Enhanced Spike-specific, but attenuated Nucleocapsid-specific T cell responses upon SARS-CoV-2 breakthrough versus non-breakthrough infections

SARS-CoV-2 vaccine breakthrough infections frequently occurred even before the emergence of Omicron variants. Yet, relatively little is known about the impact of vaccination on SARS-CoV-2-specific T cell and antibody response dynamics upon breakthrough infection. We have therefore studied the dynamics of CD4 and CD8 T cells targeting the vaccine-encoded Spike and the non-encoded Nucleocapsid antigens during breakthrough infections (BTI, n=24) and in unvaccinated control infections (non-BTI, n=30). Subjects with vaccine breakthrough infection had significantly higher CD4 and CD8 T cell responses targeting the vaccine-encoded Spike during the first and third/fourth week after PCR diagnosis compared to non-vaccinated controls, respectively. In contrast, CD4 T cells targeting the non-vaccine encoded Nucleocapsid antigen were of significantly lower magnitude in BTI as compared to non-BTI. Hence, previous vaccination was linked to enhanced T cell responses targeting the vaccine-encoded Spike antigen, while responses against the non-vaccine encoded Nucleocapsid antigen were significantly attenuated

Enhanced Spike-specific, but attenuated Nucleocapsid-specific T cell responses upon SARS-CoV-2 breakthrough versus non-breakthrough infections

SARS-CoV-2 vaccine breakthrough infections frequently occurred even before the emergence of Omicron variants. Yet, relatively little is known about the impact of vaccination on SARS-CoV-2-specific T cell and antibody response dynamics upon breakthrough infection. We have therefore studied the dynamics of CD4 and CD8 T cells targeting the vaccine-encoded Spike and the non-encoded Nucleocapsid antigens during breakthrough infections (BTI, n=24) and in unvaccinated control infections (non-BTI, n=30). Subjects with vaccine breakthrough infection had significantly higher CD4 and CD8 T cell responses targeting the vaccine-encoded Spike during the first and third/fourth week after PCR diagnosis compared to non-vaccinated controls, respectively. In contrast, CD4 T cells targeting the non-vaccine encoded Nucleocapsid antigen were of significantly lower magnitude in BTI as compared to non-BTI. Hence, previous vaccination was linked to enhanced T cell responses targeting the vaccine-encoded Spike antigen, while responses against the non-vaccine encoded Nucleocapsid antigen were significantly attenuated

Routine postoperative imaging early after lumbar decompression surgery: a prospective evaluation

Este estudo teve como objetivos analisar o protagonismo exercido pelos enfermeiros no Colegiado de Gestão Regional - COGERE a partir de sua formação acadêmica e compreender as tecnologias utilizadas por eles no seu processo de trabalho. Trata-se de estudo de caso com doze gestores do COGERE. Os dados foram coletados através das entrevistas e analisados mediante análise temática. A formação do enfermeiro se embasa no modelo biomédico, cujo núcleo de conhecimento mobiliza tecnologias duras e leve-duras, porém insuficiente para tecnologias leves. A atuação dos enfermeiros no campo da gestão em saúde requer maior constituição da noção de corresponsabilidade entre o aparelho formador e serviços de saúde, com implicação recíproca entre ensino, gestão, atenção e participação social.This study aimed to analyze the nurses’ role in a Regional Management Board - COGERE from their academic formation and understand the technologies used by them in their work process. It is a case study with twelve administrators from COGERE. Data were collected through interviews and analyzed using thematic analysis. The nursing academic formation was grounded in the biomedical model, which mobilizes hard and light-hard technologies, but not enough to hard technologies. The role of nurses in the field of health management requires a greater incorporation of the concept of co-responsibility between the educational system and health services, with a reciprocal implication among teaching, management, attention, and social participation.Este estudio tuvo como objetivo analizar el papel desempeñado por enfermeros en un Consejo de Administración Regional – COGERE a partir de su formación académica y comprender las tecnologías utilizadas por ellos en su proceso de trabajo. Se realizó un estudio de caso con 12 miembros del COGERE. Los datos fueron recogidos através de entrevistas y analizados mediante análisis temático. La formación de enfermería se basa en el modelo biomédico, que moviliza el conocimiento básico de las tecnologías duras y blandas-duras, pero insuficiente a las tecnología blandas. El papel de los enfermeros en el ámbito de la gestión en salud requiere una mayor incorporación del concepto de corresponsabilidad entre el aparato educativo y los servicios de salud, con la implicación mutua de la enseñanza, gestión, atención y participación social

Comparison of Different Carotid Stent Designs in Endovascular Therapy of Severe Carotid Artery Stenosis

Background: One of the major periprocedural risks of carotid artery stenting is embolism caused either by plaque debris or by local thrombus forming. Double-layer micromesh stent design has shown to lower the chance of debris embolism but might have a slightly higher risk of local thrombus forming. Thus, we compared two different stent designs regarding safety and outcome profile in elective patients with high-grade carotid artery stenosis using a self-expanding, double-layer micromesh carotid stent system (DLCS) or a self-expanding hybrid carotid stent system (HCS). Methods: A single-center, open-label, retrospective cohort study of 67 consecutive, elective patients with high-grade symptomatic and asymptomatic carotid stenosis was executed at a comprehensive stroke center. Outcome measures were reocclusion rate, periprocedural symptomatic ischemic events, as well as other periprocedural complications, and recurrent stroke and mortality at 30 days’ follow-up. Results: Thirty-two patients (24% women, median age 75 years (interquartile range (IQR) 71–80) were treated with DLCS, and 35 patients (29% women, median age 71 years (IQR 63–76) years) with HCS. In both groups, pretreatment carotid stenosis degree was similar (median NASCET of 80%). Successful deployment was achieved in all cases without technical failure, and both groups did not differ in reocclusion rates, recurrent stroke, and mortality within 30 days. Conclusions: DCLS and HCS revealed to have similar safety and outcome profile in elective patients with high-grade symptomatic as well as asymptomatic carotid artery stenosis

Drug-Coated Balloon Treatment in Symptomatic Intracranial High Grade Stenosis : A Retrospective Study of 33 Patients.

