Antibodies against SARS-CoV-2 Alpha, Beta, and Gamma Variants in Pregnant Women and Their Neonates under Antenatal Vaccination with Moderna (mRNA-1273) Vaccine.

The aim of the study was to examine the impact of COVID-19 vaccination on the anti-SARS-CoV-2 spike receptor binding domain IgG antibody (SRBD IgG) binding ratio (SBR) from Alpha, Beta, and Gamma variants of SARS-CoV-2 in pregnant women and neonates. The impact of antenatal influenza (flu) and pertussis (Tdap) vaccines was also studied. We enrolled pregnant women vaccinated with the Moderna (mRNA-1273) vaccine during pregnancy and collected maternal plasma (MP) and neonatal cord blood (CB) during delivery to determine the SBR via enzyme-linked immunosorbent assays (ELISA). A total of 78 samples were collected from 39 pregnant women. The SBR was higher for Alpha variants compared to Beta/Gamma variants (MP: 63.95% vs. 47.91% vs. 43.48%, p = 0.0001; CB: 72.14% vs. 56.78% vs. 53.66%, p = 0.006). Pregnant women receiving two doses of the COVID-19 vaccine demonstrated a better SBR against SARS-CoV-2 Alpha, Beta, and Gamma variants than women receiving just a single dose. Women who received the Tdap/flu vaccines demonstrated a better SBR when two COVID-19 vaccine doses were < 6 weeks apart. A better SBR was detected among women who had more recently received their second COVID-19 vaccine dose. Two doses of the COVID-19 vaccine provided recipients with a better SBR for Alpha/Beta/Gamma variants. Although Tdap/flu vaccines may affect the efficacy of the COVID-19 vaccine, different vaccination timings can improve the SBR.

Paper-Based Resazurin Assay of Inhibitor-Treated Porcine Sperm.

Porcine sperm motility was assessed via resazurin reduction color change in sperm cells using a novel paper-based assay of our own design. We applied mixtures of resazurin solution and porcine semen onto hydrophilic test circles on our paper-based device and investigated the resulting reduction reaction expressed as red and blue color intensity (RBCI). We quantified this reaction using a blue/pink color ratio from our 8 × 3 = 24 bit RGB color image. To examine enzymatic reactivity in sperm cells, we used two inhibitors: 3-Nitropropanoic acid (3-NPA) and 3-Bromopyruvic acid (3-BP). 3-NPA inhibits the citric acid cycle and electron transfer reaction in mitochondria, but did not strongly reduce sperm motility in our tests. 3-BP decreases reactivity of both mitochondrial electron transfer and glycolytic enzymes in cytosol, which significantly lowers porcine sperm motility. RBCIs of 3-NPA- and 3-BP-treated samples were significantly lower compared to our untreated control (p < 0.025). Based on these results, we feel that resazurin can be used to estimate the amount of reductants with and without inhibitor treatment. For continued research assessing the molecular mechanisms of resazurin reduction in porcine sperm, a combination assay using two or more redox indicators (e.g., resazurin and Thiazolyl Blue Tetrazolium Bromide (MTT)) embedded into our paper-based device could further our understanding of sperm cell bioenergetics.

School accreditation scheme reduces childhood obesity in Hong Kong.

Childhood obesity is an increasing threat to the health of primary school students in Hong Kong. Obesity results from energy excess from food relative to energy expenditure through physical activity. In Hong Kong, a whole day primary schooling policy has been implemented since 1993 and today most primary school students have their lunch on campus and some also purchase snacks and drinks from school tuck shops or vending machines. The EatSmart School Accreditation Scheme (ESAS) aiming at combating childhood obesity was launched in 2009/2010. Professional (health promotion, dietary, programme, etc.) support is provided to help schools formulate policies, introduce structures and implement measures to help students develop the habit of healthy eating. The aim of this study is to investigate the change of childhood obesity (including overweight) rates over time among schools awarded with ESAS accreditation. Seven-year retrospective data on obesity status were obtained for the period 2007/2008-2013/2014 (number of students = 113,322, number of measurements = 314,746) from all 105 ESAS-accredited schools. Before schools were geared up for the accreditation scheme obesity rates were fairly stable (slope test p > 0.05) among their student population ranging from 23.2% to 21.9%, whereas the rates dropped significantly (slope test p < 0.05) from 21.9% to 19.3% after intervention. For ESAS-accredited schools, there was an average annual reduction of 0.49% point in obesity rate which was 0.18% point higher than that of 0.31% point among non-ESAS-accredited schools. These results show that schools achieving ESAS accreditation are associated with a bigger improvement in the student obesity problem.

