Background Protection offered by coronavirus disease 2019 (COVID-19) vaccines wanes over time, requiring an evaluation of different boosting strategies to revert such a trend and enhance the quantity and quality of Spike-specific humoral and cellular immune responses. These immunological parameters in homologous or heterologous vaccination boosts have thus far been studied for mRNA and ChAdOx1 nCoV-19 vaccines, but knowledge on individuals who received a single dose of Ad26.COV2.S is lacking. Methods We studied Spike-specific humoral and cellular immunity in Ad26.COV2.S-vaccinated individuals (n = 55) who were either primed with Ad26.COV2.S only (n = 13) or were boosted with a homologous (Ad26.COV2.S, n = 28) or heterologous (BNT162b2, n = 14) second dose. We compared our findings with the results found in individuals vaccinated with a single (n = 16) or double (n = 44) dose of BNT162b2. Findings We observed that a strategy of heterologous vaccination enhanced the quantity and breadth of both Spike-specific humoral and cellular immunity in Ad26.COV2.S-vaccinated individuals. In contrast, the impact of the homologous boost was quantitatively minimal in Ad26.COV2.S-vaccinated individuals, and Spike-specific antibodies and T cells were narrowly focused to the S1 region. Conclusions Despite the small sample size of the study and the lack of well-defined correlates of protection against COVID-19, the immunological features detected support the utilization of a heterologous vaccine boost in individuals who received Ad26.COV2.S vaccination. Funding This study is partially supported by the Singapore Ministry of Health’s National Medical Research Council under its COVID-19 Research Fund (COVID19RF3-0060, COVID19RF-001, and COVID19RF-008), The Medical College St. Bartholomew’s Hospital Trustees – Pump Priming Fund for SMD COVID-19 Research.

Currently a quarter of all patients treated with percutanous coronary intervention (PCI) are aged >75 years, with this proportion steadily growing. This subset of patients have a number of unique characteristics, such as a greater number of cardiovascular risk factors and frequently a larger burden of coronary artery disease, when compared to younger patients, therefore potentially deriving increased benefit from revascularization. Nonetheless this population are also more likely to experience procedural complications, secondary to age-related physiological alterations, increased frailty and increased prevalence of other co-morbidities. This article reviews the various aspects and data available to clinicians pertaining to and guiding revascularization in the elderly, including the use of adjuvant pharmacotherapy, specific considerations when considering age-related physiology, and revascularization in acute coronary syndromes.

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<46 mg/g. Median time (IQR) to repeat 35d (22-74.) 70 results 100-249 mg/g indicated routine referral; median wait for review 83d (54-160.) 130 results !250 mg/g indicated urgent referral; median wait 59d (40-105.) 18% had endoscopy directly ('straight to test.') 16% of results <46 ug/g still referred.Conclusions This is the largest analysis of UK primary care FC testing to date that considers IBD specifically, as opposed to any organic intestinal disease, versus IBS. Comparing favourably to other published work, the assay platform and clinical pathway are fit for purpose in safely and effectively ruling out IBD. A 100mg/g cut-off is optimal based on the sensitivity×specificity product. Those with significantly raised results access secondary care more quickly; direct endoscopy rates appear low but data were incomplete. Repeat tests often normalize and repeats should be mandated for all positive tests. Sensitivity drops precipitously without an appropriate age limit; educating clinical users about pretest probability should minimize false negatives, streamline test workload and reduce unnecessary clinic utilization.