O-073 Perinatal outcomes of infants conceived using partner versus donor sperm - An analysis of singleton and twin pregnancies from the UK national dataset

Study question

Are perinatal outcomes different in pregnancies conceived using donor sperm compared with those with partner sperm?

Summary answer

The perinatal outcomes of singleton and twin pregnancies conceived with donor sperm are better when compared to those conceived with partner sperm

What is known already

There has been a substantial increase in the use of donor sperm in the last 15 years across the world. A recent systematic review and meta-analysis has suggested that there is an increased risk of hypertensive disorders of pregnancy and small for gestational age babies from ART treatment using donor sperm compared to partner`s sperm. This meta-analysis was limited due to poor quality of primary studies often with small sample sizes.

Study design, size, duration

This is a retrospective cohort study on 196,293 singleton and 46,275 twin pregnancies from the Human Fertilisation and Embryology Authority (HFEA) anonymised dataset including all live births from 1991 to 2016. Outcomes were preterm birth ( < 37 weeks); very preterm birth ( < 32 weeks); very low, low, high and very high birth weight ( < 1500g, < 2500g, >4000g and >4500g respectively); congenital anomaly and healthy baby (term live birth with appropriate weight and no congenital anomaly).

Participants/materials, setting, methods

All pregnancies resulting in singleton or twin livebirth were included. Any cycle involving donor oocytes, PGD, gamete intra-fallopian transfer, ectopic pregnancy, miscarriage, stillbirth, or termination was excluded. Logistic regression and generalised estimating equations were used for analysis of singletons and twins, respectively. Odds ratios (aOR) with 95% confidence intervals (CI) for donor versus partner sperm were adjusted for maternal age, previous pregnancy, cause of infertility and year for all outcomes plus gestational age for birthweight.

Main results and the role of chance

Baseline characteristics for donor and partner sperm pregnancies were assessed for singleton and twin livebirths separately. In both analyses there were significant differences between donor and partner sperm pregnancies in terms of maternal age, previous pregnancy status and cause of infertility.

Analysis of singleton births demonstrated an increased odds (aOR, 95% CI) of having a healthy baby (1.09, 1.05 - 1.12) and reduced odds of congenital anomaly (0.34, 0.29 - 0.39), very preterm birth (0.66, 0.58-0.75), preterm birth (0.81, 0.76-0.86), low birthweight 0.89 (0.83 - 0.96) in singleton births using donor sperm compared with those using partner sperm. There was, however, an increased odds of high birthweight (1.10, 1.05 - 1.16) and very high birthweight (1.16, 1.05-1.29) with donor sperm pregnancies.

Analysis of twin births conceived with donor sperm also showed higher odds of having a healthy baby (1.07, 1.01 - 1.15) and lower odds of congenital anomaly (0.52, 0.39 - 0.68) compared with partner sperm. There were no statistically significant differences between the birthweight or birth gestation outcomes for twin pregnancies.

Sensitivity analysis of only cases with complete outcome data showed no significant differences when compared to the primary analysis.

Limitations, reasons for caution

This is a retrospective study of a single nation’s routinely collected data. We could not adjust for confounders such as smoking, BMI and pregnancy complications such as pre-eclampsia, as they are not recorded in HFEA’s dataset.

Wider implications of the findings

Patients and clinicians can be reassured that donor sperm pregnancies are not at higher risk of adverse perinatal outcomes. In fact, they are more likely to result in a healthy baby. Worldwide registries should consider including maternal data to enable a better assessment of outcomes.

Trial registration number

Not applicable

P–775 Obstetric and perinatal outcomes of singleton pregnancies after blastocyst-stage embryo transfer: a systematic review and cumulative meta-analysis

Study question

Are obstetric/perinatal outcomes different in singleton pregnancies following blastocyst-stage embryo transfer when compared to cleavage-stage embryo transfer and have results changed over time?

Summary answer

Pregnancies following blastocyst are consistently associated with higher risk of large for gestational age and lower risk of small for gestational age babies

What is known already

Extended embryo culture to blastocyst-stage is widely used to select best embryos in in vitro fertilisation (IVF) cycles to improve pregnancy rates. Transfer of blastocyst-stage embryos is increasing with this being the default strategy in most clinics. As blastocysts are kept in culture until day 5, 6 or 7 after oocyte fertilisation, there are suggestions that longer exposure to culture media may have a negative impact on pregnancy outcomes. More recent primary studies have challenged some of the initial findings. We therefore conducted an updated systematic review and cumulative meta-analysis (CMA) to examine if these results have changed over time.

