Healthcare staff perceptions towards influenza and potential COVID-19 vaccination in the 2020 pandemic context

The COVID-19 pandemic generated renewed focus on infectious disease transmission in healthcare settings. This study aimed to evaluate staff perceptions towards influenza vaccination in the COVID-19 context. All healthcare workers within a major UK tertiary referral hospital were invited to answer a survey conducted from September 2^nd to 13^th, 2020. In all, 593 responses were received across a spectrum of roles; 44% reported they were more likely to get an influenza vaccine this year due to COVID-19; however, 10% felt that an influenza vaccine was less important due to social distancing. Additional questions evaluated intention to receive COVID-19 vaccination. There were substantial differences of opinion between staff groups.

Healthcare staff perceptions and misconceptions regarding antibody testing in the United Kingdom: implications for the next steps for antibody screening

BACKGROUND

Healthcare workers have been at increased risk of exposure, infection and serious complications from COVID-19. Antibody testing has been used to identify staff members who have been previously infected by SARS-CoV-2, and has been rolled out rapidly in the United Kingdom. A number of comment and editorial articles have been published that raise concerns about antibody testing in this context. We present perceptions of National Health Service (NHS) healthcare workers in relation to SARS-CoV-2 antibody testing.

METHODS

An electronic survey regarding perceptions towards SARS-CoV-2 antibody testing was distributed to all healthcare workers at a major NHS tertiary hospital following implementation of antibody testing.

RESULTS

In total, 560 healthcare workers completed the survey (80% female; 25% of Black and Minority Ethnic background; 58% from frontline clinical staff). Exploring whether they previously had COVID-19 was the primary reported reason for choosing to undergo antibody testing (85.2%). In case of a positive antibody test, 72% reported that they would feel relieved, whilst 48% felt that they would be happier to work in a patient-facing area. Moreover, 12% responded that a positive test would mean "social distancing is less important", with 34% of the responders indicating that in this case they would be both less likely to catch COVID-19 and happier to visit friends/relatives.

CONCLUSIONS

NHS staff members primarily seek out SARS-CoV-2 antibody testing for an appropriate reason. Based on our findings and given the lack of definite data regarding the extent of immunity protection from a positive SARS-CoV-2 antibody test, significant concerns may be raised regarding the reported interpretation by healthcare workers of positive antibody test results. This needs to be further explored and addressed to protect NHS staff and patients.

A prospective single-centre evaluation of the intra-individual variability of faecal calprotectin in quiescent Crohn's disease

BACKGROUND

As a non-invasive marker of gastrointestinal inflammation, faecal calprotectin (FC) is being increasingly used to guide the management of Crohn's disease. It is therefore a concern that studies have shown variability in day to day levels.

AIM

To determine the degree of this intrapersonal variability in the context of quiescent Crohn's disease.

METHODS

A single-centre prospective study was undertaken in 143 Crohn's disease patients in clinical remission. Three faecal calprotectin levels were analysed from stool samples on consecutive days. Consistency of faecal calprotectin levels was determined by measuring the intraclass correlation (ICC). Due to higher variability at higher faecal calprotectin levels, the ICC was calculated for the log-transformed values. The reliability of detecting a 'case' of active inflammation as defined for specific concentrations of faecal calprotectin was measured by the kappa statistic.

RESULTS

Ninety-eight complete sets of results were obtained. The ICC was 0.84 (95% CI: 0.79-0.89), which represents low variability across samples. The kappa statistic for the reliability of detecting a case as defined by an FC level of >50 μg/g was substantial at 0.648 (0.511-0.769).

CONCLUSIONS

Day to day variability of faecal calprotectin is low in our cohort of quiescent Crohn's disease patients and the reliability of defining a 'case' is moderately good. These data provide reassurance to clinicians using a single calprotectin sample to inform therapeutic strategies in this cohort.

The correlation of autoantibodies and uNK cells in women with reproductive failure

There is conflicting evidence on the role of autoimmune disorders in reproductive failure, including recurrent miscarriage (RM) and recurrent implantation failure (RIF), after in vitro fertilisation (IVF). Several commonly studied autoimmune markers in women with reproductive failure include antiphospholipid antibodies (APAs), thyroid peroxidase antibodies (TPA) and uterine natural killer (uNK) cells. However, there have not been any studies that have examined the correlation of these markers in women with reproductive failure. To determine if women who tested positive for autoantibodies (APA and thyroid peroxidase antibodies) have significantly higher uNK cell numbers than women who tested negative for these antibodies, the percentage of stromal cells that stained positive for CD56 was identified by immunocytochemistry in endometrial biopsies from 42 women with unexplained RM (29 women tested negative for autoantibodies and 13 women tested positive for autoantibodies) and 40 women with unexplained RIF (30 women tested negative for autoantibodies and 10 women tested positive for autoantibodies). Biopsies were obtained on days LH+7 to LH+9. There was no significant difference in uNK cell numbers between women with unexplained RM who tested negative and those who tested positive for autoantibodies. Similarly, there was no significant difference in uNK cell numbers between women with unexplained RIF who tested negative and those who tested positive for autoantibodies. In women with reproductive failure the presence of autoantibodies does not appear to affect the numbers of uNK cells in the endometrium around the time of implantation.

