Shaping nature outcomes in corporate settings

Transnational companies have substantive impacts on nature: a hallmark of living in the Anthropocene. Understanding these impacts through company provision of information is a precursor to holding them accountable for nature outcomes. The effect of increasing disclosures (of varying quality) is predicated on 'information governance', an approach that uses disclosure requirements to drive company behaviour. However, its efficacy is not guaranteed. We argue that three conditions are required before disclosures have the possibility to shape nature outcomes, namely: (1) radical traceability that links company actions to outcomes in particular settings; (2) developing organizational routines, tools and approaches that translate strategic intent to on-the-ground behaviour; and (3) mobilizing and aligning financial actors with corporate nature ambitions. While disclosure is key to each of these conditions, its limits must be taken into account and it must be nested in governance approaches that shape action, not just reporting. This article is part of the theme issue 'Bringing nature into decision-making'.

Global practitioner assessment and management of mental fatigue and mental recovery in high-performance sport: A need for evidence-based best-practice guidelines

BACKGROUND

Mental fatigue and mental recovery have gained scientific attention in relation to sporting performance, yet best practice assessment and management methods are lacking. A greater understanding of current knowledge and practices in high-performance sport are necessary.

OBJECTIVE

To understand the contemporary knowledge, beliefs, monitoring processes, management strategies, perceived responsibility, sources of evidence, and challenges, when assessing the mental fatigue and mental recovery of athletes in high-performance sport.

METHODS

A mixed-methods survey approach obtained information from 156 multi-disciplinary high-performance sport practitioners. Descriptive outputs were reported and potential differences between key concepts were detected using Wilcoxon-signed rank analysis. Thematic analysis interpreted open-text responses.

RESULTS

Only 11.5% and 5.1% of respondents indicated they were "very" knowledgeable about mental fatigue and mental recovery, respectively. Knowledge (p < 0.001) and confidence in application (p = 0.001) were significantly greater for mental fatigue than mental recovery. Nearly all respondents perceived mental fatigue and mental recovery impacted training and competition performance, with a greater negative impact during competition (p < 0.001). A limited number of respondents reported deliberate assessment (31.1%) or management (51.2%) of mental fatigue and mental recovery. A combination of sources of evidence were used to inform practice, with common challenges to implementation including staff knowledge, athlete-buy in, time-availability, and a lack of evidence. Practitioners reported that assessing and managing mental fatigue and mental recovery was multi-disciplinary in nature.

CONCLUSION

Practitioners reported that mental fatigue and mental recovery did impact performance, yet this was not reflected in the implementation of evidence-based assessment and management practices in high-performance sport.

Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation

BACKGROUND

The prevalence of type 2 diabetes is increasing rapidly, particularly among younger age groups. Estimates suggest that people with diabetes die, on average, 6 years earlier than people without diabetes. We aimed to provide reliable estimates of the associations between age at diagnosis of diabetes and all-cause mortality, cause-specific mortality, and reductions in life expectancy.

METHODS

For this observational study, we conducted a combined analysis of individual-participant data from 19 high-income countries using two large-scale data sources: the Emerging Risk Factors Collaboration (96 cohorts, median baseline years 1961-2007, median latest follow-up years 1980-2013) and the UK Biobank (median baseline year 2006, median latest follow-up year 2020). We calculated age-adjusted and sex-adjusted hazard ratios (HRs) for all-cause mortality according to age at diagnosis of diabetes using data from 1 515 718 participants, in whom deaths were recorded during 23·1 million person-years of follow-up. We estimated cumulative survival by applying age-specific HRs to age-specific death rates from 2015 for the USA and the EU.

FINDINGS

For participants with diabetes, we observed a linear dose-response association between earlier age at diagnosis and higher risk of all-cause mortality compared with participants without diabetes. HRs were 2·69 (95% CI 2·43-2·97) when diagnosed at 30-39 years, 2·26 (2·08-2·45) at 40-49 years, 1·84 (1·72-1·97) at 50-59 years, 1·57 (1·47-1·67) at 60-69 years, and 1·39 (1·29-1·51) at 70 years and older. HRs per decade of earlier diagnosis were similar for men and women. Using death rates from the USA, a 50-year-old individual with diabetes died on average 14 years earlier when diagnosed aged 30 years, 10 years earlier when diagnosed aged 40 years, or 6 years earlier when diagnosed aged 50 years than an individual without diabetes. Using EU death rates, the corresponding estimates were 13, 9, or 5 years earlier.

INTERPRETATION

Every decade of earlier diagnosis of diabetes was associated with about 3-4 years of lower life expectancy, highlighting the need to develop and implement interventions that prevent or delay the onset of diabetes and to intensify the treatment of risk factors among young adults diagnosed with diabetes.

FUNDING

British Heart Foundation, Medical Research Council, National Institute for Health and Care Research, and Health Data Research UK.

Critical Aspects of Material Selection in the Packaging and Transporting of Returned Extraterrestrial Samples

In the framework of the EU-funded EURO-CARES project, aimed at determining the actions to develop a European facility for curation of extraterrestrial samples returned by space missions, we identified the requirements (mainly in terms of materials selection) of the transportation containment facility which should contain the Sample Return Capsule (SRC), which in turn contains the extraterrestrial material returned to Earth. Transportation box design for restricted (i.e., possibly related to biological life) and unrestricted samples is different. Packaging and transport of restricted samples must guarantee the samples' preservation from the terrestrial environment and the safety of people performing these operations and, hence, must be done according to World Health Organization (WHO) rules. In the case of unrestricted samples, the only requirement is sample preservation. We propose a triple packaging as follows: (1) primary receptacle; (2) secondary package (plastic material), optional for unrestricted samples; (3) rigid, cushioned outer layer. Only for restricted samples, an additional layer is proposed, that is, the overpack. The primary receptacle coincides with the SRC. The plastic material of the secondary package must have a low outgassing rate (i.e., <10-7 torr/s) and preferably low permeability and cost. Teflon and Neoflon would be the best choices. The outer package must be rigid and resistant to breakage, and our trade-off analysis identified stainless steel and aluminum alloys as best options. The outer should be filled with an inert atmosphere to inhibit oxidation within the sample in case of leak: argon is more inert than nitrogen, but the latter is easily available. The overpack allows the box environment control (e.g., real-time contamination monitoring); ISO containers could be used to this end. Contamination of the environment inside the box can be monitored by different instruments, which should be selected on the basis of mission requirements. There are no mass limitations for box transport by ground or ship, but these solutions imply a long journey duration. Any aircraft might be used for transporting unrestricted samples. Only cargo aircraft may be used for transporting restricted samples, unless the total sample mass is lower than 50 g (WHO guidelines).

