Temporal patterns of fucoxanthin in four species of European marine brown macroalgae

Brown seaweeds are a rich source of carotenoids, particularly fucoxanthin, which has a wide range of potential health applications. Fucoxanthin fluctuates within and among seaweeds over time, frustrating efforts to utilise this resource. Thus, we require comprehensive analyses of long- and short-term concentrations across species in field conditions. Here, we used High Performance Liquid Chromatography to compare fucoxanthin content in four brown macroalgae, Ascophyllum nodosum, Fucus serratus, Fucus vesiculosus and Saccharina latissima, monthly for 1 year. F. serratus and F. vesiculosus had significantly higher fucoxanthin content (mg/g), which was highest in Spring (0.39 ± 0.04) and Autumn (0.45 ± 0.04) [mean (± SE)]. Two species, A. nodosum and F. serratus, were collected monthly at the same location for a further two non-consecutive years. For both A. nodosum and F. serratus, a significant interaction effect of seasons and years was identified, highlighting that there is variation in fucoxanthin content among and within species over time. We also show that fucoxanthin content differs significantly among months even within seasons. Therefore, it is not sufficient to assess fucoxanthin in single months to represent seasonality. We discuss how weather, nutrients and reproduction may have driven the seasonal variation, and reveal patterns of fucoxanthin concentration that can provide information concerning its availability for many important medical functions.

Metabolic profiling stratifies colorectal cancer and reveals adenosylhomocysteinase as a therapeutic target

The genomic landscape of colorectal cancer (CRC) is shaped by inactivating mutations in tumour suppressors such as APC, and oncogenic mutations such as mutant KRAS. Here we used genetically engineered mouse models, and multimodal mass spectrometry-based metabolomics to study the impact of common genetic drivers of CRC on the metabolic landscape of the intestine. We show that untargeted metabolic profiling can be applied to stratify intestinal tissues according to underlying genetic alterations, and use mass spectrometry imaging to identify tumour, stromal and normal adjacent tissues. By identifying ions that drive variation between normal and transformed tissues, we found dysregulation of the methionine cycle to be a hallmark of APC-deficient CRC. Loss of Apc in the mouse intestine was found to be sufficient to drive expression of one of its enzymes, adenosylhomocysteinase (AHCY), which was also found to be transcriptionally upregulated in human CRC. Targeting of AHCY function impaired growth of APC-deficient organoids in vitro, and prevented the characteristic hyperproliferative/crypt progenitor phenotype driven by acute deletion of Apc in vivo, even in the context of mutant Kras. Finally, pharmacological inhibition of AHCY reduced intestinal tumour burden in ApcMin/+ mice indicating its potential as a metabolic drug target in CRC.

Lipidomic Profiling of Colorectal Lesions for Real-Time Tissue Recognition and Risk-Stratification Using Rapid Evaporative Ionization Mass Spectrometry

OBJECTIVE

Rapid evaporative ionization mass spectrometry (REIMS) is a metabolomic technique analyzing tissue metabolites, which can be applied intraoperatively in real-time. The objective of this study was to profile the lipid composition of colorectal tissues using REIMS, assessing its accuracy for real-time tissue recognition and risk-stratification.

SUMMARY BACKGROUND DATA

Metabolic dysregulation is a hallmark feature of carcinogenesis; however, it remains unknown if this can be leveraged for real-time clinical applications in colorectal disease.

METHODS

Patients undergoing colorectal resection were included, with carcinoma, adenoma and paired-normal mucosa sampled. Ex vivo analysis with REIMS was conducted using monopolar diathermy, with the aerosol aspirated into a Xevo G2S QToF mass spectrometer. Negatively charged ions over 600 to 1000 m/z were used for univariate and multivariate functions including linear discriminant analysis.

RESULTS

A total of 161 patients were included, generating 1013 spectra. Unique lipidomic profiles exist for each tissue type, with REIMS differentiating samples of carcinoma, adenoma, and normal mucosa with 93.1% accuracy and 96.1% negative predictive value for carcinoma. Neoplasia (carcinoma or adenoma) could be predicted with 96.0% accuracy and 91.8% negative predictive value. Adenomas can be risk-stratified by grade of dysplasia with 93.5% accuracy, but not histological subtype. The structure of 61 lipid metabolites was identified, revealing that during colorectal carcinogenesis there is progressive increase in relative abundance of phosphatidylglycerols, sphingomyelins, and mono-unsaturated fatty acid-containing phospholipids.

CONCLUSIONS

The colorectal lipidome can be sampled by REIMS and leveraged for accurate real-time tissue recognition, in addition to riskstratification of colorectal adenomas. Unique lipidomic features associated with carcinogenesis are described.

Social Processing in Eating Disorders: Neuroimaging Paradigms and Research Domain Organizational Constructs

PURPOSE OF REVIEW

Social and environmental factors have been related to both symptom expression of disordered eating in individuals and changes in the prevalence of eating disorders (EDs) in populations. Neural differences in processing social information may contribute to EDs. This review assesses the evidence for aberrant neural responses during social processing in EDs.

