, 2011a), MICA expression on noninfected bystander cells in C. trachomatis-exposed cultures was unaffected. Further, we also demonstrated that active C. trachomatis infection is required for changes in ligand expression to occur, as these phenomena were not observed when cells were exposed to UV-inactivated EBs (Fig. 2b). These data clearly indicate distinct kinetics and effects of C. trachomatis on MHC class LBH589 supplier I and MICA and suggest that cytokines and/or chemokines released by infected host cells

do not influence MICA expression on neighboring cells. To assess the physiological consequences of C. trachomatis serovar D-mediated MHC class I and MICA modulation, mock-infected, UVEB-infected, and C. trachomatis-infected A2EN cells were

exposed to NK92MI cells in coculture experiments. NK92MI expresses NK2GD and KIR this website – receptors for MICA and MHC class I, respectively, (Fig. 3a). Similar to NK cells derived from peripheral blood mononuclear cells, these cells also contain the intracellular cytolytic granule proteins perforin and granzyme (Fig. 3b). Morphologic assessment of C. trachomatis-infected and mock-infected cocultures revealed that the majority of mock-infected cells retain normal A2EN monolayer morphology over 4 h of exposure (data not shown), while infected cells reveal morphologic evidence of cell lysis, including membrane blebbing (Video S1, Supporting information). Quantification of LDH release confirmed a significant increase in A2EN cell lysis among infected cells at 34 hpi

when compared to mock-infected control (P < 0.01), suggesting that C. trachomatis infection enhances the susceptibility of infected endocervical epithelial cell to NK cell cytolytic HAS1 activity (Fig. 4a). Pertinent to these observations, addition of a neutralizing anti-MICA antibody significantly decreased NK92MI lytic activity against C. trachomatis-infected cultures (P < 0.01). This indicates that the enhanced C. trachomatis-infected cell lysis by NK cells was dependent on MICA. Furthermore, no significant increase in susceptibility to NK cell lysis was observed in A2EN cells infected with UV-inactivated Chlamydial elementary bodies, supporting previous data that active C. trachomatis infection is required for the modulation of NK ligand expression to increase NK cell lysis. Interestingly, the differences in lysis of C. trachomatis-infected A2EN vs. mock-infected, UVEB-exposed and anti-MICA-treated targets are markedly greater at 34 hpi than at 42 hpi (Fig. 4). These data indicate that there is a significant decrease in the efficiency of lysis of C. trachomatis-infected A2EN cells at later time points postinfection (42 hpi) when compared to earlier stage infection (34 hpi) and suggest that the temporal modulation of MHC class I downregulation may impact the susceptibility of C. trachomatis-infected cells to NK cell lysis. Infected host cell lysis could result in the release of infectious or noninfectious chlamydial particles.

“
“Zinc signals, i.e. a change of the intracellular concentration of free zinc ions in response to receptor stimulation, are involved in signal transduction in several immune cells. Here, the role of zinc signals in T-cell activation by IL-2 was investigated in the murine cytotoxic T-cell line CTLL-2 and

in primary human T cells. Measurements with the fluorescent dyes FluoZin-3 and Zinquin showed that zinc is released from lysosomes into the cytosol in response to stimulation of the IL-2-receptor. Activation of the ERK-pathway was blocked by chelation of free MG-132 mw zinc with N,N,N′,N′-tetrakis-2(pyridyl-methyl)ethylenediamine, whereas zinc was not required for STAT5 phosphorylation. In addition, the key signaling molecules MEK and ERK were

activated in response to elevated free intracellular zinc, induced by incubation with zinc and the ionophore pyrithione. Downstream of ERK activation, ERK-specific gene selleck kinase inhibitor expression of c-fos and IL-2-induced proliferation was found to depend on zinc. Further experiments indicated that inhibition of MEK and ERK-dephosphorylating protein phosphatases is the molecular mechanism for the influence of zinc on this pathway. In conclusion, an increase of cytoplasmic free zinc is required for IL-2-induced ERK signaling and proliferation of T cells. Zinc signals have been observed in different cell types of the immune system, including monocytes, dendritic cells, and mast cells 1. T-cell function is particularly susceptible to zinc deprivation, and zinc signals were suggested to activate protein kinase C in T cells 1, 2. Furthermore, zinc is involved

