Influencing factors on the safety and effectiveness of venom immunotherapy

BACKGROUND AND OBJECTIVE

The safety profile of venom immunotherapy (VIT) is a relevant issue and considerable differences in safety and efficacy of VIT have been reported. The primary aim of this study was to evaluate the safety of ACE inhibitors and beta-blockers during VIT, which has already been published. For a second analysis, data concerning premedication and venom preparations in relation to systemic adverse events (AE) during the up-dosing phase and the first year of the maintenance phase were evaluated as well as the outcome of field stings and sting challenges.

METHODS

The study was conducted as an open, prospective, observational, multicenter study. In total, 1,425 patients were enrolled and VIT was performed in 1,342 patients.

RESULTS

Premedication with oral antihistamines was taken by 52.1% of patients during the up-dosing and 19.7% of patients during the maintenance phase. Taking antihistamines had no effect on the frequency of systemic AE (p=0.11) but large local reactions (LLR) were less frequently seen (OR: 0.74; 95% CI: 0.58-0.96; p=0.02). Aqueous preparations were preferentially used for up-dosing (73.0%) and depot preparations for the maintenance phase (64.5%). The type of venom preparation neither had an influence on the frequency of systemic AE nor on the effectiveness of VIT (p=0.26 and p=0.80, respectively), while LLR were less frequently seen when depot preparations were used (p<0.001).

CONCLUSION

Pretreatment with oral antihistamines during VIT significantly reduces the frequency of LLR but not systemic AE. All venom preparations used were equally effective and did not differ in the frequency of systemic AE.

Nivolumab for locally advanced and metastatic cutaneous squamous cell carcinoma (NIVOSQUACS study)-Phase II data covering impact of concomitant haematological malignancies

BACKGROUND

Monoclonal antibodies, such as cemiplimab and pembrolizumab, against the programmed death receptor (PD)-1 have become the current standard of care and first-line treatment of advanced cutaneous squamous cell carcinoma (cSCC), proving remarkable clinical benefit and acceptable safety.

OBJECTIVES

To assess efficacy and safety of the anti-PD-1 antibody nivolumab in patients with locally advanced and metastatic cSCC.

METHODS

Patients received open-label nivolumab 240 mg intravenously every 2 weeks for up to 24 months. Patients with concomitant haematological malignancies (CHMs), either non-progressing or stable under active therapy, were eligible for inclusion.

RESULTS

Of 31 patients with a median age of 80 years, 22.6% of patients achieved an investigator assessed complete response, resulting in an objective response rate (ORR) of 61.3% and a disease control rate (DCR) of 64.5%. Progression-free survival (PFS) was 11.1 months, and the median overall survival (OS) was not reached after 24 weeks of therapy. Median follow-up was 23.82 months. Subgroup analysis of the CHM cohort (n = 11; 35%) revealed an ORR of 45.5%, a DCR of 54.5%, a median PFS of 10.9 months, and median OS of 20.7 months. Treatment related adverse events were reported in 58.1% of all patients (19.4% grade 3, the remaining grade 1 or 2). PD-L1 expression and CD-8+ T-cell infiltration did not significantly correlate with clinical response, although a trend towards a shorter PFS of 5.6 months was observed with PD-L1 negativity and low CD8+ intratumoral infiltration.

CONCLUSION

This study demonstrated robust clinical efficacy of nivolumab in patients with locally advanced and metastatic cSCCs and a tolerability comparable to data of other anti-PD-1 antibodies. Favourable outcomes were obtained despite involving the oldest hitherto reported study cohort for anti-PD-1 antibodies and a significant proportion of CHM patients prone to high risk tumours and an aggressive course otherwise typically excluded from clinical trials.

SAR user guide to the rectal MR synoptic report (primary staging)

Rectal MR is the key diagnostic exam at initial presentation for rectal cancer patients. It is the primary determinant in establishing clinical stage for the patient and greatly impacts the clinical decision-making process. Consequently, structured reporting for MR is critically important to ensure that all required information is provided to the clinical care team. The SAR initial staging reporting template has been constructed to address these important items, including locoregional extent and factors impacting the surgical approach and management of the patient. Potential outputs to each item are defined, requiring the radiologist to commit to a result. This provides essential information to the surgeon or oncologist to make specific treatment deisions for the patient. The SAR Initial Staging MR reporting template has now been officially adopted by the NAPRC (National Accreditation Program for Rectal Cancer) under the American College of Surgery. With the recent revisions to the reporting template, this user guide has been revamped to improve its practicality and support to the radiologist to complete the structured report. Each line item of the report is supplemented with clinical perspectives, images, and illustrations to help the radiologist understand the potential implications for a given finding. Common errors and pitfalls to avoid are highlighted. Ideally, rectal MR interpretation should not occur in a vacuum but in the context of a multi-disciplinary tumor board to ensure that healthcare providers use common terminology and share a solid understanding of the strengths and weaknesses of MR.

