Safety and immunogenicity of hepatitis A vaccine in healthy adult volunteers

The immunogenicity and adverse reaction of an inactivated hepatitis A (HA) vaccine were investigated. Sixty healthy adult volunteers who lacked antibody to HA virus (anti-HAV) received three doses of vaccine containing 720 enzyme-linked immunosorbent assay (ELISA) units (EL.U) according to a 0, 1 and 6 month schedule. Blood tests for serum liver enzymes and anti-HAV were performed at screening 7 days prior to, and 1, 6 and 7 months after the first dose. Anti-HAV was tested by radio immunoassay and ELISA for titre determination. The seroconversion rates measured by ELISA were 98.3% (59/60) at months 1 and 6 and 100% at month 7. Sixty-one per cent (109/180) of the documented injections were followed by local symptoms, essentially mild soreness at the site of injection; and 22.2% (40/180) by minor general symptoms including malaise, fatigue and lethargy. It is concluded that HA vaccine is highly immunogenic and safe. It may replace immunoglobulin as an effective method of preventing HA virus infection in adults.     

Higher serum levels of soluble intracellular cell adhesion molecule‐1 and soluble vascular cell adhesion molecule predict peripheral artery disease in haemodialysis patients

Aim: Serum levels of soluble intracellular cell adhesion molecule‐1 (sICAM‐1), soluble vascular cell adhesion molecule‐1 (sVCAM) and monocyte chemotactic protein 1 (MCP‐1), are elevated in patients with peripheral artery disease (PAD). However, the levels of these cell adhesion molecules in patients undergoing haemodialysis (HD) are unclear. Method: A total of 112 HD patients were included and PAD was diagnosed using the ankle‐brachial index and Doppler ultrasound. Serum levels of sICAM‐1, sVCAM‐1 and MCP‐1 were assayed using enzyme linked immunosorbent assay. Results: Out of 106 HD patients, 31 (27.7%) were diagnosed with PAD. After adjusting for risk factors, higher serum levels of sVCAM‐1 and sICAM‐1 were associated with PAD in HD patients, with an odds ratio of 5.3 (95% CI 3.3–65.5) and 2.7 (95% CI 1.2–21.8) respectively. Using sVCAM‐1 and sICAM‐1 for diagnosis of PAD in HD patients, sVCAM‐1 had a sensitivity of 72.4% and specificity of 62.3% for sVCAM‐1 and sICAM‐1 had a sensitivity of 89.3% and a specificity of 40%. MCP‐1 was not associated with PAD in HD patients. In addition, the fistula of HD patients with PAD had a lower A‐V access flow. Conclusion: sVCAM‐1 and sICAM‐1 was associated with higher risk of PAD in HD patients. Moreover, HD patients with PAD had a lower blood flow and lower A‐V access flow. Our results showed that sVCAM‐1 and sICAM‐1 may be used as screening markers for PAD in HD patients.     

Quantifying acute changes in volume and nutritional status during haemodialysis using bioimpedance analysis

Aim: To determine the precision of multi‐frequency bioimpedance analysis (MFBIA) in quantifying acute changes in volume and nutritional status during haemodialysis, in patients with end‐stage renal disease (ESRD). Methods: Using whole‐body MFBIA, we prospectively studied changes in total body water (TBW), extracellular volume (ECV), intracellular volume (ICV), lean body mass (LBM), body cell mass (BCM) and fat mass (FM), pre‐ and post‐haemodialysis and tested the agreement of volume changes with corresponding acute weight change and ultrafiltration volume (UF) using Bland‐Altman analysis. Results: Forty‐four prevalent and 17 incident haemodialysis patients were studied (median age 55 years, 56% males). MFBIA‐derived TBW, ECV, ICV, LBM and BCM were significantly reduced after haemodialysis (P < 0.001), but FM remained constant. TBW change estimated weight change with mean bias of ?0.52 L, with 56/61 (91.8%) data points within limits of agreement (?2.74 L, 1.69 L). TBW change estimated UF with mean bias of ?0.62 L, with 55/61 (90.2%) data points within limits of agreement (?2.68 L, 1.43 L). ECV change underestimated weight change and UF with mean bias of ?1.17 L and ?1.27 L respectively. Similarly, ICV change underestimated both clinical measures with corresponding mean bias of ?1.34 L and ?1.44 L. Comparing incidents versus prevalent haemodialysis patients, TBW change estimated weight change with smaller mean bias (?0.10 L vs?0.69 L, respectively) and narrower limits of agreement. Conclusion: Multi‐frequency bioimpedance analysis‐derived TBW change has the best agreement with acute clinical volume change during haemodialysis compared to ECV or ICV change alone, but overall degree of precision remains poor. Nutritional assessment using LBM and BCM measurements is significantly confounded by hydration status.     

bcl-2 and p53 immunophenotypes in pre-invasive, early and advanced oesophageal squamous cancer

 

Aims:

An inverse correlation between bcl-2 and p53 expression has been reported in several types of epithelial tumour. The role of bcl-2 and p53 in the development of oesophageal squamous carcinoma has yet to be established. The expression of bcl-2 and p53 proteins has been evaluated in the multistage oesophageal tumorigenesis, which progresses from normal mucosa to dysplasia (squamous intraepithelial lesion, SIL), to invasive early and advanced oesophageal squamous cancer.  

Methods and results:

Sixty-four cases of squamous oesophageal cancer, coexisting with SIL in 18 cases, were immunohistochemically analysed for any overexpression of bcl-2 and p53 proteins. Any association of bcl-2 and p53 protein expression with patient survival was also analysed. We observed bcl-2 expression that decreased significantly during the progression of oesophageal carcinogenesis. A decreasing frequency in the expression of bcl-2 in advanced oesophageal squamous cancer coincided with frequent p53 overexpression. bcl-2 expression was correlated with patient survival by univariate analysis. The association disappeared after adjusting for tumour stage. p53 overexpression showed no association with patient survival by either univariate or multivariate analysis.  

Conclusions:

The down-regulation of bcl-2 and up-regulation of p53 in advanced oesophageal squamous cancer suggest that bcl-2 and p53 proteins may interact in the progression of oesophageal squamous cancer.