in the activation of the Src-family kinase Lck by the TCR. Here, zinc ions are required for interactions at two protein/protein interface sites. First, they stabilize the interaction between Lck and CD4 or CD8, recruiting the kinase to the TCR signaling complex 3. Second, zinc ions stabilize homodimerization of Lck, which promotes activating transphosphorylation between two Lck molecules 4. Cellular zinc homeostasis is Fenbendazole mediated by ten members of the ZnT family and 14 members of the Zrt-, Irt-like protein (ZIP) family of zinc transporters 5. Intracellular localization for most of these transporters remains to be determined. So far, no nuclear zinc transporters were identified, even though there is evidence that nuclear and cytoplasmic zinc are differentially regulated 6. In general, ZIP transport zinc into the cytoplasm, whereas ZnT transport zinc out of the cell or into cellular compartments, including different vesicular structures 7. Importantly, zinc accumulates in a lysosomal compartment of T cells, from which it is released by ZIP8 in response to TCR-mediated activation by antibodies against CD2, CD3, and CD28 8.

Antigenic stimulation of PBMC for proliferation and cytokine secretion was performed according to standard procedures (Mustafa 2009b). In brief, 2 × 105 PBMC suspended in 50 μL complete medium was seeded into the wells of 96-well tissue culture plates (Nunc, Roskilde, Denmark). Antigens

in 50 μL complete medium were added at optimal concentrations to the wells in triplicates. Whole bacilli were used at 10 μg mL−1 (wet weight) and all other antigens and peptides were used at an optimal concentration of 5 μg mL−1. The cells in the control wells did not receive any mycobacterial antigen/peptide. The final volume of the culture in each well was adjusted to 200 μL. Con A 10 μg mL−1 (Sigma Chemical,

St. Louis, MO) was used as a positive control. The plates were incubated at 37 °C in a humidified atmosphere containing 5% CO2 and 95% air. On day 6, culture selleck screening library supernatants (100 μL) were collected from each well and frozen at −20 °C until used to determine cytokine concentrations. The remaining cultures were pulsed with 1 μCi 3H-thymidine (Amersham Life Science, Amersham, UK) and harvested (Skatron Instruments AS, Oslo, Norway) according to standard procedures (Al-Attiyah et al., 2003). The incorporated radioactivity was obtained as counts per minute (c.p.m.). STA-9090 The average c.p.m. was calculated from triplicate cultures stimulated with each antigen or peptide pool, as well as from triplicate wells of negative control cultures lacking antigen. The cell proliferation results were presented as stimulation index (SI), where SI is the c.p.m. in antigen- or peptide-stimulated Thalidomide cultures per c.p.m. in cultures lacking antigen or peptide. A patient was considered to be a responder to a given antigen if the PBMC yielded SI≥3 (Al-Attiyah et al., 2003). Positive responses ≥60% were considered strong, 40% to <60% moderate, and

<40% weak (Mustafa, 2009a, b). The supernatants, collected from the cultures of PBMC of TB patients (n=20) and healthy subjects (n=12) before 3H-thymidine pulse, were randomly selected for assays to determine concentrations of secreted IFN-γ and IL-10 using FlowCytomix kits (Bender Medsystems GmbH, Vienna, Austria), according to the manufacturer’s instructions (Al-Attiyah & Mustafa, 2008, 2009). These kits allow simultaneous quantification of cytokines including IFN-γ and IL-10. In brief, FlowCytomix technology is based on spectrally discrete microspheres that are used as solid phase in an immunoassay. The beads are internally dyed with Starfire Red, a far red (685–690 nm) emitting fluorochrome, which is excited by UV, argon or HeNe lasers. The test samples were analyzed by flow cytometry using Coulter EPICS FC500 (Beckman Coulter Inc., USA). For each analysis, up to 10 000 events were acquired. The mean concentration of each cytokine was expressed as pg mL−1.

