MRSA in Conventional and Alternative Retail Pork Products

In order to examine the prevalence of Staphylococcus aureus on retail pork, three hundred ninety-five pork samples were collected from a total of 36 stores in Iowa, Minnesota, and New Jersey. S. aureus was isolated from 256 samples (64.8%, 95% confidence interval [CI] 59.9%–69.5%). S. aureus was isolated from 67.3% (202/300) of conventional pork samples and from 56.8% (54/95) of alternative pork samples (labeled “raised without antibiotics” or “raised without antibiotic growth promotants”). Two hundred and thirty samples (58.2%, 95% CI 53.2%–63.1%) were found to carry methicillin-sensitive S. aureus (MSSA). MSSA was isolated from 61.0% (183/300) of conventional samples and from 49.5% (47/95) of alternative samples. Twenty-six pork samples (6.6%, 95% CI 4.3%–9.5%) carried methicillin-resistant S. aureus (MRSA). No statistically significant differences were observed for the prevalence of S. aureus in general, or MSSA or MRSA specifically, when comparing pork products from conventionally raised swine and swine raised without antibiotics, a finding that contrasts with a prior study from the Netherlands examining both conventional and “biologic” meat products. In our study spa types associated with “livestock-associated” ST398 (t034, t011) were found in 26.9% of the MRSA isolates, while 46.2% were spa types t002 and t008—common human types of MRSA that also have been found in live swine. The study represents the largest sampling of raw meat products for MRSA contamination to date in the U.S. MRSA prevalence on pork products was higher than in previous U.S.-conducted studies, although similar to that in Canadian studies

КИСЛОТНІСТЬ ҐРУНТІВ КИЇВСЬКОЇ ОБЛАСТІ

 The results of research in the laboratory for the protection and improvement of soil fertility and project documentation and monitoring and agrochemical passport system of soils in 2016–2020 are presented. SE «Institute for Soil Protection of Ukraine». From data of materials of the agrochemical passport system of earth of the agricultural setting, in the Kyiv area, from the 654,71 thousand hectares of the earth inspected for 2016–2020, counted 316,9 thousand hectares that need liming and 90,9 thousand hectares is gypsuming. During 2016–2020, liming of sour soils was conducted on an area 35,1 thousand hectares, including for 2020 – 12,4 thousand hectares. Limestone ameliorants are added in quantity 134,1 thousand tons, including in 2020 35,3 thousand tons. Brought in the gypsum of ameliorants only in 2016 on an area 1,5 thousand hectares, in an amount 0,4 thousand tons. On the whole for areas during fifteen years of supervisions (2006–2020) the educed increase of sour soils on 4,2% (13,2 thousand hectares) and alkaline on 0,8% (21,7 thousands hectares). Given for years (2011–2020) testify to gradual reduction of sour soils on 0,3% (29,2 thousand hectares) and increase of alkaline soils on 3,5% (11,6 thousand hectares). In the last two decades to the minimum realization of works are from native soil-amendment, and separate works in general are not conducted already a few years in succession. Since 2011, chemical land reclamation of the Kyiv region has been carried out without the participation of SE «Institute for Soil Protection of Ukraine». In order to prevent the increase in areas of acidic and alkaline soils, it