259 AN AUDIT OF DNACPR FORM USAGE IN A LEVEL 4 HOSPITAL FOLLOWING RE-DESIGN AND IMPLICATIONS FOR ITS FUTURE USE

Background

In 2020 during the Covid-19 pandemic our hospital introduced a new green DNACPR form with 2 significant changes. It now specifies if the patient is or is not for resuscitation (as a yes/no choice) and a Treatment Escalation Plan (TEP) has moved to the front of the page from the back. A subsequent audit found that 19% of inpatients had forms completed, of which 68% stated DNACPR and 29% for CPR. 76% of forms had a TEP (versus 56% on the old forms). We repeated the hospital wide audit in 2022 to assess if the improvement in TEP documentation was sustained, and if it was used on all patients or primarily to document DNACPR decisions.

Methods

The hospital-wide audit was performed on the 25.05.2022. Charts were reviewed on medical and surgical wards. ICU patients were excluded. The following data were recorded: Resuscitation status, form completion, presence of a TEP, if the date of admission and form completion were recorded, if the name of doctor and nature of discussion with patient and family were documented, and if the TEP was consistent with the most recent clinical notes. The data was compared to the 2020 audit and against the Hospital’s DNAR & TEP policy.

Results

634 inpatients were identified. 15.7% (100) had a form completed of which 92% stated DNAR. One of these did not have a TEP. The doctor’s name and grade were clearly documented on all forms.

Conclusion

99% of patients who were not for CPR had a TEP indicating sustained improvement since the introduction of the new form. Given 83.3% of patients did not have any documented resuscitation status the approach of documenting yes or no for resuscitation is not being utilised. A return to a dedicated form that indicates someone should not undergo attempts at resuscitation may offer more clarity.

Managing Minds at Work: development of a digital line manager training programme

Background

Mental ill health is the leading cause of sickness absence with high economic burden. Workplace interventions aimed at supporting employers with prevention of mental ill-health in the workforce are urgently required. Managing Minds at Work (MMW) is a digital intervention targeting support for line managers in any work setting to promote better mental health at work through a preventative approach.

Objectives

To describe the design and development of the MMW digital training programme, prior to feasibility testing. We adopted a collaborative participatory design involving co-design (users as partners) and principles of user-centred design (pilot and usability testing). Agile methodology was used to co-create intervention content with a stakeholder community of practice. Development processes were mapped to core elements of the Medical Research Council (MRC) framework for developing and evaluating complex interventions.

Results

The program covers five broad areas: (i) promoting self-care techniques among line managers; (ii) designing work to prevent work-related stress; (iii) management competencies to prevent and reduce stress; (iv) having conversations with employees about mental health; (v) building a psychologically safe work environment. Pilot and usability testing (n = 37 surveys) aligned with the Technology Acceptance Model (TAM) demonstrated that MMW was perceived to be useful, relevant, and easy to use by managers across sectors, organization types and sizes. We identified positive impacts on manager attitudes and behavioural intentions related to preventing mental ill-health and promoting good mental well-being at work.

Conclusions

MMW is a digital training programme for line managers that has been co-created using rigorous development processes and aims to support employers with primary prevention in mental health. The next step is to explore the feasibility and acceptability of this intervention with line managers in diverse employment settings.

Key messages

P-413 Non-autologous human platelet lysate stimulates in vitro proliferation of primary human endometrial cells from patients with recurrent implantation failure

Study question

Does patient diagnosis impact induction of primary human endometrial cell proliferation by commercial non-autologous human platelet lysate (HPL)?

Summary answer

HPL stimulates in vitro proliferation of both primary endometrial epithelial cells (EECs) and stromal cells (ESCs) from patients with and without recurrent implantation failure (RIF).

What is known already

Inadequate endometrial receptivity and thickness are major causes for RIF. Our preliminary results suggested that non-autologous HPL stimulates in vitro proliferation of primary human EECs and ESCs isolated from patients with a history of RIF, with and without a thin endometrium (TE). In addition, using an in vitro model of embryo attachment, we reported that 48-hour treatment with HPL significantly augments the attachment of trophoblast spheroids (generated with HTR-8/SVneo cells) to EECs, suggesting an increase in endometrial receptivity following treatment. This suggests that HPL may standardize future clinical treatments for a TE and endometrial origins of RIF.

Study design, size, duration

Endometrial tissue was collected from five patients without RIF (control) and eighteen RIF patients at the CReATe Fertility Centre, Toronto, Canada. The eighteen RIF patients were further classified into three groups (N = 6 each) based on endometrial phenotype: 1) proliferative phase RIF only (without a TE), 2) secretory phase RIF only (without a TE), and 3) secretory phase RIF+TE (with a TE). Primary EECs and ESCs were enzymatically isolated and cultured separately.

Participants/materials, setting, methods

Primary EECs and ESCs were serum-starved with serum-free culture media (SFM) for 24 hours and then treated for 48 hours with the following treatment media: SFM (negative control), or SFM supplemented with 1% HPL for EECs, or 10% HPL for ESCs. Cell viability and proliferation were assessed using the metabolic assay PrestoBlue reagent and immunocytochemistry to quantify cells actively expressing the nuclear proliferation marker Ki67.

Main results and the role of chance

The metabolic assay demonstrated that 48-hour treatment with non-autologous HPL stimulates a similar significant increase in EEC viability and proliferation for all patient groups. EECs from patients without RIF (control) had the highest fold increase (1.49-fold, P &lt;0.001), followed by proliferative phase RIF only (1.41-fold, P &lt;0.001), secretory phase RIF+TE (1.39-fold, P &lt;0.001), and secretory phase RIF only (1.24-fold, P &lt;0.05). For ESCs, HPL stimulated a significant 2.69-fold increase in cell viability and proliferation for the secretory phase RIF+TE patient group (P &lt;0.01). Pairwise comparison of the ratio of actively proliferating (Ki67+) cells between SFM and HPL treatment revealed that EECs isolated from control patients had the highest and most significant increase by 27.3% (P &lt;0.05) after HPL treatment. Although not statistically significant, EECs isolated from all RIF patients displayed a similar trend of increased Ki67+ cells after HPL treatment. Whereas HPL treatment significantly increased the ratio of Ki67+ cells for ESCs isolated from both the proliferative phase (by 23.9%, P &lt;0.05) and secretory phase (by 29.9%, P &lt;0.05) endometrium of RIF only patients.

