Safety and immunogenicity of a new inactivated hepatitis A vaccine in concurrent administration with a typhoid fever vaccine or a typhoid fever + yellow fever vaccine

Two clinical studies were conducted to evaluate the safety and immunogenicity of concomitant administration of a new inactivated hepatitis A (HA) vaccine and either a typhoid fever (Vi) vaccine or a combination of Vi and yellow fever (YF) vaccines. In study 1, 62 healthy adults received HA+Vi into the deltoid muscle on contralateral sides. In study 2, 59 healthy adults received HA and a combined Vi/YF vaccine into the contralateral deltoid muscles. Reactogenicity was evaluated for 14 days following vaccination. Blood samples (for antibody titration) were obtained prior to vaccination on days 0 and 28 in study 1 and prior to vaccination on day 0 and on days 14 and 28 in study 2. The overall rate of local reactions was 19% at the HA injection site and 75% at the Vi injection site in study 1; the rate of systemic reactions was 41%. In study 2, local reactions occurred at 27% and 78% of the HA and Vi/YF injection sites; the rate of systemic reactions was 42%. All reactions were transient. Twenty-eight days after vaccination, the seroconversion rate was 100% for HA antibodies and 90% for the Vi vaccine in study 1. Rates of seroconversion in study 2 were 100% for the HA vaccine, 92% for the Vi vaccine, and 100% for the YF vaccine. Although this study was not comparative, both tested combinations were safe and immunogenic, and their routine use for persons at risk, such as travelers, can be recommended.

Randomised feasibility trial of pre-exposure rabies vaccination with DTP-IPV in infants

BACKGROUND

Pre-exposure vaccination against rabies generally simplifies treatment and could be especially beneficial to children in countries where the disease is enzootic. We studied the feasibility of administering to infants pre-exposure rabies vaccination with combined diphtheria, tetanus, whole-cell pertussis, and inactivated poliomyelitis vaccine (DTP-IPV).

METHODS

84 Vietnamese infants were randomly assigned to groups that received three doses of DTP-IPV vaccine at 2, 3, and 4 months of age alone (n = 43) or with two doses of purified Vero cell rabies vaccine (PVRV) at 2 and 4 months (n = 41). The safety and immunogenicity data of the groups were compared.

FINDINGS

All infants in both groups developed protective antibody concentrations against diphtheria, tetanus, pertussis, and polio. All infants who received the PVRV vaccine developed protective antibody concentrations against rabies. No serious adverse effects were reported, nor did systemic reactions differ between groups.

INTERPRETATION

Administration of PVRV with DTP-IPV proved safe, and elicited what are presumed to be protective antibody concentrations to all antigens in all 41 infants. Confirmation of these results could lead to integration of pre-exposure rabies vaccination into Expanded Programme on Immunisation (EPI) sessions in selected countries where rabies is enzootic.

Insulinoma cells contain an isoform of Ca2+/calmodulin-dependent protein kinase II delta associated with insulin secretion vesicles

The Ca2+/calmodulin dependent protein kinase II (CaM kinase II) is thought to play an important part in glucose-stimulated insulin secretion. To determine which of the known subtypes (alpha, beta, gamma, delta) occur in insulin-secreting cells, we amplified all types of CaM kinase II by RT-PCR and found the beta3-, gamma-, delta2- and delta6-subtypes in RINm5F insulinoma cells. None of the other 8 delta-subtypes was present. Antibodies generated against the bacterially expressed association domain of the delta2-subtype recognized the recombinant gamma and delta-subtypes. In INS-1 and RINm5F cells, as well as freshly isolated rat islets, only a 55-kDa protein corresponding in size to the delta2-subtype expressed in NIH3T3 fibroblasts was detected. The delta2-subtype therefore appears to represent the predominant subtype of CaM kinase II present in insulin secreting cells. The enzyme was primarily associated with cytoskeletal structures, and very little was present in the soluble compartment or detergent soluble fraction in INS-1- or RINm5F-cells. An analysis of its subcellular distribution was performed by sucrose and Nycodenz density gradient fractionation of INS-1 cells and detection of CaM kinase II delta by immune blots. The enzyme codistributed with insulin used as a marker for secretory granules but not with the lighter synaptic-like microvesicles detected with an antibody against synaptophysin, plasma membranes (syntaxin 1), lysosomes (arylsulfatase), or mitochondria (cytochrome c oxidase). CaM kinase II delta2 thus is identified as the subtype associated with insulin secretory granules and is likely to be involved in insulin secretion.

