The effect of early measles vaccination at 4.5 months of age on growth at 9 and 24 months of age in a randomized trial in Guinea-Bissau.

BACKGROUND: Providing an early, additional measles vaccine (MV) at 4.5 months of age has been shown to reduce child mortality in low-income countries. We studied the effects on growth at 9 and 24 months of age. METHODS: A randomized controlled trial was conducted in Guinea-Bissau from 2003-2007 including 6,648 children. Children were randomized 1:1:1 to receive Edmonston-Zagreb measles vaccine at 4.5 and 9 months of age (group A), no vaccine at 4.5 months and Edmonston-Zagreb measles vaccine at 9 months (group B), or no vaccine at 4.5 months and Schwarz measles vaccine at 9 months (group C) Data on anthropometrics were obtained at enrolment at 4.5 months of age and again at 9 and 24 months of age. Analyses were stratified by sex, season of enrolment, and neonatal vitamin A supplementation (NVAS) status, as all these factors have been shown to modify the effect of early MV on mortality. RESULTS: Overall there was no effect of early MV on anthropometry at 9 months. At 24 months children who had received early MV had a significantly larger mid-upper-arm-circumference (MUAC/in cm) (Difference = 0.08; 95% CI (0.02;0.14)) compared with children in the control group; this effect was most pronounced among girls (0.12 (0.03;0.20)). The effect of early MV on MUAC remained significant in the dry season and in girls who received placebo rather than NVAS. CONCLUSION: Early MV was associated with a larger MUAC particularly in girls. These results indicate that a two-dose measles vaccination schedule might not only reduce child mortality but also improve growth. TRIAL REGISTRATION: ClinicalTrials.gov NCT00168558 . Registered September 9, 2005, retrospectively registered.

Impact of training status on LPS-induced acute inflammation in humans.

The aim of the present study was to examine the impact of training status on the ability to induce a lipopolysaccharide (LPS)-induced inflammatory response systemically as well as in skeletal muscle (SkM) and adipose tissue (AT) in human subjects. Seventeen young (23.8 ± 2.5 yr of age) healthy male subjects were included in the study with eight subjects assigned to a trained (T) group and nine subjects assigned to an untrained (UT) group. On the experimental day, catheters were inserted in the femoral artery and vein of one leg for blood sampling and a bolus of 0.3 ng LPS/kg body wt was injected into an antecubital vein in the forearm. Femoral arterial blood flow was measured by ultrasound Doppler, and arterial and venous blood samples were drawn before (Pre) LPS injection and 30, 60, 90, and 120 min after the LPS injection. Vastus lateralis muscle and abdominal subcutaneous AT biopsies were obtained Pre and 60 and 120 min after the LPS injection. LPS increased the systemic plasma TNFα and IL-6 level as well as the TNFα and IL-6 mRNA content in SkM and AT of both UT and T. However, whereas the LPS-induced inflammatory response in SkM was enhanced in T subjects relative to UT, the inflammatory response systemically and in AT was somewhat delayed in T subjects relative to UT. The present findings highlight that training status affects the ability to induce a LPS-induced acute inflammatory response in a tissue-specific manner.

Sarcoidosis. A clinical study with special reference to the choice of biopsy procedure.

In a 10-year review of the records of 146 young male patients suspected of sarcoidosis on the basis of radiographic intrathoracic changes, the chest X-ray findings have been analysed in relation to the results of different biopsies. Most of the patients were military men, and almost all were apparently affected by the disease. Sixty-six per cent had bilateral hilar lymphadenopathy (BHL) only, 12% had isolated pulmonary lesions and 22% had both BHL and pulmonary lesions. In all patients at least one biopsy was performed, in most cases a scalene fat pad biopsy and/or a liver biopsy. Epitheloid cell granulomas were demonstrated in 86 biopsies from 64 of the 146 patients. Granulomas were obtained more frequently by scalene fat pad biopsies than by liver biopsies in the same group of patients. During the first 4--5 years of the 10-year period the scalene fat pad biopsies were done in local anesthesia in different general surgical departments without special experience of this biopsy procedure. In the last 5--6 years the scalene fat pad biopsies were done in general anaesthesia in a head and neck surgical department specially trained in this biopsy technique. Granulomas were obtained more frequently in the latter than in the former group. The highest frequency of granulomas was found among patients with both BHL and pulmonary lesions. Of the 71 patients in whom liver biopsy was performed, 43% had granulomas in the liver. A few patients had signs--although only slight--of liver affection. The results of the different biopsies are discussed in relation to the clinical picture. It is concluded that scalene fat pad biopsy in some cases can still be of some diagnostic aid in patients with radiographic intrathoracic changes suspected of sarcoidosis, although this type of biopsy has to a great extent been replaced by biopsy through mediastinoscopy. Furthermore it is concluded that comparison of different biopsies in one and the same patient could elucidate a possible relationship between the radiographic intrathoracic manifestations and the occurrence of granulomas in different intra- and extra-thoracic tissues. In this study there were only few and insignificant complications of the biopsies.