RECENT FINDINGS

This review examines how constructs within the social processing domain have been evaluated by neuroimaging paradigms in EDs, including communication, affiliation, and understanding of both oneself and others. Differences related to social processing in EDs include altered processing for self-relevant stimuli, in the context of identity, valence, expectations, and affiliative relationships. Future work is needed to integrate how differences in processing social stimuli relate to alterations in cognitive control and reward as well as specific disordered eating symptoms.

Abstract 3905: A prospective pilot study of desorption electrospray ionisation mass spectrometry (DESI-MS) for the early detection of colorectal adenoma

Background: Colorectal adenoma detection using non-invasive faecal-based biomarkers is not yet feasible. Our primary aim was to identify differential metabolomic signatures of colorectal adenomas in faecal samples using a Liquid Chromatography Mass Spectrometry (LCMS) assay. The secondary aim was to translate this assay to an Ambient Mass ionization-based technique, DESI, for high throughput, point of care diagnostics.

Methods: Patients were prospectively recruited from the colorectal cancer clinic at Imperial College NHS Trust, UK. Patients provided fresh stool samples, prior to taking bowel preparation for colonoscopy. Specimens were collected in Fecotainer (AT Medical BV) and cooled before immediate manual homogenization, aliquoting and storage at -80oC. LCMS untargeted metabolomics was performed using Reversed Phase chromatography (Acquity UPLC, Xevo G2-XS QToF, Waters) in both ElectroSpray Ionization (ESI) modes. Deactivated faecal samples applied to swabs were analysed using DESI-MS (Xevo G2-XS QToF). Multivariate Statistical Analysis was performed using Python. Logistic regression (LR) classification with Leave One patient Out Cross Validation (LOOCV) was applied. Recursive Feature Elimination and Least Absolute Shrinkage and Selection Operator (LASSO) algorithms were used for feature elimination.

Results: 36 subjects (17 females, mean age 63.5, range 42-85) were included: 17 controls, 8 adenoma, and 11 cancer patients.

Principal Component Analysis of LCMS data from both ESI modes separated the three groups. LR with LOOCV for the adenoma group showed 97% sensitivity and 100% specificity. Receiver Operator Characteristic curve based on a multivariate model of the top 5 significant features showed a diagnostic ability of binary classifiers of adenoma vs cancer 0.997 (Area under the curve (AUC), 95% CI=0.944-1), adenoma v healthy 0.981 (AUC, 95% CI=0.984-1), and healthy v cancer & adenoma 0.995 (AUC, 95% CI=0.931-1).

LR with LOOCV after LASSO on the DESI-MS data revealed sensitivity, 84%, and specificity, 95%, for the adenoma group. Specifically, these data suggest increased abundances of N-acyl amino acids, polyunsaturated chain fatty acids (n-3 PUFAs), in the adenoma group. Both species participate in arachidonic and linoleic acid pathways, where upregulation causes prostaglandin overproduction. Glycerophosphoserines, important in cell apoptosis, were significantly increased in cancer vs adenoma/controls (p < 0.01).

Conclusion: DESI-MS analysis of faecal samples can detect the presence of colorectal adenomas and distinguish them from cancer. A prospective trial is now under way to validate these findings.

Citation Format: Maria Sani, Lauren Ford, Daniel Simon, Yuchen Xiang, James McKenzie, Stefania Manetta Stavrakaki, Petra Paizs, Tausif Huq, Jim Higginson, James Alexander, Zoltan Takats, James Kinross. A prospective pilot study of desorption electrospray ionisation mass spectrometry (DESI-MS) for the early detection of colorectal adenoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3905.

Abstract 3056: Gut microbial co-metabolism influences the tumor microenvironment

Right sided colorectal cancers (RCRCs) have distinct molecular phenotypes and clinical presentations to those on the left. Gut microbial co-metabolic interactions with the RCRC microenvironment are poorly defined and present a novel therapeutic target. Here, we present a multi-omics analysis of RCRCs.

A prospective observational pilot study was performed at Imperial College London NHS Trust, UK. Treatment naive patients undergoing elective resectional surgery for primary RCRCs were recruited. Fresh intra-luminal fecal samples were obtained at three anatomical sites: 5 cm pre-, tumor, and 5 cm post-tumor. Microsatellite instability (MSI) and CDX2 expression were immunohistochemically evaluated. Metataxonomic analysis was carried out on a MiSeq Platform (Illumina, USA). Metabolomics analysis was performed using liquid chromatography mass spectrometry (Acquity UPLC, Xevo G2-S Q-TOF, Waters). After pre-processing, univariate and multivariate statistics were carried out in MetaboAnalyst and RStudio.