Overexpression of p53, EGFR, c-erbB2 and c-erbB3 in endometrioid carcinoma of the ovary

OBJECTIVES

To determine overexpression of p53, EGFR, c-erbB-2 and c-erbB-3 in endometrioid carcinoma of the ovary and to evaluate the prognostic significance of these results, especially, coexisting overexpression of p53 and one of the member of type I growth factor receptor family.

METHODS

Overexpressions of the p53, EGFR, c-erbB-2 and c-erbB-3 protein were studied by immunohistochemistry in paraffin-embedded tumor tissue from 28 patients with endometrioid carcinoma of the ovary.

RESULTS

11 (39.3%), 13 (46.4%), and 14 (50.0%) were stained positively with p53, c-erbB-2 and c-erbB-3 monoclonal antibodies. 13 (46.4%) was stained positively with EGFR polyclonal antibody. There were no relationship between p53, EGFR, C-erbB-2, c-erbB-3 and histologic grade, lymph node metastasis. The percentage of tumors with over expression of p53, EGFR, C-erbB-2 and c-erbB-3 was higher in those with stage II-III tumors compared with those with stage I, in patients with residual tumor after initial surgery compared with those without. A high survival rate was observed in patients without p53, EGFR, c-erbB-2 and c-erbB-3 overexpression respectively than those with. A highest survival rate was observed in patients with both p53 and one of EGFR, c-erbB-2 and c-erbB-3 negative compared with those both positive or either of both positive.

CONCLUSION

Overexpression of p53, EGFR, c-erbB-2 and C-erbB-3 resulted in a poorer prognosis respectively. Overexpression of both p53 and one of the EGFR, c-erbB-2 and c-erbB-3 is a worse prognostic indicator in patients with endometrioid carcinoma of the ovary.

[Early diagnosis of ectopic pregnancy by uterine curettage with serum hCG assay]

OBJECTIVE

To explore the value of uterine curettage combined with serum hCG assay in the diagnosis of early ectopic pregnancy (EP).

METHODS

Judgement was done by uterine curettage pathologic examination of uterine content and determination of serum hCG in 61 patients with suspected EP with clinical symptoms, signs and auxillary examinations.

RESULTS

Intrauterine pregnancy was confirmed in 17 patients by the presence of chorionic villi in the uterine contents. 26 patients were diagnosed as having EP by the absence of chorionic villi and elevated levels of hCG 24 hours after curettage. 18 patients who had no chorionic villi and the level of hCG fall down spontaneously after curettage were diagnosed having either intrauterine pregnancy or EP, mostly no further intervention.

CONCLUSION

Diagnostic curettage with serum hCG determination can be used for differentiating intrauterine pregnancy from EP and it can also provide a reference for further arrangement.

Therapy of patients with head injuries: key parameters for management

BACKGROUND

Secondary brain injury, presumed secondary to ischemia, increases the mortality and morbidity of traumatic brain injury. Although many mechanisms appear to be involved, many potential ischemic insults results from changes in readily observable physiologic variables.

METHODS

A focused search of scientific articles published in English to determine what data are available to suggest parameters within which key physiologic variables should be maintained.

RESULTS

Few data demonstrate that maintenance of variables within specific ranges alters outcome; however, considerable evidence establishes association with poor outcome and hypotension, intracranial hypertension, and cerebral venous saturation. Key parameters vary somewhat based upon the phase of treatment after injury. Other variables, such as systemic oxygen delivery and brain saturation measured by near-infrared spectroscopy, are less well linked to outcome.

