Effectiveness and safety of COVID-19 vaccines on maternal and perinatal outcomes: a systematic review and meta-analysis.

OBJECTIVE: To assess the effects of COVID-19 vaccines in women before or during pregnancy on SARS-CoV-2 infection-related, pregnancy, offspring and reactogenicity outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Major databases between December 2019 and January 2023. STUDY SELECTION: Nine pairs of reviewers contributed to study selection. We included test-negative designs, comparative cohorts and randomised trials on effects of COVID-19 vaccines on infection-related and pregnancy outcomes. Non-comparative cohort studies reporting reactogenicity outcomes were also included. QUALITY ASSESSMENT, DATA EXTRACTION AND ANALYSIS: Two reviewers independently assessed study quality and extracted data. We undertook random-effects meta-analysis and reported findings as HRs, risk ratios (RRs), ORs or rates with 95% CIs. RESULTS: Sixty-seven studies (1 813 947 women) were included. Overall, in test-negative design studies, pregnant women fully vaccinated with any COVID-19 vaccine had 61% reduced odds of SARS-CoV-2 infection during pregnancy (OR 0.39, 95% CI 0.21 to 0.75; 4 studies, 23 927 women; I2=87.2%) and 94% reduced odds of hospital admission (OR 0.06, 95% CI 0.01 to 0.71; 2 studies, 868 women; I2=92%). In adjusted cohort studies, the risk of hypertensive disorders in pregnancy was reduced by 12% (RR 0.88, 95% CI 0.82 to 0.92; 2 studies; 115 085 women), while caesarean section was reduced by 9% (OR 0.91, 95% CI 0.85 to 0.98; 6 studies; 30 192 women). We observed an 8% reduction in the risk of neonatal intensive care unit admission (RR 0.92, 95% CI 0.87 to 0.97; 2 studies; 54 569 women) in babies born to vaccinated versus not vaccinated women. In general, vaccination during pregnancy was not associated with increased risk of adverse pregnancy or perinatal outcomes. Pain at the injection site was the most common side effect reported (77%, 95% CI 52% to 94%; 11 studies; 27 195 women). CONCLUSION: COVID-19 vaccines are effective in preventing SARS-CoV-2 infection and related complications in pregnant women. PROSPERO REGISTRATION NUMBER: CRD42020178076.

Adaptive responses of murine osteoblasts subjected to coupled mechanical stimuli.

Restitution of the natural organization and orientation of cells is imperative for the construction of functional tissue scaffolds. While numerous studies have exploited mechanical methods to engineer tissues with the desired cellular architecture, fundamental knowledge is still lacking in understanding the manner in which morphological features can be modulated through coupled mechanical cues. To address this knowledge gap, the adhesion and alignment response of murine osteoblast cells under the synergistic effects of matrix rigidity and cyclic mechanical loading was investigated. This was accomplished by applying cyclic mechanical strain (1% at 0.05Hz) to MC3T3-E1 cells seeded on PDMS substrates of different elastic moduli (1.22, 1.70 and 2.04MPa). Results demonstrate that the overall cell density and expression of inactive vinculin increased on substrates subjected to cyclic stimulus in comparison to substrates under static loading. Conversely, in terms of the adhesion response, osteoblasts exhibited an increased growth of focal adhesion complexes under static substrates. Interestingly, results also elucidate that substrates of a stiffer matrix exposed to cyclic stimulus, had a significantly higher percentage of osteoblasts aligned parallel to the direction of the applied strain, as well as a higher degree of internal order with respect to the strain axis, in comparison to both cells seeded on substrates of lower stiffness under cyclic loading or under static conditions. These findings suggest the role of cyclic mechanical strain coupled with matrix rigidity in eliciting mechanosensitive adaptations in cell functions that allow for the reconstitution of the spatial and orientational assembly of cells in vivo for tissue engineering.

The effects of micro arc oxidation of gamma titanium aluminide surfaces on osteoblast adhesion and differentiation.

The adhesion and proliferation of human fetal osteoblasts, hFOB 1.19, on micro arc oxidized (MAO) gamma titanium aluminide (γTiAl) surfaces were examined in vitro. Cells were seeded on MAO treated γTiAl disks and incubated for 3 days at 33.5 °C and subsequently for 7 days at 39.5 °C. Samples were then analyzed by scanning electron microscopy (SEM) and alkaline phosphatase assay (ALP) to evaluate cell adhesion and differentiation, respectively. Similar Ti-6Al-4V alloy samples were used for comparison. Untreated γTiAl and Ti-6Al-4V disks to study the effect of micro arc oxidation and glass coverslips as cell growth controls were also incubated concurrently. The ALP Assay results, at 10 days post seeding, showed significant differences in cell differentiation, with P values <0.05 between MAO γTiAl and MAO Ti-6Al-4V with respect to the corresponding untreated alloys. While SEM images showed that hFOB 1.19 cells adhered and proliferated on all MAO and untreated surfaces, as well as on glass coverslips at 10 days post seeding, cell differentiation, determined by the ALP assay, was significantly higher for the MAO alloys.

