Link between supercurrent diode and anomalous Josephson effect revealed by gate-controlled interferometry

In Josephson diodes the asymmetry between positive and negative current branch of the current-phase relation leads to a polarity-dependent critical current and Josephson inductance. The supercurrent nonreciprocity can be described as a consequence of the anomalous Josephson effect -a φ0-shift of the current-phase relation- in multichannel ballistic junctions with strong spin-orbit interaction. In this work, we simultaneously investigate φ0-shift and supercurrent diode efficiency on the same Josephson junction by means of a superconducting quantum interferometer. By electrostatic gating, we reveal a direct link between φ0-shift and diode effect. Our findings show that spin-orbit interaction in combination with a Zeeman field plays an important role in determining the magnetochiral anisotropy and the supercurrent diode effect.

Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations

Whole-body electromyostimulation has proven to be a highly effective alternative to conventional resistance-type exercise training. However, due to adverse effects in the past, very extensive contraindications have been put in place for the commercial, non-medical WB-EMS market. Considering recent positive innovations e.g., federal regulation, mandatory trainer education, revised guidelines, and new scientific studies on WB-EMS application, we believe that a careful revision of the very restrictive contraindications on WB-EMS is needed. This applies all the more because many cohorts with limited options for conventional exercise have so far been excluded. During a first meeting of an evidence-based consensus process, stakeholders from various backgrounds (e.g., research, education, application) set the priorities for revising the contraindications. We decided to focus on four categories of absolute contraindications: "Arteriosclerosis, arterial circulation disorders", "Diabetes mellitus" (DM), "Tumor and cancer" (TC), "Neurologic diseases, neuronal disorders, epilepsy". Based on scientific studies, quality criteria, safety aspects and benefit/risk assessment of the category, DM and TC were moved to the relative contraindication catalogue, while arteriosclerosis/arterial circulation disorders and neurologic diseases/neuronal disorders/epilepsy were still considered as absolute contraindications. While missing evidence suggests maintaining the status of neurologic diseases/neuronal disorders as an absolute contraindication, the risk/benefit-ratio does not support the application of WB-EMS in people with arteriosclerosis/arterial circulation diseases. Despite these very cautious modifications, countries with less restrictive structures for non-medical WB-EMS should consider our approach critically before implementing the present revisions. Considering further the largely increased amount of WB-EMS trials we advice regular updates of the present contraindication list.

Genetic structure and ecological niche space of lentil's closest wild relative, Lens orientalis (Boiss.) Schmalh

Crops arose from wild ancestors and to understand their domestication it is essential to compare the cultivated species with their crop wild relatives. These represent an important source of further crop improvement, in particular in relation to climate change. Although there are about 58,000 Lens accessions held in genebanks, only 1% are wild. We examined the geographic distribution and genetic diversity of the lentil's immediate progenitor L. orientalis. We used Genotyping by Sequencing (GBS) to identify and characterize differentiation among accessions held at germplasm collections. We then determined whether genetically distinct clusters of accessions had been collected from climatically distinct locations. Of the 195 genotyped accessions, 124 were genuine L. orientalis with four identified genetic groups. Although an environmental distance matrix was significantly correlated with geographic distance in a Mantel test, the four identified genetic clusters were not found to occupy significantly different environmental space. Maxent modelling gave a distinct predicted distribution pattern centred in the Fertile Crescent, with intermediate probabilities of occurrence in parts of Turkey, Greece, Cyprus, Morocco, and the south of the Iberian Peninsula with NW Africa. Future projections did not show any dramatic alterations in the distribution according to the climate change scenarios tested. We have found considerable diversity in L. orientalis, some of which track climatic variability. The results of the study showed the genetic diversity of wild lentil and indicate the importance of ongoing collections and in situ conservation for our future capacity to harness the genetic variation of the lentil progenitor.

Dark-Matter-Induced Nucleon Decay Signals in Mesogenesis

We introduce and study the first class of signals that can probe the dark matter in mesogenesis, which will be observable at current and upcoming large volume neutrino experiments. The well-motivated mesogenesis scenario for generating the observed matter-antimatter asymmetry necessarily has dark matter charged under the baryon number. Interactions of these particles with nuclei can induce nucleon decay with kinematics differing from spontaneous nucleon decay. We calculate the rate for this process and develop a simulation of the signal that includes important distortions due to nuclear effects. We estimate the sensitivity of DUNE, Super-Kamiokande, Hyper-Kamiokande, and JUNO to this striking signal.

Sign reversal of the Josephson inductance magnetochiral anisotropy and 0-π-like transitions in supercurrent diodes

The recent discovery of the intrinsic supercurrent diode effect, and its prompt observation in a rich variety of systems, has shown that non-reciprocal supercurrents naturally emerge when both space-inversion and time-inversion symmetries are broken. In Josephson junctions, non-reciprocal supercurrent can be conveniently described in terms of spin-split Andreev states. Here we demonstrate a sign reversal of the Josephson inductance magnetochiral anisotropy, a manifestation of the supercurrent diode effect. The asymmetry of the Josephson inductance as a function of the supercurrent allows us to probe the current-phase relation near equilibrium, and to probe jumps in the junction ground state. Using a minimal theoretical model, we can then link the sign reversal of the inductance magnetochiral anisotropy to the so-called 0-π-like transition, a predicted but still elusive feature of multichannel junctions. Our results demonstrate the potential of inductance measurements as sensitive probes of the fundamental properties of unconventional Josephson junctions.

Development and usability testing of a fully immersive VR simulation for REBOA training

BACKGROUND

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a potentially life-saving procedure for bleeding trauma patients. Being a rare and complex procedure performed in extreme situations, repetitive training of REBOA teams is critical. Evidence-based guidelines on how to train REBOA are missing, although simulation-based training has been shown to be effective but can be costly and complex. We aimed to determine the feasibility and acceptance of REBOA training using a fully immersive virtual reality (VR) REBOA simulation, as well as assess the confidence in conducting the REBOA procedure before and after the training.

METHODS

Prospective feasibility pilot study of prehospital emergency physicians and paramedics in Bern, Switzerland, from November 2020 until March 2021. Baseline characteristics of trainees, prior training and experience in REBOA and with VR, variables of media use (usability: system usability scale, immersion/presence: Slater-Usoh-Steed, workload: NASA-TLX, user satisfaction: USEQ) as well as confidence prior and after VR training were accessed.

RESULTS

REBOA training in VR was found to be feasible without relevant VR-specific side-effects. Usability (SUS median 77.5, IQR 71.3-85) and sense of presence and immersion (Slater-Usoh-Steed median 4.8, IQR 3.8-5.5) were good, the workload without under-nor overstraining (NASA-TLX median 39, IQR 32.8-50.2) and user satisfaction high (USEQ median 26, IQR 23-29). Confidence of trainees in conducting REBOA increased significantly after training (p < 0.001).

CONCLUSIONS

Procedural training of the REBOA procedure in immersive virtual reality is possible with a good acceptance and high usability. REBOA VR training can be an important part of a training curriculum, with the virtual reality-specific advantages of a time- and instructor-independent learning.