Frequency and Acceptability of Adverse Events After Anterior Cervical Discectomy and Fusion: A Survey Study From the Cervical Spine Research Society.

PURPOSE: Anterior cervical discectomy and fusion has a low but well-established profile of adverse events. The goal of this study was to gauge surgeon opinion regarding the frequency and acceptability of these events. METHODS: A 2-page survey was distributed to attendees at the 2015 Cervical Spine Research Society (CSRS) meeting. Respondents were asked to categorize 18 anterior cervical discectomy and fusion-related adverse events as either: "common and acceptable," "uncommon and acceptable," "uncommon and sometimes acceptable," or "uncommon and unacceptable." Results were compiled to generate the relative frequency of these responses for each complication. Responses for each complication event were also compared between respondents based on practice location (US vs. non-US), primary specialty (orthopedics vs. neurosurgery) and years in practice. RESULTS: Of 150 surveys distributed, 115 responses were received (76.7% response rate), with the majority of respondents found to be US-based (71.3%) orthopedic surgeons (82.6%). Wrong level surgery, esophageal injury, retained drain, and spinal cord injury were considered by most to be unacceptable and uncommon complications. Dysphagia and adjacent segment disease occurred most often, but were deemed acceptable complications. Although surgeon experience and primary specialty had little impact on responses, practice location was found to significantly influence responses for 12 of 18 complications, with non-US surgeons found to categorize events more toward the uncommon and unacceptable end of the spectrum as compared with US surgeons. CONCLUSIONS: These results serve to aid communication and transparency within the field of spine surgery, and will help to inform future quality improvement and best practice initiatives.

Life Expectancy and Metastatic Spine Scoring Systems: An Academic Institutional Experience.

STUDY DESIGN: A retrospective data collection study with application of metastatic spine scoring systems. OBJECTIVES: To apply the Tomita and revised Tokuhashi scoring systems to a surgical cohort at a single academic institution and analyze spine-related surgical morbidity and mortality rates. SUMMARY OF BACKGROUND DATA: Surgical management of metastatic spine patients requires tools that can accurately predict patient survival, as well as knowledge of morbidity and mortality rates. METHODS: An Oregon Health & Science University (OHSU) Spine Center surgical database was queried (years 2002-2010) to identify patients with an ICD-9 code indicative of metastatic spine disease. Patients whose only surgical treatment was vertebral augmentation were not included. Scatter plots of survival versus the Tomita and revised Tokuhashi metastatic spine scoring systems were statistically analyzed. Spine-related morbidity and mortality rates were calculated. RESULTS: Sixty-eight patients were identified: 45 patients' (30 male patients, mean age 45 y) medical records included operative, morbidity, and mortality statistic data and 38 (26 male patients, mean age 54 y) contained complete metastatic spine scoring system data. Of the 38 deceased spine metastatic patients, 8 had renal cell, 7 lung, 4 breast, 2 chondrosarcoma, 2 prostate, 11 other, and 4 unknown primary cancers. Linear regression analysis revealed R values of 0.2570 and 0.2009 for the revised Tokuhashi and Tomita scoring systems, respectively. Overall transfusion, infection, morbidity, and mortality rates were 33% and 9%, and 42% and 9%, respectively. CONCLUSIONS: Application of metastatic prognostic scoring systems to a retrospective surgical cohort revealed an overall poor correlation with the Tomita and revised Tokuhashi predictive survival models. Morbidity and mortality rates concur with those in the medical literature. This study underscores the difficulty in utilizing metastatic spine scoring systems to predict patient survival. We believe a scoring system based on cancer type is needed to account for changes in treatment paradigms with improved patient survival over time.

Imaging characteristic analysis of metastatic spine lesions from breast, prostate, lung, and renal cell carcinomas for surgical planning: Osteolytic versus osteoblastic.

