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This study investigated the effectiveness of cooking processes that incorporated hydrated surface lethality (HSL) steps for ensuring the reduction of Salmonella on the surfaces of small-dimension meat and poultry products cooked using short-duration, high-temperature impingement oven processes. Whole-muscle chicken tenders (3% fat), beef patties (10% and 30% fat), pork patties (10% and 30% fat), and chicken patties (10% and 20% fat) were surface inoculated with a 5-strain mixture of Salmonella to yield 8 log colony-forming units/g, then cooked in a two-zone impingement oven using either dry heat or steam-humidified HSL processes. The HSL steps used steam injection to control the wet-bulb temperature at either 71.1°C or 82.2°C. Dry-heat cooking processes using a dry-bulb temperature of 204.4°C and no steam-injected HSL steps failed to consistently achieve a 6.5 log reduction of Salmonella on chicken tenders and the low-fat patty products (≤10% fat). In contrast, processes incorporating an HSL step using an 82.2°C wet-bulb temperature in one or both zones resulted in ≥6.5 log reductions of Salmonella for all products. Sufficient reductions were achieved regardless of whether this 82.2°C wet-bulb HSL step was incorporated before or after a dry-cook step. Processes that incorporated an HSL step using a 71.1°C wet-bulb temperature in both zones also resulted in reductions ≥6.5 log for all products. Processes using a 71.1°C wet-bulb HSL step in only one zone delivered ≥ 6.5 log reduction for all of the patty products. However, the one-zone 71.1°C HSL step achieved ≥6.5 log reduction in chicken tenders only if used in the first zone of the two-zone oven. When the 71.1°C HSL step was used in the second zone for chicken tenders after using dry heat in the first zone, the target reduction of 6.5 log was not achieved. This research successfully validated approaches to ensure ≥6.5 log reduction of Salmonella on product surfaces.

USDA, FSIS thermal processing guidelines (e.g. Appendix A for cooked beef, roast beef, and cooked corned beef, and Time-Temperature Tables for Cooking Ready-to-Eat Poultry Products) are widely used as validation support for cooking processes, but these procedures were developed and validated only for Salmonella in a limited number of products. To determine the extent to which Appendix A can safely be applied to other pathogens and products, a study was conducted to compare the thermal-death times of Salmonella, Listeria monocytogenes, and shiga toxin-producing E. coli (STEC) in model products representing roast beef, turkey breast, and boneless ham. Raw batter for each of the 3 products was inoculated with 8 log CFU/g of a multi-strain mixture of L. monocytogenes, Salmonella, or STEC. One-gram portions of inoculated roast beef, turkey breast, or ham batter were flattened into a thin film in moisture-impermeable pouches, vacuum-packaged, and heated at 54.4, 60.0, 65.6, or 71.1°C in a water bath. Triplicate samples were removed at predetermined time points and enumerated for surviving pathogens. The time needed to yield a 6.5-log reduction of Salmonella and STEC at 60.0, 65.6, or 71.1°C for the three product types was comparable to the times prescribed by USDA, FSIS Appendix A for Salmonella inactivation; however, at 54.4°C similar inactivation levels were not observed. L. monocytogenes showed greater thermotolerance than Salmonella and STEC for all 3 product types. These data suggest that current USDA, FSIS thermal processing guidelines are acceptable tools for ensuring the safety of cooking processes at 60.0°C or higher to inactivate Salmonella and STEC in the product types, but longer dwell times may be necessary to yield comparable log reduction of L. monocytogenes.