PURPOSE Endovascular therapy (EVT) represents an alternative treatment modality for symptomatic intracranial high-grade atherosclerotic stenosis (sICAS); however, periprocedural complication rates as well as midterm restenosis rates represent relevant limitations of EVT. Drug-coated balloon percutaneous transluminal angioplasty (DCB-PTA) may overcome some of these shortcomings. The aim of this study was to assess feasibility and safety as well as the stroke recurrence rate in 33 patients. METHODS A retrospective, monocentric cohort study of sICAS patients treated with DCB-PTA. Outcome measures were the periprocedural intracranial complication rate, the recurrent stroke rate and mortality during follow-up. RESULTS This cohort study included 33 patients with 35 sICAS treated with DCB-PTA. The median age was 72 years (interquartile range, IQR 66-77 years); median clinical and mean radiological follow-up time was 9 months (IQR 3-22 months). Median preprocedural degree of stenosis (WASID) was 80% (IQR 73-80%) and median postprocedural residual stenosis degree (WASID) was 50% (IQR 33-60%). Intracranial periprocedural complications occurred in 2 (6%) patients. The overall restenosis rate was 15% (n = 5). In four patients a symptomatic ischemic re-event occurred within 7 months after the initial treatment. None of the patients died. CONCLUSION This DCB-PTA cohort study showed a relatively low intracranial complication rate of 6% with a symptomatic recurrence rate of 12%. Larger trials are needed to validate these promising observations

Age and Stroke Severity Matter Most for Clinical Outcome in Acute Arteriosclerotic Tandem Lesions.

Background: Tandem lesions (TLs) cause up to 15-30% of all acute ischemic strokes (AISs). Endovascular treatment (EVT) is regarded as the first-line treatment; however, uncertainties remain with respect to the treatment and predictive outcome parameters. Here, we aimed to identify the clinical and demographic factors associated with functional short- and long-term outcomes in AIS patients with arteriosclerotic TLs undergoing EVT. Methods: This was a retrospective, mono-centric cohort study of 116 consecutive AIS patients with arteriosclerotic TLs who were endovascularly treated at a stroke center, with analysis of the relevant demographic, procedural, and imaging data. Results: A total of 116 patients were included in this study, with a median age of 72 years (IQR 63-80), 31% of whom were female (n = 36). The median NIHSS on admission was 14 (IQR 7-19), with a median ASPECT score of 9 (IQR 8-10) and median NASCET score of 99% (IQR 88-100%). A total of 52% of the patients received intravenous thrombolysis. In 77% (n = 89) of the patients, an antegrade EVT approach was used, with a good recanalization (mTICI2b3) achieved in 83% of patients (n = 96). Symptomatic intracerebral hemorrhage occurred in 12.7% (n = 15) of patients. A favorable outcome (mRS0-2) and mortality at 3 months were obtained for 40% (n = 47) and 28% of patients (n = 32), respectively. Age and NIHSS on admission were strongly associated with outcome parameters. Diabetes mellitus and previous neurological disorders were independently associated with long-term mortality (median 11 months, IQR 0-42). Conclusions: Younger age, lower stroke severity, and good recanalization were found to be independently associated with a favorable outcome. In contrast, older age, higher stroke severity, previous neurological disorders, and diabetes were correlated with mortality. The endovascular treatment of acute arteriosclerotic tandem lesions is feasible and relatively safe

Accuracy of pedicle screw placement in the thoracic and lumbosacral spine using a conventional intraoperative fluoroscopy-guided technique: a national neurosurgical education and training center analysis of 1236 consecutive screws

OBJECTIVE: Pedicle screw placement is a very common procedure used to stabilize all three columns of the thoracic and lumbar spine. The purpose of this study is to evaluate the incidence of screw misplacement and related complications in patients who underwent fluoroscopy-guided transpedicular screw fixation at a neurosurgical teaching institution. METHODS: We retrospectively reviewed consecutive patients who underwent fluoroscopy-guided transpedicular screw fixation from January 2007 to May 2011 in the Department of Neurosurgery, Kantonsspital Aarau, a certified Swiss National Neurosurgical Education and Training Center. The accuracy of the pedicle screw trajectory was assessed using reconstructed postoperative axial, sagittal, and coronal computed tomography images. The displacement was classified as minor (≤ 2 mm), moderate (2.1-4 mm), and severe (textgreater4 mm). RESULTS: A total of 1236 pedicle screws were placed in 273 consecutive patients in the thoracic and lumbosacral spine. All surgeries were performed under the supervision of 7 board-certified neurosurgeons and faculty members. A total of 17 surgeons, including trainees, participated in all procedures. A total of 247 (20%) screws breaching the pedicle were identified, with 135 (10.9%) minor violations, 65 (5.3%) moderate violations, and 47 (3.8%) severe violations. Sixteen (5.9%) patients developed postoperative radiculopathy. All of these patients belonged to the subgroup of severe screw displacement. CONCLUSIONS: The data presented confirm that for a training and education center, transpedicular fluoroscopy-guided screw fixation remains a technically demanding procedure. As defined in this study, neurological symptoms are likely associated only with severe screw misplacement