The success of the procedure is related to decompression of the femoral head, excision of the necrotic bone, and addition of cancellous bone graft with osteoinductive and osteoconductive properties, which augments revascularization and neoosteogenesis of the femoral head. Free vascularized fibula graft, especially in younger

patients, is a salvaging procedure of the necrotic femoral head in early precollapse stages. In postcollapse osteonecrosis, the procedure appears to delay the need for total hip arthroplasty in the majority of patients. The purpose of this review article is to update knowledge about treatment strategies in femoral head Ponatinib ic50 osteonecrosis and to compare free vascularized fibula grafting to traditional and new treatment modalities. © 2010 Wiley-Liss, Inc. Microsurgery, 2011. “
“Some sensation to the breast returns after breast reconstruction, but recovery is variable and unpredictable. We primarily sought to assess the impact of different types of breast reconstruction selleckchem [deep inferior epigastric artery perforator (DIEP) flaps versus implants] and radiation therapy on the return of sensation. Thirty-seven patients who had unilateral or bilateral breast reconstruction via a DIEP flap or implant-based reconstruction, with or without radiation therapy

(minimum follow-up, 18 months; range, 18–61 months) were studied. Of the 74 breasts, 27 had DIEP flaps, 29 had implants, and 18 were nonreconstructed. Eleven breasts with implants and 10 with DIEP flaps had had prereconstruction radiation therapy. The primary outcome was mean patient-perceived static

and moving cutaneous pressure threshold in nine areas. We used univariate and multivariate analyses to assess what independent factors affected the return of sensation (significance, P < 0.05). Implants provided better static (P = 0.071) and moving sensation (P = 0.041) than did DIEP flaps. However, among irradiated breasts, skin over DIEP flaps had significantly better sensation than did that over implants (static, P = 0.019; moving, P = 0.028). Implant reconstructions with irradiated skin had significantly worse static (P = 0.002) and moving sensation (P = 0.014) than did nonirradiated implant reconstructions. Without irradiation, skin overlying implants is PIK3C2G associated with better sensation recovery than DIEP flap skin. However, with irradiation, DIEP flap skin had better sensation recovery than did skin over implants. Neurotization trended toward improvement in sensation in DIEP flaps. © 2013 Wiley Periodicals, Inc. Microsurgery 33:421–431, 2013. “
“We report a case of Fournier’s gangrene, where we used the greater omentum as a free flap for scrotal reconstruction and outline the advantages over previously described methods. The greater omentum was harvested using a standard open technique. The deep inferior epigastric vessels were passed through the inguinal canal into the scrotal area as recipient vessels.

Moreover, reticulocytes infected with https://www.selleckchem.com/products/bay80-6946.html Plasmodium yoelii released exosomes capable of activating a protective anti-malaria immune response in naïve mice in an adjuvant-independent

manner [39]. Our present data, demonstrating the protective efficacy of exosomes in controlling an M. tuberculosis infection, supports the potential application for this type of cell-free vaccine. Unexpectedly, we did not see much protection with the BCG 9 months after vaccination. Examination of the data suggests that the BCG-vaccinated mice showed only a slightly lower CFU compared to unvaccinated mice (i.e. PBS control versus BCG, or BCG plus exosomes from untreated macrophages). However, the 0.3 log drop in spleen CFU between BCG-vaccinated and nonvaccinated mice was statistically significant. In a number of published studies, there was

protection by the initial BCG vaccination even in the absences of a booster vaccine. In most of these studies, a shorter window between BCG vaccination and boosting was used [40, 41]. Nevertheless, in some studies where protection with the primary BCG vaccination was observed, the intervals between BCG vaccination and M. tuberculosis infection were on the same learn more timeframe as in our study [42]. Interestingly, in the study by Dietrich et al. a similar ∼0.3 log drop in spleen CFU was observed when comparing unvaccinated mice to those vaccinated with BCG 8 months prior to M. tuberculosis infection [42]. These results suggest that in some cases, the protection may be minimal Carnitine palmitoyltransferase II after a long interval between vaccination and infection. The incomplete protection we observed is likely due to limited antigen-specific memory T cells available for reactivation 9 months after the initial BCG vaccination (see Fig. 7). It is unclear