ICARUS at the Fermilab Short-Baseline Neutrino program: initial operation

The ICARUS collaboration employed the 760-ton T600 detector in a successful 3-year physics run at the underground LNGS laboratory, performing a sensitive search for LSND-like anomalous ν e appearance in the CERN Neutrino to Gran Sasso beam, which contributed to the constraints on the allowed neutrino oscillation parameters to a narrow region around 1 eV2 . After a significant overhaul at CERN, the T600 detector has been installed at Fermilab. In 2020 the cryogenic commissioning began with detector cool down, liquid argon filling and recirculation. ICARUS then started its operations collecting the first neutrino events from the booster neutrino beam (BNB) and the Neutrinos at the Main Injector (NuMI) beam off-axis, which were used to test the ICARUS event selection, reconstruction and analysis algorithms. ICARUS successfully completed its commissioning phase in June 2022. The first goal of the ICARUS data taking will be a study to either confirm or refute the claim by Neutrino-4 short-baseline reactor experiment. ICARUS will also perform measurement of neutrino cross sections with the NuMI beam and several Beyond Standard Model searches. After the first year of operations, ICARUS will search for evidence of sterile neutrinos jointly with the Short-Baseline Near Detector, within the Short-Baseline Neutrino program. In this paper, the main activities carried out during the overhauling and installation phases are highlighted. Preliminary technical results from the ICARUS commissioning data with the BNB and NuMI beams are presented both in terms of performance of all ICARUS subsystems and of capability to select and reconstruct neutrino events.

Corrigendum: Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application

[This corrects the article DOI: 10.3389/fphys.2023.1174103.].

Frailty as an indicator of postoperative complications following surgical excision of non-melanoma skin cancer on the head and neck

INTRODUCTION

Non-melanoma skin cancer (NMSC) predominantly affects those aged over 90 years, with 85% of lesions arising on the head and neck, where surgical excision remains the treatment of choice. Frailty is a measure of physiologic age and can be used as a predictor of adverse treatment outcomes. The aim of this study was to determine if the Rockwood Frailty Index is predictive of complications following excision of NMSC.

METHODS

Data were collected prospectively for patients who underwent an excision of a suspected NMSC from the head or neck across a two-month period. Details of the patient, lesion and procedure were recorded alongside ASA grade and Rockwood's Frailty score. Postoperative complications were recorded four weeks later.

RESULTS

There was a total of 125 patients: 74 (60%) male, 51 (40%) female; mean age was 78 (±9.8) years. Of the excised sites, 61% were closed primarily, 26% with a full thickness skin graft (FTSG), 13% with a local flap. Frailty ranged from 1 to 7 (median = 4). ASA ranged from 1 to 4 (median = 3). A total of 21 (17%) patients reported postoperative complications. Within this group, the median frailty and ASA grades were 5 and 3. Both frailty and ASA were positively significantly associated with age (p ≤ 0.001). There was no significant difference between the frailty or ASA grades of patients that experienced complications and those who did not. Patients who had a FTSG were significantly more likely to experience complications (p ≤ 0.05).

CONCLUSIONS

Frailty is not predictive of postoperative complications following excision of NMSC on the head and neck. Postoperative complications are significantly more associated with FTSG.

The role of adjuvant treatment for early-stage uterine clear cell carcinomas

BACKGROUND

Uterine clear cell carcinoma is a rare and aggressive subtype of endometrial carcinoma. Prospective clinical trials have not been feasible for this rare tumor, and data regarding the optimal adjuvant treatment regimen for early-stage uterine clear cell carcinomas is limited. Our study's objective was to determine if adjuvant chemotherapy or radiation therapy improves patients' outcomes in stage I and II uterine clear cell carcinoma.

METHODS

Patients with stage I and II uterine clear cell carcinoma were identified at a single institution. All cases were reviewed by a gynecologic pathologist. Both pure and mixed non-serous uterine clear cell carcinomas were included. Primary outcomes were recurrence free survival and overall survival.

RESULTS

A total of 71 patients were identified including 39 (55%) pure and 32 (45%) mixed clear cell carcinoma. Most patients were FIGO stage IA (77.5%). Most patients (n = 58, 82%) received adjuvant therapy, including 43 (61%) receiving chemotherapy, 50 (70%) receiving radiation therapy, and 35 (49%) receiving both. Recurrence free survival was not significantly different among patients receiving no or <6 cycles of chemotherapy versus patients receiving 6 cycles of chemotherapy (p = 0.39). However, median OS was significantly different among patients receiving no or <6 cycles of chemotherapy versus 6 cycles of chemotherapy (p = 0.004). On univariable analysis, 6 cycles of chemotherapy was significantly associated with improved OS (HR 0.1, 95% CI 0.01-0.07). Presence of LVSI, mutated p53, number of pelvic and para-aortic lymph nodes assessed, adjuvant chemotherapy (any number of cycles), and >2 medical co-morbidities were not significant predictors of OS on univariable analysis. On multivariable analysis, 6 cycles of adjuvant chemotherapy remained a significant predictor of improved OS (HR 0.1, 95% CI 0.01-0.8).

CONCLUSIONS

In this study, administration of 6 cycles of chemotherapy appears to significantly improve OS. This finding suggests consideration of 6 cycles of adjuvant chemotherapy in patients with early-stage uterine clear cell carcinoma, however clinical trials are needed to confirm these findings.

Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application

Whole-Body Electromyostimulation (WB-EMS) is a training technology that enables simultaneous stimulation of all the main muscle groups with a specific impulse intensity for each electrode. The corresponding time-efficiency and joint-friendliness of WB-EMS may be particularly attractive for people unable or unmotivated to conduct (intense) conventional training protocols. However, due to the enormous metabolic and musculoskeletal impact of WB-EMS, particular attention must be paid to the application of this technology. In the past, several scientific and newspaper articles reported severe adverse effects of WB-EMS. To increase the safety of commercial non-medical WB-EMS application, recommendations "for safe and effective whole-body electromyostimulation" were launched in 2016. However, new developments and trends require an update of these recommendations to incorporate more international expertise with demonstrated experience in the application of WB-EMS. The new version of these consensus-based recommendations has been structured into 1) "general aspects of WB-EMS", 2) "preparation for training", recommendations for the 3) "WB-EMS application" itself and 4) "safety aspects during and after training". Key topics particularly addressed are 1) consistent and close supervision of WB-EMS application, 2) mandatory qualification of WB-EMS trainers, 3) anamnesis and corresponding consideration of contraindications prior to WB-EMS, 4) the participant's proper preparation for the session, 5) careful preparation of the WB-EMS novice, 6) appropriate regeneration periods between WB-EMS sessions and 7) continuous interaction between trainer and participant at a close physical distance. In summary, we are convinced that the present guideline will contribute to greater safety and effectiveness in the area of non-medical commercial WB-EMS application.

Spatial Distribution of Muscular Effects of Acute Whole-Body Electromyostimulation at the Mid-Thigh and Lower Leg-A Pilot Study Applying Magnetic Resonance Imaging

Whole-body electromyostimulation (WB-EMS) is an innovative training method that stimulates large areas simultaneously. In order to determine the spatial distribution of WB-EMS with respect to volume involvement and stimulation depth, we determined the extent of intramuscular edema using magnetic resonance imaging (MRI) as a marker of structural effects. Intense WB-EMS first application (20 min, bipolar, 85 Hz, 350 µs) was conducted with eight physically less trained students without previous WB-EMS experience. Transversal T2-weighted MRI was performed at baseline and 72 h post WB-EMS to identify edema at the mid-thigh and lower leg. The depth of the edema ranged from superficial to maximum depth with superficial and deeper muscle groups of the mid-thigh or lower leg area approximately affected in a similar fashion. However, the grade of edema differed between the muscle groups, which suggests that the intensity of EMS-induced muscular contraction was not identical for all muscles. WB-EMS of the muscles via surface cuff electrodes has an effect on deeper parts of the stimulated anatomy. Reviewing the spatial and volume distribution, we observed a heterogeneous pattern of edema. We attribute this finding predominately to different stimulus thresholds of the muscles and differences in the stress resistance of the muscles.