20 patients (8 females, mean age 69.9(53-83)) were included. Of the n=20 RCRCs, n=2 were ileo-cecal valve, n=4 were cecal, n=4 were cecum/proximal ascending colon, n=4 were mid-ascending colon, n=2 were ascending/hepatic flexure, n=2 were hepatic flexure, and n=2 were transverse colon cancers. Tumor classification according to TNM 8 indicated n=4 T1, n=1 T2, n=11 T3, n=4 T4; n=12 as N0, n=6 as N1, and n=2 as N2; n=2 as M0, n=1 as M1c, and n=17 as MX. All n=20 were CDX2 positive and n=16 had normal expression of mismatch repair proteins, n=4 showed MSI. Triglyceride (TG) species were significantly associated with T3-4 rather than T1-2 (p<0.01). Ceramide and diacylglycerol species were significantly associated with T1-2 rather than T3-4 (p<0.01). Multiple TG, an acyl carnitine, and a lysophosphatidic acid (LPA) species were associated with MSI status rather than no MSI status (p<0.01). An integrative analysis pipeline was developed to investigate statistically significant covariance between specific metabolites and taxa (p<0.01). Specifically, Procrustes similarity analysis of the multi-omics dataset revealed a negative correlation at pre- (p=0.606) and tumor level (p=0.738), but significant similarity at post-tumor level (p=0.045). This pattern in post-tumor may indicate cancer specific co-metabolism. At the post-tumor site, the LPA species increased in MSI, showed a negative correlation with members of the Oscillospiraceae family. Ceramide species, significantly increased in early-stage CRC, demonstrate negative correlation with the Lachnospiraceae family. Ongoing work is examining site-matched tissue samples utilizing imaging mass cytometry to define immune interactions.

Mapping the intra-luminal fecal metabolome and metataxonome in RCRC reveals potential bacterial-host co-metabolic targets that could be leveraged for stratifying immunotherapy treatment.

Citation Format: Petra Paizs, Duncan Roberts, Nathan Danckert, James Lewis, Maria Sani, Marta Jamroziak, Robert Goldin, Julian Marchesi, Lauren Ford, James Alexander, Zoltan Takats, James Kinross. Gut microbial co-metabolism influences the tumor microenvironment [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3056.

Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study

BACKGROUND

Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development.

METHODS

We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation.

FINDINGS

Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49).

INTERPRETATION

Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices.

FUNDING

National Institute for Health Research Global Health Research Group.

Surgical treatment of post-infectious hydrocephalus in infants

The management of post-infective hydrocephalus in infants remains a challenging task for the pediatric neurosurgeon. The decision-making curve is often complex in that appropriate temporizing measures need to be implemented to properly clear any infection within the CSF before any decision can be made regarding a permanent solution. The etiology differs at varying stages of neonatal development, and the weight of the child, skin fragility, and relevant surgical treatment options are often important limiting factors. Deciding on the optimal treatment option involves assessing the etiology, age, and clinical and radiological features of the individual case and selecting the most appropriate surgical option.

Abstract 271: High-throughput fecal metabolic profiling for the early detection of colorectal cancer using a direct mass spectrometry assay

Early stage diagnosis of colorectal cancer (CRC) is a key predictor of patient survival, highlighting the need for accurate diagnostic biomarkers. Laser Assisted - Rapid Evaporative Ionization Mass Spectrometry (LA-REIMS) demonstrates potential for direct from sample metabolic profiling of feces. Here, we present an optimized LA-REIMS approach for fecal metabolomic analysis in CRC for the first time.

A prospective, observational cohort biomarker discovery study was performed at an NHS hospital trust in the UK. Patients referred through the national two week wait cancer pathway were prospectively recruited. The primary outcome was to differentiate between adenomas or CRC and non-disease controls, the secondary outcome was to compare LA-REIMS to fecal immunochemical testing (FIT) against the gold-standard of colonoscopy or CT colonography. Those under the age of 18, pregnant, or unable to undergo colonic investigation were excluded. Fecal samples were analyzed using FIT (Kyowa Medex Co Ltd, Japan), with a detection limit of 7µg haemoglobin/g feces considered a positive result, as well as a LA-REIMS setup (Xevo G2-S QTof (Waters Corporation)), with optimized laser and instrumentation parameters (improved signal-to-noise and reduced carry-over between samples). After pre-processing, univariate and multivariate statistics were carried out in MetaboAnalyst 4.0. Random forest classification (RFC) with leave one out cross-validation (LOOCV) was performed.244 subjects (120 females, mean age 67.5 (range 21-93)) were included, of which n=135 were non-disease controls, n=82 adenoma patients, and n=27 CRC patients. Partial least square-discriminant analysis (PLS-DA) demonstrated a distinction between control vs CRC (Q2= 0.60087, R2= 0.89376). RFC with LOOCV for cancer vs control showed a sensitivity of 34.6% and specificity of 99.2% compared to 81.8% sensitivity and 87.2% specificity with FIT. PLS-DA of control vs adenoma (Q2= 0.64284, R2= 0.8898) demonstrated good separation. RFC with LOOCV for adenoma vs control had a sensitivity of 61.0 % and specificity of 94.7% compared to 33.8 % sensitivity and 87.2% specificity with FIT. Univariate analysis identified a feature tentatively assigned to the glycerolipid class (area under the receiver operating characteristic curve (AUROC) 0.986 (CI=0.957-1) to be more abundant in CRC vs control (false discovery rate (FDR) corrected p<0.001). A tentatively assigned organic acid (AUC 0.916, CI=0.868-0.953) was associated with control (FDR corrected p<0.001). Multiple features in the mass-to-charge ratio (m/z) range 200-400 were found to be significantly different between control vs adenoma. Annotations of the features are underway using liquid chromatography - MS/MS and spiked standards. LA-REIMS allows direct from sample metabolite profiling of feces and has applications as a novel screening tool for the early detection of CRC.