why we see this limited immune/protective response but one hypothesis is that our BCG strain failed to survive in vivo for the time necessary to induce a potent long-term memory response. Previous studies of BCG-vaccinated mice treated with antibiotics suggest that viable BCG is required for vaccine efficacy [43]. For most individuals, M. tuberculosis infection induces a protective TH1-mediated immune response characterized by the development of antigen-specific CD4+ and CD8+ lymphocytes producing IFN-γ and other TH1-type cytokines [28]. During the subunit vaccine studies, it was evident that the control of an M. tuberculosis infection required an adjuvant that induces a robust TH1 but limited TH2 immune response [44, 45]. It has been demonstrated that exosomes carrying parasitic or tumor antigens could generate a strong antigen-specific TH1 immune responses resulting in control of the parasitic infection or in limiting tumor progression [29-31]. Our previous studies indicated that exosomes released from M.

Few reports controversially attribute it to heparin locks and absence of exit-site purse-string suturing. It is also unclear whether CB is a risk factor for catheter related infection (CRI) and performance. We therefore studied factors associated with CB in a multi-ethnic Asian cohort and its association with these complications. Methods: This was a retrospective

analysis of 239 consecutive primary internal jugular TDC inserted in 212 patients by nephrologists at a single center over 3 years. All TDC NVP-AUY922 research buy were inserted under sonographic and fluoroscopic guidance. Guide-wire exchanges were excluded. Demographic, co-morbid, laboratory parameters, haemodialysis and TDC data were obtained from a prospectively collected database. Bleeding was defined as per American Society of Diagnostic Interventional Nephrology guidelines. Cases were classified into 2 groups: A (CB within 48 hours after insertion) versus B (no bleeding). Categorical and continuous selleck chemicals llc data were evaluated by Chi-square test and t-test and presented as frequency/percentage and mean ± standard deviation respectively.

Results: Demographic, co-morbid, laboratory parameters, antiplatelet, purse string utilization, heparin lock dose, haemodialysis and TDC characteristics in groups A and B are outlined in table 1. CRI and catheter patency rate at 48 hours and 30 days were comparable (table 2). 2 patients had a left brachiocephalic vein

rupture with 1 requiring stenting. Only avoidance of antiplatelet was almost significantly associated with no CB (OR 0.53, CI 0.27–1.05). Conclusion: This study refutes previous established associations of CB with high heparin concentrations Fossariinae and purse-string suturing. There may be an association of CB with antiplatelet use. CB does not predispose to early CRI and catheter dysfunction. However larger controlled studies are required to further allay these controversies. ARORA PUNEET1, SINGLA MANIKANT2, SANDHU JASVINDER SINGH3 1Assistant Professor-Nephrology, Dayanand Medical College, Ludhiana; 2Assistant Professor-Endocrinology, Dayanand Medical College, Ludhiana; 3Professor-Nephrology, Dayanand Medical College, Ludhiana Introduction: Sexual dysfunction (SD) is related to physical and psychosocial health with significant impact on quality of life (QOL). Studies addressing this issue in Indian patients with advanced kidney diseases are scarce. We sought to assess the prevalence of SD in patients on chronic dialysis and determine whether patients discuss this problem with their care providers. Methods: 100 male and 100 female end stage renal disease (ESRD) patients on maintenance haemodialysis, at least twice per week, for more than 3 months were enrolled. Unmarried, widowed and divorcee subjects were excluded. In addition, an age matched married control group of 30 subjects of each sex were also enrolled.

The volume of CSF sample is very important to achieve good PCR results, and the difficulty in collecting an adequate volume of CSF sample makes diagnosis of TB meningitis a daunting challenge in the paediatric

subjects (Kulkarni et al., 2005; Galimi, 2011). Kulkarni et al. (2005) selleck screening library documented a sensitive PCR test targeting 38 kDa protein gene using small volume of whole CSF for the diagnosis of TB meningitis in children. Their test could detect 10 femtogram (fg) of DNA and that is equivalent to 2–3 tubercle bacilli. Rafi et al. (2007) used ‘whole’ CSF instead of using the ‘sediment’ for their PCR assay, thus proving that the M. tuberculosis DNA could be present as free DNA molecules in CSF samples. The utility of CSF ‘filtrate’ for detecting M. tuberculosis

