Inhibiting Anti-angiogenic VEGF165b Activates a Novel miR-17-20a-Calcipressin-3 Pathway that Revascularizes Ischemic Muscle in Peripheral Artery Disease

Background

VEGF165a increases the expression of microRNA-17-92 cluster, promoting developmental, retinal, and tumor angiogenesis. We have previously shown that VEGF165b, an alternatively spliced VEGF-A isoform, inhibits the VEGFR-STAT3 pathway in ischemic endothelial cells (ECs) to decrease their angiogenic capacity. In ischemic macrophages (Møs), VEGF165b inhibits VEGFR1 to induce S100A8/A9 expression, which drives M1-like polarization. Our current study aims to determine whether VEGF165b inhibition promotes perfusion recovery by regulating the miR-17-92 cluster in preclinical PAD.

Methods

Hind limb ischemia (HLI) induced by femoral artery ligation and resection was used as a preclinical PAD model. Hypoxia serum starvation (HSS) was used as an in vitro PAD model. VEGF165b was inhibited/neutralized by an isoform-specific VEGF165b antibody.

Results

Systematic analysis of miR-17-92 cluster members (miR-17-18a-19a-19b-20a-92) in experimental-PAD models showed that VEGF165b-inhibition induces miRNA-17-20a (within miR-17-92 cluster) in HSS-ECs and HSS-bone marrow derived macrophages (BMDMs) vs. respective normal and/or isotype matched IgG controls to enhance perfusion-recovery. Consistent with the bioinformatics analysis that revealed RCAN3 as a common target of miR-17 and miR-20a, Argonaute-2 pull-down assays showed decreased miR-17-20a expression and higher RCAN3 expression in the RISC complex of HSS-ECs and HSS-BMDMs vs. the respective controls. Inhibiting miR-17-20a induced RCAN3 levels to decrease ischemic angiogenesis and promoted M1-like polarization to impair perfusion recovery. Finally, using STAT3 inhibitors, S100A8/A9 silencers and VEGFR1-deficient ECs and Møs, we show that VEGF165b inhibition activates the miR-17-20a-RCAN3 pathway independent of VEGFR1-STAT3 or VEGFR1-S100A8/A9 in ischemic ECs and ischemic Møs, respectively.

Conclusion

Our data revealed a hereunto unrecognized therapeutic 'miR-17-20a-RCAN3' pathway in the ischemic vasculature that is VEGFR1-STAT3/S100A8/A9 independent and is activated only upon VEGF165b inhibition in PAD.

Functional Laryngeal Assessment in Patients with Tracheostomy Following COVID-19 a Prospective Cohort Study

To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

SPLIT-DOSING OF COVID-19 VACCINES IS SAFE AND PROVIDES NON-INFERIOR ANTIBODY RESPONSIVENESS TO CONVENTIONAL VACCINE DOSING

Introduction

Vaccination has proven efficacy against COVID-19, yet allergic or adverse reactions have resulted in vaccine hesitancy nationwide. Graded or split dosing of vaccines is a relatively common allergy practice that is understudied for efficacy, particularly for COVID-19. We aimed to compare antibody responsiveness and safety of split versus conventional dosing of COVID-19 vaccines.

Methods

A total of 30 adult subjects received conventional/full (N=15) or 2-step split (N=15) dosing of a COVID-19 vaccine. Pre- and 6-week post-serum antibody levels were determined by multiplex, microsphere-based IgG quantitative assays for SARS-CoV-2 antigens including Receptor Binding Domain (RBD), Spike protein 1 (S1), and nucleocapsid (natural infection marker). The majority received Pfizer booster (73%). Any adverse reactions were recorded.

Results

Post-vaccine RBD and S1 (but not nucleocapsid) antibody expression as measured by mean fluorescent intensity increased in conventional (p=0.0006 and p=0.0054, respectively) and split (p<0.0001 and p=0.0002) dosed subjects. Findings persisted after removal of 3 subjects with evidence of new natural infection as determined by nucleocapsid antibody positive conversion. There was no difference in mean fold-change (post/pre) antibody expression for RBD (conventional: +5.3 vs. split: +26.7, p=0.22) and S1 (+11.7 vs. +27.3, p=0.26). Split dosing was overall well-tolerated with minimal adverse reactions.