Citation Format: Petra Paizs, Monika Widlak, Alvaro Perdones-Montero, Maria Sani, Lauren Ford, James L. Alexander, Simon Cameron, Ramesh Arasaradnam, James M. Kinross, Zoltan Takats. High-throughput fecal metabolic profiling for the early detection of colorectal cancer using a direct mass spectrometry assay [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 271.

Validation of Ultrasonic Harmonic Scalpel for Real-Time Tissue Identification Using Rapid Evaporative Ionization Mass Spectrometry

In this study, we integrate rapid evaporative ionization mass spectrometry (REIMS) with the Harmonic scalpel, an advanced laparoscopic surgical instrument that utilizes ultrasound energy to dissect and coagulate tissues. It provides unparalleled manipulation capability to surgeons and has superseded traditional electrosurgical tools particularly in abdominal surgery, but is yet to be validated with REIMS. The REIMS platform coupled with the Harmonic device was shown to produce tissue-specific lipid profiles through the analysis of porcine tissues in both negative and positive ionization modes. Comparison with other methods of electrosurgical dissection, such as monopolar electrosurgery and CO₂ laser, showed spectral differences in the profile dependent on the energy device used. The Harmonic device demonstrated major spectral differences in the phospholipid region of m/z 600–1000 compared with the monopolar electrosurgical and CO₂ laser-generated spectra. Within the Harmonic REIMS spectra, high intensities of diglycerides and triglycerides were observed. In contrast, monopolar electrosurgical and laser spectra demonstrated high abundances of glycerophospholipids. The Harmonic scalpel was able to differentiate between the liver, muscle, colon, and small intestine, demonstrating 100% diagnostic accuracy. The validation of the Harmonic device–mass spectrometry combination will allow the platform to be used safely and robustly for real-time in vivo surgical tissue identification in a variety of clinical applications.

Effect of Phlorotannins from Brown Seaweeds on the In Vitro Digestibility of Pig Feed

Phlorotannins have been reported to have positive effects on pig health, including improved gut health and digestibility. In this study, we investigate the effect of phenolics found in two brown seaweeds, Ascophyllum nodosum and Fucus serratus, on in vitro dry matter digestibility of seaweeds and commercial pig feed. Phlorotannin extracts and whole seaweeds were supplemented into pig feed to test their effect on digestibility. Solid-phase extraction was used to purify the phenolics to phlorotannins. The results showed a slight decrease in the digestibility of pig feed that was found to be significant when phlorotannin extracts were added from either seaweed. However, when whole A. nodosum was added to the pig feed, the effect on digestibility was less pronounced. Specifically, no significant difference in digestibility was observed at inclusion rates up to 5%, and thereafter results varied. A difference in digestibility was also observed in the same species at the same inclusion rate, collected from different seasons. This suggests that other compounds, e.g., polysaccharides, are having an effect on digestibility when whole seaweeds are supplemented to animal feed. This research has also highlighted the need to base supplementation on phenolic concentration as opposed to a standardised percentage inclusion of seaweeds to ensure that digestibility is not adversely affected.

Polyphenols from Brown Seaweeds as a Potential Antimicrobial Agent in Animal Feeds

Seaweeds offer a natural source of antimicrobials that may help curb antibiotic resistance in livestock. The antibacterial activity of phlorotannin extracts isolated from two brown seaweeds Ascophyllum nodosum and Fucus serratus was tested. The mechanism of action of phlorotannin extracts against Escherichia coli O157, Salmonella agona, and Streptococcus suis was elucidated by observing cell membrane permeability and intracellular adenosine triphosphate (ATP). The two extracts were effective at killing three foodborne pathogens without negatively affecting the pig intestinal cells. A. nodosum minimum inhibitory concentration (MIC) range for the different pathogens was between 1.56 and 0.78 mg/mL, whereas F. serratus was 3.13 mg/mL for all pathogens tested. A. nodosum was found to be much more potent compared to F. serratus. The difference in potency in the seaweeds may be a result of the phlorotannins' structural linkages. The antimicrobial properties of the seaweed extracts tested may provide alternative and complementary treatments to antibiotics and zinc oxide in animal feeds. The seasonal screening was performed on both species to assess the availability of phenolics throughout the year using two quantification methods, the Folin-Ciocalteu (FC) assay and quantitative nuclear magnetic resonance (NMR). The variation between the methods highlights the challenges involved in the quantification of complex phenolic structures. However, both methods show that the phenolics are subject to seasonal variation, which may prove problematic to the animal feed industry.