Background Pancreatic cancer diagnosis and staging can be difficult in 10–20% of patients. Positron emission tomography (PET)/computed tomography (CT) adds precise anatomical localisation to functional data. The use of PET/CT may add further value to the diagnosis and staging of pancreatic cancer. Objective To determine the incremental diagnostic accuracy and impact of PET/CT in addition to standard diagnostic work-up in patients with suspected pancreatic cancer. Design A multicentre prospective diagnostic accuracy and clinical value study of PET/CT in suspected pancreatic malignancy. Participants Patients with suspected pancreatic malignancy. Interventions All patients to undergo PET/CT following standard diagnostic work-up. Main outcome measures The primary outcome was the incremental diagnostic value of PET/CT in addition to standard diagnostic work-up with multidetector computed tomography (MDCT). Secondary outcomes were (1) changes in patients’ diagnosis, staging and management as a result of PET/CT; (2) changes in the costs and effectiveness of patient management as a result of PET/CT; (3) the incremental diagnostic value of PET/CT in chronic pancreatitis; (4) the identification of groups of patients who would benefit most from PET/CT; and (5) the incremental diagnostic value of PET/CT in other pancreatic tumours. Results Between 2011 and 2013, 589 patients with suspected pancreatic cancer underwent MDCT and PET/CT, with 550 patients having complete data and in-range PET/CT. Sensitivity and specificity for the diagnosis of pancreatic cancer were 88.5% and 70.6%, respectively, for MDCT and 92.7% and 75.8%, respectively, for PET/CT. The maximum standardised uptake value (SUVmax.) for a pancreatic cancer diagnosis was 7.5. PET/CT demonstrated a significant improvement in relative sensitivity (p = 0.01) and specificity (p = 0.023) compared with MDCT. Incremental likelihood ratios demonstrated that PET/CT significantly improved diagnostic accuracy in all scenarios (p p = 0.001). PET/CT influenced management in 250 (45%) patients. PET/CT stopped resection in 58 (20%) patients who were due to have surgery. The benefit of PET/CT was limited in patients with chronic pancreatitis or other pancreatic tumours. PET/CT was associated with a gain in quality-adjusted life-years of 0.0157 (95% confidence interval –0.0101 to 0.0430). In the base-case model PET/CT was seen to dominate MDCT alone and is thus highly likely to be cost-effective for the UK NHS. PET/CT was seen to be most cost-effective for the subgroup of patients with suspected pancreatic cancer who were thought to be resectable. Conclusion PET/CT provided a significant incremental diagnostic benefit in the diagnosis of pancreatic cancer and significantly influenced the staging and management of patients. PET/CT had limited utility in chronic pancreatitis and other pancreatic tumours. PET/CT is likely to be cost-effective at current reimbursement rates for PET/CT to the UK NHS. This was not a randomised controlled trial and therefore we do not have any information from patients who would have undergone MDCT only for comparison. In addition, there were issues in estimating costs for PET/CT. Future work should evaluate the role of PET/CT in intraductal papillary mucinous neoplasm and prognosis and response to therapy in patients with pancreatic cancer. Study registration Current Controlled Trials ISRCTN73852054 and UKCRN 8166. Funding The National Institute for Health Research Health Technology Assessment programme.

Libby amphibole (LA) causes a unique progressive lamellar pleural fibrosis (LPF) that is associated with pulmonary function decline. Pleural fibrosis among the LA-exposed population of Libby, MT, has been associated with the production of anti-mesothelial cell autoantibodies (MCAA), which induce collagen production from cultured human mesothelial cells. We hypothesized that the progressive nature of LPF could be at least partially attributed to an autoimmune process and sought to demonstrate that LA-induced MCAA trigger collagen deposition in vivo. C57BL/6 mice were exposed to LA for 7 mo, and serum was tested for MCAA by cell-based ELISA on primary mouse mesothelial cells. When treated in vitro with serum from mice exposed to LA, mesothelial cells upregulated collagen matrix production. This effect was lost when the serum was cleared of IgG using protein G beads, implicating IgG autoantibodies. Using the peritoneal cavity as a surrogate for the pleural cavity, groups of naïve (non-asbestos-exposed) mice were injected intraperitoneally with 1) control serum, 2) one dose of serum from LA-exposed mice (LA serum), 3) two doses of LA serum, or 4) two doses of LA serum cleared of IgG. After 1 mo, analysis of collagen in peritoneal walls using two-photon confocal microscopy (SHG analysis) and a hydroxyproline assay demonstrated significant increases in collagen by LA serum but not control or cleared serum. These data support the hypothesis that MCAA in LA-exposed mice induce fibrotic responses in vivo, demonstrating that an autoimmune component may be contributing to the progressive pleural fibrosis seen in LA-exposed patients.