Collagen abundance in mechanically stimulated osteoblast cultures using near infrared microscopy.

Collagen abundance in osteoblast cell cultures was determined using near infrared microscopy with chemical imaging (NIR-CI) with and without mechanical stimulation of the the cells. MC3T3-E1 mouse osteoblast cells seeded on a polycarbonate substrate were mechanically stimulated using static loads of 13.5 N, 27 N and 40 N applied to the substrates during 2, 4, 6 and 8 days of incubation. Results show that the cells increased their collagen production with 13.5 N and 27 N loads when compared to the control sample with a 27 N load resulting in a noteworthy increase (109%) in collagen production. The 40 N load on the other hand, resulted in an initial decrease in the collagen expression in the extracellular matrix, possibly as a result of cell death or inhibition of the protein secretion process followed by an increase in collagen after cell recovery and proliferation. Qualitative confirmation of these results was performed using confocal microscopy.

In vitro evaluation of human osteoblast adhesion to a thermally oxidized gamma-TiAl intermetallic alloy of composition Ti-48Al-2Cr-2Nb (at.%).

Ti-48Al-2Cr-2Nb (at.%) (gamma-TiAl), a gamma titanium aluminide alloy originally designed for aerospace applications, appears to have excellent potential as implant material. Thermal treatment of gamma-TiAl renders this alloy extremely corrosion resistant in vitro, which could improve its biocompatibility. In this study, the surface oxides produced by thermal oxidation (at 500 degrees C, and at 800 degrees C for 1 h in air) on gamma-TiAl were characterized by X-ray photoelectron spectroscopy (XPS). hFOB 1.19 cell adhesion on thermally oxidized gamma-TiAl was examined in vitro by a hexosaminidase assay, scanning electron microscopy (SEM) and confocal laser scanning microscopy (CLSM) after 1, 7 and 14 days. Ti-6Al-4V surfaces were used for comparison. Hexosaminidase assay data and CLSM analysis of focal contacts and cytoskeleton organization showed no differences in cell attachment on autoclaved and both heat-treated gamma-TiAl surfaces at the different time points. SEM images showed well organized multi-layers of differentiated cells adhered on thermally oxidized gamma-TiAl surfaces at day 14. Unexpectedly, thermally oxidized Ti-6Al-4V surfaces oxidized at 800 degrees C exhibited cytotoxic effects on hFOB 1.19 cells. Our results indicate that thermal oxidation of gamma-TiAl seems to be a promising method to generate highly corrosion resistant and biocompatible surfaces for implant applications.

Biocompatibility studies of human fetal osteoblast cells cultured on gamma titanium aluminide.

Ti-48Al-2Cr-2Nb (at. %) (gammaTiAl), a gamma titanium aluminide alloy originally designed for aerospace applications, appears to have excellent potential for bone repair and replacement. The biological response to gammaTiAl implant is expected to be similar to other titanium-based biomaterials. Human fetal osteoblast cells were cultured on the surface of gammaTiAl and Ti-6Al-4V disks with variable surface roughness for both SEM and immunofluorescent analysis to detect the presence of collagen type I and osteonectin, proteins of the bone extracellular matrix. Qualitative results show that cell growth and attachment on gammaTiAl was normal compared to that of Ti-6Al-4V, suggesting that gammaTiAl is not toxic to osteoblasts. The presence of collagen type I and osteonectin was observed on both gammaTiAl and Ti-6Al-4V. The results obtained suggest gammaTiAl is biocompatible with the osteoblast cells.

Bone tissue reaction to Ti-48Al-2Cr-2Nb (at.%) in a rodent model: a preliminary SEM study.

A variety of metals have been used to replace the skeletal framework of human beings. Gamma titanium aluminide (gammaTiAl) has been recently developed as a prospective material for turbine applications. In this preliminary study, the potential of gammaTiAl as a biomaterial was evaluated using an in vivo rat model. Sprague-Dawley rats were implanted with gammaTiAl cylinders in the femur and observed for an experimental period lasting up to 180 days. The rats were sacrificed after periods of 45, 90 and 180 days. The femurs with the gammaTiAl implants were extracted and examined using scanning electron microscopy (SEM). Normal bone growth processes were observed as early as 45 days after gammaTiAl cylinder implantation. No signs of rejection of the implant metal were observed. In fact, a layered bone growth was observed on the implant metal surface. The bone-metal interface showed signs of tissue growth from original bone to the metal surface. gammaTiAl appears to elicit a normal bone tissue reaction and hence, has potential as a metallic implant material.