Conclusion

Split dosing is safe and non-inferior in efficacy as evidenced by antibody responsiveness when compared to conventional dosing of the COVID-19 vaccines. This approach could be applied to persons with vaccine hesitancy of various reasons including allergic disease(s) to provide immunization against this pandemic and be modeled in future pandemic scenarios.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Vagus nerve stimulation: a 20-year Australian experience

BACKGROUND

Vagus nerve stimulation (VNS) therapy was first approved in the mid-1990s in the USA, Europe and Australia, with demonstrable efficacy in paediatric populations. Benefit in seizure frequency reduction can be observed up to 2 years post-intervention; however, few studies assess outcomes beyond this period. Furthermore, paediatric cohort sizes are small, limiting generalisability of outcome assessments. We evaluate VNS insertion outcomes and complications or side-effects in a large paediatric cohort, over a 20-year period from Queensland's first VNS insertion.

METHODS

A retrospective review was conducted of all paediatric VNS insertions at the Queensland Children's Hospital (QCH) and the Mater Children's Hospital/Mater Children's Private Hospital (MCH/MCPH) Brisbane. A minimum of 1-year follow-up from 1999 to 2020 was required for inclusion. Patients were assessed on demographics, epilepsy details, seizure outcomes and complications or side-effects.

RESULTS

In this extended follow-up cohort (76 patients, 7.2 ± 5.3 years), 51.3% of patients had ≥ 50% seizure frequency reduction, while 73.7% experienced an Engel III outcome (worthwhile benefit) or better. Eleven patients (14.9%) were seizure-free at follow-up, and 81.6% retained long-term therapy. Stimulation-related side-effects are common (17.1%) but rarely result in stimulation cessation (3.9%). Cessation occurred in 14 patients (18.4%) and most commonly related to minimal benefit (13.2%). Demographics, aetiology, seizure nature and surgical factors did not influence outcomes.

CONCLUSION

Over extended treatment periods, a large proportion of patients will benefit significantly from VNS therapy. Approximately 4 of 5 patients will retain VNS therapy, and in cases of cessation, this is most commonly related to minimal benefit. Underlying demographics, aetiology or seizure nature do not influence outcomes. This 20-year Queensland assessment of VNS therapy outcomes informs long-term expectation of VNS therapy.

Life is a rollercoaster: an exploration of a support group for parents and carers of those with children and young people with mental health difficulties

NHS Digital reported that one in eight children aged 5 to 19-year-old in England were identified with a mental illness, the most prevalent being emotional disorders. A diagnosis of a mental illness has a clear impact on children or young people and can also impact the health and wellbeing of family members, in particular parents and carers. We will share and discuss findings from a co-produced evaluation of a nationally recognized support group, Rollercoaster, a well-established and popular parent support group in the UK, for carers of children and young people with mental health difficulties. We will illustrate “what works” in setting up and running a support group for parents in the UK and more widely. The audience will learn what matters to the parents and carers regarding support and in terms of offering support, and how to effectively run a successful support group. Specifically, the evaluation focused on what principles could be drawn from Rollercoaster, given the wide gap in local services offering targeted support for carers. We therefore created a framework to aid in the development of other, unique support groups designed to meet the needs of their local populations. We carried out a parent/carer survey; interviews with parents/carers, support group workers and wider stakeholders; and observations of support group activities. Applying a “lesson drawing” method, we grouped what participants said around the following areas: 1) specific activities offered by Rollercoaster; 2) people who set up and run a parent/carer support group; 3) how to make a parent/carer support group successful. Engaging a wide range of parents/carers and stakeholders at every stage in the design of activities was seen as paramount. A range of skills are required by different people at various points in setting up and running the group. Success rests on constantly adapting to internal and external developments and having a bedrock of being parent led and professionally supported.

Temporal Brokering: A Measure of Brokerage as a Behavioral Process

Extant research in organizational networks has provided critical insights into understanding the benefits of occupying a brokerage position. More recently, researchers have moved beyond the brokerage position to consider the brokering processes (arbitration and collaboration) brokers engage in and their implications for performance. However, brokering processes are typically measured using scales that reflect individuals’ orientation toward engaging in a behavior, rather than the behavior itself. In this article, we propose a measure that captures the behavioral process of brokering. The measure indicates the extent to which actors engage in arbitration versus collaboration based on sequences of time stamped relational events, such as emails, message boards, and recordings of meetings. We demonstrate the validity of our measure as well as its predictive ability. By leveraging the temporal information inherent in sequences of relational events, our behavioral measure of brokering creates opportunities for researchers to explore the dynamics of brokerage and their impact on individuals, and also paves the way for a systematic examination of the temporal dynamics of networks.