Objective US Iraq and Afghanistan Veterans with post-traumatic stress disorder (PTSD) and depression are at increased risk for obesity. Understanding the contribution of health behaviors to this relationship will enhance efforts to prevent and reduce obesity. Therefore, we examined the association of PTSD and depression symptoms with binge eating, a risk factor for obesity, among Iraq/Afghanistan Veterans. Method Iraq/Afghanistan Veterans were assessed at intake to the VA Puget Sound Healthcare System-Seattle post-deployment clinic (May 2004–January 2007). The Patient Health Questionnaire was used to measure depression and binge eating symptoms, and the PTSD Checklist-Military Version assessed PTSD symptoms. Results The majority of the sample (N = 332) was male (91.5%) and Caucasian (72.6%), with an average age of 31.1 (SD = 8.5) years; 16.3% met depression screening criteria, 37.8% met PTSD screening criteria, and 8.4% met binge eating screening criteria. In adjusted models, those meeting depression (odds ratio (OR) = 7.53; 95% CI = 2.69, 21.04; p p = .01) screening criteria were more likely to meet binge eating screening criteria. Continuous measures of PTSD and depression symptom severity were also associated with meeting binge eating screening criteria ( p s Conclusion PTSD and depression are common conditions among Iraq/Afghanistan Veterans. In the present study, PTSD and depression symptoms were associated with meeting binge eating screening criteria, identifying a possible pathway by which psychiatric conditions lead to disproportionate burden of overweight and obesity in this Veteran cohort. Tailored dietary behavior interventions may be needed for Iraq/Afghanistan Veterans with co-morbid obesity and psychiatric conditions.

Lamellar pleural thickening (LPT) is a fibrotic disease induced by exposure to Libby amphibole (LA) asbestos that causes widespread scarring around the lung, resulting in deterioration of pulmonary function. Investigating the effects of autoantibodies to mesothelial cells (MCAA) present in the study populations has been a major part of the effort to understand the mechanism of pathogenesis. It has been shown in vitro that human mesothelial cells (Met5a) exposed to MCAA increase collagen deposition into the extracellular matrix (ECM). In this study, we sought to further elucidate how MCAA drive increased collagen deposition by identifying the protein targets bound by MCAA on the cellular surface using biotinylation to label and isolate surface proteins. Isolated surface protein fractions were identified as containing MCAA targets using ELISA. The fractions that demonstrated binding by MCAA were then analyzed by tandem mass spectrometry (MS/MS) and MASCOT analysis. The most promising result from the MASCOT analysis, plasminogen (PLG), was tested for MCAA binding using purified human PLG in an ELISA. We report that serum containing MCAA bound at an optical density (OD) 3 times greater than that of controls, and LA‐exposed subjects had a high frequency of positive tests for anti‐PLG autoantibodies. This work implicates the involvement of the plasminogen/plasmin system in the mechanism of excess collagen deposition in Met5a cells exposed to MCAA. Elucidating this mechanism could contribute to the understanding of LPT.

This pilot project is a province-wide and nationally=supported collaboration intended to add value to existing monitoring and surveillance exercises that currently exist and are being developed in Canada. The fundamental aim is to create a system that generates a timely flow of data on hazardous patterns of substance use and related harms so as to inform public debate, to support effective policy, and to facilitate policy-relevant epidemiological research. Pilot and feasibility exercises have been conducted in relation to developing consistent questions in surveys of general and special populations, treatment system data, data on the contents of drugs seized by police, interviews with police, rates of alcohol and other drug mortality and morbidity, alcohol sales data, and data from the emergency departments. Wherever possible, links with the equivalent national data collection processes have been established to create consistencies. This article provides a general overview of the BC pilot monitoring system and discusses some potential advantages of planning and designing a comprehensive system with built-in consistencies across data collection elements.

