Testosterone affects type I/type II interferon response of neutrophils during hepatic amebiasis

Differences in immune response between men and women may influence the outcome of infectious diseases. Intestinal infection with Entamoeba histolytica leads to hepatic amebiasis, which is more common in males. Previously, we reported that innate immune cells contribute to liver damage in males in the murine model for hepatic amebiasis. Here, we focused on the influences of sex and androgens on neutrophils in particular. Infection associated with neutrophil accumulation in the liver was higher in male than in female mice and further increased after testosterone treatment in both sexes. Compared with female neutrophils, male neutrophils exhibit a more immature and less activated status, as evidenced by a lower proinflammatory N1-like phenotype and deconvolution, decreased gene expression of type I and type II interferon stimulated genes (ISGs) as well as downregulation of signaling pathways related to neutrophil activation. Neutrophils from females showed higher protein expression of the type I ISG viperin/RSAD2 during infection, which decreased by testosterone substitution. Moreover, ex vivo stimulation of human neutrophils revealed lower production of RSAD2 in neutrophils from men compared with women. These findings indicate that sex-specific effects on neutrophil physiology associated with maturation and type I IFN responsiveness might be important in the outcome of hepatic amebiasis.

Tangential extreme ultraviolet and soft x-ray diagnostic system for time-resolved temperature measurement on the High Beta Tokamak-Extended Pulse

The High Beta Tokamak-Extended Pulse has recently incorporated a tangential multi-energy extreme ultraviolet and soft x-ray diagnostic system. This system enables measurements of the electron temperature and the examination of mode dynamics within the tokamak. While other systems have been built for poloidal views over similar temperature ranges, this is the first multi-energy tangential-view system designed to work in a temperature range below 200 eV in a tokamak. To facilitate these measurements, a filter wheel comprising five distinct groups of dual-filters has been developed and implemented. By employing a combination of 0.1 μm aluminum and 0.2 μm titanium filters, the system allows estimation of electron temperature profiles through reconstruction of the emission profile using the standard "double-foil" technique. The influence of impurities and filter oxide layers on measurement outcomes is examined. Results reveal that, while the absolute electron temperature values may exhibit some deviations, key characteristics like the electron temperature profile shape and inversion radius during sawtooth events remain consistent. This consistency confirms the system's suitability for core plasma studies. This system has proven effective in detecting and analyzing internal magnetohydrodynamic phenomena, such as sawteeth.

Assistance dogs help reduce mental health symptoms among Australian Defence Force veterans and emergency services personnel: A pilot study

The aim of this pilot study was to evaluate the effectiveness of two specialized Australian PTSD assistance dog programs in reducing PTSD and mental health symptoms over a one-year period. A total of 44 participants who were partnered with an assistance dog were analysed. Using an intent to treat analysis, compared to the baseline measures, all mental health outcomes exhibited statistically significant reductions in scores at the 3-month follow-up, and persisted at the 6-month, and 12-month follow-up. When comparing baseline to 3-month follow-up the effect size (Cohen's d) was strongest for stress (d = 0.993), followed by PTSD (d = 0.892), anxiety (d = 0.837). Analyses among those who also completed the waitlist-baseline assessment (n = 23) showed slight reductions in stress and depression prior to receiving their dog (whilst waiting for their dog). However, larger reductions were yielded across all mental health measures when comparing waitlist-baseline to 3-month follow-up.

Sex Difference in Amebiasis

Infection with the protozoan parasite Entamoeba histolytica is much more likely to cause severe, focal liver damage in males than females, although the infection rate is the same in both sexes. The differences in disease susceptibility may be due to modulation of key mechanisms of the innate immune response by sex hormones. Complement-mediated mechanisms and estrogen-dependent activated natural killer T cells lead to early elimination of the parasite in females, whereas a pathological immune axis is triggered in males. Testosterone, which is generally thought to have more immunosuppressive properties on cells of the immune response, leads to overwhelming activation of monocytes and host-dependent destruction of liver tissue in males resulting in worse outcomes.