WB-EMS Market Development-Perspectives and Threats

As a time-efficient and highly effective form of training, whole-body electromyostimulation (WB-EMS) enables personalised training for a wide range of users due to its personal training character and the individual control of the training intensity. However, due to misuse, negative side effects of WB-EMS have been reported in the past, resulting in expert guidelines for safe and effective WB-EMS application being issued. Furthermore, the use of WB-EMS is now legally permitted only for qualified personnel with certified equipment. This professionalization of the WB-EMS market as per the definition of quality standards for the devices and the personnel ensured a safe and effective WB-EMS application. However, recent market developments are undermining these standards through the growing of WB-EMS offers for the private sector. Hereby, most concepts focus on completely or predominately non-supervised WB application without control of potential overload by a qualified trainer. WB application is by no means trivial and the shift of responsibility for safety and effectiveness from the certified personnel to the trainees themselves is a clear step backwards in the development of WB-EMS use. We conclude that private, inadequately supervised WB-EMS application bears more dangers than potential benefits, not only for the trainees but also for the WB-EMS market as a whole.

Is there an inter-manufacturer difference in generic clopidogrel response?

Background

Differences in platelet aggregation response to generic clopidogrel by manufacturer has not been investigated.

Purpose

Compare rates of clopidogrel response among patients receiving medication produced by two different manufacturers after acute coronary syndrome and/or percutaneous coronary intervention.

Methods

This quality improvement project included 515 adult patients receiving clopidogrel for acute coronary syndrome or ischemic heart disease and referred for coronary angiography/percutaneous coronary intervention at a large, public hospital. The project was divided into two phases: 1. retrospective collection of baseline data; 2. two 12-week, prospective phases in which all clopidogrel in the hospital was restricted to a single manufacturer at a time. The primary outcome was clopidogrel response measured by platelet function testing defined as ADP response &lt;40% on light transmission aggregometry between two manufacturer groups. Aspirin response defined as arachidonic acid response &lt;20% was also measured.

Results

Of 515 total patients included in both phases (mean [SD] age, 64.5 [11.4] years; 351 [68.2%] men; 450 [87.4%] ACS), 52% were found to be clopidogrel responders based on results of platelet function testing (Table 1 – select variables). Among 135 patients in the prospective phase, there was a significantly lower proportion of patients who were clopidogrel responders in the Manufacturer 1 group compared to the Manufacturer 2 group (34.8% vs. 55.1%, p=0.03) (Table 2 – select variables). After adjustment for age, sex, BMI, aspirin response, therapeutic hypothermia, LHC indication, clopidogrel loading dose, time between loading dose and lab measurement, and manufacturer, aspirin response (OR [95% CI]: 0.96 [0.95–0.97], p&lt;0.001) and manufacturer (OR [95% CI]: 2.45 [1.18–5.22], p=0.02) were associated with clopidogrel response.

Conclusions

In a large public hospital, we observed that pharmacodynamic response to clopidogrel varied by drug manufacturer. Further investigation and/or regulation is needed to minimize inter-manufacturer variability.

Funding Acknowledgement

Type of funding sources: None.

Scintillation light detection in the 6-m drift-length ProtoDUNE Dual Phase liquid argon TPC

DUNE is a dual-site experiment for long-baseline neutrino oscillation studies, neutrino astrophysics and nucleon decay searches. ProtoDUNE Dual Phase (DP) is a 6  ×  6  ×  6 m 3 liquid argon time-projection-chamber (LArTPC) that recorded cosmic-muon data at the CERN Neutrino Platform in 2019-2020 as a prototype of the DUNE Far Detector. Charged particles propagating through the LArTPC produce ionization and scintillation light. The scintillation light signal in these detectors can provide the trigger for non-beam events. In addition, it adds precise timing capabilities and improves the calorimetry measurements. In ProtoDUNE-DP, scintillation and electroluminescence light produced by cosmic muons in the LArTPC is collected by photomultiplier tubes placed up to 7 m away from the ionizing track. In this paper, the ProtoDUNE-DP photon detection system performance is evaluated with a particular focus on the different wavelength shifters, such as PEN and TPB, and the use of Xe-doped LAr, considering its future use in giant LArTPCs. The scintillation light production and propagation processes are analyzed and a comparison of simulation to data is performed, improving understanding of the liquid argon properties.

POS0130 NEAR INFRARED FLUORESCENCE OPTICAL IMAGING (NIR-FOI) CAN SUPPORT THE DIFFERENTIAL DIAGNOSES OF CONNECTIVE TISSUE DISEASES

Background

Differentiation between degenerative osteoarthritis (OA) and autoimmune caused connective tissue diseases (CTD), or rheumatoid arthritis (RA) is important for effective therapy. Anamnesis, clinical examination, and analysis of laboratory parameters are helpful for diagnosis, but do not always lead to clear results. One problem is that patients often show overlapping symptoms. Particularly, imaging techniques as NIR-based fluorescence optical imaging (FOI) are playing an increasingly role as quantifiable and sensitive diagnostic methods. After injection of a fluorescent dye, changes in the microcirculation caused by inflammation can be detected due to altered blood flow and accumulation in anatomical structures of the hands. Analyses of enrichment features can be used to identify pathological changes and to support the diagnosis of degenerative and autoimmune diseases.

Objectives

The present work investigates the potential of NIR-FOI feature assessment to differentiate between various rheumatic diseases, which are accompanied by pathological changes in connective tissues.

Methods

NIR fluorescence imaging comprised 360 images/6 min. after injection of the dye. Analyses of patients with the clinical diagnosis of OA (n = 236) were compared with RA patients (n = 235), and patients diagnosed with autoimmune CTD (collagenoses) (n = 149). 17 features known to occur in FOI images were analyzed in both hands in three time periods (P1-3) after injection in two independent passes. In some cases, Prima Vista images (PVI), representing the sum of images 1-240 were also analyzed (n = 45, 33, 33 for OA, RA, CTD). Signals compared to the background were assessed as positive or negative (Figure 1). The data were analyzed statistically.

Figure 1.

Examples of significantly different features in NIR-FOI images of patients with clinically diagnosed OA, RA, or CTD. Top: the whole hands, also with nail bed injuries in phase 1 (P1) for a CTD patient (right), bottom: increased intensity in muscle-tendon junction in the forearm in phase 2 (P2) for an OA patient, increased intensity in MCP joint in phase 1 (P1) for an RA patient and a secondary Raynaud syndrome for a CTD patient in PVI.

Results

Comparing the analyses of all phases of the OA cohort with those of the RA cohort, 14 of 51 features were identified as significantly different (p<0.05). The dye accumulation in metacarpophalangeal joints (MCP) has high specificity and diagnostic odds ratio (DOR) for RA patients (91%, 4.32). Patients in the OA cohort showed an increase in the signal at the muscle-tendon junction in the forearm (80% specificity, DOR 3.11). A comparison of the RA and CTD cohorts revealed 24 significant differences, most prominent changes in the nail bed in P1 (100% specificity, DOR 8.27) and a punctate accumulation pattern in P2 (98% specificity, DOR 2.61) for the CTD cohort. Comparing the RA and CTD cohorts, 22 features were significantly different. The strongest differences were found in the PIP joints of RA patients (78% sensitivity, DOR 2.97) and in the nail bed of CTD patients (100 % specificity, DOR 8.18). In the cumulative PV images a high specificity for a secondary Raynaud’s syndrome in CTD patients was found as compared to RA (97%, DOR 17.7) and OA (91%, DOR 5.9). Further, DIP signals for OA comparing to CTD show significant differences (76 % sensitivity, DOR 2,73).

