Assessment of humoral and cellular immunity induced by the BNT162b2 SARS-CoV-2 vaccine in healthcare workers, elderly people, and immunosuppressed patients with autoimmune disease.

The development of vaccines to prevent SARS-CoV-2 infection has mainly relied on the induction of neutralizing antibodies (nAbs) to the Spike protein of SARS-CoV-2, but there is growing evidence that T cell immune response can contribute to protection as well. In this study, an anti-receptor binding domain (RBD) antibody assay and an INFγ-release assay (IGRA) were used to detect humoral and cellular responses to the Pfizer-BioNTech BNT162b2 vaccine in three separate cohorts of COVID-19-naïve patients: 108 healthcare workers (HCWs), 15 elderly people, and 5 autoimmune patients treated with immunosuppressive agents. After the second dose of vaccine, the mean values of anti-RBD antibodies (Abs) and INFγ were 123.33 U/mL (range 27.55-464) and 1513 mIU/mL (range 145-2500) in HCWs and 210.7 U/mL (range 3-500) and 1167 mIU/mL (range 83-2500) in elderly people. No correlations between age and immune status were observed. On the contrary, a weak but significant positive correlation was found between INFγ and anti-RBD Abs values (rho = 0.354, p = 0.003). As to the autoimmune cohort, anti-RBD Abs were not detected in the two patients with absent peripheral CD19+B cells, despite high INFγ levels being observed in all 5 patients after vaccination. Even though the clinical relevance of T cell response has not yet been established as a correlate of vaccine-induced protection, IGRA testing has showed optimal sensitivity and specificity to define vaccine responders, even in patients lacking a cognate antibody response to the vaccine.

Prognostic Implications of Predischarge Assessment of Gait Speed After Hip Fracture Surgery.

BACKGROUND AND PURPOSES: Hip fracture represents one of the most severe injuries in the older adults. In long-term survivors, disability is common and walking ability may be considered an important predictor of functional recovery. We investigated whether 4-m gait speed, assessed in older persons early after surgical repair of hip fracture, could predict functional recovery and subsequent development of major clinical outcomes. METHODS: This was a prospective cohort study. We included adults older than 65 years, admitted to a community acute care hospital with hip fracture, undergoing surgical repair. As soon as the participant was able to stand and walk, using walking aids as needed but with no person's help, the 4-m walking speed was tested as the main predictive variable. The outcome variables included the change in the Barthel Index (BI) from prehospital through 1 year postoperative as a continuous variable and 2 dichotomous outcomes, that is, (1) a decrease in BI greater than 5 points in 1 year and (2) a composite endpoint, combining 5+ points BI decline, death, falls, institutionalization, and need for 24-hour home assistance in 1 year. RESULTS: Sixty-two participants (mean age = 85 years) were enrolled and evaluated, on average 6 days (standard error of the mean [SEM] = 0.2) after hip fracture surgery. Compared with prefracture (mean = 96.3; SEM = 0.9), BI decreased 1 month after surgery (mean = 76.5; SEM = 2.1) and recovered only partially at 2 (mean = 84.1; SEM = 2.2) and 12 months (mean = 87.2; SEM = 2.8). A predischarge value of the walking speed below the median (20.5 cm/s) predicted a substantial BI reduction throughout the 12 months. Furthermore, the adjusted risk of a decline in functional status was reduced by 5% (odds ratio = 0.95; 95% confidence interval, 0.91-0.997; P = .038) and that of the combined outcome by 7% (odds ratio = 0.93; 95% confidence interval, 0.88-0.99; P = .013) for each centimeter per second of predischarge walking speed. DISCUSSION AND CONCLUSION: The 4-m walking speed, measured early after surgical repair of hip fracture, has profound long-term prognostic implications. This assessment approach might prove helpful in clinical decision-making on the postoperative management of older hip fracture persons.

Changes in anthropometric measures in men and women across the life-span: findings from the InCHIANTI study.

OBJECTIVES: To describe the age distribution of anthropometric parameters in a population-based sample of older persons. METHODS: Cross-sectional survey of a population-based sample of persons over a wide age-range living in the Chianti area, Italy, between 1998 to 2000. Total cohort: 1453 men and women, of whom 424 younger than 65 and 1029 aged 65 years or older. Participation rate: 69.4% in < 65 yrs and 91.6% in > or = 65 yrs. Analytical cohort: anthropometric measures were available for 1266 subjects. RESULTS: Height and weight declined with increasing age in both sexes. In men, Body mass index (BMI) increased with age up to age 45-54 and then it declined. In women, it reached its maximum at age 65-74 and remained higher than in men in each corresponding age group above 65 years of age. Waist-to-hip ratio (WHR) progressively increased in men up to age 55-64 and then slightly declined. In women WHR steadily increased over the entire age range. CONCLUSIONS: Height and weight decline with age, regardless to differences in body size attributable to secular trend. In both sexes, important fat redistribution occurs between 45 and 54 years and in older women the increase in WHR mostly reflects a reduction of fat deposits in the hips. This information may be relevant for a correct interpretation of changes in WHR in older persons. However, these findings were obtained in a cross-sectional study and should be verified in a longitudinal perspective.