Feasibility study of a high spatial and time resolution beam emission spectroscopy diagnostic for localized density fluctuation measurements in Lithium Tokamak eXperiment-β (LTX-β)

Trapped electron mode (TEM) is the main source of turbulence predicted for the unique operation regime of a flat temperature profile under low-recycling conditions in the LTX-β tokamak, while ion temperature gradient driven turbulence may also occur with gas fueling from the edge. To investigate mainly TEM scale density fluctuations, a high spatial and time resolution 2D beam emission spectroscopy (BES) diagnostic is being developed. Apart from spatially localized density turbulence measurement, BES can provide turbulence flow and flow shear dynamics. This BES system will be realized using an avalanche photodiode-based camera and narrow band interference filter. The system can acquire data at 2 MHz. Simulations with the Simulation of Spectra (SOS) code indicate that a high signal to noise ratio can be achieved with the proposed system. This will enable sampling the density fluctuations at this high time resolution. The design considerations and system optimization using the SOS code are presented.

Does community HIV combination prevention (HPTN 071 (PopART)) impact healthcare inequity?

Background

This research explores the impact of the HIV Prevention Trials Network (HPTN) 071 combination prevention (PopART) trial on horizontal inequity in Zambia and South Africa. Evidence suggests there is often inequality in healthcare utilisation in relation to socioeconomic characteristics, such as wealth. This paper is the first to address such distributional outcomes and inequities in a randomised trial setting.

Methods

We utilise horizontal inequity as a key performance metric to make value judgements with regards to the distribution of healthcare utilisation in a health system. Additionally, we supplement this index by estimating the impact of PopART on inequality in healthcare utilisation and HIV prevalence, estimating concentration curves and indices.

Results

We find a pro-rich inequity in healthcare utilisation, as ranked by wealth, before and after the trial is implemented. Pro-rich implies, for example, the 20% poorest make up less than 20% of healthcare utilisation. This suggests the trial enabled the wealthier subset of the population to take better advantage of accessing healthcare.

Conclusions

Given the high prevalence of HIV in lower-income households in Zambia and South Africa, these results strengthen the case for interventions tailored to informing poorer households about the benefits of prevention and after-care.

Key messages

• The PopART trial demonstrates as with any intervention, there is a risk of exacerbating an underlying inequity. Policies directed at these problems specifically may help alleviate such burdens.

• This paper shows one example of a distributional imbalance in the HIV population. Given the absence of work on RCT interventions, the findings may also be used to inform future trial design.

The Properties of Proinflammatory Ly6Chi Monocytes Are Differentially Shaped by Parasitic and Bacterial Liver Infections

In the past, proinflammatory CD11b+Ly6Chi monocytes were predominantly considered as a uniform population. However, recent investigations suggests that this population is far more diverse than previously thought. For example, in mouse models of Entamoeba (E.) histolytica and Listeria (L.) monocytogenes liver infections, it was shown that their absence had opposite effects. In the former model, it ameliorated parasite-dependent liver injury, whereas in the listeria model it exacerbated liver pathology. Here, we analyzed Ly6Chi monocytes from the liver of both infection models at transcriptome, protein, and functional levels. Paralleled by E. histolytica- and L. monocytogenes-specific differences in recruitment-relevant chemokines, both infections induced accumulation of Ly6C+ monocytes at infection sites. Transcriptomic analysis revealed a high similarity between monocytes from naïve and parasite-infected mice and a clear proinflammatory phenotype of listeria-induced monocytes. This was further reflected by the upregulation of M2-related transcription factors (e.g., Mafb, Nr4a1, Fos) and higher CD14 expression by Ly6Chi monocytes in the E. histolytica infection model. In contrast, monocytes from the listeria infection model expressed M1-related transcription factors (e.g., Irf2, Mndal, Ifi204) and showed higher expression of CD38, CD74, and CD86, as well as higher ROS production. Taken together, proinflammatory Ly6Chi monocytes vary considerably depending on the causative pathogen. By using markers identified in the study, Ly6Chi monocytes can be further subdivided into different populations.

Towards a real-time control of robotic ultrasound using haptic force feedback

Ultrasound is a widely used imaging technique and is appreciated for its non-invasiveness, absence of radiation, widespread availability, and compact equipment. Ergonomic difficulties in manual handling of the probe could be enhanced by a robotic controlled ultrasound. The paper addresses the development of such a system which enables remote operation of a ultrasound probe and includes haptic force feedback as well as video conferencing components for visual feedback. The development process followed a user-centered approach by investigating needs of potential end-users. Preliminary results demonstrated the functionality of the developed system for generating medical image data under laboratory conditions.