Limitations, reasons for caution

Although our data suggests that HPL treatment significantly stimulates primary endometrial cell proliferation in vitro, our sample size per group is small (N = 5-6). A larger sample size and future randomized controlled trials are needed to determine the efficacy of HPL as a treatment for a TE and/or RIF.

Wider implications of the findings

Our study provides the groundwork to improve clinical treatment of a TE and endometrial origins of RIF. We anticipate that in addition to stimulating cell proliferation, HPL will also induce a broad transcriptional response towards improved endometrial receptivity. We will next focus on characterizing the transcriptomic profile following HPL treatment.

Trial registration number

not applicable

O-135 Sperm-borne small ribonucleic acid profile significantly impacts embryo development

Study question

Do normozoospermic males with reduced pre-implantation embryo development have aberrant sperm small RNA profiles?

Summary answer

Small RNA sequencing suggests the small RNA profile may differ in normozoospermic males with low blastocyst development rates, compared to males with higher blastocyst progression.

What is known already

Current male factor infertility diagnostics are insufficient, with 30-50% of subfertile males having unknown etiology. Spermatozoa contain a complex, epigenetically-marked genome and a collection of RNAs and proteins, which are not adequately assessed by current diagnostic methods. The sperm small RNA payload is reportedly modified during epididymal transit and in response to paternal exposures, influencing which sperm small RNA species are delivered to the oocyte. Mechanistic animal studies and correlative human and animal studies have suggested that sperm small RNAs may be important for early embryonic development and health of offspring, though their diagnostic and therapeutic value are still unclear.

Study design, size, duration

Human semen samples were collected between April 2017 and August 2020 from a total of 56 male patients presenting to CReATe Fertility Centre for fertility evaluation. Clinical data was accessed retrospectively. All patients were normozoospermic, according to standard semen analysis and were using donor oocytes. Samples were divided into high (n = 20), average (n = 16), and low (n = 20) fertility groups based on their deviation (1 standard deviation) from the mean blastocyst rate.

Participants/materials, setting, methods

Semen analysis was undertaken immediately following sample collection and spermatozoa were isolated by centrifugation. Sperm small RNA was purified and eluted using the RNeasy and MiRNeasy Kits (Qiagen). Barcoded and amplified cDNA libraries were prepared from small RNA using the NEXTFLEX Small RNA-Seq Kit v3 (Bioo Scientific). Resulting libraries were pooled, size-selected to a range of 140-190 base pairs, denatured and diluted for sequencing. Single-end, 75 bp sequencing was performed using the NextSeq 550 (Illumina).

Main results and the role of chance

Sequencing generated approximately 300 million raw reads, with 30 samples exceeding 2 million reads included in the differential expression analysis. Most reads were mapped to rRNAs (69%), miRNAs (11%), and piRNAs (12%). However, transfer RNA fragments from tRNA-Gly-GCC and tRNA-Val-CAC were the most abundant sequences. Top annotated miRNAs include: miR-12136-5p; miR-21-5p; and miR-122-5p. Principal component analysis revealed 222 genes that were differentially expressed between the high (n = 14) and low (n = 11) fertility groups (p &lt; 0.05). Interestingly, the top 50 differentially expressed sRNAs are sufficient to effectively cluster sperm with poor blastocyst development rates.

Limitations, reasons for caution

The results are limited by a relatively low sequencing depth (mean of 4.1 million reads per sample) and sample size. Fertility groups were determined by blastocyst rates, which can be confounded by non-sperm-derived variables, including technical skill, embryo culturing conditions, and maternal factors (though donor oocytes were used).  

Wider implications of the findings

With additional validation, a clinically-useful panel of differentially expressed sperm small RNAs could be used to predict IVF success and evaluate therapies aimed at improving male reproductive health. Augmenting traditional semen analytics with diagnostic sperm small RNA analysis could reduce time to pregnancy and the psychosocial impacts of fertility treatment.

Trial registration number

Not applicable

154 SAFEGUARDING ADULTS AT RISK OF ABUSE—IDENTIFYING KNOWLEDGE GAPS AMONGST HOSPITAL STAFF TO GUIDE POLICY IMPLEMENTATION AND TRAINING

Background

Safeguarding is the protection of health, wellbeing and life free from abuse. Abuse is a a violation of a person’s human and civil rights; forms include psychological, financial, physical, sexual, neglect and self-neglect. Health Service Executive (HSE) drafted the 2019 ‘Adult Safeguarding Policy’ for adults at risk of abuse to replace the 2014 version. In preparation for implementation a tertiary hospital founded a Safeguarding Committee in 2021. A core objective was establishing staff understanding, experience of safeguarding and education needs to guide future training.

Methods

10-question survey of 223 staff; included doctors, nurses, allied health professionals, medical social workers, healthcare assistants, porters, psychologists.

Results

91% response rate.

184 (91%) staff were familiar with the term ‘safeguarding’; only 44% were aware of the HSE 2019 policy. 129 (64%) had experience with a case of suspected abuse. Most common forms were financial, psychological and self-neglect (n = 60, 47, 39 respectively). Sexual abuse was least common (n = 10).

47% felt ‘somewhat’ confident recognising possible abuse compared to 42% who felt ‘extremely’ or ‘very’ confident.

61% were ‘somewhat’ or ‘not so’ confident about the next steps for suspected abuse; only 11% were ‘extremely’ confident.

49% felt ‘extremely’ or ‘very’ confident in reporting a suspected abuse case; 50% felt ‘somewhat’ or ‘not so’ confident.

Most common reasons for lack of confidence were lack of training, unclear reporting process and lack of experience with cases of abuse. Medical social workers were most confident; doctors were the least.

170 (84%) wanted more safeguarding training—the most popular options were online or in-person training.