A rapid 5' nuclease fluorogenic polymerase chain reaction (PCR) assay for identifying Campylobacter jejuni was applied to Campylobacter isolates from chicken cloacal and carcass swabs collected from three chicken farms and a slaughterhouse in Thailand. The primers and the probe were based on the sequence of the gyrA gene in C. jejuni. C. jejuni isolates were identified by fluorogenic PCR assay of bacterial cells directly from Campylobacter-selective agar medium. This assay allowed the identification of C. jejuni within 1 day after colonies appeared on selective media. The fluorogenic PCR assay yielded results comparable to those of the conventional test kit (kappa = 0.76) but required less time. When the two methods disagreed with regard to species identification, results were confirmed by PCR restriction fragment length polymorphism of 23S rRNA genes. In these instances, the fluorogenic PCR assay correctly identified more isolates of C. jejuni than did the conventional test kit (six of seven isolates were unidentifiable by the conventional test kit). The fluorogenic PCR assay is a rapid and specific method that outperforms the conventional test kit in the identification of C. jejuni from environmental samples.

A study was conducted to determine the prevalence of Campylobacter with antimicrobial resistance from chickens, pigs, dairy cows, healthy farm workers, and children hospitalized with diarrhea in northern Thailand. Resistance was highest in pig samples and lowest in healthy farm workers. Resistance to fluoroquinolones and tetracycline was high in all study populations. The increased prevalence of resistant isolates from meat samples collected at markets, compared to isolates collected from animals on the farm or the slaughterhouse, suggests that contamination after carcasses leave the slaughterhouse is an important factor in the spread of resistant bacteria into the human food chain.

An 82-year-old woman who had immigrated to Canada 40 years previously, after escaping Nazi persecution in the Second World War and living in the Netherlands for 20 years, was admitted to our General Internal Medicine ward with aspiration pneumonitis. Her medical history was significant for

The effects of sanguineous and asanguineous cardioplegia on the generation of myocardial acid in the hypertrophied human heart during aortic clamping and reflow were elucidated by continuous intraoperative monitoring of myocardial pH in 42 patients undergoing valve replacement, with or without coronary bypass. The patients were divided into three groups: Group I (n = 14) received intermittent crystalloid cardioplegia; group II (n = 14) received intermittent blood cardioplegia; and group III (n = 14) received continuous blood cardioplegia. The groups were matched according to six previously elucidated determinants of myocardial acidosis. Measurements were made of myocardial pH, hydrogen ion concentration ([H+]), and the difference in pH units between myocardial pH and the pH of neutrality of water at the corresponding temperature (delta pHn). Throughout aortic clamping, myocardial pH in groups I and II fell significantly by 0.46 +/- 0.08 and 0.15 +/- 0.07 units, respectively (p less than 0.001) between the groups). In contrast, myocardial pH remained statistically unchanged throughout aortic clamping in group III (p less than 0.001 compared to groups I and II). Similar relationships were observed in [H+] and delta pHn during aortic clamping. During the early reflow, myocardial acidosis was observed in all three groups and delta pHn in group III increased from -0.26 +/- 0.10 at the end of aortic clamping to -0.57 +/- 0.07 during reperfusion (p less than 0.03). Patients in groups II and III required significantly less inotropic and mechanical cardiac support than patients in group I (p = 0.017). Hence, although continuous blood cardioplegia does not completely prevent acid accumulation during reflow, it provides better metabolic protection of the hypertrophied human heart than either intermittent crystalloid or intermittent blood cardioplegia.

(1930). Arthroplasty of the Knee Joint: (Demonstration of Cases) Acta Orthopaedica Scandinavica: Vol. 1, No. 1-4, pp. 271-274.

Catabolic states, e.g., injury or surgical trauma, are associated with hyperglycemia, elevated blood concentrations of gluconeogenic precursors, and hyperketonemia. 1 In these conditions, circulating insulin concentrations are low, but secretion of the catabolic hormones, cortisol, glucagon, and catecholamines is increased. Uncontrolled diabetes mellitus is a catabolic state also, and when insulin-dependent diabetics are deprived of insulin, there is a significant correlation between the rise in ketone body levels and plasma glucagon concentration. 2 Plasma cortisol levels also rise in insulin-deprived diabetics although this is delayed in comparison with glucagon. In this study we have investigated the metabolic effects of cortisol and glucagon at pathophysiologic concentrations in normal man and during deficiency induced by somatostatin infusion.

(1930). Operative Treatment of a Case of Luxatio Habitualis Tend. Peroneal. Bilat: (Demonstration) Acta Orthopaedica Scandinavica: Vol. 1, No. 1-4, pp. 276-276.