POS0041-HPR OUTCOME MEASURES IN RHEUMATOLOGY APPLIED IN SELF-MANAGEMENT INTERVENTIONS TARGETING PEOPLE WITH INFLAMMATORY ARTHRITIS - A SYSTEMATIC REVIEW OF OUTCOME DOMAINS AND MEASUREMENT INSTRUMENTS

Background

Self-management refers to the patient’s ability to manage a large range of consequences such as symptoms, medication, emotions, and preferable life-style changes coherent with living with a chronic disease. Evaluating the effect of interventions targeting to improve people with inflammatory arthritis (IA) self-management is a challenge because self-management interventions are complex and consensus on important outcomes is lacking. Solutions to these issues could be to consensus on a Core Outcome Set (COS) describing what outcomes are relevant and should be applied in future studies hereby lessening the heterogeneity between future studies. The purpose of this study was therefore to take the first actions in identifying possible candidate outcomes for such a COS.

Objectives

The aim was to identify, and map applied outcome domains and outcome measurement instruments from previous trials measuring the effect of self-management interventions targeting people with IA.

Methods

We performed an informative systematic literature review following guidance from the Handbooks described by ‘Outcome Measures in Rheumatology’ (OMERACT) and ‘Core Outcome Measures in Effectiveness Trials’ (COMET) initiatives. Randomized and non-randomized trials describing their experimental intervention as “self-management” and included a population of adults (≥18 years) with at least 50% diagnoses with IA (Rheumatoid arthritis, Psoriatic arthritis, Spondylarthritis) was included. Both screening of possible trials and data extraction was performed independently by two reviewers. Extracted data included: study characteristics, outcome domains and the corresponding measurement instruments. During analysis two reviewers simultaneously grouped and categorized domains and subdomains, and two senior researchers approved the categorization.

Results

Searches was performed 2021.02.08 on online databases, trial registers, conference abstracts and references of included trials. From a total of 2,502 records, we included 38 trials published between 1988 and 2021. The interventions were heterogenic and patients primarily female, diagnosed with Rheumatoid Arthritis, and a calculated mean age of 54 years. We identified 12 different outcome domains, covering 39 subdomains, collected with 119 different measurement instruments. The most frequently applied outcome domains were self-efficacy, pain, physical functioning/disability, anxiety and depression, quality of life, fatigue, global assessment/disease activity and coping. Please see Figure 1 for all outcome domains identified. The applied measurement instruments varied within each outcome domain with up to 10 different instruments applied to measure the same domain. Instruments were predominantly patient-reported outcomes.

Conclusion

The outcome domains and measurement instruments used in self-management trials were widely diverse and differ from the current general OMERACT Core Outcome Sets (COS) for IA conditions. Further steps towards the establishment of a COS to be reported in all self-management intervention trials will enhance the relevance and the subsequent impact on the body of evidence from these trials.

References

The protocol was registered in PROSPERO (ID CRD42021238749).

[1]OMERACT Handbook 2019. Available at: https://www.dropbox.com/s/fd3673fsma45qe0/OMERACT Handbook Chapter 4 Apr 16 2019.pdf?dl=0.

[2]Williamson PR, Altman DG, Bagley H, Barnes KL, Blazeby JM, Brookes ST, m.fl. The COMET Handbook: Version 1.0, 2017. Available at: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1978-4

Disclosure of Interests

None declared

The patient perspective on remote monitoring of cardiac devices: a german patient survey

Funding Acknowledgements

Type of funding sources: None.

Background

Current guidelines recommend remote monitoring for patients with implanted cardiac devices. Nevertheless, data regarding patients’ attitude using remote monitoring is lacking. This study aims to analyze the patient perspective on remote monitoring of cardiac devices in Germany.

Methods

Patients with an implanted cardiac device and remote monitoring (continuous device follow-up and remote device follow-up) of all current manufacturers in three German centers were asked to participate in the study filling in a patient questionnaire between 07-11/2021. The questionnaire consisted of 37 questions regarding patient’s baseline characteristics, individual use and judgement on remote monitoring, as well as the patient’s opinion regarding future remote monitoring perspectives. Survey participation was anonymous and on a voluntary basis.