A critical review of analytical methods used for the chemical characterisation and quantification of phlorotannin compounds in brown seaweeds

INTRODUCTION

Phlorotannins, the phenolic compounds found in brown seaweeds, are a unique and diverse class of compounds showing a huge potential for food and pharmaceutical applications.

OBJECTIVE

This review will give an account of the colorimetric assays used and a discussion of their quantitative and qualitative analytical shortcomings. It will also discuss other more complex and modern analytical chemistry methods that are currently being developed to study phlorotannins. The purpose of this review is to increase awareness of these bioactive compounds and promote further development of robust analytical methods for use in biology, food science, pharmacology and biomedical and cosmeceutical sciences.

RESULTS

Whilst the biological activity and huge commercial potential of the phlorotannins has been widely reported throughout the literature, the chemical structures and reactivity of these compounds is still not well understood. The phlorotannin content of seaweed is usually characterised using colorimetric assays. However, although these methods give a reasonable overall estimation of the total phenolic content, they lack precision and specificity.

CONCLUSION

This review highlights the strengths and weaknesses of commonly used colorimetric assays. Novel techniques are highlighted using more selective chemistry to identify this class of compounds.

A Multidisciplinary Transition Consult Service: Patient Referral Characteristics

PURPOSE

Children's hospitals must provide developmentally appropriate care to increasing numbers of young adults with complex healthcare needs as they transition to adult-oriented care. This article describes the patients, service, and short-term outcomes of an interprofessional healthcare transition (HCT) consult team comprised of nurses, social workers, a community health worker, and physicians.

DESIGN AND METHODS

The Adult Consult Team's tiered population framework stratifies patients by medical complexity. The team coordinates HCT services for patients with the highest complexity. Patients at least 18 years old are eligible if they have at least two specialists or an intellectual or developmental disability (IDD). Through a comprehensive medical and psychosocial assessment, the team prepares patients/families for adult-oriented healthcare.

RESULTS

The Adult Consult Team received 197 referrals from July 2017 to June 2018. Patients had at least two specialists (73%), IDD (71%), technology dependence (e.g., gastrostomy tube, 37%) and Medicaid insurance (57%). The team assisted patients seen in its outpatient clinic with navigating mental health services (39%), insurance issues (13%), IDD services (15%), and the guardianship process (37%) and creating comprehensive care plans.

CONCLUSIONS

The Adult Consult Team transferred 30 patients with medical complexity to adult primary and specialty care, significantly improving pediatric inpatient and outpatient capacity for pediatric-aged patients. A broad range of young adult medical, psychosocial, legal, educational, and vocational needs were addressed.

PRACTICE IMPLICATIONS

An interprofessional team approach can help large pediatric healthcare systems address the multi-faceted needs of patients who are medically and psychosocially complex as they enter adulthood.

The Osteogenic Potential of Brown Seaweed Extracts

Marine drugs hold significantly more promise than their terrestrial counterparts, which could help to solve the current shortfall in treatments for osteoporosis and other bone related diseases. Fucoxanthin is the main carotenoid found in brown seaweed, and has many perceived health benefits, including potential bone therapeutic properties. This study assessed the osteogenic potential of pure fucoxanthin and crude extracts containing both fucoxanthin and phenolic fractions (also cited to have osteogenic potential) isolated from two intertidal species of brown seaweed, Laminaria digitata and Ascophyllum nodosum. In vitro studies were performed using a human foetal osteoblast cell line (hFOBs) and primary human bone marrow stromal cells (hBMSCs). The results found pure fucoxanthin inhibitory to cell proliferation in hFOBs at higher concentrations, whereas, the crude extracts containing both polyphenols and fucoxanthin showed the ability to scavenge free radicals, which masked this effect. None of the extracts tested showed strong pro-osteogenic effects in either cell type tested, failing to support previously reported positive effects.

Early Supported Discharge for patients with febrile neutropenia - Experience at a large district hospital in the UK

Neutropenic sepsis can be life threatening, with mortality 2-21%. The heterogeneity of patients referred with "suspected neutropenic sepsis" has led to strategies being developed to risk-stratify patients and identify those with a low risk of septic complications that could be managed in the outpatient setting, such as The Multinational Association for Supportive Care in Cancer score (MASCC). Outcomes for patients referred with suspected neutropenic sepsis were assessed before and after use of MASCC guided early-supported discharge. 50/123 (41%) patients over 24 months were eligible for early-supported discharge. 26/50 patients had same-day discharge, 14 had overnight admission, 8 stayed 2 nights and 2 stayed 3 nights. Patients received on average 2 follow-up telephone consultations. There were 5 readmissions (10%) and no adverse events. In comparison group; 8 patients over 3-months would have been suitable, potentially saving 40 bed-days. This shows MASCC guided early-supported discharge is safe and cost-effective.

