The response of turkeys to dietary balanced protein during two periods of growth

1. Two experiments were conducted to measure the response of growing turkeys to dietary protein content. In the first, 960 sexed British United Turkey (BUT 6) poults were used to measure the response to balanced protein from 3 to 6 weeks of age. In the second, 1440 sexed BUT and Hybrid Converter poults were raised from 14 to 17 weeks.2. In both experiments, six levels of dietary protein were fed, with feed intake, body and feather weight gain and changes in body composition measured. The levels of protein chosen ranged from 0.53 to 1.2 of the Aviagen requirements for growing turkeys.3. In the first experiment, six poults were sampled from each sex at the start of the experiment for carcass analysis, and four were sampled from each strain and sex in the second. At the end of each experiment, eight poults from each treatment were sampled. Body composition analyses were made on individual defeathered birds.4. Weight gain increased linearly with protein intake in the early period and exponentially in the later period. In both periods, feed intake decreased as protein content reduced.5. In the early period, body lipid content increased from 20.2 to 41.5 g/kg body weight, as dietary protein content decreased, but there was no change in the later period. Efficiency of utilisation of dietary protein declined linearly with an increase in dietary protein content, from 0.87 to 0.46 g/g in the first, and from 0.43 to 0.27 g/g in the later period.6. The inability of the growing turkey to increase feed intake on marginally limiting feeds may have been due to a genetic constraints to store excess energy consumed as body lipid, resulting in the observed decrease in feed intake as dietary protein content is reduced.

Feasibility and acceptability of multidisciplinary team training in health coaching: Case study in adolescent rheumatology

The central importance of the biopsychosocial model of chronic disease is increasingly recognised in the management of long-term conditions (LTC), which are often associated with chronic pain, fatigue and disability. Despite the physical and mental health impact, 'struggle' to maintain self-efficacy, gap in effective transition to adult pathways and long term consequences of poor disease control and lifestyle choices in young people with LTCs, innovation in this age range is rarely reported in generic journals. This paper explores the feasibility and acceptability of health coaching with young service users to increase engagement and self-management, achieved through multidisciplinary team (MDT) training in Adolescent Rheumatology.

Insights into the clinical presentation, diagnostics and outcome in dogs presenting with neurological signs secondary to infection with Neospora caninum: 41 cases (2014-2023)

OBJECTIVES

To describe the clinical signs and outcome of a large cohort of dogs presenting with neurological signs secondary to Neospora caninum infection.

MATERIALS AND METHODS

Retrospective review of cases presenting to two UK referral centres with neurological signs secondary to N. caninum infection between 2014 and 2023. Presenting signs, diagnostic test results, treatment, short- and long-term outcome analysed.

RESULTS

A total of 1690 cases were assessed for eligibility. Forty-four cases with a diagnosis of neosporosis were obtained. Three cases were then excluded due to non-neurological presentations (two hepatitis and one myocarditis). A total of 41 cases were included in the study. Cerebello-vestibular signs predominated; however, presenting clinical signs were varied and the neurolocalisation was often multifocal in nature (46.3%), making neosporosis an important differential diagnosis for meningoencephalitis of unknown origin. Complete clinical improvement was rare (5.6%), and relapses were common (27.8% cases with follow-up).

CLINICAL SIGNIFICANCE

Neosporosis remains an important differential diagnosis for dogs at any age presenting with multifocal neurological signs. The outcome is considered poor and relapse rate is high.

Dietary energy:protein ratio influences the efficiency of utilisation of dietary protein by growing turkeys

1. The following experiment was designed to confirm that the efficiency of dietary protein utilisation (ep) can be reduced when the AMEn to digestible crude protein (DCP) ratio of the feed falls below a critical level. In addition, whether the efficiency would be improved at high DCP contents through the addition of oil or starch was determined.2. A 14d trial (starting at 21 d of age), using BUT 6 turkeys, was designed to measure the effects on ep of four feeds (12.1 MJ AMEn/kg) with AMEn:DCP ratios ranging from 45 to 72 MJ AMEn/kg, and two additional feeds with the same DCP as the highest protein feed, one with an AMEn:DCP ratio of 59, through the addition of canola oil, and the other with a ratio of 51 MJ/kg supplemented with both starch and oil. Twenty birds constituted each experimental unit, with two replications of each sex being used per dietary treatment.3. Ten birds per sex were sampled at the start of the trial and a further five per pen at the end for carcass analysis. Each carcass including feathers was ground and subsampled for water, protein and lipid determination.4. A split-line regression described ep on the four feeds unsupplemented with additional energy (R² = 0.81) with breakpoint at 60.6 MJ AME/kg DCP, maximum ep at 0.736 g/g, and a slope of 0.017. No improvement in ep resulted from supplementing the high protein feed with oil or a mixture of oil and starch, but feed intake and protein and lipid retention increased significantly (P < 0.05).5. The argument that insufficient energy is available to enable high protein feeds to be utilised efficiently was not corroborated by the evidence from this trial.

Relationship between ethnicity and multidisciplinary intervention for young people with rheumatic and musculoskeletal diseases

Introduction

There is growing recognition of the impact of societal factors on health throughout a patient's lifespan. The COVID-19 pandemic has exposed the impact of racial disparity on health outcomes.

Aims

We aimed to investigate the association between ethnicity and the multidisciplinary team (MDT) interventions for young people (YP) with complex care needs.

Method

This retrospective, single-centre, cross-sectional study was conducted within the department of adolescent and young adult rheumatology at University College Hospital, London, between August 2019 and August 2021. We extracted demographic, clinical and laboratory data. The index of multiple deprivation was extracted from the Office for National Statistics database. R software was used for analysis.