Results

617 patients (28.4 % women) out of three cardiac centers in Germany participated. Implanted cardiac devices were pacemakers ± cardiac resynchronization therapy (CRT) (11.9%), implantable defibrillators ± CRT (70.3%) and implantable loop recorders (17.8%). Technical problems with remote monitoring transmitter were reported to occur: never (60.3%), seldomly (25.5%), sometimes (12.0%) and all the time (2.2%). The majority of patients (84.9%) take part in remote monitoring without the help of others. After starting remote monitoring, patients reported a significant prolongation of the intervals (p<0.001) of their in-person follow-up visits (figure 1). 44.0% of the participating patients answered to have a better, 1.2% a worse and 54.8% an equal disease management since participating in remote monitoring. Regarding possible future perspectives using remote monitoring, 73.0% patients answered to own a smartphone. 48.3% of the patients would prefer a smartphone-based application for remote monitoring. 15.0% had no opinion on that question, whereas 36.7% would prefer the use of a transmitter in their bedroom.

Conclusion

In this patient survey, remote monitoring was a widely accepted tool for patients with implanted cardiac devices. Patients perceive an improvement of their disease management through telemonitoring. Furthermore, patients answered that intervals of outpatient visits could be prolonged by the use of remote monitoring. Most patients would appreciate a smartphone-based remote monitoring of their cardiac device.

P–617 Idiopathic early ovarian aging: Do biomarkers of ageing indicate premenopausal accelerated biological ageing in young women with diminished response to ART?

Study question

Do young women with idiopathic early ovarian ageing have changes in telomere length and epigenetic age indicating accelerated biological aging?

Summary answer

The telomere length and epigenetic age were comparable to those in young women with normal ovarian ageing.

What is known already

Increased risk of several health events usually considered to be age-related such as cardiovascular disease, osteoporosis, over-all morbidity and mortality have been associated with premature and early menopause when compared to the risk in women with normal menopausal age suggesting an accelerated general ageing process associated to early ovarian ageing. It is unclear whether the onset of this process may start before menopause.

Study design, size, duration

A prospective cohort study. Young women (≤ 37 years) having ART at two Danish Public fertility clinics during the period 2016 to 2018 were divided into two groups dependent on their ovarian reserve status: early ovarian ageing (EOA) (N = 55) and normal ovarian ageing (NOA)( N = 52). Number of oocytes harvested in first and subsequent cycles was used as a marker of ovarian reserve. Blood samples was drawn at time of oocyte retrieval to assess biological age.

Participants/materials, setting, methods

EOA was defined as ≥ 2 IVF cycles with ≤ 5 harvested oocytes despite sufficient stimulation with FSH and NOA as ≥ 8 oocytes harvested in minimum 1 cycle. Known causes influencing the ovarian reserve (endometriosis, ovarian surgery, etc.) was reason for exclusion. Relative telomere length (qPCR) and epigenetic age acceleration (DNA methylation levels) were measured in white blood cells as markers of accelerated biological ageing.

Main results and the role of chance

Relative telomere length was comparable with a mean of 0.46 (± sd 0.12) in the EOA group and 0.47 (0.14) in the normal ovarian ageing group (p = 0.64). The difference of predicted mean epigenetic age and mean chronological age (i.e. epigenetic age acceleration) was, insignificantly, 0.5 years older in the EOA group when compared to the NOA group( (–1.02 years (2.62) and –1.57 years (2.56), respectively, p = 0.27)), but this difference disappeared when adjusting for chronological age.

Limitations, reasons for caution

Discrete changes in epigenetic age acceleration may not have been captured as the study only had power to detect an age acceleration of ≥ 2 years.

Wider implications of the findings: By analysis of biomarkers for ageing in whole blood, we did not find any indications of a premenopausal accelerated aging in young women with idiopathic EOA. Further investigations in a similar cohort of premenopausal women is needed to fully elucidate the potential relationship between premenopausal accelerated biological ageing and EOA.

Trial registration number

The study was approved by the Danish Data protection Agency (nr 1–16–02–320–14) and the Regional committee on health research ethics of Central Region Denmark (jr.no 1–10–72–142–14).

Is the road to good health paved in gold? HIV and mining in Sub-Saharan Africa

Background

This paper measures the impact of HIV prevalence on gold production in Sub-Saharan Africa. Gold mining adds billions of gross value to the African economy, however remains a highly-prevalent industry for HIV. Some of the largest global gold producers in South Africa estimate 30% of their workforce to be HIV-positive. In comparison, the current prevalence rate in the country is 3.7% in working-aged males.

Methods

There is a reverse causality between HIV and mining. HIV exerts a direct causal influence on mining production. The mining industry creates working and living environments which accelerate the spread of HIV. Using 22 years of panel data and an external instrumental variable, overseas development assistance, supported by an Arellano-Bond estimator, we measure the causal impact of HIV on gold mining.