CONCLUSIONS

Further research is necessary to establish that manipulation of physiologic variables to maintain them within preset ranges improves outcome.

Clinical immunogenicity and tolerance studies of liquid vaccines delivered by jet-injector and a new single-use cartridge (Imule): comparison with standard syringe injection. Imule Investigators Group

A new needleless jet-injector, Mini-Imojet, was developed that administers liquid vaccines from a single-use, pre-filled cartridge named Imule, which avoids the risk of cross-contamination. We conducted clinical trials in several settings in France and West Africa to compare the immunogenicity and tolerance of five vaccines (influenza vaccine, Vi capsular polysaccharide typhoid vaccine, tetanus toxoid vaccine, diphtheria-tetanus-whole cell pertussis vaccine, and inactivated hepatitis A vaccine) administered with the Imule system vs standard syringe technique. In each vaccine study, all subjects of either group were tested for serum antibody titres to calculate the geometrical mean titres and seroconversion rates after complete vaccination. Immediate local-reactions were noted after each injection, and local and general reactions were evaluated during a predetermined period of follow-up. When delivered by the Imule technique, all the administered vaccines were of equivalent or superior immunogenicity, compared to the syringe technique. The tolerance to vaccines injected by the Imule system was acceptable in all studies. The most frequently observed reactions were mild (e.g. minor bleeding, superficial papules, erythema and induration) and could be considered to be inherent to the injection technique. The technical and safety advantages of the Mini-Imojet/Imule system, compared to sterilizable, standard disposable or autodestruct syringes and to classical multi-dose vial jet-injectors, reinforces the interest of this new injection technique for collective immunizations.

[Targeting delivery of liposomal adriamycin by intra-lymphatic infusion]

OBJECTIVE

To assess the feasibility of delivering liposomal adriamycin (lipo-ADM) to the regional lymph nodes via intralymphatic infusion in a rabbits model.

METHODS

The plasma and tissue ADM levels were measured by high performance liquid chromatography (HPLC) at 0.5 hour, 1 hour, 6 hours, 12 hours, 1 day, 7 days, 14 days, 28 days.

RESULTS

The maximum ADM level (Cmax) in the lymph nodes of lipo-ADM was 91.23 micrograms/g, which was 2 times higher than that of the free-ADM group. The area under the ADM concentrations-time curve (AUC) of the regional lymph nodes of lipo-ADM and free-ADM was 138.34 micrograms/day x g-1, 31.86 micrograms/day x g-1 respectively (P < 0.01). The pathological features showed that the lipo-ADM group had more microabscess, necrosis and fibrosis in the lymph nodes than those of the free-ADM group. The histological changes of heart were absent or slight in the lipo-ADM group.

CONCLUSIONS

lipo-ADM has a high affinity for lymphatic tissue. Intralymphatic infusion of lipo-ADM may be useful for the treatment of lymphnode metastasis in ovarian cancer.

Clinical indicators of envenoming and serum levels of venom antigens in patients bitten by Bothrops lanceolatus in Martinique. Research Group on Snake Bites in Martinique

An enzyme-linked immunosorbent assay was developed to measure venom antigen levels in the serum of 40 patients bitten by Bothrops lanceolatus. The grading system used for the severity of envenomation (grades 1 to 4, minor to major) was predominantly based on the presence of local signs. Serum venom levels increased with the grade of severity (P < 0.001, by Spearman's rank correlation test); they were 6 +/- 6 ng/mL (mean +/- SD) in clinically non-envenomed patients (grade 1, n = 3), 7.6 +/- 11.7 (n = 17), 44.3 +/- 41.8 (n = 17), and 80.3 +/- 34.1 ng/mL (n = 3) in patients diagnosed as grade 2, 3 and 4 respectively. However, venom antigens could not be detected in the serum of 54% of patients who showed clinical signs of envenomation. Most patients diagnosed as grade 2, 3 or 4 were given 20, 40 and 60 mL of a monospecific F(ab')2 antivenom, respectively. Venom concentrations > or = 15 ng/mL were observed in all patients with progressive aggravation of swelling despite the use of early antivenom therapy. No venom was detectable in blood samples taken after completion of serotherapy. All patients recovered. These results confirm the efficacy of both the clinical severity scoring system used and the therapeutic regimen.