is necessary to renew works from chemical land reclamation of soils and change going near financing of these measures. In composition the state budget to create the special State fund of economic stimulation of fertility-improving of soils, money of that will head exceptionally for the decision of problems of guard and recreation of the quality and high-performance state of soils. Sources of filling of the State fund of economic stimulation of fertility-improving of soils there can be money that come as penalty approvals for a failure to observe of projects of organization of the use of land and set crop rotations, and also compensation of losses of nutritives and humus from soils through assumption of negative balance of these elements because of without economic, consumer use of the landed resources. In fact realization of measures on the native improvement of earth is not only necessary pre-condition of creation of the ecologically balanced ecosystems but also stipulating the considerable increase of the productivity of soils, provides high economic efficiency of the inlaid resources.За даними матеріалів агрохімічної паспортизації земель  сільськогосподарського призначення, в Київській області, з 654,71 тис. га обстежених за 2016–2020 рр. земель, налічується 316,9 тис. га, що потребують вапнування та 90,9 тис. га – гіпсування. Впродовж 2016–2020 років вапнування кислих ґрунтів було проведено на площі 35,1 тис. га, в тому числі за 2020 – 12,4 тис. га. Вапнякових меліорантів було внесено в кількості 134,1 тис. тонн, у тому числі в 2020 році 35,3 тис. тонн. Гіпсові меліоранти вносились лише в 2016 році на площі 1,5 тис. га, в кількості 0,4 тис. тонн. Загалом по області впродовж п’ятнадцяти років спостережень (2006–2020 рр.) виявлене збільшення кислих ґрунтів на 4,2% (13,2 тис. га) та лужних на 0,8% (21,7 тис. га). Дані за десять років (2011–2020 рр.) свідчать про поступове зменшення кислих ґрунтів на 0,3% (29,2 тис. га) та збільшення лужних на 3,5% (11,6 тис. га). В останні два десятиліття до мінімуму скоротилося проведення робіт з докорінного поліпшення ґрунтів, а окремі роботи взагалі не проводяться вже кілька років поспіль. З 2011 року проєктна документація на проведення робіт з хімічної меліорації ґрунтів Київської області в ДУ «Держґрунтохорона» не замовлялась.  З метою запобігання збільшення площ кислих і лужних ґрунтів, необхідно відновити роботи з хімічної меліорації ґрунтів та змінити підхід до фінансування цих заходів. Створити у складі державного бюджету спеціальний Державний фонд економічного стимулювання підвищення родючості ґрунтів, кошти якого будуть спрямовуватися виключно на вирішення проблем охорони і відтворення якісного і високопродуктивного стану ґрунтів. Джерелами наповнення Державного фонду економічного стимулювання підвищення родючості ґрунтів можуть бути кошти, що надходять як штрафні санкції за недотримання проєктів землеустрою та встановлених сівозмін, а також компенсування втрат поживних речовин і гумусу з ґрунтів через допущення від’ємного балансу цих елементів унаслідок безгосподарського, споживацького використання земельних ресурсів. Адже проведення заходів з докорінного поліпшення земель є не тільки необхідною передумовою створення екологічно збалансованих екосистем, а й обумовлюючи значне підвищення продуктивності ґрунтів, забезпечує високу економічну ефективність вкладених ресурсів