Beliefs regarding COVID-19 vaccines among Canadian workers in the intellectual disability sector prior to vaccine implementation

BACKGROUND

Workers supporting adults with intellectual disabilities (ID) experience significant stress in their essential role during COVID-19 due to the high risk of their clients contracting COVID-19 and having adverse outcomes. The purpose of the current study was to describe the attitudes of workers towards COVID-19 vaccination prior to vaccination rollout, with a view to informing strategies to promote vaccine uptake within this high-risk sector.

METHODS

An online survey was sent via email to workers supporting adults with ID in Ontario, Canada, between January 21 and February 3, 2021 by agency leadership and union representatives.

RESULTS

Three thousand and three hundred and seventy-one workers, representing approximately 11.2% of Ontario workers supporting adults with ID completed an online survey. Most reported that they were very likely (62%) or likely (20%) to get a COVID-19 vaccine (vaccination intent) although 18% reported they were less likely to do so (vaccination nonintent). Workers with vaccination nonintent were younger and were more likely to endorse the beliefs that (1) it will not benefit them or those around them, (2) it was not part of their job, (3) rapid development confers uncertainties and risks, and (4) they were scared of potential vaccine side effects.

CONCLUSIONS

There is need to address common misconceptions among workers supporting adults with ID to help activate them as vaccine advocates in the communities they serve. Partnered efforts between workers, unions and agency leadership with public health experts to address concerns are required.

Peanut-induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry

BACKGROUND

Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents.

METHODS

Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre.

RESULTS

3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004).

CONCLUSIONS

The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.

Feasibility and accuracy of the automated software for dynamic quantification of left ventricular and atrial volumes and function in a large unselected population

Funding Acknowledgements

Type of funding sources: None.

Objective. Preliminary studies showed the accuracy of machine learning based automated dynamic quantification of left ventricular (LV) and left atrial (LA) volumes. We aimed to evaluate the feasibility and accuracy of machine learning based automated dynamic quantification of LV and LA volumes in an unselected population.

Methods. We enrolled 600 unselected patients (12% in atrial fibrillation) clinically referred for transthoracic echocardiography (2DTTE), who also underwent 3D echocardiography (3DE) imaging. LV ejection fraction (EF), LV and LA volumes were obtained from 2D images; 3D images were analysed using Dynamic Heart Model (DHM) software (Philips) resulting in LV and LA volume-time curves. A subgroup of 140 patients underwent also cardiac magnetic resonance (CMR) imaging. Average time of analysis, feasibility, and image quality were recorded and results were compared between 2DTTE, DHM and CMR.

Results. The use of DHM was feasible in 522/600 cases (87%). When feasible, the boundary position was considered accurate in 335/522 patients (64%), while major (n = 38) or minor (n = 149) borders corrections were needed. The overall time required for DHM datasets was approximately 40 seconds, resulting in physiologically appearing LV and LA volume–time curves in all cases. As expected, DHM LV volumes were larger than 2D ones (end-diastolic volume: 173 ± 64 vs 142 ± 58 mL, respectively), while no differences were found for LV EF and LA volumes (EF: 55%±12 vs 56%±14; LA volume 89 ± 36 vs 89 ± 38 mL, respectively). The comparison between DHM and CMR values showed a high correlation for LV volumes (r = 0.70 and r = 0.82, p &lt; 0.001 for end-diastolic and end-systolic volume, respectively) and an excellent correlation for EF (r= 0.82, p &lt; 0.001) and LA volumes.

Conclusions. The DHM software is feasible, accurate and quick in a large series of unselected patients, including those with suboptimal 2D images or in atrial fibrillation.

Table 1 DHM quality Adjustment Feasibility Good Suboptimal Minor Major Total of patients (n, %) 522/600 (87%) 327/522 (62%) 195/522 (28%) 149/522 (29%) 38/522 (6%) Normal subjects (n, %) 39/40 (97%) 23/39 (57%) 16/39 (40%) 9/39 (21%) 1/39 (3%) Atrial Fibrillation (n, %) 59/73 (81%)* 28/59 (47%) 31/59 (53%) 15/59 (25%) 6/59 (10%) Valvular disease (n, %) 271/312 (87%) 120/271 (%) 151/271 (%) 65/271 (24%) 16/271 (6%) Coronary artery disease (n, %) 47/58 (81%)* 26/47 (46%) 21/47 (37%) 16/47 (34%) 5/47 (11%) Miscellaneous (n, %) 24/25 (96%) 18/24 (75%) 6/24 (25%) 5/24 (21%) 3/24 (12%) Feasibility of DHM, image quality and need to adjustments in global population and in each subgroup. Abstract Figure 1

Restoration of normal sinus rhythm in atrial fibrillation: impact of reverse remodelling of right chambers on tricuspid regurgitation severity

Background

The severity of tricuspid regurgitation (TR) in patients with restored normal sinus rhythm (SR) after atrial fibrillation (AF) has been poorly assessed.