Results

We estimate a 1% increase in HIV leads to a decrease in gold production of 9.866 tonnes, valued at over $402 million, nearly 3% of total African gold production, significant at the 10% level. These results are robust to the findings of the Arellano-Bond estimator, which are significant at the 5% level.

Conclusions

International aid foundations and donors have made great strides in funding for HIV treatment, and it is critical for multinational corporations to take necessary action to protect the progress that has been made so far, promoting health and economic outcomes. Understanding macroeconomic impacts will raise the cost-effectiveness of public health interventions, and increase the associated economic benefits to many individual sectors, as well as overall local and country-wide economies.

Key messages

In addition to saving lives and extending the quality of HIV-positive lives, there are economic gains to be had in investing in the prevention of HIV, as demonstrated in the gold mining industry. HIV-related productivity losses readily extend to a variety of industries across Africa and abroad. Policies that minimise these losses, and maximise health gains, can only be mutually beneficial.

Androgens predispose males to monocyte-mediated immunopathology by inducing the expression of leukocyte recruitment factor CXCL1

Hepatic amebiasis, predominantly occurring in men, is a focal destruction of the liver due to the invading protozoan Entamoeba histolytica. Classical monocytes as well as testosterone are identified to have important functions for the development of hepatic amebiasis in mice, but a link between testosterone and monocytes has not been identified. Here we show that testosterone treatment induces proinflammatory responses in human and mouse classical monocytes. When treated with 5α-dihydrotestosterone, a strong androgen receptor ligand, human classical monocytes increase CXCL1 production in the presence of Entamoeba histolytica antigens. Moreover, plasma testosterone levels of individuals undergoing transgender procedure correlate positively with the TNF and CXCL1 secretion from their cultured peripheral blood mononuclear cells following lipopolysaccharide stimulation. Finally, testosterone substitution of castrated male mice increases the frequency of TNF/CXCL1-producing classical monocytes during hepatic amebiasis, supporting the hypothesis that the effects of androgens may contribute to an increased risk of developing monocyte-mediated pathologies.

A census of veterinarians in the United States

Analysis of the AVMA's electronic membership database provided information on 113,394 veterinarians living in the United States in 2018. At 39%, Millennials represented the highest percentage of the US veterinary workforce, and women (61.7%) outnumbered men (38.2%). Mean age at the time of graduation has increased since 1975, raising concerns that career length for veterinarians may be decreasing, potentially exacerbating veterinarian shortages. Overall, 83.9% of veterinarians were in private clinical practice, and substantial increases between 2008 and 2018 were seen in the numbers of veterinarians in emergency and critical care medicine and in referral or specialty practice.

Online procurement of pet supplies and willingness to pay for veterinary telemedicine

Changing consumer shopping behaviors, and specifically the shift towards online procurement of goods and services, have altered the retail landscape of nearly all goods, including pet products and services. Whilst it is known and commonly discussed that less retail business for products and medications is being conducted in clinics than in the past, it is not well documented where that commerce is now taking place, and by what customer segments. For cats, dogs, and other pets, specialty food and food in general was purchased by a high percentage of respondents at the physical store. Sixteen-percent of dog owners, 17 % of cat owners and 14 % of other animal owners purchased prescription food at the veterinarian. Ten percent of dog owners, 10 % of cat owners, and 9 % of other animal owners purchased prescription food from the physical store. A high percentage of cat and dog owners purchased flea and tick preventative, heartworm preventative and prescription medications at the veterinarian, followed by the physical store. Using a choice experiment, both dog and cat owners were willing-to-pay a statistically significant positive amount for having their veterinarian, or a veterinarian in their community (who was not their veterinarian) on the veterinary telemedicine call or video when compared to a veterinarian from outside the community. In relation to the willingness to pay (WTP) for a telemedicine veterinary consultation with a veterinarian outside of the pet owners' community, dog owners were willing to pay $38.04 more for a telemedicine veterinary consultation with their regular veterinarian, and $13.38 more for a telemedicine veterinary consultation with a veterinarian in the dog owners' community. Cat owners had a WTP of $38.12 per call or visit for having their veterinarian as the consultant which was statistically higher than their WTP for a veterinarian in their community, $12.74 when compared to a veterinarian outside their community. When comparing the mean price adjusted WTP between cat and dog owners, there were not any statistically significant differences found. Quantifying pet owner willingness to pay for commonly discussed attributes of telemedicine, such as whether a local veterinarian is consulted (versus a veterinarian from outside the community), facilitates veterinary practice management decision making as practices adjust product and service offerings to meet the changing consumer demand of pet owners in today's marketplace.