DNA by conventional PCR targeting IS6110 and devR genes as well as by real-time PCR targeting devR has been demonstrated by Haldar et al. (2009). Interestingly, it was found that CSF ‘filtrate’ exhibited better sensitivity and specificity than the ‘sediment’ by both assays. Takahashi & Nakayama (2006) designed a quantitative nested real-time PCR (QNRT-PCR) assay targeting MPB-64 protein gene to detect M. tuberculosis DNA in CSF samples, and their method was extremely useful for assessing the clinical course of patients with TB meningitis on ATT (Takahashi et al., 2008). To detect M. tuberculosis DNA in CSF samples with a wide detection range (1–105 find more copy

numbers) during the clinical course of disease, a novel wide-range quantitative nested real-time PCR (WR-QNRT-PCR) assay targeting MPB-64 protein gene has been meticulously developed (Takahashi et al., 2008). Osteoarticular TB accounts for about 1–3% of all TB cases and is the major cause of osteomyelitis (Yun et al., 2005; Sun et al., 2011). Any bone, joint or bursa can be infected but the spine, hip and knee are the preferred sites of infection, representing 70–80% of the infections (Pandey et al., 2009). TB of the spine which if not diagnosed properly and treated adequately may develop kyphosis and/or neurological complication (paraplegia; Jain et al., 2008). The accurate diagnosis of osteoarticular Acyl CoA dehydrogenase TB poses difficulty owing to deep inaccessible lesions and initiation of empirical ATT in majority of the cases (Vardhan & Yanamandra, 2011). Mostly, the diagnosis of osteoarticular TB is based on clinical suspicion and imaging findings, particularly in the endemic regions (Agashe et al., 2009; Sun et al., 2011). PCR tests based on IS6110, 16S rRNA gene and 65 kDa protein gene targets have been widely employed to confirm osteoarticular TB with varying sensitivities (Verettas et al., 2003; Negi et al., 2005b; Jain et al., 2008; Agashe et al., 2009; Sun et al., 2011; Table 1).

© 2012 Wiley Periodicals, Inc. Microsurgery, 2012. “
“Reconstruction of the radial head can be complicated in cases of wide resection, particularly in those cases including the proximal radial shaft. In such cases, radial head replacement may not be possible because of lack of adequate bone stock. Here, we report the use of a radial head prosthesis incorporated with a vascularized fibula for immediate anatomic restoration of the forearm and elbow. We present a case of a pathologic fracture

non-union in the proximal radius in a 57-year-old female with a history of multiple myeloma. Non-operative management of the fracture was unsuccessful after chemotherapy and radiation. The proximal radius and radial head were resected

and reconstructed with vascularized fibula graft in conjunction with immediate radial head prosthesis. The osteotomy site healed at 6-weeks and follow-up at 1 year showed good functional outcome. We check details feel that the use of this GSK-3 signaling pathway construct has definite promise and may be considered for reconstruction following resection of the proximal radius. © 2014 Wiley Periodicals, Inc. Microsurgery 34:475–480, 2014. “
“The distally based sural flap has become popular for reconstruction of the foot and leg. However, this flap often fails due to venous congestion. In this report, we developed a new modification of the distally based sural flap. The procedure comprised three stages. In the first stage, the flap was raised cephalad to the midpoint of the posterior aspect of the leg, involving

reanastomosis of the short saphenous vein (SSV) at the proximal end of the flap. In the second stage, ligature of the SSV was performed. In the third stage, the entire flap was raised. We treated eight patients with the flap. All flaps survived completely. Duplex scanning indicated that venous drainage of the flap was provided by the tenuous venae comitantes (VCs) surrounding the SSV. Reanastomosis of the SSV may prevent rapid venous overloading of the VCs. Our new modification may be useful to avoid venous congestion. GNAT2 © 2013 Wiley Periodicals, Inc. Microsurgery 33:534–538, 2013. “
“Background: Acute postoperative pain following craniofacial or esthetic surgery, or trauma is readily treated with medicinal regimens. Facial pain persisting for more than six months is defined as chronic and must be distinguished from nontraumatic atypical facial pain or “tic-douloureaux.” Our surgical experience managing chronic facial (trigeminal) pain is reviewed to provide insight into the success of our current algorithm for managing patients with chronic facial pain. Methods: We performed a retrospective review of nine consecutive patients operated for post-traumatic chronic trigeminal nerve pain. Most patients were women (mean age 41 years). Data evaluated included mechanism of nerve injury, physical exam, CT scans, computer-aided neurosensory testing, and diagnostic nerve blocks.