Study design, size, duration

Systematic review of studies published between 1980 and 2020, followed by aggregated meta-analysis and CMA to track the accumulation of evidence over the period of time. Exposed group: singleton pregnancies following blastocyst transfer. Non-exposed group: singleton pregnancies following cleavage-stage transfer. Sub-group analyses were conducted on fresh and frozen-thawed embryo transfers. Perinatal (categories of preterm birth and birth weight) and obstetric outcomes (hypertensive disorders of pregnancy, gestational diabetes, c-section, placental anomalies) were compared between the groups.

Participants/materials, setting, methods

Medline, EMBASE, CINHAL, Web of Science, Cochrane Central Register of Clinical Trials and International Clinical Trials Registry Platform databases were searched. Relevant journals were searched for advance access publications. Critical Appraisal Skills Programme (CASP) checklists were used to assess study quality. Two independent reviewers extracted data in 2 × 2 tables. Aggregated and CMA were performed using Comprehensive Meta-Analysis software. Risk ratio (RR) with 95% confidence interval (CI) were calculated.

Main results and the role of chance

A total of 33 observational studies were included (n = 574,756 singleton pregnancies). Pregnancies following blastocyst-stage embryo transfer are associated with a higher risk of preterm birth (PTB) (RR 1.09; 95% CI 1.01–1.17), very preterm birth (VPTB) (RR 1.15; 95% CI 1.07–1.24), large for gestational age (LGA) babies (RR 1.13; 95% CI 1.08–1.19), c-section (RR 1.05; 95% CI 1.02–1.09), and with a lower risk of small for gestational age (SGA) babies (RR 0.86; 95% CI 0.81–0.93) as compared to singleton pregnancies following cleavage-stage embryo transfer.

These findings were maintained in both fresh and frozen-thawed sub-groups for LGA and SGA. PTB was not significantly different in both sub-group analyses. The risk of VPTB was higher after blastocyst-stage embryo transfer only in the sub-group analysis of fresh embryo transfers (RR 1.17; 95% CI 1.09–1.27) and that of c-section only in the frozen-thawed sub-group (RR 1.08; 95% CI 1.04–1.12).

No other statistically significant differences for the other outcomes were noted.

The CMA suggests that for SGA and LGA subsequent studies have increased the precision of the point estimate with no change in the direction or magnitude of the treatment effect since 2014.

Limitations, reasons for caution

This analysis was constrained by the intrinsic limitations of observational studies with some of them receiving a CASP score < 10. Adjustment for confounders was not possible and a high degree of clinical and statistical heterogeneity was noted among studies.

Wider implications of the findings: Blastocyst is associated with a higher risk of LGA and a lower risk of SGA with a stable body of evidence since 2014. We may need to revisit the default position of extending embryo culture and individualise care, until further high-quality data from individual-patient-data of large registries are available.

Trial registration number

Not applicable

POS1449 SEGMENTED SHORT-FORMAT ONLINE EDUCATION SIGNIFICANTLY INCREASES PREDICTION, PROGNOSIS, AND MANAGEMENT OF FIBROSING INTERSTITIAL LUNG DISEASE ASSOCIATED WITH CONNECTIVE TISSUE DISEASE

Background:

Identifying fibrosing interstitial lung disease (ILD) at the earliest opportunity remains one of the most urgent challenges for the effective management of this potentially rapidly progressive and burdensome condition, which is frequently associated with several connective tissue diseases (CTDs). However, knowledge on how to identify early hallmarks and predictors of fibrosing ILD, as well as knowing which steps to take next is frequently lacking in clinical practice.

Objectives:

This study was conducted to determine whether online independent medical education could improve rheumatologists’ and pulmonologists’ knowledge and competence in identifying and managing progressive fibrosing ILDs earlier in the disease course.

Methods:

Rheumatologists and pulmonologists participated in five ~10-min presentations about the early identification of fibrosing ILD in patients with or without CTDs and completed all pre- and post-questions.1 The effects of the education on knowledge and competence were assessed using a 3-question, repeated pairs, pre-assessment/post-assessment study design. For all questions combined, the chi-square test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. The activity launched on October 9, 2020, and data were collected through December 18, 2020.