Impact of Comorbidities at Diagnosis of Acute Myeloid Leukemia on One-Year Mortality

Abstract The hematopoietic cell transplantation comorbidity index (HCT-CI) was specifically developed to assign weighted scores to comorbidities existing prior to allogeneic HCT; thus stratifying post-HCT mortality risks. The utility of comorbidities assessed prior to treatment for AML is unknown. Here, we a) investigated the impact of each comorbidity on 1-year overall mortality of patients (pts) with newly diagnosed AML, b) designed and validated a new comorbidity score (AML-CI) comparing its performance to that of the HCT-CI, and c) identified other relevant risk factors for AML outcomes. We retrospectively collected comorbidities and laboratorydata from 1079 pts with newly diagnosed AML who received therapy at 5 institutions from 2008- 2012. Pts were aged ≤49 (29%), 50-59 (25%), 60-69 (26%), and ≥70 (20%) years old. Cytogenetic-risks were favorable (21%), intermediate (36%), or unfavorable (43%). Regimen intensity was low in 18%, intermediate in 63%, and high in 19%. HCT-CI comorbidities were evaluated per HCT-CI standard comorbidity definitions with the exception that renal comorbidity was defined per serum creatinine and/or creatinine clearance. Newly evaluated comorbiditiesincluded including hyperlipidemia, hypertension, deep venous thrombosis, gastroesophageal reflux disease, hypothyroidism, hypoalbuminemia, thrombocytopenia, neutropenia, anemia, elevated lactate dehydrogenase (LDH), smoking, and alcohol intake. Pts were randomly divided into a training (n=710) and a testing set (n=369). In the training set, the unadjusted hazard ratios (HRs) for 1-year overall mortality were calculated for each comorbidity as well as all adjustment factors: gender, age, race, cytogenetic-risks, regimen intensity, WBC, blast count, and marrow blast percentages. Only factors that were associated with overall mortality at a significance level of P <.10 proceeded to the multivariate model. Each comorbidity that entered the multivariate model was then adjusted for the effect of other comorbidities as well as gender, age, cytogenetic-risks, and regimen intensity (Table 1). The adjusted HRs were employedas weights for individual comorbidities. In the validation set, the new AML-CI incorporating comorbidities had comparable power of prediction for 1-year overall mortality as the HCT-CI (c-statistic estimates of 0.6 for each). Augmenting the HCT-CI with the three new covariates: platelets, albumin, and LDH yielded c-statistic estimate of 0.61. Other than comorbidities, age (c-statistic of 0.65) and cytogenetic-risks (c-statistic of 0.62) independently predicted overall mortality (Table 2). Comorbidities at diagnosis of AML heavily influenced the survival of pts over the year following diagnosis. The new AML-CI has similar predictive power as the HCT-CI suggesting appropriateness of using the HCT-CI at diagnosis of AML given its familiarity to physicians. The augmented HCT-CI, age, and cytogenetic-risks independently stratified for risks of 1-year mortality. In the future, studying physical, cognitive, and social health might further clarify the prognostic role of increasing age. Targeting health limitations with interventions alongside specific AML-therapy might improve survival of patients. Table 1. Components of a new AML-CI based on multivariate evaluation of impact of comorbidities on 1-year mortality after diagnosis of AML Comorbidities HR Assigned score for AML-CI Arrhythmia* 1.0 ─ Coronary Artery* 1.1 ─ Valvular* 1.3 1 Cerebrovascular * 1.3 1 Hepatic* Mild 1.2 ─ Moderate/severe 1.2 ─ Renal* Mild 1.1 ─ Moderate/severe .8 ─ Pulmonary* Mild .9 ─ Moderate/severe 1.1 ─ Diabetes* 1.3 1 Tumor* 1.7 1 Peptic Ulcer* 1.3 1 Psychiatric* 1.3 1 Hyperlipidemia 1.0 ─ HTN 1.2 ─ Albumin 200 - 500 1.5 1 >500 - 1000 1.4 1 >1000 2.2 2 Smoking Former 1.2 ─ Current 1.1 ─ *included comorbidities within HCT-CI Table 2. Probabilities of 1-year survival per 6 different models in the validation set AML-CI HCT-CI Augmented HCT-CI* Score % OS Score % OS Score % OS 0-1 18 69 0 20 72 0-2 24 70 2 28 68 1-2 35 61 3-4 28 63 3 30 56 3-4 28 57 5-7 33 58 ≥4 23 45 ≥5 18 42 ≥8 15 34 Age Cytogenetic-risks Augmented HCTCI* + age + cyto Group % OS Group % OS Score % OS 0-49 27 81 Favorable 19 87 2-4 17 86 50-69 51 60 Intermediate 36 63 5-7 37 67 70+ 22 31 Unfavorable 45 45 8-10 27 54 ≥11 19 28 *included HCT-CI + albumin, platelet counts and LDH Disclosures Fathi: Seattle Genetics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Membership on an entity's Board of Directors or advisory committees; Agios: Membership on an entity's Board of Directors or advisory committees; Ariad: Consultancy; Exelexis: Research Funding; Takeda Pharmaceuticals International Co.: Research Funding. Sekeres:TetraLogic: Membership on an entity's Board of Directors or advisory committees; Amgen: Membership on an entity's Board of Directors or advisory committees; Celgene Corporation: Membership on an entity's Board of Directors or advisory committees. Lee:Kadmon: Consultancy; Bristol-Myers Squibb: Consultancy

Development and Validation of a Novel Acute Myeloid Leukemia–Composite Model to Estimate Risks of Mortality

This cohort study examines the prognostic association of comorbidities on 1-year mortality after initial therapy of acute myeloid leukemia and a risk-stratifying composite model that incorporates comorbidities, age, and cytogenetic/molecular risks

Intensive Versus Non-Intensive Induction Therapy for Patients (Pts) with Newly Diagnosed Acute Myeloid Leukemia (AML) Using Two Different Novel Prognostic Models

