Whole blood-based measurement of SARS-CoV-2-specific T cells reveals asymptomatic infection and vaccine immunogenicity in healthy subjects and patients with solid-organ cancers

Accurate assessment of SARS-CoV-2 immunity is critical in evaluating vaccine efficacy and devising public health policies. Whilst the exact nature of effective immunity remains incompletely defined, SARS-CoV-2-specific T-cell responses are a critical feature that will likely form a key correlate of protection against COVID-19. Here, we developed and optimized a high-throughput whole blood-based assay to determine the T-cell response associated with prior SARS-CoV-2 infection and/or vaccination amongst 231 healthy donors and 68 cancer patients. Following overnight in vitro stimulation with SARS-CoV-2-specific peptides, blood plasma samples were analysed for TH 1-type cytokines. Highly significant differential IFN-γ+ /IL-2+ SARS-CoV-2-specific T-cell responses were seen amongst previously infected COVID-19-positive healthy donors in comparison with unknown / naïve individuals (p < 0·0001). IFN-γ production was more effective at identifying asymptomatic donors, demonstrating higher sensitivity (96·0% vs. 83·3%) but lower specificity (84·4% vs. 92·5%) than measurement of IL-2. A single COVID-19 vaccine dose induced IFN-γ and/or IL-2 SARS-CoV-2-specific T-cell responses in 116 of 128 (90·6%) healthy donors, reducing significantly to 27 of 56 (48·2%) when measured in cancer patients (p < 0·0001). A second dose was sufficient to boost T-cell responses in the majority (90·6%) of cancer patients, albeit IFN-γ+ responses were still significantly lower overall than those induced in healthy donors (p = 0·034). Three-month post-vaccination T-cell responses also declined at a faster rate in cancer patients. Overall, this cost-effective standardizable test ensures accurate and comparable assessments of SARS-CoV-2-specific T-cell responses amenable to widespread population immunity testing, and identifies individuals at greater need of booster vaccinations.

Endometrial stromal sarcoma: experience from a district hospital and literature review

PURPOSE

Endometrial stromal sarcoma (ESS) is a rare malignancy of the uterus. Most cases are incidentally diagnosed on histological examination of hysterectomy specimens. Evidence on the management is accrued mainly from retrospective studies. This study aims to review the clinical experience of a district hospital in the diagnosis and management of this rare tumour over a 12-year period.

METHODS

Information on cases of ESS from 1995 to 2007 were retrieved from the histological database. All case files of identified patients were analysed and data extrapolated. A literature review was performed.

RESULTS

There were seven cases identified over this time period highlighting the rarity of ESS. Most cases were low-grade ESS and diagnosed retrospectively following surgery for presumed benign pathology. Cases with high-grade ESS and advanced stage low-grade ESS received adjuvant therapy.

CONCLUSION

The primary treatment of ESS is surgery. The role of adjuvant therapy remains debatable, but generally involves radiotherapy, chemotherapy and hormonal therapy Optimal treatment protocols may be achieved by the conduct of randomised controlled clinical trials.

Development of the Knee Standardized Clinical Interview: a research tool for studying the primary care clinical epidemiology of knee problems in older adults

OBJECTIVE

To develop a standardized clinical interview, incorporating the perspectives of general practitioners (GPs) and rheumatologists, for primary care clinical epidemiological studies of adults aged 50 yr and over with knee problems.

METHODS

Two parallel, consensus development studies using a modified nominal group technique involving GPs (n=5) and consultant rheumatologists (n=4) from North Staffordshire with reference panels of GPs (n=28) and rheumatologists (n=11) from selected centres in Great Britain, respectively. A single standardized clinical interview was formed using the clinical history questions identified in the consensus development studies and its feasibility was tested in a small sample of patients.

RESULTS

In the GP consensus development study, 115 clinical history questions were identified, of which 71 were of agreed importance following postal rating, face-to-face discussion and re-rating. In the rheumatologist study, 158 questions were identified, of which 47 were of agreed importance. There was considerable overlap in the clinical history questions independently developed by the two studies. A single standardized clinical interview containing 74 questions was formed. It contained questions on the history, onset and recent course of the complaint; nature, location and severity of current knee symptoms; impact of knee problem; past history of knee problems; family history; comorbidity; previous/current investigations and treatment; ideas, concerns and expectations. In preliminary testing it took 20-45 min to conduct and was comprehensible to patients.

CONCLUSIONS

A research tool-the Knee Standardized Clinical Interview (KNE-SCI)-has been formed from consensus development studies involving GPs and rheumatologists. In preliminary testing, it is comprehensible to patients, and forms a coherent clinical interview for research data collection. However, further evaluation is required to determine its accuracy and reliability and its usefulness for clinical epidemiological research.

The apically repositioned flap in tooth exposure

Methods of exposing impacted teeth in order to bring them into the line of the arch include gingivectomy, the apically repositioned flap and closed eruption techniques. These procedures aim to facilitate the eruption of the impacted tooth with a minimum of disruption or damage to the tooth itself or adjacent structures. The aim of this paper is to discuss the various surgical methods of exposing impacted teeth and to help to identify where the use of the apically repositioned flap is indicated. Clinical examples are presented and a surgical method for carrying out this procedure recommended.

The apically repositioned flap in tooth exposure

Methods of exposing impacted teeth in order to bring them into the line of the arch include gingivectomy, the apically repositioned flap and closed eruption techniques. These procedures aim to facilitate the eruption of the impacted tooth with a minimum of disruption or damage to the tooth itself or adjacent structures. The aim of this paper is to discuss the various surgical methods of exposing impacted teeth and to help to identify where the use of the apically repositioned flap is indicated. Clinical examples are presented and a surgical method for carrying out this procedure recommended.