Conclusion

Gaps in knowledge and confidence were identified amongst staff for cases of suspected abuse. This will guide future training in the hospital in line with the HSE Adult Safeguarding policy.

Heart transplantation outcomes in cardiac sarcoidosis

BACKGROUND

Cardiac sarcoidosis (CS) is a progressive inflammatory cardiomyopathy that can lead to heart failure, arrhythmia, and death. There is limited data on Orthotopic Heart Transplantation (OHT) outcomes in patients with CS. Here we examine outcomes in patients with CS who have undergone OHT at centers throughout the United States from 1987 to 2019.

METHODS

This was an analysis of 63,947 adult patients undergoing OHT captured in the United Network for Organ Sharing (UNOS) registry. Patients were characterized as cardiac sarcoidosis (CS) or Non-CS. Baseline characteristics were compared using chi-square and Kruskal-Wallis Tests. Outcomes of interest included primary graft failure, patient survival, treated graft rejection, hospitalization for infection, and post-transplant malignancy.

RESULTS

During the study period 227 patients with CS underwent OHT. Patients with CS were younger, had higher proportion of non-white patients, and received transplants at more urgent statuses. After multivariable modeling there was no difference in survival (HR 0.86, CI 0.59-1.3, p = 0.446) or graft failure (HR 0.849, CI 0.58-1.23, p = 0.394) between patients with CS and Non-CS. Patients with CS had lower odds of rejection (OR 0.558, CI 0.315- 0.985, p = 0.0444). Patients with CS had similar odds of hospitalization for infection and post-transplant malignancy, as Non-CS patients.

CONCLUSIONS

Patients with CS and Non-CS had similar post OHT survival, odds of graft failure, hospitalizations for infection, and post-transplant malignancy. Results of this study confirm the role of heart transplantation as a viable option for patients with CS.

P–379 Human platelet lysate improves trophoblast spheroid attachment to primary endometrial epithelial cells from patients with recurrent implantation failure

Study question

Could non-autologous platelet lysate (PL) increase attachment of HTR–8 spheroids in vitro to primary endometrial epithelial cells (EECs) from patients with recurrent implantation failure (RIF)?

Summary answer

Increased quantity of HTR–8 spheroids attached to primary EECs, isolated from patients with RIF, suggests in vitro treatment with non-autologous PL could improve endometrial receptivity.

What is known already

Inadequate endometrial receptivity and thickness are major causes for RIF. Recent studies suggest that platelet-rich plasma (PRP) may improve pregnancy outcomes for RIF and/or thin endometrium (TE) patients. Our previous results show that a commercially sourced and non-autologous human PRP/PL (HPL) promotes EC proliferation in vitro, suggesting that HPL may help to standardize future clinical treatments. In addition to EC proliferation, HPL treatment may improve embryo attachment to primary EECs isolated from patients with a history of RIF. In vitro attachment assays with trophoblast spheroids (embryo model) could help elucidate the effect of HPL on endometrial receptivity in RIF patients.

Study design, size, duration

Endometrial tissue was collected from nine RIF patients at the CReATe Fertility Centre, Toronto, Canada (Veritas REB#16580): five with (RIF+TE) and four without a TE (RIF only). Primary EECs were enzymatically isolated and treated with serum-free culture media (SFM) or 1% HPL in SFM for 48 hours before performing the attachment assay. Trophoblast cells (HTR–8/SVneo) were grown in suspension on a rocker to form 70–100 uM spheroids over 24 hours before use in the assay.

Participants/materials, setting, methods

Spheroids were fluorescently labelled with calcein-AM for 30 minutes and size-selected to capture spheroids similar in size to a human blastocyst. Spheroids were seeded on top of EEC monolayers and calcein fluorescence was immediately measured by a spectrophotometer. Following the 1-hour incubation, unattached spheroids were aspirated, and fluorescence was measured again. Spheroids were also individually quantified by fluorescent microscopy and ImageJ™ software. The percentage of spheroid attachment was calculated for calcein fluorescence and ImageJ™ quantification.

Main results and the role of chance

The HTR–8/SVneo cell line, derived from human first-trimester extravillous trophoblast cells (EVT), has been shown to be a suitable cell line to assess adhesion and invasion in vitro. Trophoblast spheroids generated from this cell line visually resembled a blastocyst and maintained expression of the EVT and implantation biomarkers: GATA3, ITGA5, and LIF. Primary EECs, treated for 48 hours with SFM supplemented with 1% commercially sourced and non-autologous HPL, overall exhibited increased attachment to HTR–8 spheroids. The percentage of spheroid attachment, as measured by fluorescence alone, significantly increase from 47.98% to 64.27% (P &lt; 0.01) of seeded spheroids in RIF+TE EEC cultures, and from 48.12% to 85.77% (P &lt; 0.001) of seeded spheroids in RIF only EEC cultures. Quantification by fluorescent microscopy and ImageJ™ software for individual calcein-stained spheroids, revealed a significant increase in spheroid attachment, from 57.52% to 86.5% (P &lt; 0.01) in RIF+TE EEC cultures, and from 42.58% to 68.90% (P &lt; 0.01) in RIF only EEC cultures.

Limitations, reasons for caution

Although there was a positive correlation between calcein fluorescence and spheroid quantity, quantification by fluorescence alone may be unreliable due to the variable numbers of cells in each spheroid. Our data suggest a more precise increase in attachment is detected when quantified by fluorescent microscopy and ImageJ™ software.

Wider implications of the findings: We report a method for functional assessment of endometrial receptivity in vitro. HPL appears to promote implantation in RIF patients in a model of embryo attachment. We predict that the observed increase in attachment is due to increased endometrial receptivity gene expression, which will be our next investigative avenue.

Trial registration number

N/A

Equal North: how can we reduce health inequalities in the North of England? A prioritization exercise with researchers, policymakers and practitioners

BACKGROUND

The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England.

METHODS

Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data.

RESULTS

In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and third priorities. Workshop 3 did not diverge from findings in Round 1.

CONCLUSIONS

Practice professionals and academics agreed that reducing health inequalities in the North of England requires prioritizing research that tackles structural determinants concerning poverty, the implications of austerity measures and unemployment.

