Efficacy and safety of live varicella zoster vaccine in diabetes: a randomized, double-blind, placebo-controlled trial.

AIMS: To elucidate varicella zoster virus (VZV)-specific cell-mediated immunity and humoral immunogenicity against live attenuated Oka varicella zoster vaccine concurrently vaccinated with 23-valent pneumococcal polysaccharide vaccine (PPSV23) in elderly people with diabetes mellitus. METHODS: This double-blind randomized controlled single-centre study of 60-70-year-old people with diabetes compared immunity and safety profiles 3 months after one dose of varicella zoster vaccine or placebo. PPSV23 was immunized simultaneously. Primary analysis evaluated cell-mediated immunity using the VZV skin test. Secondary analyses were a VZV interferon-γ enzyme-linked immunospot (ELISPOT) assay and immunoadherence haemagglutination test. Adverse experiences were recorded using diary questionnaires. RESULTS: By intent-to-treat analysis, 27 participants with diabetes who had been administered the vaccine were compared with 27 participants who were given a placebo. Changes in skin test scores were 0.41 ± 0.80 and 0.11 ± 0.93 (P = 0.2155), and geometric mean fold rises of the ELISPOT counts were 1.2 [95% confidence interval (CI) 0.2, 7.9] and 1.2 (95% CI 0.2, 7.3) (P = 0.989) in the vaccine and placebo groups, respectively. The geometric mean titre did not increase 3 months after vaccination in either group. No vaccination-related severe adverse experience was reported and no participant developed herpes zoster. DISCUSSION: Our previous results demonstrated that varicella zoster vaccine safely enhanced VZV-specific immunity in elderly people with or without diabetes. The results of this study showed that varicella zoster vaccine can be used safely, but it cannot boost virus-specific immunity in elderly people with diabetes when administered with concurrent PPSV23. Alternative strategies are needed to prevent VZV-associated diseases in this population.

Health effects and exposure assessment of aerosolized pentamidine handlers.

Nurses administering aerosolized pentamidine (AP) were studied to determine any effect AP may be having on their health. Exposure was determined by each nurse's self-report of treatment given as recorded in a daily log and personal and area pentamidine sampling. Outcome measures were self-reported symptoms recorded in a daily log and peak expiratory flow rates (PEFR) and cross-shift and cross-week pulmonary function tests (PFTs). Results revealed no dose-response effect of pentamidine exposure on cross-shift and cross-week PFTs. However, declines in cross-shift PEFRs, diffusion capacities, and increased symptom complaints were observed for a subset of the study population. This suggested that outcomes were modulated by host factors (history of hay fever and allergy) as well as exposure doses. Treatment both efficacy in containing fugitive AP aerosol was also corroborated as a means of minimizing worker exposure.

Abnormal facilitative glucose transporter gene expression in human islet cell tumors.

Our previous studies have shown that increased expression of GLUT1/erythrocyte and GLUT3/brain type glucose transporter genes in human tumors is associated with cellular transformation. We have now determined the levels of messenger RNAs (mRNAs) encoding these two glucose transporter isoforms as well as that of GLUT2/liver isoform in insulin-, glucagon-, and gastrin-secreting islet cell tumors. Northern blot analysis and reverse transcriptase-polymerase chain reaction revealed the presence of GLUT1 and GLUT3 mRNA in all human islet cell tumors and normal islets examined. In contrast, GLUT2 mRNA, which is present at high levels in normal islets, was not detected in insulinomas or other types of islet cell tumors. These results imply that GLUT1 and GLUT3 are primarily responsible for glucose uptake by these tumors.

Oral erythromycin prophylaxis against Streptococcus pyogenes infection in penicillin-allergic military recruits: a randomized clinical trial.

Historically, military recruits have required benzathine penicillin G to prevent epidemics of Streptococcus pyogenes. In this randomized clinical trial, low-dose oral erythromycin was evaluated as an alternative for prophylaxis against group A beta-hemolytic streptococci in penicillin-allergic recruits. US Marine Corps recruits (186) reporting penicillin allergy were randomly given either oral erythromycin (250 mg twice a day) or a vitamin (one tablet daily) for 60 days. Evidence of infection was defined as a two-dilution rise in anti-streptolysin O titer. The erythromycin group had a significantly lower risk of S. pyogenes infection than did the vitamin group (relative risk 0.44; 95% confidence interval, 0.22-0.89). There was no significant difference among the treatment groups in isolation of group A beta-hemolytic streptococci from throat cultures. Low-dose oral erythromycin appears as effective as benzanthine penicillin G in preventing S. pyogenes infection.

Flow cytometry crossmatching for kidney transplantation.

1. Overall, positive FCXM reactions were associated with graft losses in regrafts but not in primary transplants. 2. In transplants involving older female or CVA donors, a positive FCXM appeared to be deleterious in both first transplants and regrafts. If the donor were a younger male and not a CVA victim, only FCXM positive regrafts had low graft survival rates. 3. We presented a 3-color technique allowing the differentiation of antibody reactions against T cells, B cells, and monocytes. Another method allows the simultaneous evaluation of both IgG and IgM reactions against T cells. Using these kinds of methods may make better identification of antibodies that may be harmful to a transplant allograft possible.

The flow cytometry crossmatch in kidney transplantation.

1. Positive FCXM reactions were associated with sensitization in transplants with negative cytotoxic crossmatches. Recipients of regrafts, females, particularly those with previous pregnancies, and recipients with historical cytotoxic antibody reactivity were more likely to have FCXM detectable antibodies. 2. Primary nonfunction grafts were associated with a positive FCXM, but predominantly in those transplants involving female, older, or nontrauma donors. Nearly 40% of the FCXM positive transplants of these organs did not function during the first month posttransplant 3. Low 3-month graft survival rates were associated with a positive FCXM reaction, but once again this was seen with female, older, and nontrauma donor transplants. In addition, approximately 40% of FCXM positive transplants involving older or nontrauma donors that did survive had poor graft function at 3 months.