Results:

Overall significant improvements were seen after participation for both rheumatologists (average correct response rate of 28% at pre-assessment vs 74% at post-assessment; P<.001, representing a 165% relative percentage change [RPC]; N=39), and pulmonologists (average correct response rate of 39% at pre-assessment vs 67% at post-assessment; P<.001, representing a 72% RPC; N=102). Specifically, significant improvements were observed in clinicians’ knowledge of predictors of fibrosing ILD in patients with CTD, as well as competence in selecting the right HRCT parameters to assess prognosis and select a treatment approach to reduce the risk of disease progression (Figure 1).

Figure 1.

After participating in the activity, 59% of rheumatologists and 50% of pulmonologists had measurable improved confidence related to identifying early disease progression in patients with progressive fibrosing ILDs.

Given the very low rates of correct responses at baseline regarding predictors of fibrosing ILD and assessing prognosis, it will be important to continue to reinforce these learnings in ongoing educational programs.

Conclusion:

This study demonstrates the success of segmented online education in improving rheumatologists’ and pulmonologists’ knowledge and competence in evaluating risk and prognosis of fibrosing ILD and managing patients with CTD-ILDs. This could lead to earlier changes in therapeutic approach for those with signs of progression and result in improved overall outcomes for these patients.

References:

[1]Kolb M, Maher T, Smith V, Jacob J, Rimekasten G. Catching and Managing Progressive Fibrosing Interstitial Lung Disease Progression Earlier. Launched: Oct 9, 2020. Data as of Dec 18, 2020. Available at www.medscape.org/viewarticle/938826

Disclosure of Interests:

Christy Rohani-Montez: None declared, Marinella Calle: None declared, Chris Allen: None declared, Toby Maher Speakers bureau: Astra Zeneca, Bayer, Blade Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Galapagos, Galecto, GlaxoSmithKline R&D, Indalo, IQVIA, Pliant, Respivant, Roche and Theravance, Consultant of: Astra Zeneca, Bayer, Blade Therapeutics, Boehringer Ingelheim, Bristol-Myers Squibb, Galapagos, Galecto, GlaxoSmithKline R&D, Indalo, IQVIA, Pliant, Respivant, Roche and Theravance, Grant/research support from: Astra Zeneca and GlaxoSmithKline R&D, Vanessa Smith Speakers bureau: Boehringer-Ingelheim Pharma GmbH&Co and Janssen-Cilag NV, Consultant of: Boehringer-Ingelheim Pharma GmbH&Co, Grant/research support from: Research Foundation - Flanders (FWO), Belgian Fund for Scientific Research in Rheumatic diseases (FWRO), Boehringer-Ingelheim, Pharma GmbH&Co, and Janssen-Cilag NV, Joseph Jacob Speakers bureau: Boehringer-Ingelheim; Roche, Consultant of: Boehringer-Ingelheim, Grant/research support from: GlaxoSmithKline, Gabriela Riemekasten Speakers bureau: AbbVie; Actelion; Boehringer-Ingelheim, Consultant of: Actelion; CellTrend; Janssen, Grant/research support from: AbbVie; Actelion, Martin Kolb Speakers bureau: AstraZeneca; Boehringer-Ingelheim; Novartis; Roche, Consultant of: AbbVie Inc.; Algernon Pharma; AstraZeneca;, Boehringer-Ingelheim; Cipla; Covance; EPG Health; Galapagos NV; Gilead; GlaxoSmithKline; Indalo; MitoImmune Therapeutics Inc; Novartis; Pieris; Prometic (now Liminal Biosciences); Roche; Third Pole Inc.; TwoXAR Inc., Grant/research support from: Boehringer-Ingelheim; GlaxoSmithKline; Novartis; Prometic; Roche; Avalyn

Seven-year retrospective study understanding the latent TB infection treatment cascade of care among adults in a low incidence country

Background

Prevention of TB is paramount to achieving elimination targets as recommended by the World Health Organization’s action framework for low incidence countries striving to eliminate TB. Although the rates of TB in Canada are low, understanding the latent TB infection (LTBI) cascade is paramount to identifying gaps in care and treatment barriers, thereby increasing the effectiveness of preventive strategies. The purpose of this study was to examine the LTBI cascade of care and identify barriers to treatment completion in adults referred from primary care to a regional tertiary care TB clinic in Ottawa, Canada.