Goniozus omanensis (Hymenoptera: Bethylidae) an important parasitoid of the lesser date moth Batrachedra amydraula Meyrick (Lepidoptera: Batrachedridae) in Oman

A new species of bethylid parasitoid wasp, Goniozus omanensis Polaszek sp. n., is described based on morphology and DNA sequence data. The species is currently known only from the lesser date moth Batrachedra amydraula, a pest of economic importance, but can be reared on two factitious host species. G. omanensis is compared with G. swirskiana, known from the same host in Israel. We summarise current knowledge of G. omanensis life-history, and its potential as an agent of biological pest control.

Measles and rubella seroprevalence among adults in Georgia in 2015: helping guide the elimination efforts

A large-scale measles outbreak (11 495 reported cases, 60% aged ≥15 years) occurred in Georgia during 2013-2015. A nationwide, multistage, stratified cluster serosurvey for hepatitis B and C among persons aged ≥18 years conducted in Georgia in late 2015 provided an opportunity to assess measles and rubella (MR) susceptibility after the outbreak. Residual specimens from 3125 participants aged 18-50 years were tested for Immunoglobulin G antibodies against MR using ELISA. Nationwide, 6.3% (95% CI 4.9%-7.6%) of the surveyed population were seronegative for measles and 8.6% (95% CI 7.1%-10.1%) were seronegative for rubella. Measles susceptibility was highest among 18-24 year-olds (10.1%) and declined with age to 1.2% among 45-50 year-olds (P < 0.01). Susceptibility to rubella was highest among 25-29 year-olds (15.3%), followed by 18-24 year-olds (11.6%) and 30-34 year-olds (10.2%), and declined to <5% among persons aged ≥35 years (P < 0.001). The susceptibility profiles in the present serosurvey were consistent with the epidemiology of recent MR cases and the history of the immunization programme. Measles susceptibility levels >10% among 18-24 year-olds in Georgia revealed continued risk for outbreaks among young adults. High susceptibility to rubella among 18-34 year-olds indicates a continuing risk for congenital rubella cases.

Four priorities for new links between conservation science and accounting research

Article impact statement: New collaborations with accounting research can improve conservation impact of ecosystem-based information systems.

Abstract P4-01-01: Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer

Background. Detection of circulating tumor DNA (ctDNA) after treatment of early stage breast cancer may identify molecular residual disease. In a prior proof-of-principle study we demonstrated that detection of ctDNA predicted relapse with high accuracy (Garcia-Murillas et al Science Trans Med 2015). We conducted an independent, prospective, multi-centre validation study.

Methods. In this validation study, a cohort of 170 early stage breast cancer patients were recruited from five hospitals into two prospective sample collection studies. Patients were scheduled to receive standard chemotherapy, surgery +/- radiotherapy, adjuvant endocrine therapy and HER2 antibodies as appropriate. Plasma samples were collected for ctDNA analysis at baseline, post-surgery, three monthly for the first year of follow-up, and six monthly thereafter and shipped to a central lab for processing. Using previously established criteria, tumor was sequenced to identify somatic mutations that were tracked by digital PCR in DNA extracted from 4mls of plasma at all available time points. Buffy coat DNA was analysed at all time-points to control for clonal haematopoesis of indeterminate potential (CHIP) detection. The primary endpoint was to compare invasive disease free survival between patients with and without detection of ctDNA after treatment. A combined analysis of this validation study, and the prior proof-of-principle study, was also conducted to analyse secondary endpoints.

Results. After tumor sequencing, 101 patients from the validation study had at least one mutation to track. At median 35.5 months follow-up, ctDNA was detected in plasma of 15.8% (16/101) patients. Detection of ctDNA strongly predicted relapse, hazard ratio 24.5 (95% CI 6.5 to 93.2, P&lt;0.001 time-dependent Cox model), and was predictive of relapse in all tumor subtypes.

In the combined analysis (N=144), lead-time between ctDNA detection and relapse was 10.7 months (95% CI 7.7-17.0). Six patients had a clinical relapse that was not detected by ctDNA prior to relapse. These patients had a distinct pattern of oligo-metastatic relapse, 3 patients with brain-only metastases (P=0.0068), 1 ovarian oligo-metastasis and 2 local disease recurrence. The level of ctDNA in baseline plasma, prior to treatment, was associated with tumor subtype, highest in triple negative breast cancer (P=0.0036).

Conclusion. Detection of ctDNA after treatment is associated with a high risk of future relapse in early-stage breast cancer. Prospective studies are required to assess the potential of molecular residual disease detection to guide adjuvant therapy.

Citation Format: Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-01.

The role of citizen science in addressing grand challenges in food and agriculture research

The power of citizen science to contribute to both science and society is gaining increased recognition, particularly in physics and biology. Although there is a long history of public engagement in agriculture and food science, the term 'citizen science' has rarely been applied to these efforts. Similarly, in the emerging field of citizen science, most new citizen science projects do not focus on food or agriculture. Here, we convened thought leaders from a broad range of fields related to citizen science, agriculture, and food science to highlight key opportunities for bridging these overlapping yet disconnected communities/fields and identify ways to leverage their respective strengths. Specifically, we show that (i) citizen science projects are addressing many grand challenges facing our food systems, as outlined by the United States National Institute of Food and Agriculture, as well as broader Sustainable Development Goals set by the United Nations Development Programme, (ii) there exist emerging opportunities and unique challenges for citizen science in agriculture/food research, and (iii) the greatest opportunities for the development of citizen science projects in agriculture and food science will be gained by using the existing infrastructure and tools of Extension programmes and through the engagement of urban communities. Further, we argue there is no better time to foster greater collaboration between these fields given the trend of shrinking Extension programmes, the increasing need to apply innovative solutions to address rising demands on agricultural systems, and the exponential growth of the field of citizen science.

Abstract P2-02-01: Withdrawn

This abstract was withdrawn by the authors.

Dietary intake in people consuming a low-carbohydrate diet in the UK Biobank

BACKGROUND

Low-carbohydrate diets are becoming increasingly popular, although their dietary quality outside of clinical studies is unknown. A previous study analysed the dietary intake in people consuming a reduced-carbohydrate diet (<40% calories). However, it is not clear what foods people consume when carbohydrate is reduced to below 26% of total calories.