[Diagnosis and management strategies of hereditary ovarian cancer syndrome]

OBJECTIVE

To describe the clinical profile of hereditary ovarian cancer syndrome (HOCS), focusing on the diagnosis and management strategies.

METHOD

Eight patients from four families were identified with HOCS. The diagnosis was made by pedigree according to the criteria recommended by Lynch. Clinical manifestations and management strategies were discussed.

RESULT

The incidence of epithelial ovarian cancer in HOCS family women was 20% which was higher than that in sporadic ovarian cancer (10%) (P < 0.05). The mean onset age in patients with HOCS was 41.6% years which was younger also than that in sporadic ovarian cancer. Serous cystadenocarcinoma was the predominant histological type of the HOCS, and the prognosis seems to be better.

CONCLUSION

Women in families with HOCS are in a population of high risk for epithelial ovarian cancer. Management strategies should include periodical counselling, screening and surveillance. For women with established families, above 40 years of age and identified with HOCS or with histories of breast or colorectal cancer, prophylactic oophorectomy should be considered.

B cells are exquisitely sensitive to central tolerance and receptor editing induced by ultralow affinity, membrane-bound antigen

To assess the sensitivity of B cell tolerance with respect to receptor/autoantigen affinity, we identified low affinity ligands to the 3-83 (anti-major histocompatibility complex class I) antibody and tested the ability of these ligands to induce central and peripheral tolerance in 3-83 transgenic mice. Several class I protein alloforms, including Kbm3 and Dk, showed remarkably low, but detectable, affinity to 3-83. The 3-83 antibody bound Kb with K lambda approximately 2 x 10(5) M-1 and bound 10-fold more weakly to the Kbm3 (K lambda approximately 2 x 10(4) M-1) and Dk antigens. Breeding 3-83 immunoglobulin transgenic mice with mice expressing these ultralow affinity Kbm3 and Dk ligands resulted in virtually complete deletion of the autoreactive B cells from the peripheral lymphoid tissues. These low affinity antigens also induced receptor editing, as measured by elevated RAG mRNA levels in the bone marrow and excess levels of id- variant B cells bearing lambda light chains in the spleen. Reactive class I antigens were also able to mediate deletion of mature B cells when injected into the peritoneal cavity of 3-83 transgenic mice. Although the highest affinity ligand, Kk, was consistently able to induce elimination of the 3-83 peritoneal B cells, the lower affinity ligands were only partially effective. These results demonstrate the remarkable sensitivity of the deletion and receptor-editing mechanisms in immature B cells, and may suggest a higher affinity threshold for deletion of peripheral, mature B cells.

Immunoreactivity and pharmacokinetics of horse anti-scorpion venom F(ab')2-scorpion venom interactions