Conclusion

The present work demonstrates the detection and localization of specific, significant features in NIR-FOI of patients with different rheumatic diseases and can thus make an important contribution to diagnosis and optimization of therapy. In future, multivariate analysis and artificial intelligence algorithms can combine these features to further improve the diagnostic value.

Acknowledgements

Funded by the Federal Ministry of Education and Research (grant nb.; 13GW0341A)

Disclosure of Interests

Denise Kiesel Employee of: Xiralite GmbH, Jörn Berger Employee of: Xiralite GmbH, Egbert Gedat Employee of: Xiralite GmbH, Sarah Ohrndorf: None declared, Andreas Briel Shareholder of: Xiralite GmbH, Employee of: Xiralite Gmbh, Vieri Failli Employee of: nanoPET GmbH, Pia Welker Employee of: nanoPET GmbH

AB1363 IMAGE PATTERN ANALYSIS IN FLUORESCENCE OPTICAL IMAGING FOR DIFFERENTIAL DIAGNOSIS IN RHEUMATIC JOINT DISEASES

Background

As outlined in previous studies, different rheumatic joint diseases present specific characteristic patterns and features in fluorescence optical imaging (FOI) (1-4).

Objectives

We tested different features in FOI for their ability to differentiate various rheumatic joint diseases such as rheumatoid arthritis (RA), osteoarthritis (OA) and psoriatic arthritis (PsA) with the aim to identify clear FOI criteria for the diseases.

Methods

FOI images from patients with RA, OA, PsA and healthy volunteers were evaluated by two readers blinded for diagnosis and calibrated against each other, using the prima vista mode (PVM) and the 5-phase model. For the latter, the overall time course of FOI in each hand was divided into 5 phases with a computational algorithm. Phases 1 and 2 describe the inflow (start to 15% and 15%-90% on rising edge), phase 3 is the peak phase and phases 4 and 5 comprise the outflow (90%-36.8% and 36.8% to end on falling edge). Twenty-six different features were defined by an atlas, for example the streaky pattern feature (T) as a signal enhancement around the PIP area that appears streaky, whereby the stripes are orthogonal to the finger axis (Figure 1a). The cloudy pattern (W) is visible during the inflow on the back of the hand (Figure 1b). The enthesis feature (E) depicts a V shaped and filled pattern between nail and DIP (Figure 1c). The feature frequency in each patient and phase (PVM, 5-phase) was counted and statistically analysed.

Figure 1.

Examples for FOI patterns and features: a) (T) Streaky pattern in PVM image (OA); b) (W) Cloudy pattern on the back of the hand in phase 1 (PsA); c) (E) Enthesis pattern in phase 3.

Results

In total, 128 patients (RA (age mean 54.2; SD 10.6; median 52.4), OA (58.0; 14.3; 60.1), and PsA (47.9; 12.7; 46.8)) and healthy volunteers (32 in each group) were included in the feature reading. In our analysis, OA can be differentiated from RA on the basis of the feature T. Feature T is found in phase 3 (χ2: 4.61; diagnostic odds ratio (DOR): 7.49; sensitivity (TPR) 0.11; specificity (TNR): 0.98; positive predictive value (PPV): 0.87; negative predictive value (NPV): 0.52), phase 5 (χ2: 18.5; DOR: 5.60; TPR 0.55; TNR: 0.82; PPV: 0.76; NPV: 0.64 and PVM (28.3; 12.1; 52%; 92% 87%; 65%). By means of the feature E, a distinction between RA and PsA is only limited possible (χ2: 9.58; DOR: 3.65; TPR 0.40; TNR: 0.84; PPV: 0.71; NPV: 0.59). But PsA can well be distinguished from RA by the appearance of pattern W in phase 1 (χ2: 7.68; DOR: 6.92; TPR 0.19; TNR: 0.97; PPV: 0.86; NPV: 0.54).

Other significant features yield high specificity (70%-98%) while having low sensitivity (12%-52%).

Conclusion

This work demonstrates that FOI feature analysis has the potential for differential diagnosis with FOI, which could optimize the (early) diagnostic process of rheumatic joint diseases. A majority of features yield high specificity, but only low sensitivity. The combination of different features using artificial intelligence might lead to improved diagnostic accuracy.

References

[1]Werner SG, et al. Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology. Ann Rheum Dis. 2012; 71(4):504-510.

[2]Glimm AM, et al. Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study. Ann Rheum Dis. 2016; 75(3):566-570.

[3]Wiemann O, et al. The “green nail” phenomenon in ICG-enhanced fluorescence optical imaging - a potential tool for the differential diagnosis of psoriatic arthritis. J Dtsch Dermatol Ges. 2019;17(2):138-147.

[4]Schmidt A, et al. Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging. Arthritis Res Ther. 2020; 22(1):192.

Disclosure of Interests

None declared

Treatment outcome of atypical EGFR mutations in the German National Network Genomic Medicine Lung Cancer (nNGM)

BACKGROUND

Atypical EGFR mutations occur in 10-30% of NSCLC patients with EGFR mutations and their sensitivity to classical EGFR-tyrosine kinase inhibitors (TKI) is highly heterogeneous. Patients harboring one group of uncommon, recurrent EGFR mutations (G719X, S768I, L861Q) respond to EGFR-TKI. Exon 20 insertions are mostly insensitive to EGFR-TKI but display sensitivity to exon 20 inhibitors. Clinical outcome data of patients with very rare point and compound mutations upon systemic treatments are still sparse to date.

PATIENTS AND METHODS

In this retrospective, multi-center study of the national Network Genomic Medicine (nNGM) in Germany, 856 NSCLC cases with atypical EGFR mutations including co-occuring mutations were reported from 12 centers. Clinical follow-up data after treatment with different EGFR-TKI, chemotherapy and immune checkpoint inhibitors were available from 260 patients. Response to treatment was analyzed in three major groups: (1) uncommon mutations (G719X, S7681, L861Q and combinations), (2) exon 20 insertions and (3) very rare EGFR mutations (very rare single point mutations, compound mutations, exon 18 deletions, exon 19 insertions).

RESULTS

Our study comprises the largest thus far reported real-world cohort of very rare EGFR single point and compound mutations treated with different systemic treatments. We validated higher efficacy of EGFR-TKI in comparison to chemotherapy in group 1 (uncommon), while most exon 20 insertions (group 2) were not EGFR-TKI responsive. In addition, we found TKI sensitivity of very rare point mutations (group 3) and of complex EGFR mutations containing exon 19 deletions or L858R mutations independent of the combination partner. Notably, treatment responses in group 3 (very rare) were highly heterogeneous. Co-occurring TP53 mutations exerted a non-significant trend for a detrimental effect on outcome in EGFR-TKI treated patients in groups 2 and 3 but not in group 1.

CONCLUSIONS

Based on our findings we propose a novel nNGM classification of uncommon EGFR mutations.

Vestibular testing in children - The suppression head impulse (SHIMP) test

INTRODUCTION

The incidence of vestibular disorders and vertigo during childhood is increasing and pediatric clinicians have become more sensitive to children's balance disorders; thus, there is a need for appropriate detection test procedures for peripheral vestibular hypofunction. In order to ensure a reliable diagnosis and minimize misdiagnosis, a standardized clinical procedure via careful history and clinical examination is recommended. However, children, especially, are often unable to verbalize "vertigo" in a concrete manner, which often necessitates a consultation with a pediatrician holding nonspecific symptoms. The so-called suppression of the head impulse test (SHIMPs) represents a modification of the video head impulse test (HIMP) and is used for a more sensitive assessment of residual vestibular functions. In adults, SHIMPs are already an established diagnostic method. Nevertheless, to date, nothing is known about the applicability and standard values in childhood.