Changes to country-specific hepatitis A travel vaccination recommendation for UK travellers in 2017-responding to a vaccine shortage in the national context

OBJECTIVES

A routine review of hepatitis A travel vaccination recommendations was brought forward in June 2017 due to hepatitis A vaccine shortages and a concurrent outbreak in men who have sex with men (MSM). There were three objectives: first, to document the review process for changing the recommendations for the UK travellers in June 2017. Second, to study the impact of these changes on prescribing in general practice in 2017 compared with the previous 5 years. Third, to study any changes in hepatitis A notifications in June-October 2017 compared with the previous 5 years.

STUDY DESIGN

This is an observational study.

METHODS

Travel vaccination recommendations for countries with either low-risk (<20%) or high-risk (>90%) status according to child hepatitis A seroprevalence were not changed. A total of 67 intermediate-risk countries with existing recommendations for most travellers and with new data on rural sanitation levels were shortlisted for the analysis. Data on child hepatitis A seroprevalence, country income status, access to sanitation in rural areas and traveller volumes were obtained. Information about the vaccine supply was obtained from Public Health England. Changes to the existing classification were made through expert consensus, based on countries' hepatitis A seroprevalence, sanitation levels, level of income, volume of travel and hepatitis A traveller cases. Data on the number of combined and monovalent hepatitis A-containing vaccines prescribed in England, 2012-2017, were obtained from the National Health Service Business Service Authorities. The number of monthly prescriptions for January-September 2017 was compared with the mean number of prescriptions for the same month in the previous 5 years (t-test, α = 5%, df = 4). The number of hepatitis A cases notified in June-October 2017 not related to the MSM outbreak was compared with the number of notifications in the same months in previous years.

RESULTS

A total of 36 countries were downgraded based on good access (80+% of population) to sanitation in rural areas and the intermediate-risk status in terms of child hepatitis A seroprevalence. For these countries, vaccination would only be recommended to travellers staying long term, visiting friends and relatives or staying in areas without good sanitation. There was a significant decline in hepatitis A vaccine prescriptions in June-September 2017, and there was no increase in the number of notifications.

CONCLUSIONS

Hepatitis A vaccination recommendations for travel were revised in 2017 following a systematic approach to maintain continuity of supply after a hepatitis A vaccine shortage and increased hepatitis A vaccine demand related to a large outbreak. Improved access to good sanitation in rural areas and low seroprevalence estimates among children have led to 36 countries to no longer require vaccination for most travellers. These changes do not seem to have impacted on hepatitis A notifications in England, although further research will be needed to quantify the impact more precisely.

Acute metabolic actions of the major polyphenols in chamomile: an in vitro mechanistic study on their potential to attenuate postprandial hyperglycaemia

Transient hyperglycaemia is a risk factor for type 2 diabetes and endothelial dysfunction, especially in subjects with impaired glucose tolerance. Nutritional interventions and strategies for controlling postprandial overshoot of blood sugars are considered key in preventing progress to the disease state. We have identified apigenin-7-O-glucoside, apigenin, and (Z) and (E)−2-hydroxy-4-methoxycinnamic acid glucosides as the active (poly)phenols in Chamomile (Matricaria recutita) able to modulate carbohydrate digestion and absorption in vitro as assessed by inhibition of α-amylase and maltase activities. The latter two compounds previously mistakenly identified as ferulic acid hexosides were purified and characterised and studied for their contribution to the overall bioactivity of chamomile. Molecular docking studies revealed that apigenin and cinnamic acids present totally different poses in the active site of human α-amylase. In differentiated Caco-2/TC7 cell monolayers, apigenin-7-O-glucoside and apigenin strongly inhibited D-[U-¹⁴C]-glucose and D-[U-¹⁴C]-sucrose transport, and less effectively D-[U-¹⁴C]-fructose transport. Inhibition of D-[U-¹⁴C]-glucose transport by apigenin was stronger under Na⁺-depleted conditions, suggesting interaction with the GLUT2 transporter. Competitive binding studies with molecular probes indicate apigenin interacts primarily at the exofacial-binding site of GLUT2. Taken together, the individual components of Chamomile are promising agents for regulating carbohydrate digestion and sugar absorption at the site of the gastrointestinal tract.

Abstract P5-15-02: Withdrawn

This abstract was withdrawn by the authors.

Mild extraction methods using aqueous glucose solution for the analysis of natural dyes in textile artefacts dyed with Dyer's madder (Rubia tinctorum L.)

