

CONCLUSION

A diver's examination should include a triple assessment: asthma control, number of exacerbations and treatment compliance. Homogenizing the recommendations would improve the framework for the practice of diving among asthmatics and allow larger studies in this population. Communicating the current recommendations remains important to divers, dive instructors and doctors in the context of the development of scuba diving.

Exploiting the Plant Secretory Pathway to Improve the Anticancer Activity of a Plant-Derived HPV16 E7 Vaccine

The human papillomavirus 16 (HPV16) E7 oncoprotein can be considered a ‘tumor-specific antigen’ and, therefore, it represents a promising target for a therapeutic vaccine against HPV-associated tumors. Efficient production of E7 protein with a plant-based transient expression system has been already described and it was demonstrated that E7-containing crude plant extracts confer partial protection against tumor challenge in a mouse model system. Before adopting the plant-based system as a cost-effective method for the production of an E7-based anti-cancer vaccine, some aspects, such as the oncoprotein yield, need further investigation. In the present study, we report the transient expression, mediated by a potato virus X (PVX)-derived vector, of the E7 protein targeted to the secretory system of Nicotiana benthamiana plants by using a plant-derived signal sequence. Targeting the antigen to the secretory pathway enhanced the E7 protein expression levels about five-fold. Mice immunized by s.c. administration with crude foliar extracts containing E7 showed strong stimulation of cell-mediated immune response after five boosters, as detected by ELISPOT. After challenging with the E7-expressing C3 tumor cells, tumor growth was completely inhibited in 80% of the vaccinated animals and a drastic reduction of tumor burden was observed in the remaining tumor-affected mice. These data demonstrate that, by enhancing E7 yield, it is possible to improve the anti-cancer activity of the plant-based experimental vaccine and open the way for a large-scale production of the E7 protein which could be purified or used as ‘in planta’ formulation, also suitable for oral therapeutic vaccination.

Behavior of A Cell Line Derived from A Mouse Submaxillary Adenocarcinoma during the Initial 480 Days in Vitro

A cell line was established from a transplantable adenocarcinoma, containing viral particles of the A and B type, derived from a tumor appearing spontaneously in the submaxillary region of a male mouse of the C3H/He strain. This line, after 480 days in vitro, did not change the original epithelial-like morphology, the viral expression, the membrane immunofluorescence and the degree of agglutination by various plant lectins. After 208 days of culture, the presence of up to 3 pairs of metacentric chromosomes appeared in about 55% of the cells. However, this change in the chromosomal pattern was not sufficient, at least within the limits of our observation, to modify significantly the other parameters investigated, with the possible exception of the oncogenicity, which showed a modest decrease after 296 days of culture.

CD74 regulates complexity of tumor cell HLA class II peptidome in brain metastasis and is a positive prognostic marker for patient survival

Despite multidisciplinary local and systemic therapeutic approaches, the prognosis for most patients with brain metastases is still dismal. The role of adaptive and innate anti-tumor response including the Human Leukocyte Antigen (HLA) machinery of antigen presentation is still unclear. We present data on the HLA class II-chaperone molecule CD74 in brain metastases and its impact on the HLA peptidome complexity.We analyzed CD74 and HLA class II expression on tumor cells in a subset of 236 human brain metastases, primary tumors and peripheral metastases of different entities in association with clinical data including overall survival. Additionally, we assessed whole DNA methylome profiles including CD74 promoter methylation and differential methylation in 21 brain metastases. We analyzed the effects of a siRNA mediated CD74 knockdown on HLA-expression and HLA peptidome composition in a brain metastatic melanoma cell line.We observed that CD74 expression on tumor cells is a strong positive prognostic marker in brain metastasis patients and positively associated with tumor-infiltrating T-lymphocytes (TILs). Whole DNA methylome analysis suggested that CD74 tumor cell expression might be regulated epigenetically via CD74 promoter methylation. CD74high and TILhigh tumors displayed a differential DNA methylation pattern with highest enrichment scores for antigen processing and presentation. Furthermore, CD74 knockdown in vitro lead to a reduction of HLA class II peptidome complexity, while HLA class I peptidome remained unaffected.In summary, our results demonstrate that a functional HLA class II processing machinery in brain metastatic tumor cells, reflected by a high expression of CD74 and a complex tumor cell HLA peptidome, seems to be crucial for better patient prognosis.