Comparison of the safety and immunogenicity of concomitant and sequential administration of an adult formulation tetanus and diphtheria toxoids adsorbed combined with acellular pertussis (Tdap) vaccine and trivalent inactivated influenza vaccine in adults

The annual contact for influenza vaccination provides an opportunity to ensure that adults have received other recommended vaccines such as Tdap. Healthy 19-64 year-olds were randomized to receive concomitant administration of Tdap and influenza vaccines or influenza vaccine followed (in 4-6 weeks by) Tdap. 720 participants were enrolled. No clinically relevant between-group differences were observed in the rates or severities of erythema, swelling, or pain at the Tdap injection site. Injection-site pain was the most commonly reported adverse event (66.6% concomitant administration group versus 60.8% sequential administration group); most pain was graded as mild and resolved by day 3. Seroprotection and seroresponse rates for all influenza strains were comparable between the two groups. For diphtheria and tetanus, seroprotection rates and post-vaccination GMTs were non-inferior in the concomitant administration group compared to the sequential administration group. A trend for lower antibody responses to pertussis antigens PT, FHA, and FIM was observed after concomitant administration and, for PRN, this difference failed the non-inferiority criteria. While there is a small diminution in antibody response to tetanus and pertussis antigens, concomitant administration of Tdap and influenza vaccine was well tolerated and immunogenic and may offer practical advantages including convenience, compliance, and cost-savings.     

Alpha-1- antitrypsin in intracellular inclusions of diethyl-nitrosamine induced hepatomas of C57BLxC3H F1 mice

Six large hepatic nodules obtained 46 to 74 weeks after a singledose of diethylnitrosamine (0.625 or 1.25 µg/gm) in infantC₅₇BLxC₃H F₁ male mice were studied to elucidate the natureof intracytoplasmic inclusions in the hepatic cells of thesenodules. By light microscopy, the nodules consistuted a spectrumof lesions ranging from some which were well differentiatedadenomas to others which were frank carcinomas. Round or ovaleosinophilic intracytoplasmic inclusions were consistently seenin the well differentiated adenomatous lesions. Some of theseinclusions were PAS positive and resisted diastase digestionwhile others were either negative or only weakly PAS positive.By electron microscopy, they were most commonly crystalline,contained a reticulated electron dense material and were locatedin the distended rough endoplasmic reticulum. On immunofluorescencethe inclusions showed marked specific reactivity with antiseraagainst human alpha-₁-antitrypsin. The presence of alpha-₁-antitrypsinin these inclusions was further supported by the resistanceof these inclusions to digestion by trypsin or papain but notby the pepsin or pronase.     

Sublingual vaccination with influenza virus protects mice against lethal viral infection

We assessed whether the sublingual (s.l.) route would be an effective means of delivering vaccines against influenza virus in mice by using either formalin-inactivated or live influenza A/PR/8 virus (H1N1). Sublingual administration of inactivated influenza virus given on two occasions induced both systemic and mucosal antibody responses and conferred protection against a lethal intranasal (i.n.) challenge with influenza virus. Coadministration of a mucosal adjuvant (mCTA-LTB) enhanced these responses and resulted in complete protection against respiratory viral challenge. In addition, s.l. administration of formalin-inactivated A/PR/8 plus mCTA-LTB induced systemic expansion of IFN-gamma-secreting T cells and virus-specific cytotoxic T lymphocyte responses. Importantly, a single s.l. administration of live A/PR/8 virus was not pathogenic and induced protection mediated by both acquired and innate immunity. Moreover, s.l. administration of live A/PR/8 virus conferred heterosubtypic protection against respiratory challenge with H3N2 virus. Unlike the i.n. route, the A/PR/8 virus, whether live or inactivated, did not migrate to or replicate in the CNS after s.l. administration. Based on these promising findings, we propose that the s.l. mucosal route offers an attractive alternative to mucosal routes for administering influenza vaccines.     

Safe injection practices for administration of propofol

Sepsis and postoperative infection can occur as a result of unsafe practices in the administration of propofol and other injectable medications. Investigations of infection outbreaks have revealed the causes to be related to bacterial growth in or contamination of propofol and unsafe medication practices, including reuse of syringes on multiple patients, use of single-use medication vials for multiple patients, and failure to practice aseptic technique and adhere to infection control practices. Surveys conducted by AORN and other researchers have provided additional information on perioperative practices related to injectable medications. In 2009, the US Food and Drug Administration and the Centers for Disease Control and Prevention convened a group of clinicians to gain a better understanding of the issues related to infection outbreaks and injectable medications. The meeting participants proposed collecting data to persuade clinicians to adopt new practices, developing guiding principles for propofol use, and describing propofol-specific, site-specific, and practitioner-specific injection techniques. AORN provides resources to help perioperative nurses reduce the incidence of postoperative infection related to medication administration.     

An in vitro comparison of microleakage between Resilon and gutta-percha with a fluid filtration model

This investigation compared microleakage of teeth obturated with gutta-percha and teeth obturated with Resilon by using a fluid filtration model. Forty-six human, single-rooted, mandibular premolars were studied. Teeth were randomly assigned to 2 experimental groups of 21 teeth each, designated as group G (gutta-percha) and group R (Resilon). Two control groups, both containing 2 teeth, served as positive and negative controls. Group G, gutta-percha and AH 26 sealer, and group R, Resilon and Epiphany sealer, were obturated by using warm vertical condensation. The specimens were tested for microleakage with an in vitro fluid filtration apparatus at 10 psi at 4 intervals: 1, 7, 30, and 90 days. A two-way repeated measures analysis of variance model with fixed effects for group, time, and group by time interaction was used to analyze microleakage data. This study demonstrated that canals obturated with Resilon and Epiphany sealer leaked statistically less than canals obturated with gutta-percha and AH 26 sealer at day 1 (P < .0014), day 7 (P < .0002), day 30 (P < .0015), and day 90 (P < .0170). The mean fluid microleakage for both group G and group R increased from day 1 to day 90. The results showed that Resilon is a suitable replacement for gutta-percha as a root canal filling material on the basis of its increased resistance to fluid microleakage.     

An in vitro evaluation of the contents of root canals obturated with gutta percha and AH-26 sealer or Resilon and Epiphany sealer

The purpose of this study was to compare the contents of root canals obturated with gutta percha and AH-26 sealer (Dentsply, Tulsa, OK) to canals obturated with the Resilon and Epiphany (Pentron, Wallingford, CT) system. Canal contents were assessed by determining the percentage of canal space occupied by core material, sealer, voids, and debris. Forty extracted human maxillary anterior teeth were instrumented, and the teeth were randomly assigned to either the gutta percha/AH 26 group or the Epiphany/Resilon group. Canals were obturated, and the teeth were subsequently embedded in resin and sectioned horizontally at 2, 4, and 6 mm from the anatomic apex. Sections were photographed by using a low vacuum scanning electron microscope. Image-J (Wayne Rasband; National Institute of Health, Bethesda, MD) software was used to quantify the proportion of core material, sealer, voids, and debris in each canal. Percentages and statistical comparisons for each method were compared. There were no significant differences found among the two groups in terms of the percentage of core (p = 0.9), sealer (p = 0.58), debris (p = 0.999), or voids (p = 1.00). Additionally, there were no differences in the percentage of core material, sealer, debris, or voids at any of the examined levels (2, 4, or 6 mm).