Results

We identified 310 YP referred to the MDT with a median age of 18 years (interquartile range 17-19). The female patient to male patient ratio was 2.4. Over a third of our cohort were from deprived areas. Comparison between Black, Asian and minority ethnic (BAME) and White ethnic groups revealed significant differences in terms of referral for pain optimisation (p=0.006), social support (p<0.00001), and adherence and non-clinic attendance (p=0.0004).

Conclusion

Our findings reveal the importance of quality data for early identification and support of vulnerable YP, particularly those from BAME communities.

Pediatric Sarcoidosis: Retrospective Analysis of Biopsy-Proven Patients

OBJECTIVE

To describe the phenotype, disease course, and treatment of a large cohort of children with sarcoidosis.

METHODS

Patients with biopsies consistent with sarcoidosis, performed between 2010 and 2020, were included in this study. Patients' notes were reviewed retrospectively. Children with disease onset before 5 years of age were compared with older children. Regression analysis was performed to determine predictors of treatment outcome.

RESULTS

In total, 48 children with a mean age at diagnosis of 9.5 years, with a male to female ratio of 0.71, were identified. In total, 72% of the children were of Black race and 94% had multiorgan disease, with an average of 4.8 organs involved, most commonly lymph nodes (65%), skin (63%), and eyes (60%). Laboratory findings of note included raised serum calcium in 23% of patients and raised angiotensin-converting enzyme in 76% of patients. Out of 14 patients tested, 6 had mutations in NOD2. In total, 81% of patients received systemic steroids and 90% received conventional disease-modifying antirheumatic drugs (DMARDs); in 25% of patients, a biologic was added, mostly anti-tumor necrosis factor (anti-TNF). Although most patients could be weaned off steroids (58%), most remained on long-term DMARDs (85%). Children under the age of 5 years presented more often with splenomegaly (P = 0.001), spleen involvement (P = 0.003), and higher C-reactive protein (P = 0.10). Weight loss was more common in adolescents (P = 0.006). Kidney (P = 0.004), eye (P = 0.005), and liver involvement (P = 0.03) were more common in Black patients. Regression analysis identified no single factor associated with positive treatment outcomes.

CONCLUSION

Multiorgan involvement, response to steroids, and chronic course are hallmarks of pediatric sarcoidosis. The phenotype significantly varies by age and race. Where conventional DMARDs were not efficacious, the addition of an anti-TNF agent was beneficial.

AB1566-HPR SHIFTING THE MINDSET: USING A HEALTH COACHING APPROACH FOR HEALTH PROMOTING CONSULTATION IN ADOLESCENT RHEUMATOLOGY

Background

Juvenile rheumatic diseases have a significant negative impact on health early in life which may affect later health outcomes. The Adolescent and Young Adult Rheumatology Department (AYAD) at University College London Hospitals (UCLH) looks after over 2,000 young people with a variety of rheumatological conditions and provides developmentally appropriate interdisciplinary (ID) approach to healthcare.

Health coaching (HC) is “a behavioural intervention that facilitates participants in establishing and attaining health promoting goals in order to change lifestyle-related behaviour, with the intent of reducing health risks, improving self-management of chronic conditions, and increasing health related quality of life”.[1] Evidence shows that health coaching can improve health related behaviours including medication adherence, patient activation, and use of healthcare resources. [2-4]

Objectives

The aim of this project is to enable young people attending the AYAD to establish and achieve their own health-promoting goals and thereby change behaviour and increase confidence in self-management. As a first stage the aim was to develop health coaching capabilities within our ID Team by March 2022.

Methods

The strategy to deliver this project included commissioning a recognised core skills health coaching course for multidisciplinary team (MDT) members. Pre and post course surveys were completed by participants.

Results

All the AYA team members comprising 3 physiotherapists, 2 nurse specialists, a transition pathway coordinator, 4 consultants and 2 senior registrars took part in the health coaching workshops.

A pre course survey (10/ 12 responded) revealed that 70% of MDT members felt their consultations focused solely on young people’s medical/clinical care. 80% reported they discuss lifestyle choices such as sleep, and weight management. 40 % felt that their consultation times were long enough to discuss resources that would support long-term management. 30% reported they felt effective in facilitating Young people and their families to self-manage and/or had sufficient health coaching awareness to facilitate behaviour change.

The course was delivered over 2 separate days, one week apart, and included educational material, presentations, group discussion and skills development delivered in a coaching style.

A post course survey (11/12 responses) demonstrated 100% of participants were satisfied with the course content, delivery, facilitation and opportunities to work and learn with colleagues, and felt that the skills were applicable to their work. They reported that the skills learned could be applied beyond healthcare, for example, with colleagues or in leadership roles, the course helped to raise self-awareness of behaviours that can negatively and positively impact patient and family engagement in their care, and that using some techniques and small changes to practice could potentially have a big impact on quality of care and outcomes as well as patient and staff experience.

Conclusion

Health coaching skills were considered as a useful tool by all AYAD team members.

Skills gained on the course were considered useful in managing young people and applicable in settings beyond clinical care.