METHODS

In the present cross-sectional study, the dietary and nutrient intake collected via up to five consecutive 24-h dietary recalls and a food frequency questionnaire of 444 individuals (aged 46-79 years) consuming <26% of calories from carbohydrate (LCHO) was compared with that of 131 897 individuals consuming ≥45% calories from carbohydrate (NCHO) using the UK Biobank Dataset. Absolute cut-offs to define the low-carbohydrate group (<130 g day^-1 ; n = 1953 versus ≥225 g day^-1 , n = 113 036) were also used.

RESULTS

Both NCHO (>45% calories and ≥225 g) groups consumed significantly more high-sugar, high-fat snacks [median 6.0, interquartile range (IQR) = 2.0-11.0 and median 6.0, IQR = 3.0-11.8, respectively) compared to the LCHO (<26% calories and <130 g) groups (median 0, IQR = 0-2.8 and median 1, IQR = 0-3.8, respectively) (P < 0.0001). Both LCHO groups reported consuming significantly more red meat, oily fish, nuts and seeds but fewer fruits, vegetables and pulses compared to the NCHO groups. In general, the consumption of oily fish, nuts, seeds and pulses was low across the whole cohort and differences in intake between the LCHO and NCHO groups were small. After adjusting for socio-economic status, most differences remained.

CONCLUSIONS

Carbohydrate restriction is associated with both beneficial and potentially deleterious dietary changes compared to a normal carbohydrate intake.

Prevalence and predictors of thyroid functional abnormalities in newly diagnosed AL amyloidosis

BACKGROUND

Data on the effect of systemic immunoglobulin light chain amyloidosis (AL amyloidosis) on thyroid function are limited.

OBJECTIVE

To assess the prevalence of hypothyroidism in AL amyloidosis patients and determine its predictors.

METHODS

1142 newly diagnosed AL amyloidosis patients were grouped based on the thyroid-stimulating hormone (TSH) measurement at diagnosis: hypothyroid group (TSH above upper normal reference; >5 mIU L^-1 ; n = 217, 19% of study participants) and euthyroid group (n = 925, 81%). Predictors for hypothyroidism were assessed in a binary multivariate model. Survival between groups was compared using the log-rank test and a multivariate analysis.

RESULTS

Patients with hypothyroidism were older, more likely to present with renal and hepatic involvement and had a higher light chain burden compared to patients in the euthyroid group. Higher proteinuria in patients with renal involvement and lower albumin in patients with hepatic involvement were associated with hypothyroidism. In a binary logistic regression model, age ≥65 years, female sex, renal involvement, hepatic involvement, kappa light chain restriction and amiodarone use were independently associated with hypothyroidism. Ninety-three per cent of patients in the hypothyroid group with free thyroxine measurement had normal values, consistent with subclinical hypothyroidism. Patients in the hypothyroid group had a shorter survival compared to patients in the euthyroid group (4-year survival 36% vs 43%; P = 0.008), a difference that was maintained in a multivariate analysis.

CONCLUSION

A significant proportion of patients with AL amyloidosis present with hypothyroidism, predominantly subclinical, which carries a survival disadvantage. Routine assessment of TSH in these patients is warranted.

Abstract P6-09-45: Long-term follow-up of early stage breast cancer patients with results of MammaPrint®, Oncotype DX® and MammoStrat® risk classification assays

Introduction: The use of genomic tests for the prediction of breast cancer recurrence is becoming more common. MammaPrint® (MP, Agendia Inc.) is a 70-gene microarray assay designed to assess the 10-year risk of recurrence in an untreated population that was not selected for ER/HER2 results. The Oncotype DX® Recurrence Score® (RS, Genomic Health, Inc.) is a 21-gene RT-PCR assay that is clinically validated to predict the 10-year risk of distant recurrence in ER+ patients treated with Tamoxifen. MammoStrat® (MS, Clarient, Inc.) is an IHC assay that uses 5 antibodies and has been validated in a similar population as RS. Several recent reports show that these assays classify patients differently with significant discordances for all risk groups (Shivers, et al., SABCS 2013; Denduluri, et al., ASCO Breast 2011; Poulet, et al., SABCS 2012; Schneider, et al., ASCO 2013). The present study is an analysis of long-term follow-up in a cohort of patients who have results for all three of these risk-stratifying assays side by side in the same samples.

Methods: Patients with ER+ N0-N1 early-stage breast cancer with an MP result obtained as part of their routine clinical care were identified at the University of South Florida (USF, N=65) and Morton Plant Hospital (N=83). After local IRB approval, slides and/or blocks were cut and de-identified at USF and sent to Genomic Health and Clarient for blinded testing. Clinicopathological features were also reviewed by 3 breast pathologists.

Results: 148 patients with an MP result had tissue available to send for RS and MS assays. These patients had a median age of 62 years; median tumor size 1.8 cm; 9% low grade, 59% intermediate grade and 32% high grade. In our previous analysis of this study, of 148 patients with MP results, 53% were low risk and 47% were high risk. Of 135 samples that yielded enough RNA to produce an RS result, 53% were low risk, 26% were intermediate risk and 21% were high risk. Of 129 samples that yielded an MS result, 44% were low risk, 28% were moderate risk and 28% were high risk. Of 121 patients with results for all 3 assays, only 22% were concordant for low risk and 9% were concordant for high risk across all 3 assays. Overall, 30% of cases showed a major discordance such as low risk for one assay and high risk for another. After median follow-up of 54 months, 9 patients have had a distant metastasis and/or 8 patients have died (11 patients total). One patient who had bone metastasis and died had been classified as low risk by all 3 assays. Three patients with distant metastases had a major discordance between assays, with two high risk and one low risk result. Seven patients were classified as high or intermediate/moderate risk by all 3 assays.

Conclusions: This direct comparison demonstrates that although the assays classify a large proportion of patients differently, the patients who ended up with a distant metastasis and/or died of breast cancer had been classified as high risk by at least two of the three assays. This study has important clinical implications since these assays are used to help make treatment decisions regarding which patients might benefit from chemotherapy.

Citation Format: Shivers SC, Russell S, Blumencrancz L, Mehindru A, Acs G, Ellis D, Vrcelj V, Zanchi A, Blumencrancz PW, Carter E, King J, Cox CE. Long-term follow-up of early stage breast cancer patients with results of MammaPrint®, Oncotype DX® and MammoStrat® risk classification assays [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-45.