Interrelationships between blood pressure, sodium, potassium, serum cholesterol, and protein intake in Japanese.

Interrelationships among blood pressure (BP), sodium (Na), potassium (K), dietary protein, and serum cholesterol level (Chol) were examined in 62% (1120) of 1818 Japanese inhabitants of both sexes aged over 30 years who lived in a rural village in Japan. Fasting single-spot urine specimens were collected in the morning to measure Na, K, urea nitrogen (UN), inorganic sulfate (SO4), and creatinine (Cr). The Cr ratios of Na, K, UN, SO4, Na/K, and SO4/UN were analyzed by multiple regression analysis to determine independent associations with BP together with age, obesity index, hematocrit (Hct), Chol, triglyceride (TG), and fasting serum glucose level (Glu). Except for Na/Cr in men, Na/Cr and Na/K were found to be independently and positively related to BP, particularly to systolic BP (SBP). In contrast, K/Cr and SO4/UN (an index related to the dietary score of sulphur-containing amino acids derived mainly from animal protein) were both negatively associated with SBP, and UN/Cr (an index of total protein intake) was positively associated with SBP in men. Chol was linked to BP negatively in men but positively in women. Age, obesity index, TG, and Hct were generally positively and significantly related to BP in both sexes. The results confirmed on epidemiological grounds the positive link of Na and the negative link of K to BP within a single population in Japan. They further suggest, although only in men, that there is a negative relationship of Chol and dietary animal protein with BP.

Dietary risk factors of stroke and hypertension in Japan -- Part 2: Validity of urinalysis for dietary salt and protein intakes under a field condition.

Utility of urinalysis as a method for estimating dietary salt and protein intakes was examined in volunteers from farming and fishing villages in Japan and the data was compared to findings in a survey on diets. We found that partial urine samples and even a fasting single spot urine in the a.m. could serve as valid substitutes for 24-hour (hr) urine collections. Further, significant correlations were obtained between levels of salt in the diet estimated by survey interviews and urinary sodium (Na) and between interview-estimated dietary total or animal protein and urinary inorganic sulfate (SO4). In comparative studies between farming and fishing villages, almost the same findings, higher salt in a farming village and higher animal protein in a fishing village, were obtained in the urinalysis and the survey on diets. These findings clearly indicate that urinalysis, as a method for estimating dietary salt and protein intake in population surveys, has distinct advantages.

Dietary risk factors of stroke and hypertension in Japan -- Part 1: Methodological assessment of urinalysis for dietary salt and protein intakes.

In our attempt to design a method which would be more reliable than dietary survey interviews when estimating salt and protein intakes in a population survey, a urinalysis-related study was done on volunteers. Urinary sodium (Na), urea nitrogen (UN) and inorganic sulfate (SO4), all indices of dietary salt, protein and sulfoamino acids, respectively, were confirmed to reflect the nutritional condition. Interaction between salt and protein was not observed at least at the dietary levels used in the present study (for salt, 0.33 and 0.1 g/kg body weight/day; for protein, 1.6 and 0.7 g/kg body weight/day). Excretion of components was delayed several days or more after dietary ingestion, and nutritional estimation by urinalysis, therefore, may not be so much affected by daily variables in the diet intake. Further, partial urine samples proved to have a highly significant correlation with 24-hour (hr) urine, as for urinary Na, potassium (K), SO4, UN and their creatinine (Cr) ratios, thus indicating the availability of partial urine samples as substitutes for 24-hr urine specimens. Thus, urinalysis is a more readily facilitated, more scientific and more quantitative method for epidemiological nutritional surveys.

Dietary risk factors of stroke and hypertension in Japan -- Part 3: Comparative study on risk factors between farming and fishing villages in japan.

General medical examinations were performed in two rural areas of Shimane Prefecture in Japan, one was a farming village and the other a fishing village where incidences of death due to stroke differed, higher in the former and lower in the latter. Comparisons were made on salt and protein intake by analyzing the fasting single spot urine collected in the morning and by blood tests. Urine samples were analyzed for sodium (Na), potassium (K), urea nitrogen (UN), inorganic sulfate (SO4) and creatinine (Cr) and blood samples for cholesterol (Chl), triglyceride (TG), hematocrit (Ht) and hemoglobin (Hb). Blood pressure, Na/Cr, Na/K and Ht were higher in the farming village and K/Cr, UN/Cr, SO4/Cr, SO4/UN, Chl and TG were higher in the fishing village. These findings indicate the higher salt intake and lower intake of K, animal protein and fat in the farming village. This typical dietary pattern of the Japanese may explain the higher incidence of hypertension and stroke in the farming village.

Effect of acute arterial hypertension in stroke-prone and stroke-resistant SHR.

Acute transient hypertension by norepinephrine was loaded to stroke-resistant (SHRSR), stroke-prone (SHRSP), and normotensive Wistar Kyoto (WK) rats. (SHRSP were most sensitive to norepinephrine in young pre-hypertensive group.) Its effects on cerebral small vessels were studied using Evans Blue to detect the increase of vascular permeability. Severe macroscopic dye-leakages were observed in the areas of "recurrent branching" and "boundary zone", especially among young SHRSP, while SHRSR seemed to be least prone to dye-leakage both in young and adult groups. Among the adults, there was little difference between SHRSP and WK, probably because of the adaptive structural changes of arterial walls in SHRSP caused by long-standing hypertension.