The immunoreactivity and pharmacokinetics of a new horse F(ab')2 scorpion antivenom and its effect on Buthus occitanus mardochei venom plasma disposition in the rabbit were studied. The scorpion venom-specific F(ab')2 affinity constant determined by immunoradiometric assay was 1.6 +/- 0.6 10(8) M-1. One group received a F(ab')2 bolus dose of 9.57 mg.kg-1 i.v. bolus or i.m.. The plasma F(ab')2 concentration followed a biexponential decline after i.v. administration with distribution and elimination half-lives of 2.54 +/- 0.36 and 49.52 +/- 3.07 hr, respectively. The total volume of distribution (Vdss or Vd beta) was between 230 and 255 ml.kg-1. Total body clearance was 3.56 +/- 0.34 ml.kg-1.hr-1. After intramuscular administration, Tmax was 48 hr and the absolute bioavailability was 36%. Two other groups of rabbits received i.v.60 micrograms.kg-1 B. occitanus mardochei venom either alone (control group) or followed by 3 mg.kg-1 scorpion venom-specific F(ab')2 administered by intravenous infusion 1.75 hr later. In the rabbits treated with horse F(ab')2 antivenom the venom concentration profile was initially identical to that observed in the control group which received venom alone before F(ab')2 administration. Subsequent infusion of antivenom induced a 1.5-fold elevation of the plasma venom concentration with a Tmax 0.5 hr after F(ab')2 administration. The AUC was 10-fold higher in the F(ab')2-treated group than in the control group in the post-F(ab')2 infusion period. Twelve hours after F(ab')2 administration the venom disposition declined with a terminal half-life equal to that of F(ab')2 (49.49 +/- 7.53 hr). These data show the ability of F(ab')2 to alter venom pharmacokinetics and demonstrate that the scorpion toxins adopt the F(ab')2 elimination properties.

[Management and prognosis of advanced ovarian cancer associated with bowel metastasis and obstruction]

OBJECTIVE

To investigate the high risk factors and prognostic factors of bowel metastasis and obstruction in the patients with late stage ovarian cancer by analyzing the clinical characteristics and to find out appropriate methods to solve this difficult problem.

METHODS

151 cases with ovarian cancer in stages I and IV who received the treatment from January 1, 1988 to December 31, 1992 were analyzed retrospectively.

RESULTS

Operative residues, diffuse bowel metastasis, small intestinal involvement and papillary serous cystadenocarcinoma were found to be high risk factors for bowel obstruction. Age, duration between operation and obstruction, level of CA125 at occurrence of obstruction, numbers of operation and the histologic grade were disclosed as prognostic factors. The prognosis was much worse if the score is more than 6.

CONCLUSION

Due attention paid to the high risk factors and the prognostic factors should be emphasized to improve the quality of life and the survival rate.

[Peripheral branches of the facial nerve in the cheek and chin area. Anatomy and clinical consequences]

The available descriptions of the innervation of the depressor anguli oris muscle and the peripheral distribution of the terminal branches of the marginal mandibular branch and buccal branches of the facial nerve are conflicting. Based upon dissections of 25 head halves we investigated the courses of the terminal branches of the marginal mandibular and buccal nerves. The marginal mandibular and buccal branches were found to form in the area of the mental foramen the mental and buccal plexus innervating the mimetic muscles by terminal nerve branches in the cheek area. The buccal plexus supplied the muscles of upper lip, cheek and nose. Furthermore, the depressor anguli oris muscle was also supplied by the buccal plexus. We also observed connections between marginal mandibular branch and mental nerve and between buccal branches of the facial nerve and buccal nerve of the trigeminal nerve. In case of injury to the marginal mandibular branch the depressor anguli oris muscle is not affected. Injury to the nerve branches of the depressor anguli oris muscle can be caused by operations or lesions in the area of the posterior border of this muscle.

Establishment and functional characterization of human peritoneal fibroblasts in culture: regulation of interleukin-6 production by proinflammatory cytokines