Cerebrospinal fluid liquid biopsy for detecting somatic mosaicism in brain

Brain somatic mutations are an increasingly recognized cause of epilepsy, brain malformations and autism spectrum disorders and may be a hidden cause of other neurodevelopmental and neurodegenerative disorders. At present, brain mosaicism can be detected only in the rare situations of autopsy or brain biopsy. Liquid biopsy using cell-free DNA derived from cerebrospinal fluid has detected somatic mutations in malignant brain tumours. Here, we asked if cerebrospinal fluid liquid biopsy can be used to detect somatic mosaicism in non-malignant brain diseases. First, we reliably quantified cerebrospinal fluid cell-free DNA in 28 patients with focal epilepsy and 28 controls using droplet digital PCR. Then, in three patients we identified somatic mutations in cerebrospinal fluid: in one patient with subcortical band heterotopia the LIS1 p. Lys64* variant at 9.4% frequency; in a second patient with focal cortical dysplasia the TSC1 p. Phe581His*6 variant at 7.8% frequency; and in a third patient with ganglioglioma the BRAF p. Val600Glu variant at 3.2% frequency. To determine if cerebrospinal fluid cell-free DNA was brain-derived, whole-genome bisulphite sequencing was performed and brain-specific DNA methylation patterns were found to be significantly enriched (P = 0.03). Our proof of principle study shows that cerebrospinal fluid liquid biopsy is valuable in investigating mosaic neurological disorders where brain tissue is unavailable.

Dysphagia presentation and management following COVID-19: an acute care tertiary centre experience

OBJECTIVES

As the pathophysiology of COVID-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.

RESULTS

During the first wave of the COVID-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.

CONCLUSION

Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with COVID-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.

Association of premature menopause with incident pulmonary hypertension

Background

Several forms of pulmonary hypertension (PH) disproportionately affect women. Prior animal and human studies suggest that oestradiol exerts mixed effects on the pulmonary vasculature. Whether premature menopause represents a risk factor for PH is currently unknown.

Purpose

To test the independent association of premature menopause with incident PH.

Methods

We included women in the UK Biobank who were 40–69 years old and postmenopausal at enrolment and underwent pulmonary function testing at the baseline study visit. Women with missing menopause data, prevalent PH, extreme pulmonary function test outliers (Z&gt;5 or Z&lt;−5), and those with congenital heart disease were excluded. Premature menopause was defined as occurring before age 40 years. Reproductive history, including age at menopause and use of menopausal hormone therapy (MHT), was ascertained by participant self-report at enrolment. PH risk factors and relevant co-morbidities were captured by participant self-report and by ICD code. Incident PH was ascertained by the appearance of a qualifying ICD code (ICD-9 4160; ICD-10 I27.0, I27.2). Follow-up began at study enrolment, with time to censoring determined by date of PH diagnosis or last encounter in the medical record. Multivariable Cox proportional hazard models tested the association between premature menopause and incident PH, with adjustment for age, race, ever-smoking, body-mass index, systolic blood pressure, antihypertensive medication use, non-high-density lipoprotein cholesterol, cholesterol-lowering medication use, C-reactive protein, prevalent type 2 diabetes, obstructive sleep apnoea, heart failure, venous thromboembolism, mitral regurgitation, aortic stenosis, forced vital capacity (FVC), the forced expiratory volume in 1 second (FEV1)/FVC ratio, and ever-use of MHT.

Results

Among 138,518 postmenopausal women (mean [SD] age at enrolment 60.0 [5.4] years), 5,440 women (3.9%) had a history of premature menopause. Incident PH was diagnosed in 253 women over a median 8.1 (interquartile range 7.4–8.8) years of follow-up. Mean age at menopause was 48.3 (6.4) years among women with incident PH vs. 49.7 (5.1) years among those without PH (P&lt;0.001). Crude cumulative incidence of PH was 0.40% among women premature menopause vs. 0.17% among those without (Figure 1). After multivariable adjustment, premature menopause remained independently associated with PH (hazard ratio [HR] 1.91, 95% CI 1.15–3.16, P=0.01). Ever-use of MHT was not significantly associated with incident PH (HR 0.93, 95% CI 0.68–1.26, P=0.62). In sensitivity analysis excluding 4,461 women with prevalent heart failure, venous thromboembolism, mitral regurgitation, or aortic stenosis, the HR for PH associated with premature menopause was 2.19 (95% CI 1.28–3.74, P=0.004).

Conclusions

Premature menopause is an independent risk factor for PH in women.