The next stage of this project will include embedding the techniques learned into clinical practice and measuring qualitative and quantitative outcomes over time

References

[1]van Ryn, M., & Heaney, C. A. (1997). Developing effective helping relationships in health education practice. Health Education & Behavior, 24(6), 683–702

[2]https://www.health.org.uk/publications/reducing-emergency-admissions-unlocking-the-potential-of-people-to-better-manage-their-long-term-conditions

[3]Newman P, McDowell A, Life changing conversations: clinicians experience of health coaching in the east of England, 3-2-147 Future Hosp J June 1, 2016

[4]https://www.england.nhs.uk/wp-content/uploads/2020/03/health-coaching-implementation-and-quality-summary-guide.pdf

Disclosure of Interests

None declared

Understanding the diagnosis and management of multisystem inflammatory syndrome in adults (MIS-A) in the UK: results of a national Delphi process

Infection with SARS-CoV-2 may trigger a delayed hyper-inflammatory illness in children called paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS). A similar syndrome is increasingly recognised in adults termed multisystem inflammatory syndrome in adults (MIS-A) and may present acutely to medical or surgical specialties with severe symptoms, such as acute abdominal pain or cardiogenic shock. No national guidelines exist in the UK for the management of MIS-A and there is limited evidence to guide treatment plans. We undertook a national Delphi process to elicit opinions from experts in hyperinflammation about the diagnosis and management of MIS-A with the dual aim of improving recognition and producing a management guideline. Colleagues in paediatrics successfully initiated a national consensus management document that facilitated regional multidisciplinary referral and follow-up pathways for children with PIMS-TS, and we propose a similar system be developed for adult patients across the UK. This would facilitate better recognition and treatment of MIS-A across the multiple specialties to which it may present as well as enable follow-up with specialty services post-discharge.

P174 HLA B27 status and disease phenotype: a cohort study of 223 patients with enthesitis-related arthritis

Background/Aims

Enthesitis-related arthritis (ERA) is a subtype of juvenile idiopathic arthritis (JIA) accounting for 10-20% of patients with JIA. ERA is associated with a poor prognosis compared to other JIA subtypes. Whilst a high proportion of patients with ERA are HLA-B27 positive, the correlation between HLA-B27 status and disease phenotype is not well described. The aim of our study was to investigate the influence of HLA-B27 status on ERA phenotype.

Methods

Demographic and clinical data were collected and HLA-B27 positive and negative patients were compared. All subjects included met ILAR classification criteria. The data were analysed using R software (R version 4.0.4). Median and interquartile range (IQR) were calculated for continuous variables and frequency and percentage for categorical variables. Subgroup comparison was performed using the chi-squared test for qualitative variables, and Wilcoxon rank-sum for quantitative variables. P values less than 0.05 were considered significant.

Results

223 patients were included in this study. The median age of symptom onset was 12 years (IQR: 9-14). The median disease duration was 11 years (IQR: 7-14). 18% of patients had family history of HLA-B27-related disease and 67% had positive HLA-B27. 54% of patients were on conventional disease modifying anti-rheumatic drugs (cDMARDs). 80% were on biologic DMARDs (bDMARD). HLA-B27 positive patients (n = 148) and negative patients (n = 68) were compared. Our analysis revealed a higher proportion of male patients in the HLA-B27 positive cohort (74% [n = 111] versus 59% [n = 39], p = 0.02). HLA-B27 positive subjects developed ERA at an older age compared to the HLA-B27 negative group at 12 versus 11 years, respectively (p = 0.02). HLA-B27 positive patients also had a higher probability of an axial phenotype within 12 months of disease onset 51% (n = 75) in the HLA-B27 positive group versus 32% (n = 22) in the HLA-B27 negative group (p = 0.01). At any point of disease course, sacroiliitis was also more common in the HLA-B27 positive group (78% [n = 116] versus 63% [n = 43], p = 0.01), who also had a higher usage of bDMARDS (74% [n = 110] versus 56% [n = 38], p = 0.006). There was no significant difference between the two groups in terms of ethnicity, family history of HLA-B27 disease or the prevalence of extra-articular manifestations, including uveitis.

Conclusion

Our study revealed that patients with ERA who were HLA-B27 positive, were more likely to be male, developed disease at an older age and had a higher probability of axial phenotype at onset and later in disease. They also had an increased bDMARD requirement. These data suggest that HLA-B27 confers a worse prognosis clinically which is consistent with findings from other studies.

Disclosure

A. Bouraoui: None. C. Fisher: None. J. Glanville: None. D. Sen: None.

P027 Challenges and opportunities in embedding quality data into routine clinical practice using electronic health record systems

Background/Aims

The emergence of the electronic health record system (EHRS) creates opportunities for standardising clinical data which can be used for service improvement and research. However, there are also challenges related to EHRS use particularly with respect to data quality and availability. In this project, our goal is to enhance the use of EHRS to enable timely access to reliable high quality clinical data which can be used for research and Quality Improvement. We aimed to improve the entry of structured clinical data starting with problem list, medication list and core outcome variables by 70% within 12 months.

Methods

We audited our current practice and developed an improvement strategy to incorporate standardized documentation into our adolescent and young adult (AYA) rheumatology clinics. We initially extracted a baseline report for AYA patients to establish our baseline data quality and availability. We also compared structured data to narrative data. Then we organised meetings to develop a shared understanding of the challenges. Subsequent departmental meetings were organised to prioritise and then agree on actions which were summarised in a driver diagram. Then we ran 5 cycles of change and measured data over time including the weekly proportion of clinic encounters using standardised problem lists, medication lists, core outcomes variables. We also measured the use of Smart tools built within our EHRS. Smart-Tools are processes that enable efficiency through easier ordering, navigation and documentation in an EHRS. Using the patient interface ‘MyCare’, we engaged with our patients to encourage them to prepare for their appointment including updating their medication list and completing health questionnaires.