Methods

Electronic medical records between January 2010 and December 2016 were reviewed retrospectively and an LTBI cascade of care was constructed from The Ottawa Hospital TB clinic and surrounding primary care clinics. A cohort of 2207 patients with untreated LTBI was used to ascertain the associations between demographic and clinical factors for both treatment non-initiation and non-completion using log-binomial univariable and multivariable regression models.

Results

Of 2207 patients with untreated LTBI who were seen in the clinic during the study period, 1771 (80.2%) were offered treatment, 1203 (67.9% of those offered) started treatment, and 795 (66.1% of those started) completed treatment. In multivariable analysis, non-initiation of treatment was associated with older age (adjusted risk ratio [aRR] 1.06 per 5-year increase, 95% CI: 1.03–1.08) and female gender (aRR 1.28, 95% CI: 1.11–1.47). Non completion of treatment was associated with referral from the TB Clinic back to the primary care team following initial consult (aRR 1.62, 95% CI: 1.35–1.94) and treatment with the standard of 9 months of Isoniazid (9H) compared to 4 months of Rifampin (4R) (aRR 1.45, 95% CI:1.20–1.74).

Conclusions

LTBI treatment completion was significantly decreased among patients who were referred back to primary care from the TB clinic. The 4R regimen resulted in more people completing LTBI treatment compared to 9H in keeping with a recently published RCT. Improved education, communication, and collaboration between tertiary care TB clinics and primary care teams may improve treatment completion rates and address the TB burden in low incidence communities in Canada.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10733-9.

Diagnostic Challenges And Clinical Implications For Systemic EBV-Associated T-Cell Lymphoproliferative Disorders Of Childhood

Introduction/Objective

Systemic EBV-associated T-cell lymphoproliferative disorders of childhood (S-EBV-T-LPD) comprise three major forms: EBV-positive hemophagocytic lymphohistiocytosis (EBV-HLH), systemic EBV-positive T- cell lymphoma (S-EBV-TCL), and systemic T-cell chronic active EBV infection (S-T-CAEBV). These disorders are rare in children and young adults in Western countries and are associated with poor outcomes. Frequently patients were treated initially for EBV-HLH and subsequently found to have relapsed/refractory EBV-HLH vs S-EBV-TCL or overt EBV+ TCL, the latter of which requires different therapy than EBV-HLH. We report the clinicopathologic findings of 13 cases, including 8 previously reported. (PMID: 31099136)

Methods

Thirteen cases of S-EBV-T-LPD were identified at Texas Children’s Hospital from 1990 to 2020. Clinicopathologic and relevant laboratory parameters were recorded.

Results

Patients included six females and seven males of Hispanic (n=6), Asian (4), and Caucasian origins (3) ages 1-22 years (median 2). All had fever, hepatosplenomegaly, cytopenias, abnormal EBV serologies, and significantly elevated peripheral blood EBV- DNA load by quantitative PCR. Histologic features were variable ranging from EBV+ T-cell infiltrates with subtle architectural distortion and mild atypia to overt morphologic appearance of lymphoma.

Consistent findings were aberrant T-cell populations identified by immunohistochemistry (n=4) or bone marrow flow cytometry (n=9, 1-50%, mean 16%). Five patients were classified as overt EBV+ TCL with abnormal karyotyping identified in 3. Seven patients had pathology findings indistinguishable between EBV-HLH and S-EBV-TCL and were classified as EBV-HLH/S-EBV-TCL. One patient had S-T-CAEBV. Outcomes were dismal after HLH-directed immuno/chemotherapy protocols with/without bone marrow transplant as only three EBV-HLH/S-EBV-TCL patients were alive at 1.5, 2.5 months, and 9 years follow-up.

Conclusion

This series from North America demonstrate challenges in the diagnosis and management of S-EBV-T- LPD cases. Particularly, EBV-HLH and S-EBV-TCL, which require vastly different treatment strategies, may initially present with overlapping clinicopathological features. Further studies are needed to address clear diagnostic criteria to guide appropriate management.

