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To our knowledge, this is the largest American single-center experience demonstrating that CBE-EMR with close endoscopic surveillance is an effective treatment modality for BE with HGD/IMC. Although the rate of stenosis development is significant, it is easily treated by endoscopic dilation. Patients considering endoscopic ablation should be counseled appropriately. The role of CBE-EMR in patients with lymphatic invasion or superficial submucosal invasion remains to be defined.

BACKGROUNDWe identified an outbreak of AmpC–producingEscherichia coliinfections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in ablaCMYgene and a distinctivefumC/ fimHtyping profile.OBJECTIVETo determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CRE. coliand AmpCE. colicirculating at hospital A.METHODSWe reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identicalblaCMY-2,fumC, andfimHalleles or related pulsed-field gel electrophoresis patterns.RESULTSThirty-five of 49 AmpCE. colitested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer’s recommended cleaning guidelines.CONCLUSIONRecommended reprocessing guidelines are not sufficient.Infect Control Hosp Epidemiol2015;00(0): 1–9

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Wine grape pomace (WGP) as a source of antioxidant dietary fiber (DF) was used to fortify baked goods, including breads, muffins, and brownies. Pinot Noir WGP (RWGP) and Pinot Grigio WGP (WWGP) substituted wheat flour at concentration of 5%, 10%, and 15% for bread, 10%, 15%, 20%, and 25% RWGP for brownies, and 5%, 10%, and 15% RWGP or 10%, 15%, and 20% WWGP for muffins. The finished products were evaluated for total phenolic content (TPC), radical scavenging activity (RSA), and total DF, as well as physicochemical and sensory properties. WGP flour blends were also tested for solvent retention capacity (SRC). The highest TPC and RSA values for bread and muffins were achieved in 15% RWGP fortified samples with TPC and RSA values of 68.32 mg gallic acid equivalent (GAE)/serving and 80.70 AAE mg/serving, respectively for bread, and 2164 mg GAE/serving and 1526 mg AAE/serving, respectively for muffins. Brownies fortified with 10% RWGP had the highest RSA value (115.52 mg AAE/serving) while the control had the highest TPC value (1152 mg GAE/serving). Breads and muffins with 15% RWGP and brownies with 25% RWGP had the highest amount of DF (6.33, 12.32, and 7.73 g/serving, respectively). Sensory evaluation concluded that there is no difference in overall liking of 5% and 10% RWGP breads and muffins or 15% and 20% WGP brownies compared to the controls. This study demonstrated that WGP is a viable functional ingredient in bakery goods to increase TPC, RSA, and DF in consumer's diets.

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