Familiarity and Use of Veterinary Services by US Resident Dog and Cat Owners

Simple Summary

Demographic information including pet ownership, veterinary use, and beliefs regarding veterinary care were collected from 997 U.S. residents. Approximately half of respondents had a dog, or had a dog in the past five years, while 37% of respondents had a cat. Veterinary visits differed between cat and dog owners, with over 90% of dog owners visiting a veterinarian at any time and 40% of cat owners visiting a veterinarian at any time. Using logit models, the likelihood of visiting a veterinarian increased with the age and income of the pet owner. Being a cat owner decreased the likelihood of visiting the veterinarian.

Abstract

Pet ownership, veterinary use, and beliefs regarding veterinary care were elicited through the use of a nationally representative survey of 997 U.S. residents. Fifty-one percent of respondents have or had a dog in the past five years and 37% have or had a cat in the past five years. Over ninety percent of cat and dog owners had visited a veterinarian at any time, but only about 40% visited a veterinarian annually. With the rise of options in veterinary medicine, including low-cost options for vaccines and spay/neuter, further study and analysis of pet-owners use of veterinary care is warranted. Fifty-four percent of dog owners and 40% of cat owners who went to a low-cost spay/neuter clinic also went to a veterinarian/clinic/practice. This finding suggests that pet-owners who use low-cost options do so in a manner that supplements rather than replaces traditional veterinary care. Logit models were employed to evaluate the relationship between dog and cat owner demographics and visiting a veterinarian. The probability of visiting a veterinarian increased with age and income for dog owners.

3304High sensitive cardiac troponin i at admission and 30 minutes later to rule-in or rule-out acute myocardial infarction - Preliminary results from the RACING-MI trial

Introduction

Current ESC guidelines have introduced a 0h/1h algorithm for accelerated rule-in or rule-out of acute myocardial infarction (MI) when using assay specific high-sensitive cardiac troponin I (hs-cTnI). Several studies have investigated the diagnostic performance and safety of this approach using different hs-cTnI assays. However, little is known of the diagnostic performance of a 0h/30min algorithm.

Purpose

To evaluate the diagnostic accuracy of early rule-in or rule-out of MI after 30 minutes by applying assay specific hs-cTnI cut-off values from a recently validated 0h/1h algorithm.

Methods

We prospectively enrolled chest pain patients suggestive of MI admitted to the Emergency Department. Patients underwent serial hs-cTnI measurements at admission (0 hour) and after 3 hours according to clinical practice. In addition, hs-cTnI measurements were performed after 30 minutes. The assay specific cut-off values from the 0h/1h algorithm were applied to the 30 minute cohort (figure 1). Final diagnosis was adjudicated independently by two physicians.

Results

In total, 943 patients were included. MI was the final diagnosis in 67 (7.1%) patients. Overall, absolute hs-cTnI values after 30 minutes were significantly higher in the MI group than in the non-MI group (19.2 (Q1:Q3) 2.7–75.3) ng/L versus 0.1 (0.2–0.7) ng/L, p<0.001). When applying the assay-specific hs-cTnI cut-off valuesfor the 0h/1h algorithmto the 30 minute patient cohort, 52.4% of patients were classified as rule-out with a negative predictive value of 100% (95% CI: 99.2–100). In total, 8.5% were classified as rule-in with a positive predictive value of 83.8% (95% CI: 74.2–90.3). Sensitivity was 100% (95% CI: 94.6–100) and specificity was 97.4% (95% CI: 95.7–98.6). Overall, 39.1% were assigned to the observational zone with a 3.5% prevalence of MI.

Conclusions

The use of assay specific hs-cTnI measurement at admission (0h) and 30 min later can be used to safely rule-out MI. This indicates that it might be safe to develop a 0h/30min algorithm and hereby reduce time to diagnosis even further. NCT03634384.

Acknowledgement/Funding

Randers Regional Hospital, A.P Møller Foundation, Boserup Foundation, Korning Foundation, Højmosegård Grant, Siemens Healthcare (TNIH assays), etc.