AB1272 ONLINE EDUCATION BOOSTS CLINICIAN KNOWLEDGE ABOUT EMERGING THERAPIES FOR PATIENTS WITH SYSTEMIC SCLEROSIS-ASSOCIATED INTERSTITIAL LUNG DISEASE

Background:

Systemic sclerosis-associated interstitial lung disease (SSc-ILD) has traditionally been treated with therapies such as cyclophosphamide, mycophenolate mofetil, and hematopoietic stem cell transplantation. However, these therapies are limited by potential toxicity, as well as duration and magnitude of effect. Clinicians need awareness of emerging therapies in late-stage clinical trials that may address these limitations.

Objectives:

This study was conducted to determine whether online independent medical education could improve rheumatologists’ and pulmonologists’ knowledge of emerging therapies for the management of SSc-ILD.

Methods:

Physicians (N = 2,076) participated in a 30-minute, 2-faculty, video-based, online CME with synchronized slides.1The majority of participants were rheumatologists (n = 522) or pulmonologists (n = 557), but the cohort also included clinical immunologists (n = 132) and other physicians with an interest in the topic (n = 865). This study focuses on the 120 rheumatologists and 111 pulmonologists who completed all pre- and post-questions. The effects of the education on knowledge was assessed using a 3-question, repeated pairs, pre-assessment/post-assessment study design. For all questions combined, the chi-square test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. The activity launched on September 17, 2019, and data were collected through November 5, 2019.

Results:

Overall significant improvements were seen after participation for both rheumatologists (average correct response rate of 55% at pre-assessment vs 75% at post-assessment; P<.001, N=120), and pulmonologists (average correct response rate of 60% at pre-assessment vs 77% at post-assessment; P<.001, N=111). Specifically, significant improvements were observed in clinicians’ knowledge of clinical trial data for emerging SSc-ILD therapies (figure).

Figure.

Clinicians from APAC (n = 67) and Europe (n = 79) made up the majority of the cohort, and had similar rates of correct responses without significant differences, indicating consistent effects, independent of the region of origin. After participating in the activity, 48% of pulmonologists and rheumatologists had measurable improved confidence related to their knowledge of emerging therapies for patients with SSc-ILD.

Despite the increases in knowledge and confidence observed, the rates of correct responses suggest there is still room for improvement; therefore, ongoing education will be needed to reinforce knowledge of the latest data evaluating new therapies for SSc-ILD and what they will mean for future practice.

Conclusion:

This study demonstrates the success of online, video-based education in improving rheumatologists’ and pulmonologists’ knowledge of the latest clinical data on emerging therapies for SSc-ILD. This could lead to earlier adoption of new, efficacious therapies that may slow disease progression and improve overall outcomes for these patients.

References:

[1]Distler O, Hoffmann-Vold A-M. How Can We Meet the Treatment Needs of Patients With Systemic Sclerosis-Interstitial Lung Disease? Launched: 9/17/2019. Data as of 11/5/2019. Available atwww.medscape.org/viewarticle/917034

Disclosure of Interests:

Christy Rohani-Montez: None declared, Marinella Calle: None declared, Chris Allen: None declared, Anna-Maria Hoffmann-Vold Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Actelion, Bayer, GlaxoSmithKline, Speakers bureau: Boehringer Ingelheim, Actelion, Roche, Oliver Distler Grant/research support from: Grants/Research support from Actelion, Bayer, Boehringer Ingelheim, Competitive Drug Development International Ltd. and Mitsubishi Tanabe; he also holds the issued Patent on mir-29 for the treatment of systemic sclerosis (US8247389, EP2331143)., Consultant of: Consultancy fees from Actelion, Acceleron Pharma, AnaMar, Bayer, Baecon Discovery, Blade Therapeutics, Boehringer, CSL Behring, Catenion, ChemomAb, Curzion Pharmaceuticals, Ergonex, Galapagos NV, GSK, Glenmark Pharmaceuticals, Inventiva, Italfarmaco, iQvia, medac, Medscape, Mitsubishi Tanabe Pharma, MSD, Roche, Sanofi and UCB, Speakers bureau: Speaker fees from Actelion, Bayer, Boehringer Ingelheim, Medscape, Pfizer and Roche

THU0584 CASE-BASED ONLINE EDUCATION SIGNIFICANTLY INCREASES CLINICIAN COMPETENCE IN ASSESSING SSC-ILD DISEASE PROGRESSION AND IMPLEMENTING APPROPRIATE THERAPY

Background:

Due to the heterogeneity in both the initial manifestations of systemic sclerosis (SSc) and progression with SSc-associated interstitial lung disease (SSc-ILD), diagnosis and prognosis can be challenging in clinical practice. Clinicians need expert case-based guidance on how best to monitor patients with SSc and the treatment implications.