Figure 1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): U.S. National Heart, Lung, and Blood Institute

Chiari 1 malformation: age-based outcomes in a paediatric surgical cohort

PURPOSE

Substantial evidence exists describing differences between paediatric and adult Chiari 1 malformation (CM1) patients. Differences in clinical presentation between very young (0-6 years old) and older (7-18 years old) paediatric patients is similarly well-established. However, progression on these findings with regard to surgical outcomes is limited. We aimed to establish whether inter-paediatric age group modifies surgical outcome for CM1 decompression.

METHODS

Retrospective chart review was conducted for 65 patients receiving posterior fossa decompression between 2006 and 2018. Presenting features, surgical management, and outcome were evaluated and stratified into very young patients (0-6 years) or older patients (7-18 years). Outcomes were assessed using the Chicago Chiari Outcome Scale (CCOS), a validated 16-point framework for comparison.

RESULTS

Very young patients (21 patients) scored significantly lower in surgical outcome overall compared with older patients (44 patients) (12.1 ± 3.2/16 vs 14.2 ± 1.6/16, p = 0.011), and across 3/4 CCOS subscores: non-pain symptoms, functionality, and complications. Very young patients also returned to theatre more commonly (47.6% vs 13.6%, p = 0.003), primarily for re-do decompression (7/10 patients, 70%). Finally, the presentation of very young patients differed to older patients with significantly more oropharyngeal (38.1% vs 9.0%, p = 0.014) and motor symptoms (47.6% vs 22.7%, p = 0.042).

DISCUSSION

Very young patients (0-6 years) do not appear to respond as well to standard posterior fossa decompression, as their older (7-18 years) paediatric counterparts, in the absence of several baseline cohort characteristic differences. We hypothesise underlying anatomical differences may contribute to this finding.

Precision measurement of the neutral pion lifetime

The explicit breaking of the axial symmetry by quantum fluctuations gives rise to the so-called axial anomaly. This phenomenon is solely responsible for the decay of the neutral pion π⁰ into two photons (γγ), leading to its unusually short lifetime. We precisely measured the decay width Γ of the [Formula: see text] process. The differential cross sections for π⁰ photoproduction at forward angles were measured on two targets, carbon-12 and silicon-28, yielding [Formula: see text], where stat. denotes the statistical uncertainty and syst. the systematic uncertainty. We combined the results of this and an earlier experiment to generate a weighted average of [Formula: see text] Our final result has a total uncertainty of 1.50% and confirms the prediction based on the chiral anomaly in quantum chromodynamics.

Assessing and visualising hazard impacts to enhance the resilience of Critical Infrastructures to urban flooding

The design, construction and maintenance of Critical Infrastructures (CI) is commonly based on standards that are rigorous, so as to withstand any climate or weather-linked pressures. However, due to climate change, climate characteristics may shift, resulting in increased frequency/magnitude of potential failures, or exposure to new unknown risks. As vital components for the normal functioning of modern societies, the resilience of CIs under climate stressors encompasses their structural integrity, their operational elements, and their capacity to maximize business output. In this work, we propose an integrated and participatory methodological approach to enhance the resilience of interconnected CIs to urban flooding under climate change, by assessing the risk and introducing adaptation measures. The main objectives of the proposed methodology and approach are: (i) to provide scientific evidence for better understanding of how future climate regimes might affect normal operation of interconnected CI in urban areas during their lifespan; (ii) to assess the cost-effectiveness of different adaptation measures; (iii) to involve local stakeholders and operators in the co-design of the approach, as well as the assessment and the evaluation of adaptation measures; (iv) to combine computational modelling with advanced 3D visualisation techniques for effectively engaging stakeholders in decision making; (v) to include risk assessment and damage functions co-designed by end-users and local stakeholders; (vi) to integrate all of the aforementioned components in a specifically designed cloud platform as a Decision Support System for end-users, (vii) to validate the DSS by the end users and local stakeholders. The paper presents the computational background and tools. Additionally, it describes a Case Study in Torbay, UK, where the full methodology and the proposed participatory approach have been applied, with all the specifics, i.e., the scenarios of extreme flooding, the numerical and visualisation results, the response of the stakeholders and the evaluation of selected adaptation measures.