BACKGROUND: Surgeons treating metastatic spine disease can use computed tomography (CT) imaging to determine whether lesions are osteolytic, osteoblastic, or mixed. This enables treatment that considers the structural integrity of the vertebral body (VB), which is impaired with lytic lesions but not blastic lesions. The authors analyzed CT imaging characteristics of spine metastasis from breast, lung, prostate, and renal cell carcinomas (RCCs) to determine the metastasis patterns of each of these common tumors. METHODS: The authors identified patients with metastatic spine disease treated during a 3-year period. Variables studied included age, sex, and cancer type. Lesions from breast, lung, prostate, and RCC primary lesions were selected for imaging analysis. RESULTS: Sixty-six patients were identified: 17 had breast metastasis, 14 prostate, 18 lung, and 17 RCC. Breast cancer metastasis involved 33% of VBs with 56%, 20%, and 24% osteolytic, osteoblastic, and mixed, respectively. Prostate cancer metastasis involved 35% of VBs with 14%, 62%, and 24% osteolytic, osteoblastic, and mixed, respectively. Lung cancer metastasis involved 13% of VBs with 64%, 33%, and 3% osteolytic, osteoblastic, and mixed, respectively. RCC metastasis involved 11% of VBs with 91%, 7%, and 2% osteolytic, osteoblastic, and mixed lesions, respectively. CONCLUSIONS: To improve surgical planning, we advocate the use of CT prior to surgery to evaluate whether spine metastases are osteolytic or osteoblastic. In cases of osteolytic lesions, the concern is of segmental instability requiring reconstruction and the risk for screw pull out should instrumentation be considered. In cases of osteoblastic lesions, surgeons should consider debulking dense bone.

Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the Medicare population.

STUDY DESIGN: Retrospective cohort analysis of Medicare claims for 2006-2009. OBJECTIVE: To examine whether interspinous distraction procedures are used selectively in patients with more advanced age or comorbidity, and whether they are associated with fewer complications, lower costs, and less revision surgery than laminectomy or fusion surgery. SUMMARY OF BACKGROUND DATA: A manufacturer-sponsored randomized trial suggested an advantage of interspinous spacer surgery compared with nonsurgical care, but there are few comparisons with other surgical procedures. Furthermore, there are few population-based data evaluating patterns of use of these devices. METHODS: We used Medicare inpatient claims data to compare age and comorbidity for patients with spinal stenosis undergoing surgery (n = 99,084) with (1) an interspinous process spacer alone; (2) laminectomy and a spacer; (3) decompression alone; or (4) lumbar fusion (1-2 level). We also compared these 4 groups for cost of surgery and rates of revision surgery, major medical complications, wound complications, mortality, and 30-day readmission rates. RESULTS: Patients who received spacers were older than those undergoing decompression or fusion, but had little evidence of greater comorbidity. Patients receiving a spacer alone had fewer major medical complications than those undergoing decompression or fusion surgery (1.2% vs. 1.8% and 3.3%, respectively), but had higher rates of further inpatient lumbar surgery (16.7% vs. 8.5% for decompression and 9.8% for fusion at 2 yr). Hospital payments for spacer surgery were greater than those for decompression alone but less than for fusion procedures. These associations persisted in multivariate models adjusting for patient age, sex, comorbidity score, and previous hospitalization. CONCLUSION: Compared with decompression or fusion, interspinous distraction procedures pose a trade-off in outcomes: fewer complications for the index operation, but higher rates of revision surgery. This information should help patients make more informed choices, but further research is needed to define optimal indications for these new devices. LEVEL OF EVIDENCE: 4.

Current paradigm of the 18-kDa translocator protein (TSPO) as a molecular target for PET imaging in neuroinflammation and neurodegenerative diseases.

Neuroinflammation is a process characterised by drastic changes in microglial morphology and by marked upregulation of the 18-kDa translocator protein (TSPO) on the mitochondria. The continual increase in incidence of neuroinflammation and neurodegenerative diseases poses a major health issue in many countries, requiring more innovative diagnostic and monitoring tools. TSPO expression may constitute a biomarker for brain inflammation that could be monitored by using TSPO tracers as neuroimaging agents. From medical imaging perspectives, this review focuses on the current concepts related to the TSPO, and discusses briefly on the status of its PET imaging related to neuroinflammation and neurodegenerative diseases in humans.

Use of bone morphogenetic proteins in spinal fusion surgery for older adults with lumbar stenosis: trends, complications, repeat surgery, and charges.

STUDY DESIGN: Retrospective cohort study of Medicare claims. OBJECTIVE: Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. SUMMARY OF BACKGROUND DATA: Small, randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications and, in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. METHODS: We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n = 16,822). We identified factors associated with BMP use: major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). RESULTS: Use of BMP increased rapidly, from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 more than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group system averaged only about $850 more. Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9% vs. 19.0%, P < 0.001). CONCLUSION: In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation.

Secondary and tertiary hyperparathyroidism: role of preoperative localization.