Purpose

Our study aimed to assess (1) right chamber remodelling and (2) TR severity in patients with AF who have had their rhythms restored to normal sinus.

Methods

We prospectively evaluated 94 consecutive patients hospitalized for AF who received either ablation, direct current cardioversion, or pharmacological therapy. Patients were divided into two groups according to their cardiac rhythm at 6 months follow up (6M): restoration to SR (SR group, n=54), persistence of AF (AF group, n=40). TR vena contracta (VC), TR grade severity was divided into 4 grades using an integrated approach (0: none or trace; 1: mild; 2: moderate; 3: severe TR). Two dimensional (2D) end diastolic (ED) tricuspid annulus (TA) diameter in the apical 4 chambers view, three-dimensional (3D) indexed volumes (3D Vi) of the right atrium (RA) and right ventricle (RV) in end systole (ES) and ED were acquired using transthoracic echocardiography at admission and at 6M.

Results

At 6M, in the SR group a significant improvement in TR VC (Figure A) and TR grade (Figure B) were noted, whereas there was no differences in the AF group (0.41 vs. 0.42cm, p=0.24 for TR VC; 1.70 vs. 1.76, p=0.16 for mean TR grade). In the SR group a significant reduction in 3D ES RV Vi, 2D ED TA diameter, 3D ES and ED Vi of the RA (Table) were observed. Regression of TR VC was correlated with regression of right cavities parameters (ρ=0.47, p&lt;0.001 for 2D ED TA diameter; ρ=0.34, p&lt;0.005 for 3D ES RA Vi; ρ=0.33, p&lt;0.005 for 3D ED RV Vi; ρ=0.29, p&lt;0.005 for 3D ES RV Vi).

Conclusion

Restoration of normal SR in patients with AF results in beneficial remodelling of right cavities at 6M of follow-up which were associated with a significant decrease in TR severity. Strategies for normal SR restoration in patients with AF and TR should be vigorously attempted.

TR Evolution

Funding Acknowledgement

Type of funding source: None

Artificial intelligence-guided image acquisition on patients with implanted electrophysiological devices: results from a pivotal prospective multi-center clinical trial

Background

A novel, recently FDA-authorized software uses deep learning (DL) to provide prescriptive transthoracic echocardiography (TTE) guidance, allowing novices to acquire standard TTE views. The DL model was trained by &gt;5,000,000 observations of the impact of probe motion on image orientation/quality. This study evaluated whether novice-acquired TTE images guided by this software were of diagnostic quality in patients with and without implanted electrophysiological (EP) devices, focusing on RV size and function, which were thought to be sensitive to EP devices. Some aspects of the study have previously been presented.

Methods

240 patients (61±16 years old, 58% male, 33% BMI &gt;30 kg/m2, 91% with cardiac pathology) were recruited. 8 nurses without echo experience each acquired 10 view TTEs in 30 patients guided by the software. 235 of the patients were also scanned by a trained sonographer without assistance from the software. 5 Level 3 echocardiographers independently assessed the diagnostic quality of the TTEs acquired by the nurses and sonographers to evaluate the effect of EP devices on DL software performance.

Results

Nurses using the AI-guided acquisition software acquired TTEs of sufficient quality to make qualitative assessments of right ventricular (RV) size and function in greater than 80% of cases for patients with and without implanted EP devices (Table). There was no significant difference between nurse- and sonographer-acquired scans.

Conclusion

These results indicate that new DL software can guide novices to obtain TTEs that enable qualitative assessment of RV size even in the presence of implanted EP devices. The results of the comparison to sonographer-acquired exams indicate the software performance is robust to presence of pacemaker/ICD leads visible in the images (Figure).

Nurse-acquired TTE with visible ICD lead

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Caption Health, Inc.

Impact of rhythm in non-valvular atrial fibrillation on four cardiac chamber deformation imaging

Background

Few studies have assessed the evolution of cardiac chambers deformation imaging in patients with atrial fibrillation (AF) according to cardiac rhythm outcome.

Purpose

To evaluate cardiac chamber deformation imaging in patients admitted for AF and the evolution at 6-month follow-up (M6).