P2673Challenging time limits: Using a single high-sensitive troponin I to rule-out acute myocardial infarction in early presenters

Introduction

According to ESC guidelines, an acute myocardial infarction (MI) can be excluded without serial troponin measurements in patients presenting with a single high-sensitive troponin below the 99th percentile and chest pain starting >6 hours prior to admission. However, it is unclear if single-testing of high-sensitive troponin can rule-out MI in early presenters.

Purpose

To investigate the diagnostic performance of a single value of high-sensitive cardiac troponin I (hs-cTnI) at presentation for ruling-out MI in patients presenting with chest pain to the Emergency Department irrespective of chest pain onset.

Methods

We conducted a substudy of preliminary data from the RACING-MI trial. We included patients presenting with chest pain suggestive of MI to the Emergency Department of a Regional Hospital. We used the Siemens hs-cTnI (Siemens Healthcare, TNIH, Limit of detection: 2.21 ng/L) and a diagnostic cut-off value <3 ng/L to rule-out MI at presentation. Two physicians independently adjudicated the final diagnosis based on all clinical information. Patients were stratified based on time from chest pain onset to hospital admission as very early (0–3 hours), early (3–6 hours) and late presenters (>6 hours).

Results

We included 989 patients with available hs-cTnI results at admission. MI was confirmed in 82 (8.3%) patients. Using hs-cTnI <3 ng/L as diagnostic cut-off value at presentation, 302 (30.5%) patients without MI were classified as rule-out. Overall, the negative predictive value (NPV) for MI was 100% (95% CI 98.7–100).

Based on chest pain onset, 33.8% of patients were classified as very early, 12.8% as early, and 42.7% as late presenters, with 10.7% patients with unreported/unknown onset. NPV was 100% (95% CI 96.5–100) for very early, 100% (95% CI 88.3–100) for early and 100% (95% CI 97.3–100) for late presenters.

Conclusions

Using a single hs-cTnI value <3ng/L as diagnostic cut-off to rule-out MI seems to be safe and to allow rapid rule-out of MI in patients presenting with chest pain to the emergency department, even in very early presenters.

ClinicalTrials.gov Identifier: NCT03634384.

Acknowledgement/Funding

Randers Regional Hospital, A.P Møller Foundation, Boserup Foundation, Korning Foundation, Højmosegård Grant, Siemens Healthcare (TNIH assays), etc.

["I will do laparoscopy somewhere else" : Total, highly immersive virtual reality without side effects?]

BACKGROUND

For virtual reality laparosopic simulation we developed a new, highly immersive simulation mode. The goal of the current pilot study was to investigate if kinetosis or other negative vegetative side effects can be caused by a total virtual training set-up (TVRL).

METHODS

In this study 20 participants with varying degrees of expertise in laparoscopy performed 3 tasks (i.e. ring exchange, fine dissection and cholecystectomy) in regular (VRL) and immersive mode (TVRL) with a head-mounted display (HMD) on a laparoscopic simulator. Aside from performance scores, the heart rate was recorded and the occurrence of vertigo was investigated.

RESULTS

Surgical performance was independent of the VR mode (VRL or TVRL). Participants' heart rate was higher in TVRL without reaching statistical significance. Kinetosis occurred in two participants (10%) with a history of motion sickness.

CONCLUSION

Laparoscopic training can take place in a total virtual environment with limited nagative vegetative side effects. Special attention should be paid to participants with a history of motion sickness. The development of TVRL enables new perspectives for surgical training.

Magnetic perturbation diagnostics in the high-temperature lithiated environment of LTX-β

Magnetic perturbation measurements will be invaluable for characterizing Lithium Tokamak Experiment Beta (LTX-β) plasmas due to the time-evolving 3D nature of the magnetic fields generated by eddy currents in the vessel and copper shell segments, as well as enhanced MHD instability drive due to newly introduced neutral beam heating. The LTX-β upgrade includes two new arrays of Mirnov coils: a shell eddy sensor array of two-axis coils distributed over the back surface of one shell segment and a toroidal array of poloidal field coils at the low-field side midplane gap. Evaporative lithium wall-coating and the high temperatures required for liquid lithium wall operation both complicate the implementation of in-vessel diagnostics. While the shell array is protected from lithium exposure, the shell segment to which it is mounted will at times exceed 300 °C. The toroidal array, however, will experience direct line-of-sight exposure to the lithium evaporator as well as close proximity to the hot shell and may also be subject to poorly confined beam-driven fast ions. We describe how the two new Mirnov coil arrays meet these environmental challenges and enhance the LTX-β diagnostic suite.