MATERIAL AND METHODS

In this monocentric, prospective study, we investigated whether SHIMPs enable a sensitive functional analysis of the vestibular system in healthy children of different ages. For this purpose, SHIMPs were performed in 40 children aged 3-18 years.

RESULTS

In this study, we demonstrated that SHIMPs can be easily performed in children (3-18 years). It is vital that the test be appropriately explained for children to ensure sufficient test tolerance and compliance.

CONCLUSION

SHIMPs are a helpful supplement to clinically established vestibular tests such as the HIMP in pediatric vestibular balance disorder diagnostics and can be integrated into the clinical routine, especially in children who have minimal verbal abilities or understanding of the instructions for HIMP. Similar to the HIMP, SHIMPs are characterized by a short test duration and a high tolerance.

Cost-effectiveness analysis of tumor molecular classification in high-risk early-stage endometrial cancer

PURPOSE

Tumor molecular analyses in endometrial cancer (EC) includes 4 distinct subtypes: (1) POLE-mutated, (2) mismatch repair protein (MMR) deficient, (3) p53 mutant, and (4) no specific molecular profile. Recently, a sub-analysis of PORTEC-3 demonstrated notable differences in treatment response between molecular classification (MC) groups. Cost of testing is one barrier to widespread adoption of MC. Therefore, we sought to determine the cost-effectiveness of MC in patients with stage I and II high-risk EC.

METHODS

A Markov decision model was developed to compare tumor molecular classification (TMC) vs. no testing (NT). A healthcare payor's perspective and 5-year time horizon were used. Base case data were abstracted from PORTEC-3 and the molecular sub-analysis. Cost and utility data were derived from public databases, peer-reviewed literature, and expert input. Strategies were compared using the incremental cost-effectiveness ratio (ICER) with effectiveness in quality-adjusted life years (QALYs) and evaluated with a willingness-to-pay threshold of $100,000 per QALY gained. Sensitivity analyses were performed to test model robustness.

RESULTS

When compared to NT, TMC was cost effective with an ICER of $25,578 per QALY gained; incremental cost was $1780 and incremental effectiveness was 0.070 QALYs. In one-way sensitivity analyses, results were most sensitive to the cost of POLE testing, but TMC remained cost-effective over all parameter ranges.

CONCLUSIONS

TMC in early-stage high-risk EC is cost-effective, and the model results were robust over a range of parameters. Given that MC can be used to guide adjuvant treatment decisions, these findings support adoption of TMC into routine practice.

Erratum: Azimuthal Anisotropy of K_{S}^{0} and Λ+Λ[over ¯] Production at Midrapidity from Au+Au Collisions at sqrt[s]_{NN}=130 GeV [Phys. Rev. Lett. 89, 132301 (2002)]

This corrects the article DOI: 10.1103/PhysRevLett.89.132301.

Erratum: Azimuthal Anisotropy at the Relativistic Heavy Ion Collider: The First and Fourth Harmonics [Phys. Rev. Lett. 92, 062301 (2004)]

This corrects the article DOI: 10.1103/PhysRevLett.92.062301.

POS1401 ASSESSMENT OF INTERREADER RELIABILITY IN SCORING PATIENTS WITH HAND OSTEOARTHRITIS AND PSORIATIC ARTHRITIS BY FLUORESCENCE OPTICAL IMAGING

Background:

Fluorescence Optical Imaging (FOI) utilises the fluorophore indocyanine green (ICG) to reflect enhanced microcirculation in hand and finger joints due to inflammation.

Objectives:

We wanted to assess the interreader reliability of FOI enhancement in patients with hand osteoarthritis (OA) and psoriatic arthritis (PsA). Furthermore, predefined typical morphologic patterns were included to determine the ability of FOI to discriminate between both diagnoses.

Methods:

An atlas with example images of grade 0-3 in different joint groups and typical morphologic patterns (‘streaky signals’[1], ‘green/blue nail sign’[2], ‘Werner sign’[3,4], and ‘Bishop’s crozier sign’) of PsA and hand OA was created. Two readers scored all joints in both hands (30 in total) of 20 cases with hand OA and PsA. The cases were randomly mixed and both readers were blinded to diagnosis. Each joint was rated on a semiquantitative scale from 0 to 3 in five different images (PrimaVista Mode (PVM), phase 1, 2 (first and middle image), and 3) during the FOI sequence according to the scoring method FOIAS (fluorescence optical imaging activity score)[1,3]. Interreader reliability on scoring joint enhancement was calculated using linear weighted Cohen’s kappa (κ). Agreement on diagnosis (hand OA vs. PsA) and different morphologic patterns was assessed by calculating (regular) Cohen’s kappa.

Results:

Overall agreement on scoring joint enhancement (all phases) was substantial (κ = 0.75), with greatest consensus in phase 2 first (κ = 0.75) and lowest agreement in phase 1 (κ = 0.46). Reliability varied in different joint groups (wrist, MCP, (P)IP, DIP), with almost perfect overall agreement on PIP joint affection (κ = 0.81), substantial agreement on wrist (κ = 0.69) and DIP joint affection (κ = 0.63), and moderate agreement on MCP joint affection (κ = 0.49) across all phases. Consensus on morphologic patterns showed overall fair agreement (κ = 0.37) with a similar kappa value on the ability to discriminate between both diagnoses (κ = 0.3).

Conclusion:

Joint enhancement in FOI can be reliably assessed using a predefined scoring method. The ability of FOI to differentiate between hand OA and PsA seems to be limited. Clearer definition and more training might be needed to better agree on morphologic patterns in FOI.

References:

[1] Glimm AM, Werner SG, Burmester GR, et al. Ann Rheum Dis. 2016 Mar;75(3):566-570

[2] Wiemann O, Werner SG, Langer HE, et al. J Dtsch Dermatol Ges. 2019 Feb;17(2):138-148

[3] Werner SG, Langer HE, Ohrndorf S, et al. Ann Rheum Dis. 2012 Apr;71(4):504-510

[4] Zeidler H 2019. Fluoreszenzoptische Bildgebung. In: Zeidler H, Michel BA. Differenzialdiagnose rheumatischer Erkrankungen 5. Aufl. Springer, Heidelberg, S. 88-89

Disclosure of Interests:

Benedict Drude: None declared, Øystein Maugesten: None declared, Stephanie Gabriele Werner: None declared, Gerd Rüdiger Burmester: None declared, Jörn Berger Employee of: Xiralite GmbH, Ida K. Haugen: None declared, Sarah Ohrndorf: None declared

Prospects for beyond the Standard Model physics searches at the Deep Underground Neutrino Experiment: DUNE Collaboration

The Deep Underground Neutrino Experiment (DUNE) will be a powerful tool for a variety of physics topics. The high-intensity proton beams provide a large neutrino flux, sampled by a near detector system consisting of a combination of capable precision detectors, and by the massive far detector system located deep underground. This configuration sets up DUNE as a machine for discovery, as it enables opportunities not only to perform precision neutrino measurements that may uncover deviations from the present three-flavor mixing paradigm, but also to discover new particles and unveil new interactions and symmetries beyond those predicted in the Standard Model (SM). Of the many potential beyond the Standard Model (BSM) topics DUNE will probe, this paper presents a selection of studies quantifying DUNE's sensitivities to sterile neutrino mixing, heavy neutral leptons, non-standard interactions, CPT symmetry violation, Lorentz invariance violation, neutrino trident production, dark matter from both beam induced and cosmogenic sources, baryon number violation, and other new physics topics that complement those at high-energy colliders and significantly extend the present reach.