Methods

In forty-one consecutive patients hospitalised for AF two-dimensional transthoracic echocardiography was performed at admission (M0) and after six months (M6) of follow up. In addition to the usual parameters of chamber size and function, chamber deformation imaging was obtained including global left atrium (LA) and right atrium (RA) reservoir strain, global left ventricular (LV) and right ventricular (RV) free wall longitudinal strain. Patients were divided into three groups according to their cardiac rhythm at M0 and M6: AF at M0 and sinus rhythm (SR) at M6 (AF-SR) (n=23), AF at M0 and AF at M6 (AF-AF) (n=11), SR at M0 (spontaneous conversion before the first echocardiography exam) and SR in M6 (SR-SR) (n=7)

Results

In comparison with SR patients (n=7), at M0, AF patients (n=34)) had lower global LA reservoir strain (+5.2 (+0.4 to 12.8) versus +33.2 (+27.0 to +51.5)%; p&lt;0.001), lower global RA reservoir strain (+8.6 (−5.4 to 11.6) versus +24.3 (+12.3 to +44.9)%; p&lt;0.001), lower global LV longitudinal strain (respectively −12.8 (−15.2 to −10.4) versus −19.1 (−21.8 to −18.3)%; p&lt;0.001) and lower global RV longitudinal strain (respectively −14.2 (−17.3 to −10.7) versus −23.8 (−31.1 to −16.2)%; p=0.001). When compared with the AF-SR group at M0 the AF-AF group had no significant differences with regard to global LA and RA reservoir strain, global LV and RV longitudinal strain (Table). Between M0 and M6 there was a significant improvement in global longitudinal strain of the four chambers in the AF-SR group whereas no improvements were noted in the AF-AF and SR-SR group (Figure).

Conclusion

Initial atrial and ventricular deformations were not associated with rhythm outcome at six-month follow up in AF. The improvement in strain in all four chambers strain suggests global reverse remodelling all cardiac cavities with the restoration of sinus rhythm.

Evolution of strain between M0 and M6

Funding Acknowledgement

Type of funding source: None

1184 Evaluation Of A Novel Sleep Medicine Educational Program For The Primary Care Provider

Introduction

Inadequate exposure to and insufficient training in sleep medicine across the medical education continuum contributes to a lack of patient access to sleep care. We created a self-directed learning curriculum in sleep medicine aimed at practicing primary care providers.

Methods

In this pilot study, primary care providers, including physicians (PCP) and advanced practice nurses (APP-N), were invited to complete 3 application (app)-based core sleep educational modules in exchange for free continuing education and maintenance of certification credits. The modules were case-based and fully autonomous. Individuals had access to discussion boards moderated by a board-certified sleep physician and were given the option to complete two additional modules on advanced sleep topics. We assessed participants’ opinions on the course and any effect on behavior, measured as change in the number of sleep-related orders.

Results

Nineteen providers (12 PCP, 7 APP-N) completed the 3 required core modules. Five participants completed at least one additional module. A total of 94.4% reported they would recommend this curriculum to a colleague. Fifteen participants had prior experience with online courses; 93.3% noted that the sleep online modules provided a similar or better experience. Upon completion, 77.8% of learners anticipated this educational activity would contribute to either a great degree or completely to improvements in the health outcomes of their patients. All participants achieved the post-test score of 80% required to receive 1 CME/CNE credit per module completed. The number of sleep consultations or sleep study orders in the 4 months after course completion increased by 24.2% on average compared to the 4 months prior to the course (p=0.0157).

Conclusion

Based on Kirkpatrick’s model, this novel, app-based curriculum met levels 1-3 (positive reaction, knowledge transfer, and impact on behavior). Larger, longer-term studies are needed to assess the benefits of increasing knowledge in sleep medicine on patient care (Kirkpatrick Level 4).

Support

Funded by NIH NHLBI 5-R25-HL-120874-04

Molecular diagnosis of polymicrobial brain abscesses with 16S-rDNA-based next-generation sequencing

OBJECTIVES

Brain abscesses lead to high mortality despite antibiotic and surgical treatment. Identification of causative bacteria is important to guide antibiotic therapy, but culture-based methods and molecular diagnostics by Sanger sequencing of 16S PCR products are hampered by antibiotic treatment and the often polymicrobial nature of brain abscesses. We have applied 16S-rRNA-based next-generation sequencing (NGS) for metagenomic analysis of intracranial abscess (brain and epidural) and meningitis samples.

METHODS

Seventy-nine samples from 54 patients with intracranial abscesses or meningitis were included. DNA was subjected to 16S PCR. Amplicons were analysed with the Illumina MiSeq system, sequence reads were blasted versus the NCBI 16S bacterial database and analysed using MEGAN software. Results were compared to those of gram-staining, culture and Sanger sequencing.