Creating new guidelines on how best to treat foot symptoms in people with EB

Epidermolysis bullosa (EB) is a complex rare condition that affects the skin and many parts of the body. Those born with EB have skin so fragile they are called 'butterfly children', their skin is quite simply as fragile as the wing of a butterfly. In the UK it is estimated that there are more than 5,000 people living with EB and 500,000 worldwide. Little clinical guidance for care existed until DEBRA International started a programme to develop clinical practice guidelines (CPGs). There were no previous guidelines and few published studies on foot care in EB so treatment decisions were largely based on individual opinion and experience. The panel - made up of clinical experts and people living with EB representing Australia, the UK, and the USA - aimed to describe foot problems in people of all ages with EB, and summarise current evidence and management. The authors used a logical podiatric (foot) care literature review focussed on patients with EB. The authors found that the evidence in this area was limited but several interventions (treatments) currently practised by podiatrists show positive outcomes. The study allowed the group to make recommendations on how to treat foot and nail disorders in patients with EB. Furthermore, the authors concluded that further research is needed. This is a summary of the study: Foot care in epidermolysis bullosa: evidence-based guideline.

The Safety and Immunogenicity of GTU®MultiHIV DNA Vaccine Delivered by Transcutaneous and Intramuscular Injection With or Without Electroporation in HIV-1 Positive Subjects on Suppressive ART

Previous studies have shown targeting different tissues via the transcutaneous (TC) and intramuscular injection (IM) with or without electroporation (EP) has the potential to trigger immune responses to DNA vaccination. The CUTHIVTHER 001 Phase I/II randomized controlled clinical trial was designed to determine whether the mode of DNA vaccination delivery (TC+IM or EP+IM) could influence the quality and function of induced cellular immune responses compared to placebo, in an HIV positive clade B cohort on antiretroviral therapy (ART). The GTU^®MultiHIV B DNA vaccine DNA vaccine encoded a MultiHIV B clade fusion protein to target the cellular response. Overall the vaccine and regimens were safe and well-tolerated. There were robust pre-vaccination IFN-γ responses with no measurable change following vaccination compared to placebo. However, modest intracellular cytokine staining (ICS) responses were seen in the TC+IM group. A high proportion of individuals demonstrated potent viral inhibition at baseline that was not improved by vaccination. These results show that HIV positive subjects with nadir CD4+ counts ≥250 on suppressive ART display potent levels of cellular immunity and viral inhibition, and that DNA vaccination alone is insufficient to improve such responses. These data suggest that more potent prime-boost vaccination strategies are likely needed to improve pre-existing responses in similar HIV-1 cohorts (This study has been registered at http://ClinicalTrials.gov under registration no. NCT02457689).

Validation of Three Rapid Screening Methods for Detection of Verotoxin-Producing Escherichia coli in Foods: Interlaboratory Study

An interlaboratory study was conducted for the validation of 3 methods for the detection of all verotoxin-producing Escherichia coli (VTEC) in foods. The methods were a multi-analyte 1-step lateral flow immunoassay (LFIA) for detection of E. coli O157 and verotoxin (VT); an enzyme-linked immunosorbent assay targeted against VT1, VT2, and VT2c (VT-ELISA); and a polymerase chain reaction (PCR) method for detection of VT genes (VT-PCR). Aliquots (25 g or 25 mL) of 4 food types (raw minced [ground] beef, unpasteurized milk, unpasteurized apple juice [cider], and salami) were individually inoculated with low numbers (&lt;9 to 375 cells/25 g) of 6 test strains of E. coli (serogroups O26, O103, O111, O145, and O157) with differing VT-producing capabilities. Five replicates for each test strain and 5 uninoculated samples were prepared for each food type. Fourteen participating laboratories analyzed samples using the LFIA, 9 analyzed the samples by ELISA, and 9 by PCR. The LFIA for O157 and VT had a specificity (correct identification of negative samples) of 92 and 94%, respectively, and a sensitivity (correct identification of positive samples) of 94 and 55%, respectively. The VT-ELISA and VT-PCR

A Medium for the Presumptive Detection of Enterobacter sakazakii in Infant Formula: Interlaboratory Study