The functional and morphologic integrity of the peritoneal membrane is of major importance for the successful treatment of patients with chronic peritoneal dialysis. This study aimed at the establishment and functional characterization of human peritoneal fibroblasts (HPFB) in cell culture. HPFB were isolated from human omentum by enzymatic digestion and cultured. Confluent HPFB could be identified as spindle-shaped cells, growing in parallel arrays and whorls which stained positive for vimentin and negative for factor VIII, cytokeratin 18, and desmin. Maximum cell growth was observed after 24 h in medium supplemented with 10% fetal calf serum. HPFB could be growth arrested and maintained in fetal calf serum-depleted medium (0.1%) for > 48 h without loss of cell viability as evaluated by intracellular ATP determination. Stimulation of resting HPFB for 0.5 to 48 h with increasing doses of interleukin (IL)-1 beta and/or tumor necrosis factor-alpha (1 to 10,000 pg/mL) resulted in a dose- and time-dependent induction of IL-6 messenger RNA and an increase in immunoreactive IL-6 protein secreted into HPFB supernatants, which was significant with IL-1 beta or tumor necrosis factor-alpha doses as low as 1 pg/mL. HPFB IL-6 production could be inhibited by both actinomycin D or cycloheximide, which suggests that the induction of IL-6 occurs both on a transcriptional and a post-transcriptional level. In summary, this cell culture model is expected to facilitate further investigation of the potential role of the HPFB in the peritoneal cytokine network of patients treated with chronic peritoneal dialysis.

Avulsion of the popliteus muscle in a malinois dog

A four-month-old malinois was presented for lameness which was attributed to an avulsion of the origin of the popliteus muscle. Surgical repair by internal fixation with a lag screw and washer resulted in resolution of the lameness.

Expression, localization and functional role of small GTPases of the Rab3 family in insulin-secreting cells

We examined the presence of small molecular mass GTP-binding proteins of the Rab3 family in different insulin-secreting cells. Rab3B and Rab3C were identified by western blotting in rat and in human pancreatic islets, in two rat insulin-secreting cell lines, RINm5F and INS-1, as well as in the hamster cell line HIT-T15. In contrast, Rab3A was detected in rat pancreatic islets as well as in the two insulin-secreting rat cell lines but not in human pancreatic islets and was only barely discernible in HIT-T15 cells. These findings were confirmed by two-dimensional gel electrophoresis followed by GTP-overlay of homogenates of pancreatic islets and of the purified protein. Northern blotting analysis revealed that Rab3D is expressed in the same insulin-secreting cells as Rab3A. Separation of the cells of the rat islets by fluorescence-activated cell sorting demonstrated that Rab3A was exclusively expressed in beta-cells. Rab3A was found to be associated with insulin-containing secretory granules both by immunofluorescence, immunoelectron microscopy and after sucrose density gradient. Overexpression in HIT-T15 cells of a Rab3A mutant deficient in GTP hydrolysis inhibited insulin secretion stimulated by a mixture of nutrients and bombesin. Insulin release triggered by these secretagogues was also slightly decreased by the overexpression of wild-type Rab3A but not by the overexpression of wild-type Rab5A and of a Rab5A mutant deficient in GTP hydrolysis. Finally, we studied the expression in insulin-secreting cells of rabphilin-3A, a putative effector protein that associates with the GTP-bound form of Rab3A. This Rab3A effector was not detectable in any of the cells investigated in the present study. Taken together these results indicate an involvement of Rab3A in the control of insulin release in rat and hamster. In human beta-cells, a different Rab3 isoform but with homologous function may replace Rab3A.

[Single-dose intramuscular methotrexate for treatment of ectopic pregnancy]

OBJECTIVE

The efficacy and indication of single-dose intramuscular methotrexate to treat early ectopic pregnancy were explored.

METHODS

27 cases of ectopic pregnancy were treated by single-dose intramuscular methotrexate (50 mg/m2) without citrovorum rescue. The beta-hCG was monitored regularly till it became normal. Twelve of them recieved this regimen in outpatient service.

RESULTS

24 cases (88.9%) were successfully treated. Three failed and switched to operation. There were no significant differences (P > 0.05) in gestational age and size of adnexa ectopic mass between successful cases and failed cases, but highly significant differences (P < 0.01) in occurrence rate of abdominal pain and beta-hCG titers before treatment.

CONCLUSION

The early diagnosis and adherence to strict criteria are the keys to successful management. No abdominal pain, ectopic mass < or = 5 cm in greatest dimension and titer of serum beta-hCG < 6000 IU/L were mainly indications of drug treatment.