RESULTS

The NGS workflow was successful for 51 intracranial abscesses (46 brain and five epidural) and nine meningitis samples. Inclusion of (mono)bacterial meningitis samples allowed us to establish a cut-off criterion for the exclusion of contaminating sequences. In total 86 bacterial taxa were identified in brain abscesses by NGS, with Streptococcus intermedius and Fusobacterium nucleatum as most prevalent species; Propionibacterium and Staphylococcus spp. were associated with epidural abscesses. NGS identified two or more bacterial taxa in 31/51 intracranial abscesses, revealing the polymicrobial nature of these infections and allowing the discrimination of up to 16 bacterial taxa per sample.

CONCLUSION

These results extend earlier studies showing that NGS methods expand the spectrum of bacteria detected in brain abscesses and demonstrate that the MiSeq platform is suitable for metagenomic diagnostics of this severe infection.

P1766 Comparison of left ventricular stroke volume in healthy adults among regions around the world: results from the World Alliance of Societies of Echocardiography (WASE) Normal Values Study

Funding Acknowledgements

WASE Normal Values Study is sponsored by American Society Echocardiography Foundation.

OnBehalf

the WASE Investigators

Background

The American Society of Echocardiography (ASE) and the European Association of Cardiovascular Imaging (EACVI) chamber quantification guidelines provide normal reference values for a variety of size and function parameters. While used worldwide, these were predominantly obtained from American and European Caucasian populations and may not represent individuals from other regions around the world. Accordingly, ASE in collaboration with its International Alliance Partners conducted the World Alliance of Societies of Echocardiography (WASE) Normal Values Study to establish and compare normal echocardiographic values across races, ethnicities and countries worldwide. While most previous studies focused on left ventricular (LV) size and ejection fraction, LV stroke volume (SV) in healthy normal subjects has not been well defined. In this report, we aim to examine similarities and differences in normal LV SV indexed by body surface area (SVI) among regions around the world.

Methods

WASE Normal Values Study is a multinational, observational, cross-sectional study. Individuals free from known cardiac, lung and renal disease were prospectively enrolled with even distribution among age groups and gender. Echocardiographic images were acquired following a standardized protocol. LV SV was assessed by Doppler-derived (LVOT diameter and VTI) and two-dimensional (2D) biplane Simpson’s methods. LV SVI was calculated to account for differences in body size. These measurements were analyzed (TOMTEC) in a single core laboratory following ASE/EACVI Guidelines.

Results

As of May 2019, LV SV has been analyzed in 1164 cases from 13 countries, representing 8 distinct regions worldwide. In this population, age, body surface area and 2D LV ejection fraction were 47 ± 17 years old (range 18-87 years old), 1.76 ± 0.22 m² (range 0.95-2.44 m²) and 63.2 ± 2.9 % (range 52.7-73.7 %), respectively. LV SV and SVI by Doppler were larger than those obtained by 2D method in all regions. LV SV and SVI in both methods had significant differences among regions (p&lt; 0.0001, Kruskal-Wallis test). LV SV and SVI in South Asia (India) were smallest in both methods and were also significantly smaller than other Asian regions (Figure). North America and Europe had largest LV SV and SVI by Doppler method, while Oceania had largest values by 2D.

Conclusions

The WASE Normal Values Study shows geographical variability in LV SVI across continents and countries. This information should be considered when determining normative values for SV and SVI.

Abstract P1766 Figure.

104 Left ventricular stroke volume differences among echocardiographic methods in healthy adults from the World Alliance of Societies of Echocardiography (WASE) Normal Values Study

Funding Acknowledgements

WASE Normal Values Study is sponsored by American Society Echocardiography Foundation.

OnBehalf

the WASE Investigators

Background

Left ventricular (LV) stroke volume (SV) can be determined by multiple ultrasound methods, including Doppler, two- (2D) and three-dimensional (3D) echocardiography. However, how methods compare to each other is not well understood. In this report from the WASE study, we aim to examine and compare normal reference ranges for SV and SV index (SVI) obtained from healthy adults by Doppler, 2D Simpson’s and 3D methods.

Methods

WASE Normal Values Study is a multinational, observational, cross-sectional study. Individuals free from known cardiac, lung and renal disease were prospectively enrolled with even distribution among age groups and gender. Doppler, 2D and 3D datasets were acquired at the enrolling centers, following a standardized protocol. LV SV was measured by three methods: Doppler (LV outflow tract diameter and velocity time integral), 2D biplane Simpson’s rule and 3D volume method. SV was indexed by body surface area (SVI). All measurements were analyzed (TOMTEC) in two core laboratories (for 2D and 3D) following ASE Guidelines. Methods were compared by Friedman test and Bland-Altman analysis.