Results

Initial audit comparing structured and narrative data, revealed poor quality data with 50% of problem lists documented in a structured manner. Of those, 20% were not entered correctly. 70% of medication lists were entered in a non-structured manner. 80% of those with structured medication lists were entered inaccurately. There was no structured documentation of core outcomes variables or joint examination in all encounters which was also inconsistently entered in the free text. Over the last 12 months, 5 cycles of change were implemented testing a number of interventions including developing clinic encounters templates and smart tools within EHRS. The weekly entry of structured problem list improved from 50% to 98%. The Smart-Phrase use and AYA template weekly use rate improved from 0% to 70% and the entry of core outcome variables has improved from 0% to 30% of cases.

Conclusion

This project supports the feasibility of implementing standardized data into routine clinical practice that can be used for research and service improvement. This has created an opportunity to improve data quality and accuracy. Most importantly, this work has facilitated a standardisation of clinical practice and better engagement between clinicians and patients.

Disclosure

A. Bouraoui: None. C. Fisher: None. D. Sen: None.

Mental health improvements after elective spine surgery: a Canadian Spine Outcome Research Network (CSORN) study

BACKGROUND CONTEXT

Spine patients have a higher rate of depression then the general population which may be caused in part by levels of pain and disability from their spinal disease.

PURPOSE

Determination whether improvements in health-related quality of life (HRQOL) resulting from successful spine surgery leads to improvements in mental health.

STUDY DESIGN/SETTING

The Canadian Spine Outcome Research Network prospective surgical outcome registry.

OUTCOME MEASURES

Change between preoperative and postoperative SF12 Mental Component Score (MCS). Secondary outcomes include European Quality of Life (EuroQoL) Healthstate, SF-12 Physical Component Score (PCS), Oswestry Disability Index (ODI), Patient Health Questionaire-9 (PHQ9), and pain scales.

METHODS

The Canadian Spine Outcome Research Network registry was queried for all patients receiving surgery for degenerative thoracolumbar spine disease. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement in postoperative disability (ODI) and secondary measures. Multivariate analysis examined factors predictive of MCS improvement.

RESULTS

Eighteen hospitals contributed 3222 eligible patients. Worse ODI, EuroQoL, PCS, back pain and leg pain correlated with worse MCS at all time points. Overall, patients had an improvement in MCS that occurred within 3 months of surgery and was still present 24 months after surgery. Patients exceeding Minimally Clinically Important Differences in ODI had the greatest improvements in MCS. Major depression prevalence decreased up to 48% following surgery, depending on spine diagnosis.

CONCLUSIONS

Large scale, real world, registry data suggests that successful surgery for degenerative lumbar disease is associated with reduction in the prevalence of major depression regardless of the specific underlaying diagnosis. Worse baseline MCS was associated with worse baseline HRQOL and improved postoperatively with coincident improvement in disability, emphasizing that mental wellness is not a static state but may improve with well-planned spine surgery.

Similarities and Differences Between Juvenile and Adult Spondyloarthropathies

Spondyloarthritis (SpA) encompasses a broad spectrum of conditions occurring from childhood to middle age. Key features of SpA include axial and peripheral arthritis, enthesitis, extra-articular manifestations, and a strong association with HLA-B27. These features are common across the ages but there are important differences between juvenile and adult onset disease. Juvenile SpA predominantly affects the peripheral joints and the incidence of axial arthritis increases with age. Enthesitis is important in early disease. This review article highlights the similarities and differences between juvenile and adult SpA including classification, pathogenesis, clinical features, imaging, therapeutic strategies, and disease outcomes. In addition, the impact of the biological transition from childhood to adulthood is explored including the importance of musculoskeletal and immunological maturation. We discuss how the changes associated with adolescence may be important in explaining age-related differences in the clinical phenotype between juvenile and adult SpA and their implications for the treatment of juvenile SpA.

O14 Frequency and site of clinically unsuspected synovitis on whole-body MRI in juvenile idiopathic arthritis

Background/Aims 

Magnetic resonance imaging can facilitate the diagnosis of JIA, but is also increasingly used for monitoring disease activity in individual joints. This prospective study aims to measure the frequency of subclinical synovitis on whole-body MRI, in adolescent patients with JIA.

Methods 

JIA patients were recruited from a tertiary adolescent and young adult rheumatology clinic, between September 2019 and August 2020. All patients were examined by a senior rheumatology registrar, before undergoing a contrast enhanced whole-body MRI scan. Patients were assigned to a clinically active or inactive group, depending on their active joint count (AJC); active patients had AJC≥ 1, while the clinically inactive patients had an AJC =0. The post-contrast, water-only mDixon images were assessed for synovitis by one radiologist, blinded to clinical information. Only joints that were definitely abnormal were counted as synovitic. Eighty-one joints per patient were examined with both methods. The presence of subclinical synovitis in a patient was defined as synovitis in one or more joints on MRI, which were not active clinically.

Results 

Thirty-two patients aged 15 to 24 were included in the analysis. The patient characteristics and the frequency of subclinical synovitis are summarised in the table. Subclinical synovitis was detected in a similar proportion of JIA patients in both active and inactive groups (46.7% vs. 41.2%, P = 0.76). The most frequent region with subclinical synovitis was the hindfoot, detected in 22% (7/32) of JIA patients and 17.2% (11/64) of hindfoot joints assessed by MRI. The second most common joint with clinically unsuspected inflammation was the knee, found in 19% (6/32) of JIA patients and 14% (9/64) knee joints. Similarly, 16% (5/32) of the adolescent patients had active disease in the hip, ankle or midfoot joints. The frequency of elbow involvement was also considerable, with 12% (7/58) of joints with subclinical synovitis in 14% (4/29) of JIA patients.