Three-dimensional microscale hanging drop arrays with geometric control for drug screening and live tissue imaging

Existing three-dimensional (3D) culture techniques are limited by trade-offs between throughput, capacity for high-resolution imaging in living state, and geometric control. Here, we introduce a modular microscale hanging drop culture where simple design elements allow high replicates for drug screening, direct on-chip real-time or high-resolution confocal microscopy, and geometric control in 3D. Thousands of spheroids can be formed on our microchip in a single step and without any selective pressure from specific matrices. Microchip cultures from human LN229 glioblastoma and patient-derived mouse xenograft cells retained genomic alterations of originating tumors based on mate pair sequencing. We measured response to drugs over time with real-time microscopy on-chip. Last, by engineering droplets to form predetermined geometric shapes, we were able to manipulate the geometry of cultured cell masses. These outcomes can enable broad applications in advancing personalized medicine for cancer and drug discovery, tissue engineering, and stem cell research.

Efficacy of Whole-Body Electromyostimulation (WB-EMS) on Body Composition and Muscle Strength in Non-athletic Adults. A Systematic Review and Meta-Analysis

This systematic review and meta-analysis set out to determine the efficacy on whole-body electromyostimulation (WB-EMS) on body composition and strength parameters in non-athletic cohorts. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) WB-EMS trials with at least one exercise and one control group, (c) WB-EMS as primary physical intervention, (d) WB-EMS with at least six electrodes covering most muscle groups, (e) non-athletic cohorts. We searched eight electronic databases up to June 30, 2020, without language restrictions. Standardized mean differences (SMD) for muscle mass parameters, total body fat mass, maximum leg extension, and trunk extension strength were defined as outcome measures. In summary, 16 studies with 19 individual WB-EMS groups representing 897 participants were included. Studies vary considerably with respect to age, BMI, and physical conditions. Impulse protocols of the studies were roughly comparable, but training frequency (1-5 sessions/week) and intervention length (6-54 weeks) differed between the studies. SMD average was 1.23 (95%-CI: 0.71-1.76) for muscle mass, 0.98 (0.74-1.22) for maximum leg, and 1.08 (0.78-1.39) for maximum trunk extension strength changes (all p < 0.001). SMD for body fat changes (-0.40, [-0.98 to 0.17]), however, did not reach significance. I ² and Q-statistics revealed substantial heterogeneity of muscle and fat mass changes between the trials. However, rank and regression tests did not indicate positive evidence for small-study bias and funnel plot asymmetries. This work provided further evidence for significant, large-sized effects of WB-EMS on muscle mass and strength parameters, but not on body fat mass. Clinical Trial Registration: ClinicalTrials.gov, PROSPERO; ID: CRD42020183059.

Heading in Soccer: Does Kinematics of the Head-Neck-Torso Alignment Influence Head Acceleration?

There is little scientific evidence regarding the cumulative effect of purposeful heading. The head-neck-torso alignment is considered to be of great importance when it comes to minimizing potential risks when heading. Therefore, this study determined the relationship between head-neck-torso alignment (cervical spine, head, thoracic spine) and the acceleration of the head, the relationship between head acceleration and maximum ball speed after head impact and differences between head accelerations throughout different heading approaches (standing, jumping, running). A total of 60 male soccer players (18.9 ± 4.0 years, 177.6 ± 14.9 cm, 73.1 ± 8.6 kg) participated in the study. Head accelerations were measured by a telemetric Noraxon DTS 3D Sensor, whereas angles for the head-neck-torso alignment and ball speed were analyzed with a Qualisys Track Manager program. No relationship at all was found for the standing, jumping and running approaches. Concerning the relationship between head acceleration and maximum ball speed after head impact only for the standing header a significant result was calculated (p = 0.024, R2 = .085). A significant difference in head acceleration (p < .001) was identified between standing, jumping and running headers. To sum up, the relationship between head acceleration and head-neck-torso alignment is more complex than initially assumed and could not be proven in this study. Furthermore first data were generated to check whether the acceleration of the head is a predictor for the resulting maximum ball speed after head impact, but further investigations have to follow. Lastly, we confirmed the results that the head acceleration differs with the approach.

Can A Superimposed Whole-Body Electromyostimulation Intervention Enhance the Effects of a 10-Week Athletic Strength Training in Youth Elite Soccer Players?

Strength training in youth soccer has both a preventive and a sports-specific component. Whole-body electromyostimulation (WB-EMS) could represent an interesting time-saving add-on to classical strength exercises in performance-oriented soccer. The objective of this study was to find out whether a 10-week superimposed WB-EMS training might have a more positive impact on strength parameters in male youth elite soccer players than regular athletic strength exercises alone. A total of 30 male youth soccer players from a youth academy aged 15 to 17 years participated in the study. Before and after the intervention, the isometric extension and flexion forces of trunk and knee, and the hip abduction and adduction forces were tested. Twelve players (control group) absolved a conventional 20-minute strength training once a week for a period of ten weeks. Eighteen players absolved the same exercises but with superimposed WB-EMS. Blood creatine kinase concentration was measured for training control. ANOVAs, Friedman tests and post hoc t-tests were calculated (p = 0.05) to examine the strength development during the training period between the groups. While we could not find significant strength increases in the leg, hip and trunk muscles in the control group (<4%), the strength of the WB-EMS group improved significantly in 4 of the 6 muscle groups tested. In this group, the strength of knee flexors increased significantly by 20.68 ± 21.55%, knee extensors by 31.43 ± 37.02%, hip adductors by 21.70 ± 12.86% and trunk flexors by 33.72 ± 27.43%. The rates of strength increase are partly in line with other studies, partly clearly higher, which might be explained by the athletically active target group. A 10-week superimposed WB-EMS training improves the strength of certain leg, hip and trunk muscles in male adolescent elite soccer players to a greater extent than a pure athletic strength training of the same duration.

Whole-body electromyostimulation in physical therapy: do gender, skinfold thickness or body composition influence maximum intensity tolerance?

[Purpose] Whole-body electromyostimulation (WB-EMS) is an extension of the EMS application known in physical therapy. In WB-EMS, body composition and skinfold thickness seem to play a decisive role in influencing the Ohmic resistance and therefore the maximum intensity tolerance. That is why the therapeutic success of (WB-)EMS may depend on individual anatomical parameters. The aim of the study was to find out whether gender, skinfold thickness and parameters of body composition have an influence on the maximum intensity tolerance in WB-EMS. [Participants and Methods] Fifty-two participants were included in the study. Body composition (body impedance, body fat, fat mass, fat-free mass) and skinfold thicknesses were measured and set into relation to the maximum intensity tolerance. [Results] No relationship between the different anthropometric parameters and the maximum intensity tolerance was detected for both genders. Considering the individual muscle groups, no similarities were found in the results. [Conclusion] Body composition or skinfold thickness do not seem to have any influence on the maximum intensity tolerance in WB-EMS training. For the application in physiotherapy this means that a dosage of the electrical voltage within the scope of a (WB-) EMS application is only possible via the subjective feedback (BORG Scale).