Results

As of May 2019, 646 cases have been analyzed in both 2D and 3D datasets. In this population, age was 45 ± 16 years old (range 18-85) and body surface area was 1.76 ± 0.22 m² (range 0.95-2.44). LV EF by 2D Simpson’s rule and 3D method were 63.2 ± 2.9 and 62.3 ± 5.0 %, respectively (p &lt; 0.0001, Wilcoxon test). SVI by Doppler, 2D and 3D were 39.6 ± 7.6, 33.8 ± 6.5 and 41.0 ± 9.4 ml/m², respectively. There were significant differences between the three methods (p &lt; 0.0001, Friedman test). 2D underestimated SVI compared to Doppler by 14.6% (mean of differences 5.8 ml/m², p &lt; 0.0001) and 3D by 17.6% (7.2 ml/m², p &lt; 0.001). The difference between Doppler and 3D was smaller (3.4% lower by Doppler) but still statistically significant (1.4 ml/m², p = 0.0008). The results are shown in the figure.

Conclusions

Comparing 3 modalities in a large population of healthy individuals, SV and SVI are underestimated by 2D Simpson’s method. Given the large differences, combining 2D and Doppler or 3D measurements for hemodynamic calculations (such as regurgitant volumes and fraction) should be done with caution.

Abstract 104 Figure.

Optical spectroscopy as a diagnostic tool for metal ion beam production with an ECRIS

At GSI, the CAPRICE ECRIS is used to provide heavy ion beams to the UNILAC (Universal Linear Accelerator) accelerator. In order to satisfy the demand of metal ion beams, a resistively heated oven is routinely used. This evaporation technique allows the ion beam production from natural and enriched solid elements or compounds with high efficiency and low material consumption. Often it is required to provide high charge state ion beams from rare or extremely rare isotopes as ⁴⁸Ca, e.g., for the investigation of super heavy elements. In order to maintain the ion beam stable for the entire scheduled beam time, the plasma inside the ion source must remain as stable as possible. The tuning of ion source parameters and oven power affecting the oven temperature and, in turn, the evaporation rate is necessary. A strong relationship between the microwave power and the oven heating was observed, thus affecting the power control, the plasma stability, and the material consumption. Hence, it was investigated how an optical spectrometer can be used as a predictive diagnostic tool to detect ion source instabilities. Furthermore, the effect of parasitic oven heating by coupling of microwaves was investigated. Optical emission spectroscopy was performed by analyzing the light from the plasma and from the oven through the extraction aperture. The measurements enabled us to distinguish between resistive heating and microwave heating. The results of this investigation are presented.

P5253Does regional myocardial strain by cardiac magnetic resonance feature tracking reflect scar in ischemic heart disease?

Background

Cardiac magnetic resonance (CMR) late gadolinium enhancement (LGE) is the gold standard for detection of myocardial scar. We hypothesized that CMR Feature Tracking (FT)-derived regional myocardial strain may reflect the presence of scar and could thus potentially be used instead of LGE imaging.

Purpose

The aim of this study was to determine the relationship between FT-derived regional myocardial strain and LGE in patients with coronary artery disease (CAD).

Methods

Seventy-five patients with CAD and typical ischemic LGE patterns on CMR (1.5T) were included (mean age 60±12 years, 70% males). Myocardial strain analysis and LGE identification were performed using dedicated commercial software. Scar was defined by presence of LGE in the same area of the myocardium in both short- and long-axis views. Peak systolic regional longitudinal and circumferential strain (RLS, RCS) values were calculated in the region of interest corresponding to the LGE area and also in a non-LGE myocardial region as a reference in each patient. These comparisons were repeated for a subgroup of 36 patients with left ventricular (LV) ejection fraction (EF) <40% to determine whether the relationship between strain and LGE holds in the presence of reduced LV function, when strain measurements may be altered as a reflection of reduced LVEF itself.

Results

Both global longitudinal and circumferential strain values were abnormal (−12.8±5.1% and −11.4±4.1%, respectively), reflecting LV dysfunction in this CAD cohort (EF = 40±16%). The magnitude of both RLS and RCS was significantly reduced in areas of LGE, compared to those without LGE: RLS −10.0±5.8% versus −20.4±7.5% (p<0.001); RCS −10.1±5.3±% versus −18.9±7.5%, respectively (p<0.001). Same pattern was noted in the reduced EF subgroup: RLS −8.0±4.7% versus −16.9±6.6% (p<0.001), RCS −7.7±4.3±% versus −16.0±7.9%, respectively (p<0.001). The figure depicts 2 representative cases in long and short axis views, LGE detection and concomitant regional strain analysis.

LGE and regional strain analysis.

Conclusion

Reduced magnitude of regional longitudinal and circumferential strain by CMR-FT correlates with presence of LGE. Pending further validation, this finding may constitute the basis for detection of scar without contrast enhanced imaging, and would result in reduced cost, scan time and risk associated with gadolinium.