Objectives:

This study was conducted to determine whether online case-based independent medical education could improve rheumatologists’ and pulmonologists’ competence in evaluating and monitoring SSc-ILD progression and initiating the right treatments when progression is identified.

Methods:

Rheumatologists and pulmonologists participated in two comprehensive online case studies, using a ‘test then teach’ approach and completed all pre- and post-questions.1The effects of the education on knowledge and competence were assessed using a 3-question, repeated pairs, pre-assessment/post-assessment study design. For all questions combined, the chi-square test assessed differences from pre- to post-assessment. P values <.05 are statistically significant. The activity launched on September 24, 2019, and data were collected through December 9, 2019.

Results:

Overall significant improvements were seen after participation for both rheumatologists (average correct response rate of 65% at pre-assessment vs 97% at post-assessment; P<.001, N=89), and pulmonologists (average correct response rate of 64% at pre-assessment vs 95% at post-assessment; P<.001, N=71). Specifically, significant improvements were observed in clinicians’ competence in assessing response to therapy and monitoring for disease progression; and managing evidence of disease worsening (figure).

Figure.

After participating in the activity, 54% of rheumatologists and 51% of pulmonologists had measurable improved confidence related to communicating with patients with SSc-ILD about the possibility of disease progression.

Given that only around half of clinicians provided correct responses at baseline, it will be important to continue to reinforce these learnings in ongoing education.

Conclusion:

This study demonstrates the success of online, case-based education in improving rheumatologists’ and pulmonologists’ competence in managing patients with SSc-ILD. This could lead to earlier changes in therapeutic approach for those with signs of progression and result in improved overall outcomes for these patients.

References:

[1]Denton C. When SSc-ILD Starts Progressing: Monitoring and Managing Those at Risk for Poor Prognosis. Launched: 9/24/2019. Data as of 12/9/2019. Available atwww.medscape.org/viewarticle/918465

Disclosure of Interests:

Christy Rohani-Montez: None declared, Marinella Calle: None declared, Chris Allen: None declared, Christopher Denton Grant/research support from: GlaxoSmithKline, CSL Behring, and Inventiva, Consultant of: Medscape, Roche-Genentech, Actelion, GlaxoSmithKline, Sanofi Aventis, Inventiva, CSL Behring, Boehringer Ingelheim, Corbus Pharmaceuticals, Acceleron, Curzion and Bayer

Progress in High-Speed Spin Testing of Superconducting Wire and Tapes for High-Field NMR Magnet Qualification

This paper summarizes the status of a 3-year, NIH-funded research project to study the strength of high temperature superconductors under high circumferential hoop stress, in order to qualify these materials for high-field (> 1 GHz-class NMR magnets. The unique approach presented here is to spin test coils at high rotational speeds, approaching 100,000 rpm, in order to induce the necessary hoop stress. Thermal strain compatibility between the Bi-2212 wire and Inconel wire has been qualified, including thermal cycling. Assembly and testing of the first low-speed (< 30,000 rpm) rotor is now in process, and the design of second, higher speed (> 60,000 rpm) rotor, is also underway.

P6484Invasive and non-invasive characterisation of low gradient aortic stenosis

Background

Low gradient severe aortic stenosis (LGAS) is associated with unfavourable outcomes when compared to high gradient aortic stenosis (HGAS), yet the contributing pathophysiology is poorly understood.

Methods

Symptomatic LGAS and HGAS patients undergoing trans-catheter aortic valve implantation (TAVI) underwent 3T stress perfusion cardiac magnetic resonance imaging (CMR) pre-(within 24 hours) and post-(4–6 months) TAVI. Left ventricular (LV) contractility and coronary flow/pressure were measured during hyperaemia and rapid pacing, immediately before and after TAVI, using a conductance LV catheter and dual-pressure and Doppler sensor–tipped guidewire in the mid-left anterior descending coronary artery.