Abstract P1-11-06: Learning curve for the SAVI SCOUT breast localization and surgical guidance system

Background: The gold standard for localizing non-palpable breast lesions for surgical excision is wire localization (WL). Multiple disadvantages for WL include complicated scheduling and migration of the wire after placement. Radioactive seed localization (RSL) mitigates these disadvantages, but regulatory requirements regarding radiation limit more universal adoption. The SAVI SCOUT surgical guidance system (an FDA cleared medical device) eliminates the drawbacks of WL without the regulatory requirements of RSL. SCOUT utilizes electromagnetic wave technology and infrared light to provide intra-operative guidance during surgical excision. The purpose of this study is to describe the learning curve associated with adoption of this new technology.

Method: An IRB-approved prospective, single-arm, multi-site trial enrolled women with non-palpable breast lesions requiring localized surgical excision. After informed consent, a radiologist or surgeon used imaging guidance to implant the SCOUT reflector into the target lesion. Intraoperatively, the surgeon used SCOUT for localization of the reflector and removal of the target lesion. We evaluated the association of several independent variables with respect to successful localization and surgical excision including: tumor side, tumor quadrant, distance of reflector from the skin, and the number of SCOUT localized breast excisions performed by operating surgeon up to the 1st five cases. We studied the relationship between these independent variables and the following dependent variables: reflector detection post-placement, reflector detection pre-incision, and reflector localization post-incision.Statistical analysis utilized the z-test to perform a two-sided test of equality at an alpha level of 0.05 with adjustment for multiple comparisons by the Bonferroni method. T-tests were used to perform two-sided tests of equality for numeric variables.

Results: Across 11 institutions, 16 surgeons performed a total of 153 surgical excisions. Overall success rates of reflector detection pre-incision and post-incision were 98% (150/153) and 99% (151/153), respectively. The reflectors were successfully removed in 100% (153/153) of cases. Difficulty with reflector detection immediately post placement was significantly associated with reflectors more than 4 cm (P=0.034) or 5 cm (P=0.007) from the skin, or the procedure being the 1st SCOUT case by the operating surgeon (P=0.036). Operating surgeons performing their 1st SAVI localization procedure were significantly associated with difficult reflector detection post-incision (p=0.044). Subsequent procedures, up to the first five SCOUT localizations, noted no significant difficulty with reflector detection.

Conclusions: The SAVI SCOUT surgical guidance system is a viable surgical localization procedure for non-palpable breast lesions. Surgeons were 100% successful at removing the reflectors during surgical excision. Difficulty with reflector detection was not noted after the surgeon's 1st SCOUT procedure. Overall, it appears the learning curve for reflector placement and localization for non-palpable breast lesions is relatively short. However, depth of the reflector in relation to skin likely affects reflector detection during this early learning period.

Citation Format: Shukla SC, Shivers SC, Mattingly A, Russell S, Mehindru A, Carter E, Cox CE. Learning curve for the SAVI SCOUT breast localization and surgical guidance system [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-11-06.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Temporary protection of rainbow trout gill epithelial cells from infection with viral haemorrhagic septicaemia virus IVb

The branchial epithelium is not only a primary route of entry for viral pathogens, but is also a site of viral replication and subsequent shedding may also occur from the gill epithelium. This study investigated the potential of agents known to stimulate innate immunity to protect rainbow trout epithelial cells (RTgill-W1) from infection with VHSV IVb. RTgill-W1 cells were pretreated with poly I:C, FuGENE(®) HD + poly I:C, lipopolysaccharide (LPS), LPS + poly I:C or heat-killed VHSV IVb and then infected with VHSV IVb 4 days later. Cytopathic effect (CPE) was determined at 2, 3, 4, 7 and 11 days post-infection. Virus in cells and supernatant was detected using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR). All of the treatments delayed the onset of CPE (per cent of monolayer destruction), compared with untreated controls; however, killed VHSV or poly I:C combined with LPS was the most effective. Similarly, the detection of viral RNA in the supernatant was delayed, and the quantity was significantly (P < 0.05) reduced by all treatments with the exception of LPS alone (4 days). Unlike many of the other treatments, pretreatment of RTgill-W1 with heat-killed VHSV did not upregulate interferon 1, 2 or MX 1 gene expression.

Anaesthesia for head and neck surgery: United Kingdom National Multidisciplinary Guidelines

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The anaesthetic considerations for head and neck cancer surgery are especially challenging given the high burden of concurrent comorbidity in this patient group and the need to share the airway with the surgical team. This paper provides recommendations on the anaesthetic considerations during surgery for head and neck cancer. Recommendations • All theatre staff should participate in the World Health Organization checklist process. (R) • Post-operative airway management should be guided by local protocols. (R) • Patients admitted to post-operative care units with tracheal tubes in place should be monitored with continuous capnography. Removal for tracheal tubes is the responsibility of the anaesthetist. (R) • Anaesthetists should formally hand over care to an appropriately trained practitioner in the post-operative or intensive care unit. (G) • Intensive care unit staff looking after post-operative tracheostomies must be clear about which patients are not suitable for bag-mask ventilation and/or oral intubation in the event of emergencies. (R).

Abstract P5-06-01: The role of thyroid hormones in breast tumorigenesis: A translational study utilizing mouse models, cell culture and patient data

Breast cancer and thyroid hormone signaling have been linked since the 1960s. Breast cancer patients have a higher incidence of thyroid cancer, and thyroid cancer patients have a higher incidence of breast cancer than would be predicted by chance alone, supporting a link between thyroid hormone signaling and breast malignancy. Despite many correlative studies, the role and mechanism of thyroid hormone signaling in mammary tumorigenesis has not been elucidated. Past studies have not comprehensively evaluated thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) levels with breast cancer status in the same individual. The results are further confounded by issues of temporality; studies have either assessed thyroid hormone levels before or after diagnosis, prohibiting conclusions regarding whether thyroid disruption is a cause or effect of breast cancer. In vitro models demonstrate that mammary cells have thyroid hormone receptors and respond to thyroid hormones; however these studies have not been extended to in vivo models.