Conclusion 

In conclusion, 43.8% of JIA patients had subclinical synovitis on whole-body MRI scan with no significant difference between the clinically active vs. inactive JIA patients. Large joints were predominantly affected. Further research is required to validate our findings in a larger cohort of JIA patients.

Disclosure 

V. Choida: None. C. Ciurtin: None. T.J.P. Bray: None. D. Sen: None. C. Fisher: None. M. Leandro: None. M.A. Hall-Craggs: None.

Biomarkers of Response to Biologic Therapy in Juvenile Idiopathic Arthritis

Background: Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthritis of childhood, characterized by various clinical phenotypes associated with variable prognosis. Significant progress has been achieved with the use of biologic treatments, which specifically block pro-inflammatory molecules involved in the disease pathogenesis. The most commonly used biologics in JIA are monoclonal antibodies and recombinant proteins targeting interleukins 1 (IL-1) and 6 (IL-6), and tumor necrosis factor α (TNF-α). Several biomarkers have been investigated in JIA. Aims: To assess the level of evidence available regarding the role of biomarkers in JIA related to guiding clinical and therapeutic decisions, providing disease prognostic information, facilitating disease activity monitoring and assessing biologic treatment response in JIA, as well as propose new strategies for biologic therapy-related biomarker use in JIA. Methods: We searched PubMed for relevant literature using predefined key words corresponding to several categories of biomarkers to assess their role in predicting and assessing biologic treatment response and clinical remission in JIA. Results: We reviewed serological, cellular, genetic, transcriptomic and imaging biomarkers, to identify candidates that are both well-established and widely used, as well as newly investigated in JIA on biologic therapy. We evaluated their role in management of JIA as well as identified the unmet needs for new biomarker discovery and better clinical applications. Conclusion: Although there are no ideal biomarkers in JIA, we identified serological biomarkers with potential clinical utility. We propose strategies of combining biomarkers of response to biologics in JIA, as well as routine implementation of clinically acceptable imaging biomarkers for improved disease assessment performance.

The paradox-breaking panRAF plus SRC family kinase inhibitor, CCT3833, is effective in mutant KRAS-driven cancers

BACKGROUND

KRAS is mutated in ∼90% of pancreatic ductal adenocarcinomas, ∼35% of colorectal cancers and ∼20% of non-small-cell lung cancers. There has been recent progress in targeting G12CKRAS specifically, but therapeutic options for other mutant forms of KRAS are limited, largely because the complexity of downstream signaling and feedback mechanisms mean that targeting individual pathway components is ineffective.

DESIGN

The protein kinases RAF and SRC are validated therapeutic targets in KRAS-mutant pancreatic ductal adenocarcinomas, colorectal cancers and non-small-cell lung cancers and we show that both must be inhibited to block growth of these cancers. We describe CCT3833, a new drug that inhibits both RAF and SRC, which may be effective in KRAS-mutant cancers.

RESULTS

We show that CCT3833 inhibits RAF and SRC in KRAS-mutant tumors in vitro and in vivo, and that it inhibits tumor growth at well-tolerated doses in mice. CCT3833 has been evaluated in a phase I clinical trial (NCT02437227) and we report here that it significantly prolongs progression-free survival of a patient with a G12VKRAS spindle cell sarcoma who did not respond to a multikinase inhibitor and therefore had limited treatment options.

CONCLUSIONS

New drug CCT3833 elicits significant preclinical therapeutic efficacy in KRAS-mutant colorectal, lung and pancreatic tumor xenografts, demonstrating a treatment option for several areas of unmet clinical need. Based on these preclinical data and the phase I clinical unconfirmed response in a patient with KRAS-mutant spindle cell sarcoma, CCT3833 requires further evaluation in patients with other KRAS-mutant cancers.

A description of the growth and moulting of feathers in commercial broilers

1. Changes in feather length and weight and daily losses of down, contour feathers, remiges and retrices were studied in two commercial broiler strains to determine feather growth and moult in broilers up to 112 d of age. 2. Ten pens of 20 chicks for each sex x strain were fed adequate amounts of dietary protein in a four-phase feeding programme. Ten birds were sampled per genotype at 14, 28, 42, 56, 70, 84, 98 and 112 d. Feather loss was determined for individual birds caged within a nylon net. 3. All feathers were dry-plucked from each of seven tracts, with representative feathers from the capital-cervical, dorsopelvic and interscapular, pectoral and femoral tracts being randomly selected. Three rectrices of the dorsocaudal tract and three primaries and secondaries of the humeral-alar tract of the right wing were evaluated. 4. The length of the selected feathers was measured, and the feathers from each tract and from the whole bird were weighed. 5. A wide range of rates of maturing (0.0250-0.0907/d) and mature weights (9.62-52.9 g) were evident between sampled tracts. 6. Feather weight failed to predict some moults which were detected by the measurement of feather losses. From the weight data, moulting was evident only in the humeral-alar and dorsocaudal tracts, whereas, when daily losses were measured, contour feathers accounted for over 0.7 proportion of feather losses. Logistic equations adequately described the cumulative losses of down, contour feathers and remiges. 7. Feather loss needs to be considered when feather growth is determined from feather weight at different ages. 8. The rate of maturing (B) of feathers was numerically higher in Ross males and females than in the Cobb strain. In females, B was higher than in males (0.0483 vs. 0335/d) but the mature weight was lower (162 vs. 230 g).