A standard method for the detection of Enterobacteriaceae was modified for the presumptive detection of Enterobacter sakazakii, and the modified method was validated in an interlaboratory trial with 16 laboratories from 8 European countries. The modification included a differential-elective medium for the isolation of E. sakazakii, consisting of nutrient agar (NA) supplemented with 4-methyl-umbelliferyl α-D-glucoside (α-MUG). A 25 g sample was added to 225 mL buffered peptone water. After incubation at 35° or 37°C for 16 or 20 h, 10 mL nonselective enrichment was transferred into 90 mL selective enrichment. The selective enrichment was streaked on violet-red bile glucose agar (VRBGA) and incubated at 37°C for 24 h. It was streaked in parallel on NA plates supplemented with α-MUG at 50 mg/L and incubated at 25°C for 16 h, and afterwards for an additional 24 h at room temperature in the dark. E. sakazakii appeared as vivid yellow colonies under normal light and showed blue/violet fluorescence under UV light on NA + α-MUG plates. Validation samples represented powdered infant formula without E. sakazakii (blanks) and with low (1–10 colony-forming units [CFU]/25 g) and medium (1–10 CFU/g) contamination levels. All samples contained Pseudomonas aeruginosa and Lactobacillus spp. as background flora. The specificity for blank samples was 100%. The sensitivity of the low contamination level was similar for VRBGA and NA + α-MUG, i.e., 66.7% (66.7% accordance, 53.9% concordance). For the medium level the sensitivities were 96.7% (93.3% accordance, 93.5% concordance) for VRBGA and 98.3% (96.9% accordance, 96.9% concordance) for NA + α-MUG.

Foot care in epidermolysis bullosa: evidence-based guideline

This guideline was designed to provide service providers and users with an evidence-based set of current best practice guidelines for people and their families and carers, living with epidermolysis bullosa (EB). A systematic literature review relating to the podiatric care of patients with EB was undertaken. Search terms were used, for which the most recent articles relating to podiatric treatment were identified from as early as 1979 to the present day, across seven electronic search engines: MEDLINE, Wiley Online Library, Google Scholar, Athens, ResearchGate, Net and PubFacts.com. The Scottish Intercollegiate Guidelines Network (SIGN) methodology was used. The first guideline draft was analysed and discussed by clinical experts, methodologists and patients and their representatives at four panel meetings. The resulting document went through an external review process by a panel of experts, other healthcare professionals, patient representatives and lay reviewers. The final document will be piloted in three different centres in the U.K. and Australia. Following an EB community international survey the outcomes indicated six main areas that the community indicated as a priority to foot management. These include blistering and wound management, exploring the most suitable footwear and hosiery for EB, management of dystrophic nails, hyperkeratosis (callus), maintaining mobility and fusion of toes (pseudosyndactyly). The evidence here is limited but several interventions currently practised by podiatrists show positive outcomes.

Role of filtration in managing the risk from Cryptosporidium in commercial swimming pools - a review

Most commercial swimming pools use pressurised filters, typically containing sand media, to remove suspended solids as part of the water treatment process designed to keep water attractive, clean and safe. The accidental release of faecal material by bathers presents a poorly quantified risk to the safety of swimmers using the pool. The water treatment process usually includes a combination of maintaining a residual concentration of an appropriate biocide in the pool together with filtration to physically remove particles, including microbial pathogens, from the water. However, there is uncertainty about the effectiveness of treatment processes in removing all pathogens, and there has been growing concern about the number of reported outbreaks of the gastrointestinal disease cryptosporidiosis, caused by the chlorine-resistant protozoan parasite Cryptosporidium. A number of interacting issues influence the effectiveness of filtration for the removal of Cryptosporidium oocysts from swimming pools. This review explains the mechanisms by which filters remove particles of different sizes (including oocyst-sized particles, typically 4-6 μm), factors that affect the efficiency of particle removal (such as filtration velocity), current recommended management practices, and identifies further work to support the development of a risk-based management approach for the management of waterborne disease outbreaks from swimming pools.

Dysplasia severity is associated with poor quality of life in patients with Barrett's esophagus referred for endoscopic eradication therapy

Limited data exist regarding patient-reported outcomes and quality of life (QOL) experienced by patients with Barrett's esophagus (BE) referred for endoscopic eradication therapy (EET). Specifically, the impact of grade of dysplasia has not been explored. The purpose of this study is to measure patient-reported symptoms and QOL and identify factors associated with poor QOL in BE patients referred for EET. This was a prospective multicenter study conducted from January 2015 to October 2017, which included patients with BE referred for EET. Participants completed a set of validated questionnaires to measure QOL, symptom severity, and psychosocial factors. The primary outcome was poor QOL defined by a PROMIS score >12. Multivariable logistic regression analysis was performed to identify factors associated with poor QOL. In total, 193 patients participated (mean age 64.6 years, BE length 5.5 cm, 82% males, 92% Caucasians) with poor QOL reported in 104 (53.9%) participants. On univariate analysis, patients with poor QOL had lower use of twice daily proton pump inhibitor use (61.5% vs. 86.5%, P = 0.03), shorter disease duration (4.9 vs. 5.9 years, P = 0.04) and progressive increase in grade of dysplasia (high-grade dysplasia: 68.8% vs. 31.3%, esophageal adenocarcinoma: 75.5% vs. 24.5%, P < 0.001). Multivariate analysis demonstrated that high-grade dysplasia was independently associated with poor QOL (OR: 5.57, 95% CI: 1.05, 29.5, P = 0.04). In summary, poor QOL is experienced by the majority of patients with BE referred for EET and the degree of dysplasia was independently associated with poor QOL, which emphasizes the need to incorporate patient-centered outcomes when studying treatment of BE-related dysplasia.