Human C-peptide in normal and diabetic subjects.

Concentrations of human C-peptide, IRI (immunoreactive insulin) and glucose were determined during oral glucose tolerance test (1.75 g glucose/kg ideal body weight) in 14 normal persons (N), 9 maturity-onset diabetics (DI) and 10 insulin-requiring diabetics (DII) never treated with insulin and in 3 formerly insulin treated diabetics. The mean fasting levels of C-peptide and IRI in the first three groups were: N: 0.37 +/- 0.02 nM and 0.048 +/- 0.009 nM, DI: 0.86 +/- 0.17 nM and 0.11 +/- 0.029 nM, DH: 0.37 +/- 0.04 nM and 0.063 +/- 0.009 nM. One hour after oral glucose ingestion, the respective values increased to: N: 2.53 +/- 0.20 nM and 0.52 +/- 0.077 nM, DI: 2.49 +/- 0.31 nM and 0.49 +/- 0.11 nM, DH: 0.49 +/- 0.05 nM and 0.11 +/- 0.014 nM. Although secreted from the pancreas in equimolar concentrations, the molar ratio of C-peptide to insulin in peripheral blood was about 7 in the fasting state, falling to about 5 in the glucose stimulated condition. Maturity-onset diabetics had higher fasting levels of C-peptide than normal subjects, in agreement with the IRI levels. Three patients previously treated with insulin and having insulin antibodies showed C-peptide responses significantly below the normal range. In one of these patients, the test was repeated 9 months later when the insulin antibodies had disappeared, and the C-peptide response observed at that time was much higher. It is suggested that insulin antibodies cause an impaired IRI - and consequently C-peptide response - by constantly removing insulin from the granules in the B-cell. In normal humans the peripheral C-peptide responses to the oral glucose load showed less relative variation than do the insulin responses. Therefore, a radioimmunoassay for C-peptide in addition to the assay for insulin will provide supplementary information on insulinsecretion.

Serum IRI in insulin-treated diabetics during a 24-hour period.

Serum immunoreactive insulin extracted with acid ethanol (total IRI) and blood glucose were measured in two groups of diabetics and a control group during 24-hour periods. One group of diabetics had received insulin for less than 1 month, and none had yet developed insulin antibodies. The other had been treated with insulin for 2 years or more. The average level of total IRI in the diabetics without antibodies was similar to that in the normals, but highly elevated in diabetics with antibodies, although the blood glucose levels were similar in the two diabetic groups. The increase in total IRI after the insulin injections was more rapid in patients receiving quick-acting insulin and most pronounced in those with the highest levels of total IRI. The total IRI peaked in the afternoon and dropped during the night. The short-term insulin-treated patients showed a better degree of diabetes control than those treated for 2 years or more. No correlation was found however, between the total IRI level and the degree of control in the latter group. The patients with the highest levels of total IRI had the highest frequency of hypoglycemic episodes. This is in agreement with the concept that the insulin antibodies may function as a circulating depot, which releases insulin irrespective of the metabolic need.

Plasma potassium and insulin during extracorporeal circulation using a glucose-containing pump prime.

In order to investigate the possible relationship between a glucose-containing pump prime and changes in plasma potassium during extracorporeal circulation, determinations were made of blood glucose and plasma insulin, potassium, and magnesium in 18 subjects undergoing open-heart surgery. In 6 of the patients, the same parameters had been measured during a pre-operative glucose tolerance test. It was found that the elimination of glucose was considerably impaired during extracorporeal circulation, in spite of high insulin levels. During the first minutes of extracorporeal circulation, plasma potassium fell more than during the glucose tolerance test, in spite of comparable insulin levels. It is concluded that changes in plasma potassium during extracorporeal circulation do not reflect insulin activity to any noticeable extent.