Characterization of invasive trophoblasts generated from human embryonic stem cells

BACKGROUND

Abnormal human embryo implantation leads to poor foetal development and miscarriage, or pre-eclampsia. Ethical and practical considerations concerning implantation limit its investigation, and it is often difficult to extrapolate findings in laboratory animals when implantation processes show diverse species differences. Therefore, it is important to develop new in vitro models to study the earliest events of human implantation. The aim of this study was to derive trophoblast cell lines from human embryonic stem cells (hESCs) by a robust protocol and co-culture of these cells with an established endometrial cell culture system to validate a model of trophoblast invasion at implantation.

METHODS

Derivation of trophoblast cell lines from hESC lines was established by spontaneous and induced differentiation of embryoid bodies and by initial measurement of hCGβ secretion by enzyme-linked immunosorbent assay and their phenotype investigated using gene- and protein-expression markers. Vesicles formed from an aggregating trophoblast were co-cultured with decidualized human endometrial stromal cells in hypoxic (2% oxygen) and normoxic (20% oxygen) environments.

RESULTS

Derived villous cytotrophoblast cell (CTB) lines further differentiated to invasive, extra-villous CTBs. Eventually, cells lost their proliferative capacity, with some lines acquiring karyotypic changes, such as a gain in the X chromosome. Cell-invasion assays confirmed that the extra-villous CTBs were invasive and erosion of the endometrial stromal layer occurred, particularly under hypoxic conditions in vitro.

CONCLUSIONS

Trophoblast cell lines derived from hESCs differentiate and adapt in vitro and can be used as a model to study the mechanisms of early trophoblast invasion.

A preliminary study comparing the endometrial expression of inhibin, activin and follistatin in women with a history of implantation failure after IVF treatment and a control group

The aim of this study was to evaluate the expression of activin: beta A and beta B subunit and follistatin in endometrium of women with implantation failure (n = 10) and compare it with a fertile control group (n = 7). Immunohistochemical staining intensity for follistatin in the endometrial glandular epithelium from women with implantation failure were significantly lower than that in control women (P = 0.03). The decreased expression of follistatin in epithelial cells in the endometrium of women with implantation failure after in vitro fertilisation (IVF) may suggest that follistatin may play a role in the implantation process.

Effect of laparoscopic ovarian diathermy on circulating inhibin B in women with anovulatory polycystic ovary syndrome

BACKGROUND

Laparoscopic ovarian diathermy (LOD) frequently induces ovulation in patients with polycystic ovary syndrome (PCOS). The mechanism by which this effect occurs remains largely unexplained. The aim of this study was to measure changes in inhibin B production in response to LOD to see whether this could explain the mechanism of action of LOD.

METHODS

This prospective study included 50 anovulatory women with PCOS. All women underwent LOD. Blood samples were collected before and after LOD to measure plasma concentrations of inhibin B, gonadotrophins and androgens.

RESULTS

The pre-operative median plasma concentration of inhibin B was 110.0 pg/ml (range 19.0-567.0 pg/ml). There was a statistically significant inverse correlation (r= -0.286; P < 0.05) between body mass index (BMI) and inhibin B. Non-obese women with PCOS (BMI <or= 30 kg/m2; n=37) displayed significantly (P < 0.05) higher plasma inhibin B concentrations [122.0 pg/ml (range 19.0-567.0 pg/ml)] compared with those [51.0 pg/ml (range 27.0-201.0 pg/ml)] of obese PCOS women (BMI > 30 kg/m2; n=13). Following LOD, 39 women ovulated. No statistically significant change of inhibin B after LOD was observed in the overall group of women with PCOS or in the subgroup of non-obese PCOS women with higher pre-operative inhibin B.

CONCLUSIONS

The lack of any change of inhibin B after LOD makes it unlikely that this hormone has any role to play in the mechanism of action of LOD.

Recurrent miscarriage: aetiology, management and prognosis

Recurrent miscarriage (RM) is a heterogeneous condition. A large number of studies has recently been published, yet many of them have conflicting conclusions. The various aetiological factors, management, prognostic features and outcomes of a subsequent pregnancy in women with RM are reviewed.

Use of human menopausal gonadotropins in the treatment of endometrial defects associated with recurrent miscarriage: preliminary report

OBJECTIVE

To test the hypothesis that controlled ovarian stimulation by gonadotropins, which enhances estrogen priming, is of beneficial value in the treatment of endometrial defects associated with recurrent miscarriage.

DESIGN

A retrospective, observational, nonrandomized study.

SETTING

A regional recurrent miscarriage clinic in a teaching hospital.

PATIENT(S)

Twenty-one subjects with otherwise unexplained recurrent miscarriage who had retarded endometrial development in the mid-luteal phase. Endometrial biopsies were timed by the luteinizing hormone surge.

INTERVENTION(S)

Controlled ovarian stimulation using human menopausal gonadotropins and repeat endometrial biopsy in the treatment cycle in 13 subjects.

MAIN OUTCOME MEASURE(S)

Histological dating of endometrial biopsy in treatment cycles and miscarriage rate in treatment and nontreatment cycles.

RESULT(S)

Eleven (85%) of the 13 biopsies in the treatment cycle were found to be normal. The miscarriage rate in the treatment group, 2 of 13, was significantly lower than that in the nontreatment group (7/12) (chi2 5.0, P<.05).

CONCLUSION(S)

In this small series, preliminary experience suggests that controlled ovarian stimulation by human menopausal gonadotropins in the follicular phase is an effective treatment for luteal phase defect associated with recurrent pregnancy loss. There is now a case for a prospective, controlled study to confirm the value of such a treatment.

Endocrinological and endometrial factors in recurrent miscarriage

OBJECTIVE

To investigate the endocrinological and endometrial factors in women with unexplained recurrent miscarriage

DESIGN

Prospective, case study

SETTING

Recurrent miscarriage clinic, Jessop Hospital for Women, Sheffield

PARTICIPANTS

One hundred and forty-four women with unexplained recurrent (> or =3) miscarriages

METHODS

A blood sample was obtained in early follicular phase (day 3-5) to measure follicle stimulating hormone, luteinising hormone, prolactin, androgens and thyroid function; daily blood/urine samples were obtained from mid-follicular phase to measure luteinising hormone until the luteinising hormone surge was identified; endometrial biopsy and a further blood sample for progesterone measurement were obtained in the mid-luteal phase. A transvaginal ultrasonography was performed to evaluate ovarian morphology.

RESULTS

Hypersecretion of luteinising hormone or ultrasonographic features of polycystic ovarian disease was present in 8% and 7.8% of women, respectively. The free androgen index was elevated in 14.6% of subjects. In the mid-luteal phase, low progesterone level was found in 17.4% and delayed endometrial development was noted in 27.1% of women. Although women with recurrent miscarriage women and delayed endometrium had significantly lower progesterone levels than those with normal endometrial development, only 8/24 had mid-luteal progesterone levels below 30 nmol/L. Recurrent miscarriage was not associated with hyperprolactinaemia or abnormal thyroid function test.

CONCLUSIONS

Endocrinological and endometrial abnormalities are present in about a quarter of women with unexplained recurrent miscarriage.

Multivariate comparison of adolescent offspring of substance abuse parents: community and treatment samples

Adolescent offspring of substance abuse parents (SA+) were compared on the scales of the Drug Use Screening Inventory to offspring of control parents (SA-). Neither clinical nor community samples of SA+ subjects were different from controls. These findings indicate that parental substance abuse does not necessarily impart maladjustment to their offspring.

Identification of steroids in rat adrenal glands by liquid chromatography-thermospray mass spectrometry

Liquid chromatography-thermospray mass spectrometry was applied to identify corticosterone, 11-deoxy-18-hydroxycorticosterone, 18-hydroxycorticosterone and aldosterone as the major corticosteroids in the intracellular and extracellular pools of rat adrenals.

Ultrastructural aspects of sporogenesis in the apogamous fern Dryopteris borreri

The events that accompany sporogenesis in the apogamous fern Dryopteris borreri parallel those seen in sexually reproducing ferns. Organelles dedifferentiate and redifferentiate, and form a discrete band across the equator of dyads; nuclear vacuoles and lipid spherosomes appear during prophase, and the major part of the ribosome population is removed and subsequently replaced during meiosis. Similar events have been found to occur during sporogenesis in mosses, gymnosperms and angiosperms, and therefore characteristic of the meiotic transition from sporophyte to gametophyte, even in the absence of a transition from diplophase to haplophase. The novel aspects of meiosis in D. borreri are largely those connected with the restitution event that precedes meiosis I and serves to maintain the sporophytic chromosome number throughout the life cycle of this fern. Pre-meiotic cells are regularly found to be cleaved by annular wall ingrowths, which traverse the cytoplasm but not the nuclei. The significance of these ingrowths in relation to theories concerning apogamy and plant cell division are discussed.