Investigation of the relationship between ionised and total calcium in dogs with ionised hypercalcaemia

OBJECTIVES

To investigate the relationship between total and ionised calcium concentrations in dogs with ionised hypercalcaemia and to evaluate how albumin influences this relationship.

METHODS

Initially, a reference interval for ionised and total calcium was established using a large population of healthy adult dogs. Our teaching hospital clinical database was searched to identify adult dogs with ionised hypercalcaemia between 2012 and 2017, a time frame when the same sample handling and analysis protocols were in place as for the healthy reference interval population. The relationship between ionised and total calcium concentrations was then examined in the ionised hypercalcaemia population.

RESULTS

Based on biochemical analysis of 351 healthy adult dogs, a reference interval of 1.18 to 1.53 mmol/L for ionised calcium and 2.24 to 2.85 mmol/L for total calcium was established. Using these reference intervals, 63 dogs with ionised hypercalcaemia were identified, of which 23 did not have total hypercalcaemia. Only seven of the 23 dogs with ionised hypercalcaemia and total calcium below the upper limit of the reference interval had hypoalbuminemia. The majority of dogs with ionised hypercalcemia and normal total calcium had a modest increase in ionised calcium.

CLINICAL SIGNIFICANCE

If relying on total calcium alone, more than one third of dogs with ionised hypercalcaemia will be classified as normocalcaemic and the majority of these dogs had normal serum albumin.

A description of the potential growth and body composition of two commercial broiler strains

1. The potential growth of feathers and feather-free body and their chemical components was measured in two commercial broiler strains. 2. A total of 200 chicks of each sex x strain were fed adequate amounts of dietary protein using a four-phase feeding programme. Ten birds per genotype were sampled at 14, 28, 42, 56, 70, 84, 98 and 112 d of age. They were weighed before and after being dry-plucked to determine the weight of feathers, and the feather-free body was then minced and analysed for water, protein and lipid. 3. Body weights and chemical composition of males of the two strains were similar throughout the trial. Females of the two strains differed only in their body lipid contents, with mature Cobb females being higher than Ross (1371 vs. 1210 g). 4. Mature body weights of males and females from both strains averaged 8420 g and 6650 g; mature body protein weights averaged 1555 g and 1030 g; and mature body lipid contents averaged 908 and 1290 g, respectively. 5. Rates of maturing per day of body weights of males and females of both strains averaged 0.0385 and 0.0368; feather-free body protein was 0.0316 and 0.0348 and body lipid was 0.0503 and 0.0375, respectively. The rates for body lipid differed between Cobb and Ross females (0.0352 vs. 0.0397/d). Separate equations were required for males and females to describe the allometric relationship between lipid and protein in the feather-free body. 6. The rate of maturing of feathers in females was higher than in males (0.0526 vs. 0398/d) and the mature weight was lower (205 vs. 266 g), respectively. Mature body weights of broilers in this trial were considerably higher than those measured using the same protocol 24 years ago, whereas rates of maturing remained the same.

The adequacy of tissue microarrays in the assessment of inter- and intra-tumoural heterogeneity of infiltrating lymphocyte burden in leiomyosarcoma

The characterisation and clinical relevance of tumour-infiltrating lymphocytes (TILs) in leiomyosarcoma (LMS), a subtype of soft tissue sarcoma that exhibits histological heterogeneity, is not established. The use of tissue microarrays (TMA) in studies that profile TIL burden is attractive but given the potential for intra-tumoural heterogeneity to introduce sampling errors, the adequacy of this approach is undetermined. In this study, we assessed the histological inter- and intra-tumoural heterogeneity in TIL burden within a retrospective cohort of primary LMS specimens. Using a virtual TMA approach, we also analysed the optimal number of TMA cores required to provide an accurate representation of TIL burden in a full tissue section. We establish that LMS have generally low and spatially homogenous TIL burdens, although a small proportion exhibit higher levels and more heterogeneous distribution of TILs. We show that a conventional and practical number (e.g. ≤3) of TMA cores is adequate for correct ordinal categorisation of tumours with high or low TIL burden, but that many more cores (≥11) are required to accurately estimate absolute TIL numbers. Our findings provide a benchmark for the design of future studies aiming to define the clinical relevance of the immune microenvironments of LMS and other sarcoma subtypes.

Embryonal and Alveolar Rhabdomyosarcoma in Adults: Real-Life Data From a Tertiary Sarcoma Centre

AIMS

Embryonal and alveolar rhabdomyosarcoma (ERMS, ARMS) are subtypes of RMS that mainly occur in children, with relatively good outcomes. The incidence in adults is extremely low and survival is significantly worse compared with children. Data are scarce and literature generally combines all RMS subtypes, including pleomorphic RMS, which primarily occurs in adults and behaves more like undifferentiated pleomorphic sarcoma. The aim of this study was to evaluate patient and tumour characteristics, outcome and prognostic factors in adult patients with ERMS and ARMS.

MATERIALS AND METHODS

All adult (18 years or older) ERMS and ARMS patients (presenting 1990-2016) were identified from a prospectively maintained database and were included in this analysis.

RESULTS

Overall, 66 patients were included (42 men, 24 women). The median age at presentation was 28 years (range 18-71). The median overall survival for all ARMS (n = 42) and ERMS (n = 24) patients was 18 months, with a 5-year overall survival rate of 27%. Patients presenting with localised disease (n = 38, 58%) and metastatic disease (n = 25, 42%), had a 5-year overall survival rate of 36% and 11%, respectively. In univariate analysis we found alveolar subtype, fusion gene positivity, infiltrative tumour and metastatic presentation to be negative prognostic factors.