Madder (Rubia tinctorum L.) has been widely used as a red dye throughout history. Acid-sensitive colorants present in madder, such as glycosides (lucidin primeveroside, ruberythric acid, galiosin) and sensitive aglycons (lucidin), are degraded in the textile back extraction process; in previous literature these sensitive molecules are either absent or present in only low concentrations due to the use of acid in typical textile back extraction processes. Anthraquinone aglycons alizarin and purpurin are usually identified in analysis following harsh back extraction methods, such those using solvent mixtures with concentrated hydrochloric acid at high temperatures. Use of softer extraction techniques potentially allows for dye components present in madder to be extracted without degradation, which can potentially provide more information about the original dye profile, which varies significantly between madder varieties, species and dyeing technique. Herein, a softer extraction method involving aqueous glucose solution was developed and compared to other back extraction techniques on wool dyed with root extract from different varieties of Rubia tinctorum. Efficiencies of the extraction methods were analysed by HPLC coupled with diode array detection. Acidic literature methods were evaluated and they generally caused hydrolysis and degradation of the dye components, with alizarin, lucidin, and purpurin being the main compounds extracted. In contrast, extraction in aqueous glucose solution provides a highly effective method for extraction of madder dyed wool and is shown to efficiently extract lucidin primeveroside and ruberythric acid without causing hydrolysis and also extract aglycons that are present due to hydrolysis during processing of the plant material. Glucose solution is a favourable extraction medium due to its ability to form extensive hydrogen bonding with glycosides present in madder, and displace them from the fibre. This new glucose method offers an efficient process that preserves these sensitive molecules and is a step-change in analysis of madder dyed textiles as it can provide further information about historical dye preparation and dyeing processes that current methods cannot. The method also efficiently extracts glycosides in artificially aged samples, making it applicable for museum textile artefacts.

Bayesian Source Attribution of Salmonellosis in South Australia

Salmonellosis is a significant cause of foodborne gastroenteritis in Australia, and rates of illness have increased over recent years. We adopt a Bayesian source attribution model to estimate the contribution of different animal reservoirs to illness due to Salmonella spp. in South Australia between 2000 and 2010, together with 95% credible intervals (CrI). We excluded known travel associated cases and those of rare subtypes (fewer than 20 human cases or fewer than 10 isolates from included sources over the 11-year period), and the remaining 76% of cases were classified as sporadic or outbreak associated. Source-related parameters were included to allow for different handling and consumption practices. We attributed 35% (95% CrI: 20-49) of sporadic cases to chicken meat and 37% (95% CrI: 23-53) of sporadic cases to eggs. Of outbreak-related cases, 33% (95% CrI: 20-62) were attributed to chicken meat and 59% (95% CrI: 29-75) to eggs. A comparison of alternative model assumptions indicated that biases due to possible clustering of samples from sources had relatively minor effects on these estimates. Analysis of source-related parameters showed higher risk of illness from contaminated eggs than from contaminated chicken meat, suggesting that consumption and handling practices potentially play a bigger role in illness due to eggs, considering low Salmonella prevalence on eggs. Our results strengthen the evidence that eggs and chicken meat are important vehicles for salmonellosis in South Australia.

Isolation and extraction of ruberythric acid from Rubia tinctorum L. and crystal structure elucidation

Madder (Rubia tinctorum L.) has been exploited as a dye throughout history. The roots of the plant are very rich in the highly coloured glycosidic compounds ruberythric acid and lucidin primeveroside, alongside the corresponding aglycons which can be readily formed by deglycosylation, particularly during extraction. Supported by (1)H and (13)C NMR data, the conclusive X-ray crystal structure of the natural dye ruberythric acid is presented for the first time. The solid state structure revealed extensive intermolecular hydrogen bonding interactions between the sugar moieties in the unit cell, but only intramolecular hydrogen bonding through the hydroxyquinone groups. There is also some additional π-π stacking from the anthraquinone moiety.

Working in the real world: a review of sociological concepts of health and well-being and their relation to modern mental health nursing

Since 2008, the world has witnessed several socio-economic upheavals that have fundamentally changed the global economy. Within the UK, these upheavals have coincided with a change in political administration and thus a new approach to managing the volatility of economy. This change has resulted in root and branch reform of service provision that is based around a model that incorporates a shrinking public sector coupled with an increase in civic participation (i.e. 'The Big Society' espoused by the UK-governing coalition). It is also unlikely that healthcare provision on a global level will remain unchanged in such turbulent times. It would therefore seem a useful time to review how socio-economic forces are believed to affect the health and well-being of an individual. These forces include social inequality, the mechanisms of social inclusion and exclusion, social role and the erosion of resilience. This paper will then conclude by offering some potential avenues that nurses can explore to make these forces less damaging for their clients. These avenues include developing a clinical focus based around positive psychology, well-being and some novel ways that nurses can help overcome the maintenance cycles that perpetuate inequality and exclusion.

Cannabinoids and bone: endocannabinoids modulate human osteoclast function in vitro

BACKGROUND AND PURPOSE

Both CB(1) and CB(2) cannabinoid receptors have been shown to play a role in bone metabolism. Crucially, previous studies have focussed on the effects of cannabinoid ligands in murine bone cells. This study aimed to investigate the effects of cannabinoids on human bone cells in vitro.

EXPERIMENTAL APPROACH

Quantitative RT-PCR was used to determine expression of cannabinoid receptors and liquid chromatography-electrospray ionization tandem mass spectrometry was used to determine the presence of endocannabinoids in human bone cells. The effect of cannabinoids on human osteoclast formation, polarization and resorption was determined by assessing the number of cells expressing α(v) β(3) or with F-actin rings, or measurement of resorption area.