Somatic GNAQ mutation in the forme fruste of Sturge-Weber syndrome

Objective

To determine whether the GNAQ R183Q mutation is present in the forme fruste cases of Sturge-Weber syndrome (SWS) to establish a definitive molecular diagnosis.

Methods

We used sensitive droplet digital PCR (ddPCR) to detect and quantify the GNAQ mutation in tissues from epilepsy surgery in 4 patients with leptomeningeal angiomatosis; none had ocular or cutaneous manifestations.

Results

Low levels of the GNAQ mutation were detected in the brain tissue of all 4 cases—ranging from 0.42% to 7.1% frequency—but not in blood-derived DNA. Molecular evaluation confirmed the diagnosis in 1 case in which the radiologic and pathologic data were equivocal.

Conclusions

We detected the mutation at low levels, consistent with mosaicism in the brain or skin (1.0%–18.1%) of classic cases. Our data confirm that the forme fruste is part of the spectrum of SWS, with the same molecular mechanism as the classic disease and that ddPCR is helpful where conventional diagnosis is uncertain.

Vulnerability of Southeast Greenland Glaciers to Warm Atlantic Water From Operation IceBridge and Ocean Melting Greenland Data

We employ National Aeronautics and Space Administration (NASA)'s Operation IceBridge high-resolution airborne gravity from 2016, NASA's Ocean Melting Greenland bathymetry from 2015, ice thickness from Operation IceBridge from 2010 to 2015, and BedMachine v3 to analyze 20 major southeast Greenland glaciers. The results reveal glacial fjords several hundreds of meters deeper than previously thought; the full extent of the marine-based portions of the glaciers; deep troughs enabling warm, salty Atlantic Water (AW) to reach the glacier fronts and melt them from below; and few shallow sills that limit the access of AW. The new oceanographic and topographic data help to fully resolve the complex pattern of historical ice front positions from the 1930s to 2017: glaciers exposed to AW and resting on retrograde beds have retreated rapidly, while glaciers perched on shallow sills or standing in colder waters or with major sills in the fjords have remained stable.

Abstract P5-12-03: Withdrawn

This abstract was withdrawn by the authors.

Manifesto for filmmaking as organisational research

This article is an effort to build a manifesto for the academic acceptability of filmmaking as organisational research. While a film does not offer an argument with premises to reach a conclusion, it does accomplish its own distinctive manifestation of research as a performance of thought. Drawing on experience of academic film projects, we promote the idea of using filmmaking not only to convey research ideas but also to communicate the full sensory variety of organisational life. Finally, we see film as a powerful and valid feature of academic research output, providing opportunities for scholars to convey understanding to a broader public than the academy alone.

BedMachine v3: Complete Bed Topography and Ocean Bathymetry Mapping of Greenland From Multibeam Echo Sounding Combined With Mass Conservation

Greenland's bed topography is a primary control on ice flow, grounding line migration, calving dynamics, and subglacial drainage. Moreover, fjord bathymetry regulates the penetration of warm Atlantic water (AW) that rapidly melts and undercuts Greenland's marine-terminating glaciers. Here we present a new compilation of Greenland bed topography that assimilates seafloor bathymetry and ice thickness data through a mass conservation approach. A new 150 m horizontal resolution bed topography/bathymetric map of Greenland is constructed with seamless transitions at the ice/ocean interface, yielding major improvements over previous data sets, particularly in the marine-terminating sectors of northwest and southeast Greenland. Our map reveals that the total sea level potential of the Greenland ice sheet is 7.42 ± 0.05 m, which is 7 cm greater than previous estimates. Furthermore, it explains recent calving front response of numerous outlet glaciers and reveals new pathways by which AW can access glaciers with marine-based basins, thereby highlighting sectors of Greenland that are most vulnerable to future oceanic forcing.