Acknowledgement/Funding

ARP: Research support (software) from Neosoft and Philips

Intestinal macrophages in mucosal immunity and their role in systemic lupus erythematosus disease

Monocytes play an important role in inducing host systemic immunity against invading pathogens and inflammatory responses. After activation, monocytes migrate to tissue sites, where they initiate both innate and adaptive immune responses, and become macrophages. Although mucosal macrophages produce inflammatory cytokines in response to pathogens, the perturbations in innate immune signaling pathway have been implicated in autoimmune diseases such as systemic lupus erythematosus (SLE). In this review, we focus on the role of human macrophages in intestinal innate immune responses, homeostasis, and SLE disease. We further discuss sex differences in the intestinal macrophages and their role in the physiology and pathogenesis of SLE.

[Application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma: a report of 33 cases]

Objective: To analyze the application of vascular replacement technique with allogenic blood vessel in radical resection for pancreatic carcinoma. Methods: The clinical data of 33 patients with vascular invasion of pancreatic carcinoma who underwent radical resection from April 2013 to April 2017 in Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital were retrospectively analyzed. There were 14 males and 19 females with age of (62.5±10.6)years(ranging from 35 to 78 years). Vascular replacement technique with allogenic blood vessel was used on all patients who underwent radical resection for pancreatic carcinoma. The operation procedure was made according to the specific location of the carcinoma, and the allogenic blood vessel was selected according to the type of vascular invasion. The matching vessel was selected for replacement to the patient who was invaded only one vessel. And the "Y" type of iliac vein was selected for replacement to the patient who was invaded the confluence of portal vein, splenic vein and superior mesenteric vein. After the operation, the patients were followed up by telephone and outpatient review. Results: All of 33 patients were successfully completed the operations. There were 28 patients underwent pancreaticoduodenectomy with vascular replacement, and 5 patients underwent total pancreatectomy with vascular replacement. All the patients were confirmed pancreatic carcinoma and R0 resection according to the postoperative pathology. There were 16 patients with the carcinoma invasion the confluence of portal vein, splenic vein and superior mesenteric vein, 12 patients with the carcinoma invasion the superior mesenteric vein, and 5 patients with the carcinoma invasion the portal vein. There was no perioperative death in this group and no complications related to allogenic blood vessel. The incidence of postoperative complications was 18.2% (6/33), and the incidence of pancreatic fistula was 6.1% (2/33), all of which were biochemical fistula. There were 32 patients were followed up, and the follow-up rate was 96.9%. The median survival time was 14.6 months. The half-year, 1-year and 2-year survival rates were 75.6%, 37.6% and 27.4%. Conclusion: The application of vascular replacement technique with allogenic blood vessel for pancreatic carcinoma has a great significance for improving the R0 resection rate and the prognosis of patients.

Cross-sectional study on allergic sensitization of Austrian adolescents using molecule-based IgE profiling

BACKGROUND

Allergen-specific IgE antibodies are a hallmark of type I allergy. The aim of this cross-sectional study was to analyze the sensitization profiles of an Austrian adolescent population utilizing molecule-based IgE diagnosis.

METHODS

Serum samples of 501 nonselected pupils from Salzburg, Austria, were tested in ImmunoCAP ISAC^® for IgE reactivity to 112 single allergens. Sensitization profiles were assessed and statistically coordinated with reported allergies.

RESULTS

In the population aged 12-21 years, 53.5% showed IgE reactivity to at least one allergen tested. The highest prevalence was found for Phl p 1 from grass pollen (26.5%), group 2 mite allergens (18.2%), Bet v 1 from birch pollen (16.3%) and Fel d 1 from cat (14.4%). The majority of participants showed a complex sensitization profile and reacted on average to 9 allergens. Pollen sensitization was highly prevalent (41.7%) and mainly driven by group I grass and PR-10 allergens of the Betulaceae family, while Pla l 1 represented the most relevant weed. Diagnosed and self-reported allergies were noted in 21.9% and 45.5% of participants, respectively, and correlated well with in vitro results. Among atopic individuals, 71.4% reported to suffer from at least one allergy; concordance was found for grass and cat sensitization, while venom- and weed pollen-positive individuals were frequently asymptomatic.

CONCLUSIONS

More than half of the tested adolescent population had already established an atopic status presenting a complex IgE reactivity profile dominated by pollen sensitization. Detailed molecule-based analysis allows determining relevant biomarkers and monitoring of the atopic status in populations.