In the current study, we took a translational approach by combining data from cell culture, mouse models and breast cancer patients from the City of Hope Cancer Registry (CHCR). We used the murine MMTV-PyMT model of breast cancer and treated mice with the anti-thyroid drug PTU; lowering T4 levels and increasing TSH. These mice developed significantly larger mammary tumors than untreated animals or those treated with T4 (p= 0.0012 and p=0.0183, respectively). Next, we showed that MCF10a cells in vitro are sensitive to both T4 and TSH added to the culture medium. We hypothesize that even subtle perturbations in normal thyroid hormone levels can stimulate mammary cell growth, increasing risk of transformation. We extended these findings to a small pilot study of 879 invasive and 136 in situ female breast cancer patients with comprehensive thyroid hormone lab analyses in the CHCR (total=984). Pre-treatment results were available for 44 women. TSH was significantly elevated for invasive versus in situ patients (Pt-test =0.016), regardless of the timing of the test. Pre-treatment TSH levels were significantly increased as the severity of disease increased (Pt-test =0.026). Women diagnosed stage 1 disease with no recurrence had a mean TSH level of 1.68 ± 1.87 (Standard Deviation: SD), whereas women diagnosed with stage 1 disease who returned with metastasis had a mean of 2.64 ± 1.72 SD. In the same women, free T4 and total T4 levels were lower and T3 levels were higher (Pt-test&lt; 0.05) in women with invasive versus in situ disease.

These studies support the hypothesis that even minimally dysregulated thyroid hormone levels may increase the risk of breast cancer development and progression to aggressive disease. Many women over the age of 50 suffer from sub-clinical hypothyroidism, and our results suggest that sub-clinical hypothyroidism increases breast cancer risk and disease progression. Interestingly, our data indicate that as disease progresses, dependence on TSH lessens, and the most striking differences may be seen in early and low grade disease. Collectively, our data highlight a need to further investigate the role of sub-clinical hypothyroidism in breast cancer.

Citation Format: Franco A, Jolly LA, Russell S, Goldstein L, DeHart J. The role of thyroid hormones in breast tumorigenesis: A translational study utilizing mouse models, cell culture and patient data. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-06-01.

Patterns of individual coping, engagement with social supports and use of formal services among a five-country sample of resilient youth

BACKGROUND

Although resilience among victims of child abuse is commonly understood as a process of interaction between individuals and their environments, there have been very few studies of how children's individual coping strategies, social supports and formal services combine to promote well-being.

METHOD

For this study, we conducted a multi-phase analysis of a qualitative dataset of 608 interviews with young people from five countries using grounded theory strategies to build a substantive theory of young people's service and support use patterns. We started with an analysis of ten interviews (two from each country) and then compared these findings to patterns found in each country's full dataset.

RESULTS

The substantive theory that emerged explains young people's transience between individual coping strategies (cognitive and behavioral), reliance on social supports (family members, peers and teachers), and engagement with formal service providers whose roles are to provide interventions and case management. Young people's patterns of navigation were shown to be contingent upon the individual's risk exposure, his or her individual capacity to cope, and the quality of the formal and informal supports and services that are available and accessible.

CONCLUSION

Differing amounts of formal resources in low-, middle- and high-income countries influence patterns of service use. Implications for better coordination between formal mental health services and social supports are discussed.

Nutrient and plant secondary compound composition and iron-binding capacity in leaves and green stems of commonly used plant browse (Carolina willow; Salix caroliniana) fed to zoo-managed browsing herbivores

Plant secondary compounds are diverse structurally, and associated biological effects can vary depending on multiple factors including chemical structure and reaction conditions. Phenolic compounds such as tannins can chelate dietary iron, and supplementation of animal species sensitive to iron overload with tannins may prevent/treat iron overload disorder. We assessed the nutrient and phenolic composition and iron-binding capacity of Carolina willow (Salix caroliniana), a plant fed to zoo-managed browsing herbivores. Based on studies in other plant species and the chemical structures of phenolic compounds, we hypothesized that the concentration of condensed tannins in willow would be inversely related to the concentration of phenolic glycosides and directly related to iron-binding capacity. Our results indicated that willow nutrient composition varied by year, season, and plant part, which could be taken into consideration when formulating animal diets. We also found that the predominant plant secondary compounds were condensed tannins with minimal phenolic glycosides. Instead of binding to iron, the willow leaf extracts reduced iron from the ferric to ferrous form, which may have prooxidative effects and increase the bioavailability of iron depending on animal species, gastrointestinal conditions, and whole animal processes. We recommend identifying alternative compounds that effectively chelate iron in vitro and conducting chelation therapy trials in vivo to assess potential effects on iron balance and overall animal health.

Adult liver transplantation in the congenital absence of inferior vena cava

Whereas congenital absence of inferior vena cava observed in paediatric population more often than not, as an isolated or syndromic variety, this is seldom encountered in adult liver transplant recipients. There appear few sporadic reports in the literature on experience of such anomaly in adults. Given the rarity of situation, surprising encounters of such anomalies may pose challenge to the unprepared transplant surgeon and unfavourable outcomes may even have resulted in under-reportage of this condition. In this brief report we document our recent experience with two such cases and this is supplemented with extensive reference to the literature on classification of such anomalies with the endeavour to document implications of such in the adult liver transplant setting.

Amyloid associated with neoplasia in two captive tricolour sharkminnows Balantiocheilus melanopterus Bleeker

Amyloid associated with pancreatic adenocarcinoma was discovered in two captive adult tricolour sharkminnows Balantiocheilus melanopterus Bleeker found dead in a freshwater display. Enlarged abdomens expanded by bloody ascitic fluid and grossly visible masses of abnormal tissue were present surrounding sections of the stomach and intestine. Histologically, the masses were composed of areas of well-organized exocrine pancreatic acini interspersed with cords of poorly differentiated, spindle-shaped cells that compressed and effaced normal parenchyma. These cells possessed small numbers of cytoplasmic zymogen granules; the exocrine nature of these cells was confirmed using transmission electron microscopy (TEM). Fibrovascular connective tissue of the hepatopancreas and mesenteries was expanded by lightly eosinophilic, hyaline, homogeneous acellular material. Similar material greatly expanded the tunica media of large blood vessels in the hepatopancreas. After staining with Congo red or thioflavin T, this material exhibited red-green dichroism under polarized light or bright green fluorescence under ultraviolet light (255 nm), respectively. The non-branching fibrils, of indeterminate length, had an approximate diameter of 10-20 nm using TEM. Although exocrine pancreatic neoplasia is relatively common in fish, the presence of amyloid is not. To our current knowledge, the latter has not yet been described in association with a neoplastic lesion in fish.