Abstract P5-11-10: Evaluation of the relationship between psychological distress and risk for breast cancer

Introduction: Women at increased risk for breast cancer (due to family history or having a pathogenic germline mutation in a cancer causing gene) have greater distress levels, which can impact quality of life and screening behavior. The goal of our study was to evaluate distress related to different risk factors for breast cancer and examine the stability of this distress over time.

Methods: Women at increased risk for breast cancer who enrolled in the High-Risk Breast Program (HRBP) at the University of Vermont Medical Center were eligible for participation. Women with strong family history, a genetic mutation or atypia on biopsy (benign breast disease, BBD) who completed the Impact of Event Scale (IES) at least once were identified. The IES is a self-reported measure designed to measure subjective distress within the past seven days in relation to a stressor. The scale is based on a two-factor intrusion-avoidance model. Linear regression was used to examine change in distress over time and to compare distress levels between risk groups. Both risk measures and distress scores were examined using bivariate plots and normal probability plots. Pearson correlation coefficients and least squares regression coefficients were obtained along with 95% confidence intervals. In addition to treating the risk estimates as continuous measures, these estimates were grouped into low or average risk (&lt;=2%) over five years, moderate risk (2%-4%) over five years, and high risk (&gt;=5%) over five years. Using the ordinal classification into three risk groups, analysis of variance was conducted to detect group differences in average psychological distress using a 5% significance level.

Results: The cohort comprised 344 women at increased risk for breast cancer due to a strong family history (80%), a genetic mutation (9%) or benign breast disease (16%). Mean IES score was 16.8 (CI 15.5, 18.2), and indicates high distress levels in this cohort. IES scores decreased over time (p&lt;0.001 and p=0.003 after 4 and 8 years, respectively). Scores did not differ between the overall group and either women with a strong family history (p=0.06) or women with BBD (p=0.8). Women with genetic mutations had higher IES scores than those without (p=0.023). IES scores were positively associated with the number of risk factors an individual had (1, 2, or 3 risk factors: p=0.003).

Conclusion: We demonstrated that distress is similar among different risk categories and that distress decreases over time; patterns not previously recognized. Women with benign breast disease have IES scores similar to women with strong family histories of breast cancer. Women with multiple risk factors are also noted to have higher scores. Women with genetic mutations appear to have the highest distress levels. These findings further our understanding of cancer related distress. Targeting women with highest distress levels may improve both quality of life and screening adherence.

Citation Format: Vennard K, Crocker A, Ogheneruona A, Cuke M, Wood M. Evaluation of the relationship between psychological distress and risk for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-11-10.

Protective effects of exogenous and endogenous hydrogen sulfide in mast cell-mediated pruritus and cutaneous acute inflammation in mice

The recently described 'gasomediator' hydrogen sulfide (H₂S) has been involved in pain mechanisms, but its effect on pruritus, a sensory modality that similarly to pain acts as a protective mechanism, is poorly known and controversial. The effects of the slow-releasing (GYY4137) and spontaneous H₂S donors (Na₂S and Lawesson's reagent, LR) were evaluated in histamine and compound 48/80 (C48/80)-dependent dorsal skin pruritus and inflammation in male BALB/c mice. Animals were intradermally (i.d.) injected with C48/80 (3μg/site) or histamine (1μmol/site) alone or co-injected with Na₂S, LR or GYY4137 (within the 0.3-100nmol range). The involvement of endogenous H₂S and K_ATP channel-dependent mechanism were also evaluated. Pruritus was assessed by the number of scratching bouts, whilst skin inflammation was evaluated by the extravascular accumulation of intravenously injected ¹²⁵I-albumin (plasma extravasation) and myeloperoxidase (MPO) activity (neutrophil recruitment). Histamine or C48/80 significantly evoked itching behavior paralleled by plasma extravasation and increased MPO activity. Na₂S and LR significantly ameliorated histamine or C48/80-induced pruritus and inflammation, although these effects were less pronounced or absent with GYY4137. Inhibition of endogenous H₂S synthesis increased both Tyrode and C48/80-induced responses in the skin, whereas the blockade of K_ATP channels by glibenclamide did not. H₂S-releasing donors significantly attenuate C48/80-induced mast cell degranulation either in vivo or in vitro. We provide first evidences that H₂S donors confer protective effect against histamine-mediated acute pruritus and cutaneous inflammation. These effects can be mediated, at least in part, by stabilizing mast cells, known to contain multiple mediators and to be primary initiators of allergic processes, thus making of H₂S donors a potential alternative/complementary therapy for treating inflammatory allergic skin diseases and related pruritus.