CONCLUSION

Survival in adult ERMS and ARMS patients is poor and the current data may be useful in the design of trials with novel agents. Ideally, paediatric and adult oncologists should set up trials together to get a better understanding of biological, genetic and clinically relevant factors in this disease.

The growth of turkeys 1. Growth of the body and feathers and the chemical composition of growth

1. The potential growth of modern turkey genotypes was measured using male and female BUT 6 (BUT) and Hybrid Converter (HYB) strains. At one-day-old, 720 male and 960 female poults were randomly allocated to 48 littered pens in two houses with 30 males or 40 females of each strain per pen. Five feeds of decreasing protein content were fed to both sexes during the growing period. 2. Birds were weighed at 1, 7, 14, 21, 35, 56, 77, 119 d (males only), 126 d (females only) and 140 d (males only) and, on each occasion, six birds were selected and removed for carcass analysis. 3. Growth was similar in both strains, but the growth rate of females appeared to decline relative to the earlier trajectory after 70 d, and this tendency being greater in HYB females. 4. HYB birds of both sexes had more feathers than BUT to 77 d, but thereafter these differences were non-significant. A single allometry between feather and body protein weight was observed over all genotypes with no differences apparent between sexes within strains. The Gompertz curve adequately described the growth of body protein, water and ash. 5. Body lipid (g/100g bodyweight) declined in the early stages of growth. This might reflect an energy deficiency in the diet or might indicate that the present description of lipid growth does not apply in turkeys as it does in other species. 6. Whereas the description of body growth, feather growth and the chemical components of growth given in this paper may not fully reflect the true potential of the genotypes used, nevertheless they provide useful information regarding the latest genotypes available in the turkey industry. Some of the observations suggested that current performance might be improved if further research is conducted regarding dietary energy transactions.

The growth of turkeys 2. Body components and allometric relationships

1. The relationships between the main components of the body and body protein among males and females of BUT 6 (BUT) and Hybrid Converter (HYB) turkey strains were examined. 2. The weights of breast meat, breast skin, drumstick meat, drumstick skin, thigh meat, thigh skin and wing-plus-skin as well as the head, neck, feet, blood, heart, liver and gizzard were measured at different stages of growth after which all components of each bird were minced together in order to determine the feather-free body protein weight of each bird sampled. Using the weights of the components and the protein content of each bird the allometric relationships between the components and body protein were determined and then compared for each strain x sex combination. 3. By excluding the breast weights at day-old and at 7 d, the remaining points produced an acceptable allometric relationship (R² = 0.992). Thigh weight could be predicted for all strain x sex combinations using one allometric equation, as could drumstick skin weight. Breast and thigh skin weights differed between males and females. Females of the HYB strain exhibited heavier drumstick and wing-plus-skin weights at a given body protein weight than the other three strain x sex combinations. These differences in both the constant term and regression coefficient in the allometric equations between genotypes are probably due to differences in the amount of lipid that is deposited in these tissues. 4. Sexes differed in the allometric relationships for head, feet, heart and liver, while breeds differed in gizzard weight. A common relationship between the four genotypes could be used to predict the weight of blood in the carcass. 5. The allometric equations fitted to the data in this trial enable the accurate prediction of the weights of the different physical components given the weight of body protein.

The use of laser-based diagnostics for the rapid identification of infectious agents in human blood

AIMS

To investigate the use of a laser-based method of detection as a potential diagnostic test for the rapid identification of infectious agents in human blood.

METHODS AND RESULTS

In this study, the successful differentiation of blood spiked with viruses, bacteria or protozoan parasites to clinically relevant levels is demonstrated using six blood types (O+, O-, AB+, A+, A-, B+) using blood from different individuals with blood samples prepared in two different laboratories. Experiments were performed using various compositions of filters, experimental set-ups and experimental parameters for spectral capture.

CONCLUSIONS

The potential for developing a laser-based diagnostic instrument to detect the presence of parasites, bacteria and viruses in human blood capable of providing analysis results within minutes was demonstrated.

SIGNIFICANCE AND IMPACT OF THE STUDY

There is an ongoing need for clinical diagnostics to adapt to newly emerging agents and to screen simultaneously for multiple infectious agents. A laser-based approach can achieve sensitive, multiplex detection with minimal sample preparation and provide rapid results (within minutes). These properties along with the flexibility to add new agent detection by simply adjusting the detection programming make it a promising tool for clinical diagnosis.

Sacroiliac Joint Ankylosis in Young Spondyloarthritis Patients Receiving Biologic Therapy: Observation of Serial Magnetic Resonance Imaging Scans

OBJECTIVE

To assess the temporal relationship between initiating biologic therapy and magnetic resonance imaging (MRI) scores of inflammation and structural damage in young patients with spondyloarthritis.

METHODS

A local adolescent/young adult patient rheumatology database was searched for patients ages 12-24 years who had evidence of sacroiliitis on MRI and a clinical diagnosis of enthesitis-related arthritis (ERA) with axial involvement or nonradiographic axial spondyloarthritis. Patients treated with tumor necrosis factor inhibitor (TNFi) therapy who had undergone a minimum of 1 MRI scan before and 2 MRI scans after starting TNFi therapy (over ≥2 years) were included. Images of the sacroiliac joints were scored for inflammation and structural abnormalities (including erosions, fat metaplasia, and fusion). The effects of TNFi therapy and of time since initiation of TNFi therapy on inflammation and structural abnormalities were assessed using a mixed-effects regression analysis.