BACKGROUND: The usefulness of both technetium Tc-99m sestamibi (MIBI) scintigraphy and ultrasonography (USG) scan for the detection of enlarged parathyroid glands secondary to renal hyperparathyroidism is rarely addressed. METHODS: A retrospective study from July 1999 to June 2005 was carried out on patients with secondary and tertiary hyperparathyroidism to determine the role of preoperative localization. RESULTS: In the 5 years, 73 patients with renal hyperparathyroidism underwent initial bilateral neck exploration with total parathyroidectomy. Four patients underwent neck exploration with parathyroidectomy for persistent hyperparathyroidism. Two patients underwent neck exploration with parathyroidectomy for recurrent hyperparathyroidism. For patients with initial secondary/tertiary hyperparathyroidism, MIBI scintigraphy correctly showed 101 of 276 (36.6%) surgically confirmed enlarged parathyroids, whereas USG scan showed 99 of 276 (35.9%) surgically confirmed enlarged parathyroids. For persistent or recurrent secondary/tertiary hyperparathyroidism, MIBI scintigraphy and USG scan had sensitivity of 100 and 50%, respectively. CONCLUSIONS: In conclusion, preoperative localization studies have a limited value when used before first neck exploration in secondary/tertiary hyperparathyroidism because of the poor results in identifying all parathyroid glands. In persistent/recurrent hyperparathyroidism, it may play a useful role in localization of the missed or ectopic parathyroid gland.

Diagnostic accuracy of 2-[fluorine-18]fluro-2-deoxy-D-glucose positron emission tomography imaging in nonsquamous tumors of the head and neck.

PURPOSE: To evaluate the diagnostic accuracy of 2-[fluorine-18]fluro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting nonsquamous tumors of the extracranial head and neck (NSTHN). MATERIALS AND METHODS: The records of all patients with suspected or proven NSTHN undergoing PET imaging in our institution over a 12-year period were reviewed. Forty-four patients (24 males and 20 females; age range, 6-81 years; mean age, 51.2 years) were classified into 3 main groups: thyroid tumors (n = 19), salivary gland tumors (n = 7), and miscellaneous lesions (n = 18). The PET findings for each individual group with respect to the primary site, cervical nodal and distant metastases, were correlated with histopathology or follow-up (2-year minimum) RESULTS: The overall diagnostic accuracy of FDG-PET for all NSTHN was 86%, However, the diagnostic accuracy varied for the histologic subtype (thyroid, salivary, miscellaneous) and the area being evaluated (primary site, nodal metastases, distant metastases). CONCLUSION: There is variable diagnostic accuracy of FDG-PET in detecting different histologic subtypes of NSTHN. This information should be taken into consideration when considering PET for evaluation of NSTHN.

Hypodensity of >1/3 middle cerebral artery territory versus Alberta Stroke Programme Early CT Score (ASPECTS): comparison of two methods of quantitative evaluation of early CT changes in hyperacute ischemic stroke in the community setting.

BACKGROUND: The one third middle cerebral artery territory ((1/3) MCA) method and the Alberta Stroke Program Early CT Score (ASPECTS) were used to detect significant early ischemic changes (EIC) on CT brain of acute stroke patients. We sought to compare the reliability of the 2 methods in routine clinical practice. METHODS: Eighty consecutive patients admitted to a community hospital in Hong Kong with suspected acute ischemic stroke and a CT brain scan performed within 6 hours of symptom onset were included. Five blinded observers (1 neurologist, 2 general radiologists, and 2 neuroradiologists) independently evaluated the scans, using the ATLANTIS/CT Summit criteria for >(1/3) MCA involvement, and ASPECTS (1/3) MCA involvement, all observers agreed in 57 cases (71%), with moderate interobserver agreement (kappa=0.49). For ASPECTS

CT and MR imaging of solitary extramedullary plasmacytoma of the nasal tract.

BACKGROUND AND PURPOSE: Solitary extramedullary plasmacytoma (SEP) is rare. The purpose of this study was to determine the CT and MR imaging features of SEP of the nasal tract. METHODS: We retrospectively reviewed three CT and two MR images of three histologically proved cases in two men and one woman aged 43-66 years. RESULTS: The plasmacytomas predominantly involved the nasopharynx in two cases and the nasal cavity in one. Two of the tumors were bulky solid masses, whereas the third showed infiltrative features. They were predominantly masses or infiltrative lesions with soft-tissue attenuation on CT scans. The lesions were isointense and hyperintense on T1- and T2-weighted MR images, respectively. The tumors revealed moderate-to-marked contrast enhancement and may have been associated with lytic bone destruction. CONCLUSION: The imaging features of SEP are nonspecific. However, this entity should be included in the differential diagnosis of tumors in the nasopharynx and nasal cavity.