Efficacy of a two-component acellular pertussis vaccine in infants

OBJECTIVE: This case-control study investigated the protective efficacy against pertussis of three doses of a two-component acellular pertussis vaccine (manufactured by Biken in Japan) combined with diphtheria and tetanus toxoids (manufactured by Connaught Laboratories in the US) in infants. METHODS: A case-control study was performed in 63 pediatric practices in Germany. Prospective recruitment of 16,780 infants ages 6 to 17 weeks took place between February, 1993, and July, 1994. According to parental choice infants received either Biken acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTacP) (74.6%) at approximately 2, 4 and 6 months of age, or a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine (10.9%), diphtheria-tetanus toxoids vaccine (12.5%) or no vaccine (2.0%). Prospective surveillance of pertussis cases between February, 1993, and May, 1995, was accomplished by culturing all infants < or =2 years of age presenting with cough > or = 7 days. A pertussis case was defined as any cough of 21 days or longer plus a positive Bordetella pertussis culture or household contact exposure. RESULTS: We identified 241 pertussis cases prospectively by 11,017 B. pertussis cultures and 949 controls matched for age were selected from the same pediatric practices. Medical history and demographic and vaccine status data were collected from each case and for four controls. Data were analyzed through conditional logistic regression taking into account individual matching and adjusting for potential confounding variables. DTacP combined with diphtheria and tetanus toxoids vaccine was 82% protective (95% confidence interval, 68 to 90), diphtheria-tetanus toxoids-whole cell pertussis vaccine was 96% protective (95% confidence interval, 78 to 99). Protection against typical B. pertussis infection characterized by paroxysmal cough lasting > or =21 days was 96% (95% confidence interval, 87 to 99) for DTacP and was 97% (95% confidence interval, 79 to 100) for diphtheria-tetanus toxoids-whole cell pertussis vaccine. Adjustment for potentially confounding variables did not change the results significantly. CONCLUSIONS: Three doses of the two-component acellular pertussis vaccine protected infants against pertussis disease during the period before the recommended booster vaccination. For typical pertussis disease as defined by the WHO efficacy was high and similar to that of a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine.     

Mutual information based registration of multimodal stereo videos for person tracking

Research presented in this paper deals with the systematic examination, development, and evaluation of a novel multimodal registration approach that can perform accurately and robustly for relatively close range surveillance applications. An analysis of multimodal image registration gives insight into the limitations of assumptions made in current approaches and motivates the methodology of the developed algorithm. Using calibrated stereo imagery, we employ maximization of mutual information in sliding correspondence windows that inform a disparity voting algorithm to demonstrate successful registration of objects in color and thermal imagery. Extensive evaluation of scenes with multiple objects at different depths and levels of occlusion shows high rates of successful registration. Ground truth experiments demonstrate the utility of the disparity voting techniques for multimodal registration by yielding qualitative and quantitative results that outperform approaches that do not consider occlusions. A basic framework for multimodal stereo tracking is investigated and promising experimental studies show the viability of using registration disparity estimates as a tracking feature.     

Economic evaluation of hysteroscopic endometrial ablation versus vaginal hysterectomy for menorrhagia

PURPOSE: To assess the efficacy and safety of percutaneous catheter drainage combined with alcohol sclerosis in the treatment of postoperative lymphoceles. PATIENTS AND METHODS: Thirteen patients with 14 postoperative symptomatic lymphoceles were treated. Drainage catheters were inserted under ultrasound (n = 13) or computed tomographic (n = 1) guidance. Lymphocele sclerosis was performed by instilling 10-100 mL of absolute alcohol into the lymphocele cavity and aspirating the alcohol after 30 minutes. Sclerosis sessions were carried out one to three times per day, usually three times per week. Catheter sinograms were obtained and prophylactic antibiotics administered. Imaging was repeated if symptoms or signs of recurrence developed. RESULTS: Successful drainage and sclerosis were achieved in all 13 patients. One patient with a recurrence was successfully treated with repeated drainage and alcohol ablation. No adverse effects of alcohol instillation were seen. The mean duration of catheterization was 36 days (range, 17-65 days; median, 30 days). CONCLUSION: Percutaneous drainage combined with alcohol ablation is a safe and effective treatment of postoperative lymphoceles.     

Two structural adaptations for regulating transmitter release at lobster neuromuscular synapses

The distal accessory flexor muscle (DAFM) in the lobster (Homarus americanus) walking leg consists of 5 muscle fiber bundles. All five bundles, one proximal, one distal, and 3 medial, are innervated by one excitatory and one inhibitory motor neuron. Both neurons release more transmitter on the distal bundle than on the proximal bundle. The aim of our studies was to investigate the structural basis of this differentiation. Thin sections cut at 50 microns intervals showed a similar number of excitatory synapses on the two bundles. Freeze-fracture views of excitatory synapses showed that synapse size, active zone number per synapse, and intramembrane particle density in the postsynaptic membrane are similar proximally and distally. Active zones at synapses on the distal bundle are larger and contain about 50% more large intramembrane particles, which are thought to include the voltage-gated Ca2+ channels that couple the action potential to transmitter release, than their counterparts on the most proximal bundle. This difference in channel number appears to produce a disproportionate increase in the probability of transmitter release sufficient to account for most of the proximal-distal disparity in the amplitude of the excitatory postsynaptic potential. In contrast, staining the inhibitor for antibodies to the inhibitory neurotransmitter, GABA, showed that it forms more varicosities on the distal bundle than on the proximal bundle. Because most of the synapses are located in the varicosities, differences in synapse number likely regulate the proximal-distal disparity in the amount of inhibitory transmitter released. Therefore, the regional differentiation in the amount of transmitter released in the DAFM appears to be based on two distinct mechanisms. In the inhibitor, transmitter release appears to be regulated differentially by differences in synapse number. In the excitor, transmitter release appears to be regulated differentially from a similar number of synapses by differences in active zone structure.     

In utero exchange transfusion in homozygous alpha-thalassaemia: a case report

We report a case of homozygous alpha-thalassaemia with hydrops fetalis presenting at 22 weeks of gestation. In utero exchange transfusion was performed with maternal blood at 23 weeks. 25 weeks and 29 weeks of gestation. The fetus was delivered at 29 weeks of gestation without significant neonatal complication. Post-transfusion haemoglobin pattern after transfusion suggested that a total haematocrit of 0.52 may be the desired post-exchange transfusion haematocrit to aim for and the total haematocrit of haemoglobin A and haemoglobin Portland dropped approximately one percent per day.