RESULTS

Twenty-nine patients (ages 12-23 years) with ERA or nonradiographic axial spondyloarthritis who underwent TNFi therapy were included. Inflammation scores were significantly lower in patients receiving TNFi treatment (P = 0.013), but there was no significant effect of time from TNFi initiation on inflammation (P = 0.125). Conversely, there was no significant effect of active TNFi treatment on fusion scores (P = 0.308), but fusion scores significantly increased with time from TNFi initiation (P < 0.001); a similar positive relationship between time since biologic start and fat metaplasia scores was observed.

CONCLUSION

TNFi therapy failed to prevent the eventual development of joint ankylosis in this cohort of young patients with spondyloarthritis, despite a substantial reduction in inflammation with TNFi therapy.

VIVD: Virtual in vitro distribution model for the mechanistic prediction of intracellular concentrations of chemicals in in vitro toxicity assays

In vitro toxicity testing routinely uses nominal treatment concentrations as the driver for measured toxicity endpoints. However, test compounds can bind to the plastic of culture vessels or interact with culture media components, such as lipids and albumin. Additionally, volatile compounds may partition into the air above culture media. These processes reduce the free concentrations of compound to which cells are exposed. Models predicting the freely dissolved concentrations by accounting for these interactions have been published. However, these have only been applied to neutral compounds or assume no differential ionisation of test compounds between the media and cell cytoplasm. Herein, we describe an in vitro distribution model, based on the Fick-Nernst Planck equation accounting for differential compound ionisation in culture medium and intracellular water. The model considers permeability of ionised and unionised species and accounts for membrane potential in the partitioning of ionised moieties. By accounting for lipid and protein binding in culture medium, binding to cell culture plastic, air-partitioning, and lipid binding in the cell, the model can predict chemical concentrations (free and total) in medium and cells. The model can improve in vitro in vivo extrapolation of toxicity endpoint by determining intracellular concentrations for translation to in vivo.

Sensitivity and specificity of microRNA-122 for liver disease in dogs

BACKGROUND

Current tests for diagnosing liver disease in dogs are sub-optimal. MicroRNA-122 (miR-122) is a sensitive and specific biomarker of liver injury in humans and rodents. Circulating miR-122 could have utility in identifying dogs with liver disease.

OBJECTIVE

Establish the reference interval for miR-122 in healthy dogs and determine performance in a range of dog breeds with liver disease and control animals with non-liver disease.

ANIMALS

Stored serum from 120 healthy dogs, 100 dogs with non-liver diseases, and 30 dogs with histologically confirmed liver disease was analyzed.

METHODS

Retrospective study. Medical records of dogs with liver disease, non-liver disease and healthy dogs were reviewed. Serum miR-122 concentrations were measured by PCR and compared with the characteristics of the dogs and their conventional clinical measurements.

RESULTS

In healthy dogs the 2.5th, 50th, and 97.5th quartiles of miR-122 were 110 (90% CI 80-114), 594 (505-682), and 3312 (2925-5144) copies/μL, respectively. There was no difference between healthy dogs and dogs with non-liver disease (median ± IQR: healthy dogs 609 [327-1014] copies/μL; non-liver disease 607 [300-1351] copies/μL). miR-122 was higher in dogs with liver disease (11 332 [4418-20 520] copies/μL, P < .001 compared to healthy dogs). miR-122 identified dogs with liver disease with high accuracy (receiver operating characteristic area under curve for comparison with healthy dogs: 0.93 [95% CI 0.86-0.99]). The upper limit of normal for healthy dogs (3312 copies/μL) had a sensitivity of 77% and specificity of 97% for identifying liver disease.

CONCLUSION AND CLINICAL IMPORTANCE

Liver disease can be sensitively and specifically diagnosed in dogs by measurement of miR-122.

Impact of the Spinal Instability Neoplastic Score on Surgical Referral Patterns and Outcomes

Background

The Spinal Instability Neoplastic Score (sins) was developed to identify patients with spinal metastases who may benefit from surgical consultation. We aimed to assess the distribution of sins in a population-based cohort of patients undergoing palliative spine radiotherapy (rt) and referral rates to spinal surgery pre-rt. Secondary outcomes included referral to a spine surgeon post-rt, overall survival, maintenance of ambulation, need for re-intervention, and presence of spinal adverse events.

Methods

We retrospectively reviewed ct simulation scans and charts of consecutive patients receiving palliative spine rt between 2012 and 2013. Data were analyzed using Student's t-test, Chi-squared, Fisher's exact, and Kaplan-Meier log-rank tests. Patients were stratified into low (<7) and high (≥7) sins groups.

Results

We included 195 patients with a follow-up of 6.1 months. The median sins was 7. The score was 0 to 6 (low, no referral recommended), 7 to 12 (intermediate, consider referral), and 13 to 18 (high, referral suggested) in 34%, 59%, and 7% of patients, respectively. Eleven patients had pre-rt referral to spine surgery, with a surgery performed in 0 of 1 patient with sins 0 to 6, 1 of 7 with sins 7 to 12, and 1 of 3 with sins 13 to 18. Seven patients were referred to a surgeon post-rt with salvage surgery performed in two of those patients. Primary and secondary outcomes did not differ between low and high sins groups.

Conclusion

Higher sins was associated with pre-rt referral to a spine surgeon, but most patients with high sins were not referred. Higher sins was not associated with shorter survival or worse outcome following rt.