Abstract Background: Induction therapy for newly diagnosed AML pts can be classified as intensive or non-intensive. Non-intensive therapies are increasingly used in pts aged >65 years due to concerns about their ability to tolerate intensive chemotherapy. However, the relative benefit-risk ratios associated with intensive versus non-intensive therapies in AML pts is likely affected by age, comorbidities, and disease-related characteristics, such as cytogenetic and molecular features. Here, we examine these relationships. Methods: Data from 1295 newly diagnosed AML patients, given induction therapy between 2008 and 2012 at six participating academic centers, were retrospectively collected. We used two previously validated models to define distinct prognostic groups, and within each, compared 2-year mortality rates according to whether pts received intensive or non-intensive therapy. Non-intensive therapy principally included azacitidine, decitabine, or low-dose cytarabine, while intensive therapies primarily included the standard 7+3 regimen or "high-dose" cytarabine combinations with anthracyclines or purine analogs. The first model (Blood 2015; 126:532) was a composite of the prognostic effects of age, comorbidity index, and cytogenetic/genetics risks per European Leukemia Net (ELN) classification. The second (JCO 2011; 29(33): 4417) was a treatment related mortality (TRM) index including 8 pt- and AML-specific risk factors. Results: Age distribution of the pts were ≤49 (23%), 50-59 (20%), 60-69 (33%), and ≥70 (24%) years old. Median follow-up for currently alive pts was 41 (range, 0-99) months. Cytogenetic-molecular risks per ELN classification were favorable (18%), intermediate I and II (39%), or unfavorable (43%). Induction treatments were intensive in 77% and non-intensive in 23% of pts. The proportion of patients receiving non-intensive therapy increased with increasing age (Table 1). Almost all pts (99%) with the lowest composite scores (1-3) received intensive therapies and were therefore omitted from the comparisons with either model. Per the composite model grouping, pts had better survival rates if they received intensive therapy, although the differences were not statistically significant in pts with composite scores ≥10 (Table 2). Pts with TRM scores of 0-4 and ≥5, with a score of 5 corresponding to the median score, statistically significantly benefitted from intensive therapies (Table 2). Among all pts aged 70-79 years old (n=242), 41% received intensive therapy, while 59% received non-intensive therapy. The intensively treated pts in this age range had statistically significantly higher survival rates at 2 years (26% versus 13%, HR: 0.73, 95% CI: 0.54-0.98, P=0.04, Figure). Conclusion: After accounting for underlying prognosis using 2 validated models, we found pts with newly diagnosed AML generally had better survival if they received intensive therapy. This survival benefit was not statistically proven for pts with the highest composite scores (≥10). Early mortality was not increased in older pts given intensive versus non-intensive therapy (Figure), likely due to improvements in supportive care which allowed the greater anti AML effect of intensive therapy to become manifest over time. While we cannot exclude the effects of selection bias, absent a randomized trial our results suggest intensive therapy could be considered for most pts, up to the age of 80 years, regardless of their comorbidity burden. Although results seem better with intensive therapy, less than 50% of patients with composite scores >3 given such therapies were predicted to be alive at 2 years, suggesting the need for randomized clinical trials between novel intensive and non-intensive therapies to achieve better survival. Table 1 Regimen intensity per pt age groups Table 1. Regimen intensity per pt age groups Table 2 Comparisons of hazard ratios (HR) and 2-year rates of survival between intensive and non-intensive initial therapies Table 2. Comparisons of hazard ratios (HR) and 2-year rates of survival between intensive and non-intensive initial therapies Figure. Intensive versus non-intensive therapies among pts aged 70-79 years with AML Figure. Intensive versus non-intensive therapies among pts aged 70-79 years with AML Disclosures Fathi: Bexalata: Other: Advisory Board participation; Celgene: Consultancy, Research Funding; Merck: Other: Advisory Board participation; Agios Pharmaceuticals: Other: Advisory Board participation; Seattle Genetics: Consultancy, Other: Advisory Board participation, Research Funding. Sekeres:Millenium/Takeda: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees. Mukherjee:Novartis: Consultancy, Honoraria, Research Funding; Ariad: Consultancy, Honoraria, Research Funding; Celgene: Consultancy, Honoraria, Research Funding. Wang:Incyte: Speakers Bureau; Immunogen: Research Funding. Shami:JSK Therapeutics: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding