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BackgroundThe decline of humoral response to COVID-19 vaccine led to authorise a booster dose. Here, we characterised the kinetics of B-cell and T-cell immune responses in patients with multiple sclerosis (PwMS) after the booster dose.MethodsWe enrolled 22 PwMS and 40 healthcare workers (HCWs) after 4–6 weeks from the booster dose (T3). Thirty HCWs and 19 PwMS were also recruited 6 months (T2) after the first dose. Antibody response was measured by anti-receptor-binding domain (RBD)-IgG detection, cell-mediated response by an interferon (IFN)-γ release assay (IGRA), Th1 cytokines and T-cell memory profile by flow cytometry.ResultsBooster dose increased anti-RBD-IgG titers in fingolimod-treated, cladribine-treated and IFN-β-treated patients, but not in ocrelizumab-treated patients, although antibody titres were lower than HCWs. A higher number of fingolimod-treated patients seroconverted at T3. Differently, T-cell response evaluated by IGRA remained stable in PwMS independently of therapy. Spike-specific Th1-cytokine response was mainly CD4+T-cell-mediated, and in PwMS was significantly reduced (p<0.0001) with impaired IL-2 production compared with HCWs at T3. In PwMS, total Th1 and IFN-γ CD4+T-cell responders to spike protein were increased from T2 to T3.Compared with HCWs, PwMS presented a higher frequency of CD4+and CD8+terminally differentiated effector memory cells and of CD4+effector memory (TEM) cells, independently of the stimulus suggesting the association of this phenotype with MS status. CD4+and CD8+TEMcell frequency was further increased at T3 compared with T2.ConclusionsCOVID-19 vaccine booster strengthens humoral and Th1-cell responses and increases TEMcells in PwMS.

Background: Controlled attenuation parameter (CAP) has been suggested as a new non-invasive measurement performed during transient elastography (TE) to assess liver steatosis. The aim of this study was to evaluate CAP values head to head with ultrasound (US) as reference standard. Methods: A consecutive cohort of patients attending abdominal US in an outpatient liver unit was included in this study with simultaneous CAP determination using the FibroScan®M probe and fibrosis scored by TE. Patients were subdivided in four groups on the basis of risk factors for Metabolically Associated Fatty Liver Disease (MAFLD). Results: Four hundred thirty-five patients were included in the analysis: 221 (51%) were male; 117 (26.9%) were in control group, 144 (33.1%) in group 2 with inactive HCV or HBV infection and at low-risk for MAFLD, 134 (30.8%) in group 3 at high-risk of MAFLD, 40 (9.2%) in group 4 at high-risk of MAFLD and concomitant inactive HCV or HBV infection. Liver steatosis detected with US evaluation was observed in the 41% of the entire cohort; in particular in the 3.4%, 20.1%, 83.6% and 87.4% of the group 1, 2, 3 and 4, respectively (p&lt; 0.001). In patients at high-risk factor for MAFLD (group 3 and 4), CAP median levels were found statistically different among the severity-grading groups for US steatosis (S0 [n.27], ≥S1 [n.59], ≥S2 + S3 [n.89]), observing higher CAP levels in patients with a higher steatosis grade (≥S2 + S3 327.5 [±40.6] vs ≥S1 277.7 [±45.6] vs S0 245.1 [±47.4]; p &lt; 0.001 for the whole cohort analysis) (p&lt; 0.001 between ≥S2 + S3 and ≥S1) (p&lt; 0.001 between ≥S2 + S3 and S0) (p= 0.004 between ≥S1 and S0). ROC analysis showed that the global performance of the CAP median level ≥ 258 to predict liver steatosis (S0 vs S1–3), was excellent with an Area Under the Curve (AUC) value of 0.87 [CI 95% 0. 835–0.904] with an 84% of sensitivity and a 78% of specificity, and a positive predictive value (PPV) of 73% and negative predictive value (NPV) of 88%. A TE-kPa median value &lt;8.0 was detected in the 100%, 84%, 83.6% and 60% of patients in group 1, 2, 3 and 4, respectively. A TE-kPa median value >13.0 was detected in the 0%, 4.2%, 5.2% and 17.5% of patients in group 1, 2, 3 and 4, respectively. Conclusions: CAP values are strongly associated with the standard US criteria for different degree of steatosis. Integrating TE up to 5% of patients may be identified at risk for advanced fibrosis.

The aim of the study was to assess psychological distress in duodenal ulcer (DU) and acute gastroduodenitis (AGD). Sixty-one consecutive, unselected patients (DU=25; AGD=36) were compared with their respective controls matched for age, sex, level of formal education, and social class. Psychological distress was assessed using the Kellner-Sheffield Symptom Rating Test. In order to reduce to the minimum the possible effects of the duration of the symptoms and awareness of the diagnosis, the study was carried out before diagnosis on subjects whose symptoms were of recent onset. The DU and AGD patients had higher mean scores than the controls for neuroticism and anxiety; moreover the mean scores for depression and somatization of the AGD patients were also higher than those of the controls. On the basis of these data, the authors discuss the possibility that gastroduodenitis might be an independent entity or part of the spectrum of acid peptic (ulcer) disease.

There has been a search for factors that can assist in early identification of colonic polyps. Recently it was proposed that the presence of skin tags (cutaneous papillomas) may be used to identify people with colon polyps. The study was undertaken to assess the relationship between skin tags and colon polyps. The results of 150 colonoscopies were evaluated. The presence or absence of skin tags was noted for each patient. At least one adenomatous polyp was found in 59 of 150 patients (39 percent). Seventy-two patients (48 percent) had skin tags, and 33 patients (22 percent) had both skin tags and polyps. The positive predictive value of polyps was 45.8 percent and the negative predictive value was 66 percent; this association was considered statistically nonsignificant. The relative probability of a patient with skin tags having colon polyps was 1.37. The conclusion is that skin tags, as a predictor of colon neoplasm, are not important enough to warrant an endoscopy examination when the patient is without colon symptoms. There appears to be a different prevalence of polyps in the patients examined. Further study should be carried out in the general population. (Consumer Summary produced by Reliance Medical Information, Inc.)