Effects of an Impulse Frequency Dependent 10-Week Whole-body Electromyostimulation Training Program on Specific Sport Performance Parameters

The difference in the efficacy of altered stimulation parameters in whole-body-electromyostimulation (WB-EMS) training remains largely unexplored. However, higher impulse frequencies (>50 Hz) might be most adequate for strength gain. The aim of this study was to analyze potential differences in sports-related performance parameters after a 10-week WB-EMS training with different frequencies. A total of 51 untrained participants (24.9 ± 3.9 years, 174 ± 9 cm, 72.4 ± 16.4 kg, BMI 23.8 ± 4.1, body fat 24.7 ± 8.1 %) was randomly divided into three groups: one inactive control group (CON) and two training groups. They completed a 10-week WB-EMS program of 1.5 sessions/week, equal content but different stimulation frequencies (training with 20 Hz (T20) vs. training with 85 Hz (T85)). Before and after intervention, all participants completed jumping (Counter Movement Jump (CMJ), Squat Jump (SJ), Drop Jump (DJ)), sprinting (5m, 10m, 30m), and strength tests (isometric trunk flexion/extension). One-way ANOVA was applied to calculate parameter changes. Post-hoc least significant difference tests were performed to identify group differences. Significant differences were identified for CMJ (p = 0.007), SJ (p = 0.022), trunk flexion (p = 0.020) and extension (p=.013) with significant group differences between both training groups and CON (not between the two training groups T20 and T85). A 10-week WB-EMS training leads to significant improvements of jump and strength parameters in untrained participants. No differences could be detected between the frequencies. Therefore, both stimulation frequencies can be regarded as adequate for increasing specific sport performance parameters. Further aspects as regeneration or long term effects by the use of different frequencies still need to be clarified.

AB0325 FLUORESCENCE OPTICAL IMAGING (FOI) AIDS DIFFERENTIAL DIAGNOSIS OF RHEUMATIC DISEASES AND INCREASES TREATMENT RESPONSE RATE IN RA THROUGH PATIENT STRATIFICATION

Background:

In recent years, indocyanine green (ICG)-enhanced FOI has become clinically available as a novel tool for the early detection of rheumatic diseases, assessment of disease activity and monitoring of treatment response. The high sensitivity of this method allows visualization of slight changes in the microcirculation of the hands as a sign of inflammation. Different rheumatic diseases present characteristic signal enhancement patterns, which may facilitate differential diagnosis. Signal enhancement in metacarpophalangeal (MCP) joints, for example, can frequently be seen in patients with rheumatoid arthritis (RA).

Objectives:

We analyzed data of a multicentric clinical study (OPERA, n = 3300) including patients with different rheumatic diseases. Patients were divided into groups using clinical parameters followed by FOI examination to test the hypothesis that this method can improve the diagnosis.

Methods:

The present study involved 200 patients with RA (n=200), divided into groups according to Steinbrocker’s (STBR) staging system, patients that had degenerative osteoarthritis (OA, n=100), and a control group without clinical symptoms (n=40). RA patients were examined before and during treatment with biologicals, glucocorticoids (GK), or DMARDs. Clinical and laboratory assessments were made by analyses of DAS28, patient questionnaires, rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), erythrocyte sedimentation rate (ESR), and x-rays. FOI signal intensity (SI) was defined by ratio of areas with SI in patients and controls. Image sequences were analyzed visually, and MCP joints were judged as positive if in the early phase of ICG inflow, a higher SI in any MCP region was found in comparison to the control group.

Results:

Initially, serum factors typical for RA patients were analyzed in the different groups. In 23 % of OA patients RF and/or ACPA were detected in the serum. Surprisingly, in the STBR I group, only 35 % of patients were tested as serum-positive for RF and/or ACPA. After FOI, the patients were subdivided into two groups with and without ICG enrichment in MCPs. In the MCP-positive group, the percentage of RF/ACPA-positive STBRI patients increased to 83%, with only 25 % seropositive patients in the MCP-negative group. In STBRII-IV cohorts, the proportion of RF/ACPA-positive patients was initially higher as in the STBRI group, but also increased after FOI analysis of MCP positivity. In the group treated with biologicals (STBRI-IV), responders were identified both by clinical parameters and FOI. After treatment, 42 % of all analyzed patients were found to respond to treatment. Compared to all patients, the MCP-positive group showed a significantly increased response rate at 71%, while all patients (100%) in the MCP-negative group were identified as non-responders (Figure 1).

Conclusion:

The study indicates that FOI is highly effective for the diagnosis of RA, selection of the appropriate therapy, and for the monitoring of therapeutic success. Treatment response rate can be increased (from 42% to 71%) through patient stratification in terms of ICG enrichment in MCP.

Figure.

Disclosure of Interests:

Mark Ferl: None declared, Sarah Ohrndorf: None declared, Jörn Berger Employee of: Xiralite GmbH, Andreas Briel Shareholder of: Xiralite GmbH, Pia Welker Employee of: Xiralite GmbH

Rapid Isothermal Amplification and Portable Detection System for SARS-CoV-2

The COVID-19 pandemic provides an urgent example where a gap exists between availability of state-of-the-art diagnostics and current needs. As assay details and primer sequences become widely known, many laboratories could perform diagnostic tests using methods such as RT-PCR or isothermal RT-LAMP amplification. A key advantage of RT-LAMP based approaches compared to RT-PCR is that RT-LAMP is known to be robust in detecting targets from unprocessed samples. In addition, RT-LAMP assays are performed at a constant temperature enabling speed, simplicity, and point-of-use testing. Here, we provide the details of an RT-LAMP isothermal assay for the detection of SARS-CoV-2 virus with performance comparable to currently approved tests using RT-PCR. We characterize the assay by introducing swabs in virus spiked synthetic nasal fluids, moving the swab to viral transport medium (VTM), and using a volume of that VTM for performing the amplification without an RNA extraction kit. The assay has a Limit-of-Detection (LOD) of 50 RNA copies/μL in the VTM solution within 20 minutes, and LOD of 5000 RNA copies/μL in the nasal solution. Additionally, we show the utility of this assay for real-time point-of-use testing by demonstrating detection of SARS-CoV-2 virus in less than 40 minutes using an additively manufactured cartridge and a smartphone-based reader. Finally, we explore the speed and cost advantages by comparing the required resources and workflows with RT-PCR. This work could accelerate the development and availability of SARS-CoV-2 diagnostics by proving alternatives to conventional laboratory benchtop tests.

Frequency-Dependent Reaction of the Triceps Surae Muscle of the Mouse During Electromyostimulation

The difference in the efficacy of altered stimulation parameters in whole-body-electromyostimulation training (WB-EMS) has hardly been examined. Higher impulse frequencies (>50 Hz) might be most adequate for strength gains because of the force frequency relationship (FFR), which describes a greater force production by increasing the applied frequency. Frequencies below this value, however, also seem to have positive influences on muscle strength increases. Therefore, the aim of this study was to analyze possible muscle length changes to different stimulation frequencies of the dissected mouse triceps surae muscle. A bending rod transducer was used to measure and compare changes in muscle lengths at different frequencies in relation to the initial length in the prepared muscle. We found significant differences between the muscle shortening at different frequencies (p < 0.001). At 20 Hz the largest muscle shortening was observed (20 Hz = 3.32 ± 2.06, 60 Hz = 0.77 ± 0.58, 85 Hz = 0.32 ± 0.29, 100 Hz = 0.31 ± 0.29). From a frequency of 60 Hz, the muscle shortening decreased progressively, at stimulation frequencies above 60 Hz the lowest shortenings were recorded. The results demonstrate a different behavior of the isolated triceps surae muscle of the mouse in an ex vivo environment. Even if there is no FFR in this investigation, the results indicate a higher metabolic demand using higher frequencies in electromyostimulation, despite the experimental execution in ex vivo design. Therefore, future studies should take this faster fatigue into account when drawing up training protocols in order to counteract possible frequency modulations.