Results

24 patients were recruited resulting in 19 suitable datasets (LGAS N=9, HGAS N=10, equally matched for comorbidities and B-natriuretic peptide level). LGAS patients had a smaller LV end diastolic volume index (p=0.035) and lower LV mass index (LVMI) (p=0.037). Pre-TAVI stress global endocardium-epicardium gradient was 0.88±0.09 and global myocardial perfusion reserve (MPR) 2.0±0.48 in 14 patients (6 LGAS and 8 HGAS patients, no difference between groups). Pre-TAVI, baseline coronary data demonstrated lower augmentation pressure (AP, p=0.035) and augmentation index (AIx, p=0.02) in the LGAS group. LGAS patients also exhibited a shorter ejection time (p=0.015), larger forward compression waves during rest, hyperaemia and rapid pacing, and smaller backward expansion waves (BEW) (p=0.001). Lower baseline end systolic pressure (p=0.004), inotropy (dP/dt+, p=0.045), lusitropy (dP/dt-, p=0.069), and stroke work (p=0.019) were observed in the LGAS group. Whilst LV size was smaller the LGAS group, rapid pacing induced a more significant drop in end systolic volume (p=0.045) and ejection fraction (p=0.015) in patients with HGAS. Post-TAVI, the hyperaemic BEW fell sharply (p<0.001), along with coronary VTI (p=0.02), and average pulse velocity (p=0.028), and AP and AIx remained lower (p=0.034 and p=0.031, respectively). The forward expansion wave was reduced in LGAS during rapid pacing. The HGAS group displayed a more profound drop in dP/dt+ (p=0.011) and dP/dt- p=0.014) at rest following intervention. Repeat CMR demonstrated statistically significant reduction in LV size and LVMI (p=0.012 and p<0.001, respectively) with significant increase in 3D global peak radial, circumferential and longitudinal strain (p=0.004, p=0.001 and p=0.018, respectively). Post-TAVI stress global endocardium-epicardium gradient was 0.88±0.13 and MPR 2.46±0.59 (improved from pre-TAVI, p=0.05). There was no difference in remodelling patterns or perfusion between the two groups.

Conclusion

This is the first study detailing the combined invasive and CMR pathophysiological changes in LGAS. Despite invasive parameters indicating a disease of less severe AS, the level of perfusion abnormality is disproportionate which may in part, relate to their adverse prognosis.

Acknowledgement/Funding

This research is funded by a Clinical Research Training Fellowship grant from the British Heart Foundation (FS/16/51/32365).

High flow rate nanofluidics for in-liquid electron microscopy and diffraction

We introduce a nanofluidic platform that can be used to carry out femtosecond electron diffraction (FED) and transmission electron microscopy (TEM) measurements in liquid samples or in-liquid specimens, respectively. The nanofluidic cell (NFC) system presented herein has been designed to withstand high sample refreshing rates (over one kilohertz), a prerequisite to succeed with FED experiments in our lab. Short beam paths, below 1 μm, in combination with ultrathin membranes (less than 100 nm thick) are necessary conditions for in-liquid FED and TEM studies due to the strongly interacting nature of electrons. Depending on the application, the beam path in our NFC can be tuned between 50 nm and 10 μm with ultrathin stoichiometric silicon nitride (Si₃N₄) windows as thin as 20 nm. Stoichiometric Si₃N₄ has been selected to reduce membrane bulging owing to its higher tensile stress and transparency in the UV-vis-NIR region to allow for laser excitation in FED experiments. Key design parameters and improvements made over previous NFC systems are discussed, and some preliminary electron images obtained by 200 kV scanning TEM are presented.

Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment

INTRODUCTION

The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas.

MATERIALS AND METHODS

A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively.

RESULTS

Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture.

CONCLUSIONS

This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.

Preparation for fatherhood: A role for olfactory communication during human pregnancy?

There is evidence across a range of bi-parental species that physiological changes may occur in partnered males prior to the birth of an infant. It has been hypothesised that these hormonal changes might facilitate care-giving behaviours, which could augment infant survival. The mechanism that induces these changes has not been identified, but evidence from several species suggests that odour may play a role. The current study investigated this in humans by recording testosterone and psychological measures related to infant interest and care in men (n = 91) both before and after exposure to odours from either pregnant women or non-pregnant control women. We found no evidence for an effect of odour cues of pregnancy on psychological measures including self-reported sociosexual orientation and social dominance scores, ratings of infant or adult faces, or testosterone levels. However, we found that brief exposure to post-partum odours significantly increased the reward value of infant faces. Our study is the first to show that the odour of peri-partum women may lead to upregulation of men's interest in infants.