KEY RESULTS

Human osteoclasts express both CB(1) and CB(2) receptors. CB(2) expression was significantly higher in human monocytes compared to differentiated osteoclasts. Furthermore, the differentiation of human osteoclasts from monocytes was associated with a reduction in 2-AG levels and an increase in anandamide (AEA) levels. Treatment of osteoclasts with LPS significantly increased levels of AEA. Nanomolar concentrations of AEA and the synthetic agonists CP 55 940 and JWH015 stimulated human osteoclast polarization and resorption; these effects were attenuated in the presence of CB(1) and/or CB(2) antagonists.

CONCLUSIONS

AND IMPLICATIONS Low concentrations of cannabinoids activate human osteoclasts in vitro. There is a dynamic regulation of the expression of the CB(2) receptor and the production of the endocannabinoids during the differentiation of human bone cells. These data suggest that small molecules modulating the endocannabinoid system could be important therapeutics in human bone disease.

LINKED ARTICLES

This article is part of a themed section on Cannabinoids in Biology and Medicine. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue-8. To view Part I of Cannabinoids in Biology and Medicine visit http://dx.doi.org/10.1111/bph.2011.163.issue-7.

Randomized trial of adjunctive topiramate therapy in infants with refractory partial seizures

OBJECTIVE

To evaluate the efficacy and safety of adjunctive topiramate (sprinkle capsules or oral liquid) in reducing daily rates of partial-onset seizures (POS) in infants with refractory POS.

METHODS

In this double-blind, placebo-controlled, parallel-group, international study, infants (n = 149) with clinical or EEG evidence of refractory POS were randomly allocated (1:1:1:1) to receive adjunctive topiramate 5, 15, or 25 mg/kg/d or placebo for 20 days. The primary variable was the median percentage reductions in daily POS rate from baseline to final assessment as recorded on a 48-hour video-EEG.

RESULTS

Of the 149 infants (mean age 12 months) included in the intent-to-treat analysis set, 130 completed the study. Median percentage reduction from baseline in daily POS rate was not significantly different (p = 0.97) between topiramate 25 mg/kg (20.4%) and placebo (13.1%). Lower doses were not formally tested, but nominal p values for comparisons with placebo were not significant (15-mg/kg/d dose: p = 0.97; 5-mg/kg/d dose: p = 0.91). Treatment-emergent fever, diarrhea, vomiting, anorexia, weight decrease, somnolence, and viral infection occurred more frequently (> or = 10% difference) with topiramate than with placebo.

CONCLUSION

In infants aged 1-24 months, topiramate 5, 15, or 25 mg/kg/d was not effective as adjunctive treatment for refractory partial-onset seizures. No new safety concerns associated with topiramate use were noted.

CLASSIFICATION OF EVIDENCE

This interventional study provides Class I evidence that topiramate 5, 15, or 25 mg/kg/d compared with placebo does not significantly reduce seizure rates in infants aged 1 month to 2 years with refractory partial-onset seizures.

Safety profile of ibuprofen suspension in young children

The Children's Analgesic Medicine Project (CAMP) was a multicenter, all-comers, openlabel, prospective study to compare the safety of ibuprofen suspension with acetaminophen suspension in children with fever and/or pain. Four hundred and twenty four (424) pediatricians enrolled 41 810 children (aged 1 month to 18 years old) at 69 US clinics. Safety data included information concerning medication use and adverse events (AEs) summarized by severity and analyzed by age groups (younger and older than 2 years). Among 30 144 children who took at least one dose of ibuprofen or acetaminophen, 14 281 were younger (< 2 yrs) and 15 863 were older ([Symbol: see text] 2 to < 12 yrs). Within both age groups, the incidence rates for specific AEs, including abdominal pain, insomnia, and hyperkinesia were rare and generally < 1% for both treatments. For younger children, fever, vomiting, diarrhea, rhinitis, rash and otitis media were the only AEs with an incidence rate > 1% (in either treatment group). For older children, the only AEs with an incidence rate > 1% in either group were rhinitis, pharyngitis and otitis media. AEs were generally mild to moderate for both treatments within the two age groups. There were no serious AEs, including anaphylaxis, Reye's syndrome, renal failure, GI bleeding/perforation or necrotizing fasciitis. There was a slightly higher overall incidence of side effects in the ibuprofen group (17.6% vs. 15.0%) for the younger children; and similar results were seen in the older children (11.9% vs. 10.7%). This may have been due to the preference of physicians to treat the sicker children with ibuprofen. There were four deaths, all unrelated to study medication, all occurring in children < 2 yrs (herpes encephalitis, sepsis due to 5. pneumoniae, medulloblastoma, and sudden infant death syndrome). The safety of ibuprofen suspension in children < 2 yrs was demonstrated in this study. The safety profile in children < 2 yrs is consistent with the excellent profile observed in children [Symbol: see text] 2 yrs. Overall, ibuprofen exhibited an AE profile similar to acetaminophen in both younger and older children.