Effects of a 6-Week Strength Training of the Neck Flexors and Extensors on the Head Acceleration during Headers in Soccer

The importance of well trained and stable neck flexors and extensors as well as trunk muscles for intentional headers in soccer is increasingly discussed. The neck flexors and extensors should ensure a coupling of trunk and head at the time of ball contact to increase the physical mass hitting the ball and reduce head acceleration. The aim of the study was to analyze the influence of a 6-week strength training program (neck flexors, neck extensors) on the acceleration of the head during standing, jumping and running headers as well as after fatigue of the trunk muscles on a pendulum header. A total of 33 active male soccer players (20.3 ± 3.6 years, 1.81 ± 0.07 m, 75.5 ± 8.3 kg) participated and formed two training intervention groups (IG1: independent adult team, IG2: independent youth team) and one control group (CG: players from different teams). The training intervention consisted of three exercises for the neck flexors and extensors. The training effects were verified by means of the isometric maximum voluntary contraction (IMVC) measured by a telemetric Noraxon DTS force sensor. The head acceleration during ball contact was determined using a telemetric Noraxon DTS 3D accelerometer. There was no significant change of the IMVC over time between the groups (F=2.265, p=.121). Head acceleration was not reduced significantly for standing (IG1 0.4 ± 2.0, IG2 0.1 ± 1.4, CG -0.4 ± 1.2; F = 0.796, p = 0.460), jumping (IG1-0.7 ± 1.4, IG2-0.2 ± 0.9, CG 0.1 ± 1.2; F = 1.272, p = 0.295) and running (IG1-1.0 ± 1.9, IG2-0.2 ± 1.4, CG -0.1 ± 1.6; F = 1.050, p = 0.362) headers as well as after fatigue of the trunk musculature for post-jumping (IG1-0.2 ± 2.1, IG2-0.6 ± 1.4; CG -0.6 ± 1.3; F = 0.184, p = 0.833) and post-running (IG1-0.3 ± 1.6, IG2-0.7 ± 1.2, CG 0.0 ± 1.4; F = 0.695, p = 0.507) headers over time between IG1, IG2 and CG. A 6-week strength training of the neck flexors and neck extensors could not show the presumed preventive benefit. Both the effects of a training intervention and the consequences of an effective intervention for the acceleration of the head while heading seem to be more complex than previously assumed and presumably only come into effect in case of strong impacts.

The Impact of Whole-Body Electromyostimulation on Body Posture and Trunk Muscle Strength in Untrained Persons

Muscular imbalances of the trunk muscles are held responsible for changes in body posture. At the same time, whole-body electromyostimulation (WB-EMS) has been established as a new training method that enables simultaneous stimulation of many muscle groups. This study was aiming to analyze if a 10 weeks WB-EMS training changes posture-relevant parameters and/or improves isometric strength of the trunk extensors and flexors, and if there are differences based on stimulation at 20 Hz and 85 Hz. Fifty eight untrained adult test persons were divided into three groups (control, CON; training with 20 Hz stimulation, TR20; training with 85 Hz, TR85). Anthropometric parameters, trunk extension and flexion forces and torques, and posture parameters were determined before (n = 58) and after (n = 53: CON: n = 15, TR20: n = 19, TR85: n = 19) a 10 weeks WB-EMS training program (15 applications, 9 exercises). Differences between the groups were calculated for pre- and post-tests using univariate ANOVA and between the test times using repeated (2 × 3) ANOVA. Comparisons of pairs were calculated post hoc based on Fisher (LSD). No differences between the groups were found for the posture parameters. The post hoc analysis of both trunk flexion and trunk extension forces and torques showed a significant difference between the groups TR85 and CON but no difference between the other group pairs. A 10 weeks whole-body electrostimulation training with a stimulation frequency of 85 Hz in contrast to training with a stimulation frequency of 20 Hz improves the trunk muscle strength of an untrained group but does not significantly change posture parameters.

Adjustment Effects of Maximum Intensity Tolerance During Whole-Body Electromyostimulation Training

Intensity regulation during whole-body electromyostimulation (WB-EMS) training is mostly controlled by subjective scales such as CR-10 Borg scale. To determine objective training intensities derived from a maximum as it is used in conventional strength training using the one-repetition-maximum (1-RM), a comparable maximum in WB-EMS is necessary. Therefore, the aim of this study was to examine, if there is an individual maximum intensity tolerance plateau after multiple consecutive EMS application sessions. A total of 52 subjects (24.1 ± 3.2 years; 76.8 ± 11.1 kg; 1.77 ± 0.09 m) participated in the longitudinal, observational study (38 males, 14 females). Each participant carried out four consecutive maximal EMS applications (T1-T4) separated by 1 week. All muscle groups were stimulated successively until their individual maximum and combined to a whole-body stimulation index to carry out a possible statement for the development of the maximum intensity tolerance of the whole body. There was a significant main effect between the measurement times for all participants (p < 0.001; 𝜂² = 0.39) as well as gender specific for males (p = 0.001; 𝜂² = 0.18) and females (p < 0.001; 𝜂² = 0.57). There were no interaction effects of gender × measurement time (p = 0.394). The maximum intensity tolerance increased significantly from T1 to T2 (p = 0.001) and T2 to T3 (p < 0.001). There was no significant difference between T3 and T4 (p = 1.0). These results indicate that there is an adjustment of the individual maximum intensity tolerance to a WB-EMS training after three consecutive tests. Therefore, there is a need of several habituation units comparable to the identification of the individual 1-RM in conventional strength training. Further research should focus on an objective intensity-specific regulation of the WB-EMS based on the individual maximum intensity tolerance to characterize different training areas and therefore generate specific adaptations to a WB-EMS training compared to conventional strength training methods.

What Approaches are Most Effective at Addressing Micronutrient Deficiency in Children 0-5 Years? A Review of Systematic Reviews

Introduction Even though micronutrient deficiency is still a major public health problem, it is still unclear which interventions are most effective in improving micronutrient status. This review therefore aims to summarize the evidence published in systematic reviews on intervention strategies that aim at improving micronutrient status in children under the age of five. Methods We searched the literature and included systematic reviews that reported on micronutrient status as a primary outcome for children of 0-5 years old, had a focus on low or middle income countries. Subsequently, papers were reviewed and selected by two authors. Results We included 4235 reviews in this systematic review. We found that (single or multiple) micronutrient deficiencies in pre-school children improved after providing (single or multiple) micronutrients. However home fortification did not always lead to significant increase in serum vitamin A, serum ferritin, hemoglobin or zinc. Commercial fortification did improve iron status. Cord clamping reduced the risk of anemia in infants up to 6 months and, in helminth endemic areas, anthelminthic treatment increased serum ferritin levels, hemoglobin and improved height for age z-scores. Anti-malaria treatment improved ferritin levels. Discussion Based on our results the clearest recommendations are: delayed cord clamping is an effective intervention for reducing anemia in early life. In helminth endemic areas iron status can be improved by anthelminthic treatment. Anti-malaria treatment can improve ferritin. In deficient populations, single iron, vitamin A and multimicronutrient supplementation can improve iron, vitamin A and multimicronutrient status respectively. While the impact of home-fortification on multimicronutrient status remains questionable, commercial iron fortification may improve iron status.