Investigation of pulsed mode operation with the frequency tuned CAPRICE ECRIS

In order to increase the intensity of the highly charged ions produced by the Electron Cyclotron Resonance Ion Sources (ECRISs), techniques like the frequency tuning and the afterglow mode have been developed and in this paper the effect on the ion production is shown for the first time when combining both techniques. Recent experimental results proved that the tuning of the operating frequency of the ECRIS is a promising technique to achieve higher ion currents of higher charge states. On the other hand, it is well known that the afterglow mode of the ECRIS operation can provide more intense pulsed ion beams in comparison with the continuous wave (cw) operation. These two techniques can be combined by pulsing the variable frequency signal driving the traveling wave tube amplifier which provides the high microwave power to the ECRIS. In order to analyze the effect of these two combined techniques on the ion source performance, several experiments were carried out on the pulsed frequency tuned CAPRICE (Compacte source A Plusiers Résonances Ionisantes Cyclotron Electroniques)-type ECRIS. Different waveforms and pulse lengths have been investigated under different settings of the ion source. The results of the pulsed mode have been compared with those of cw operation.

Ion beam emittance from an ECRIS

Simulation of ion beam extraction from an Electron Cyclotron Resonance Ion Source (ECRIS) is a fully 3 dimensional problem, even if the extraction geometry has cylindrical symmetry. Because of the strong magnetic flux density, not only the electrons are magnetized but also the Larmor radius of ions is much smaller than the geometrical dimension of the plasma chamber (Ø 64 × 179 mm). If we assume that the influence of collisions is small on the path of particles, we can do particle tracking through the plasma if the initial coordinates of particles are known. We generated starting coordinates of plasma ions by simulation of the plasma electrons, accelerated stochastically by the 14.5 GHz radio frequency power fed to the plasma. With that we were able to investigate the influence of different electron energies on the extracted beam. Using these assumptions, we can reproduce the experimental results obtained 10 years ago, where we monitored the beam profile with the help of viewing targets. Additionally, methods have been developed to investigate arbitrary 2D cuts of the 6D phase space. To this date, we are able to discuss full 4D information. Currently, we extend our analysis tool towards 5D and 6D, respectively.

Poly(3-hydroxybutyrate-co-valerate)/poly(3-thiophene ethyl acetate) blends as a electroactive biomaterial substrate for tissue engineering application

Polyblend films based on poly(3-hydroxybutirate-co-valerate) and poly(3-thiophene ethyl acetate) – PHBV/PTAcEt showed low cytotoxicity, good adhesion and mammalian cell proliferation. The physical–chemical properties were explored.

Peripheral hemodynamics, blood viscosity, and the renin-angiotensin system in hemodialysis patients under therapy with recombinant human erythropoietin

Treatment of renal anemia with rhEPO (120 U/kg body weight/hemodialysis) in transfusion-dependent patients on maintenance hemodialysis led to an increase in blood pressure, regional peripheral resistance and whole blood viscosity. Our results are in agreement with earlier findings that partial correction of renal anemia results in hemodynamic changes characterized by a fall in cardiac output together with an increase in blood pressure due to increased vascular resistance. The increase in whole blood viscosity correlated with the increase in regional peripheral resistance but not with the increase in mean arterial blood pressure. Thus, other regulating factors of vascular resistance must be involved. Correction of renal anemia does not influence the reninangiotensin system. However, peripheral responsiveness of vascular smooth muscles may have changed due to improved tissue oxygenation and thus leading to an increase in vasoconstriction.

Galanin modulates human and murine neutrophil activation in vitro

AIMS

Polymorphonuclear neutrophils are key players in innate immunity. The innate immune system needs to be tightly controlled to ensure proper activation but also no overactivation. Galanin has been shown to regulate inflammatory reactions, and therefore, we aimed to elucidate the expression of galanin and its three receptors (GAL1 -GAL3 ) in polymorphonuclear neutrophils and to evaluate whether galanin exerts direct or indirect effects on human and murine polymorphonuclear neutrophils.

METHODS

Human peripheral polymorphonuclear neutrophils were isolated from fresh blood of healthy donors, and murine polymorphonuclear neutrophils were isolated from bone marrow of C57BL/6N mice. Gene expression was evaluated by qRT-PCR. As a marker for polymorphonuclear neutrophil activation, CD11b integrin surface expression was measured by FACS analysis. Furthermore, a label-free technology measuring ligand-induced dynamic mass redistribution was used to evaluate the response of polymorphonuclear neutrophils to galanin.

RESULTS

GAL2 receptor expression was found in both human and murine polymorphonuclear neutrophils, galanin and GAL3 receptor were exclusively expressed in murine bone marrow polymorphonuclear neutrophils, and GAL1 receptor was not detectable in polymorphonuclear neutrophils of either species. Galanin treatment was not able to induce CD11b integrin surface expression or dynamic mass redistribution in human polymorphonuclear neutrophils and murine bone marrow polymorphonuclear neutrophils. However, galanin treatment significantly enhanced the response of polymorphonuclear neutrophils of both species to interleukin-8.

CONCLUSION

Galanin can be regarded as an immunomodulatory peptide as it can sensitize polymorphonuclear neutrophils towards pro-inflammatory cytokines in humans and mice.