The standard for PD is essentially similar to that for HD, except that it is recommended that preparation for PD is commenced a little earlier. There are find more other guidelines relevant to commencement of dialysis, specifically concerning the mode of dialysis at initiation and pre-dialysis education. CARI5 suggests that the main determinants of dialysis modality choice are preference of a fully informed patient, absence of medical

and surgical contraindications and resource availability. In the absence of these imperatives, it is suggested that CAPD (but not automated PD) be considered in preference to haemodialysis. The main reasons for preferring PD are the greater ease to commence with incremental dialysis and the better preservation of residual renal function. In addition, there may be an advantage in delaying vascular access, less post-transplant delayed graft function and possibly improved early survival. Within Asia, the approach

to dialysis initiation varies greatly from country to country. For example, Hong Kong has adopted a ‘peritoneal dialysis first’ (PD-first) policy which is regarded as an important contributor to the success of its dialysis program. The relative costs of dialysis DZNeP price vary greatly among countries; in Hong Kong the substantially lower annual cost of PD than chronic HD is thought

to be a major reason for the success of their PD-first policy. In the early 1980s, two charity organizations (The Hong Kong Kidney Foundation and the Hong Kong Kidney Patients Trust Fund (HKKPTF)) were established Galeterone to subsidize the costs of CAPD and in selected patients automated PD (APD). In addition, HKKPTF subsidizes the purchase of ultraviolet disinfection devices. This provision of APD and ultraviolet disinfection are seen as important reasons for dramatic decreases in the rate of PD peritonitis in Hong Kong. There are also recommendations about pre-dialysis education. These stress the importance of informed decision making by patients and their families and carers, the value of multidisciplinary clinics with input from medical, nursing and allied health personnel using standardized protocols, and the value of pre-dialysis education. Many renal units in Asia and worldwide have adopted a structured approach to pre-dialysis care. For example, at Westmead Hospital (Sydney), patients with stage 3b disease (GFR 30–45 mL/min per 1.73 m2) are managed in a ‘healthy kidney’ clinic where the accent is on mitigation of cardiovascular risk and prevention of CKD progression. During this time, patients are given written information about care during the pre-dialysis period, as well as dialysis and transplantation.

There was a suggestion that women responded better than men to vaccination. The second-generation or yeast-derived vaccine (YDV) was found to have similar efficacy in healthy recipients to the earlier LDK378 PDV. An early investigation found 97% seroconversion in 32

HD patients with the YDV.56 Bruguera et al. examined the YDV in over 270 HD patients.57 Using a four-dose schedule and dosing at 0, 1, 2 and 6 months with 40 µg vaccine, 69% of patients achieved an anti-HBs titre of ≥10 IU/L (considered protective). If the fourth dose was given at 12 months, the seroprotection rate reached 76%. When the vaccine is used in immunocompetent individuals using a three-dose schedule, a 90–95% seroprotection rate is expected. Clearly, in vaccine recipients with renal failure, the rates are substantially lower. In an attempt to improve seroconversion rates, current buy GW-572016 recommendations state that dialysis patients should receive higher vaccine doses than individuals with normal renal function. As such,

40 µg of Recombivax HB at 0, 1 and 6 months, or 40 µg of Engerix B at 0, 1, 2 and 6 months should be administered. The best reported response rates to these schedules are <85% achieving seroprotection.58,59 Not only is the response to the vaccine blunted, but anti-HBs levels decline more rapidly after immunization in HD patients compared with healthy individuals, such that in 41% of responsive patients the levels are undetectable at three years.60 Other reports suggest that in up to 42% there are no detectable anti-HBs levels one year after vaccination.26 The likelihood of a seroconversion response to hepatitis B vaccine decreases as renal failure progresses. As mentioned above, Köhler et al. found a far superior response to the PDV in their small group of pre-dialysis patients.53 This has been borne out by other studies more recently using YDV.61,62 As a result, guidelines also recommended that patients with CKD be vaccinated as early as possible in the course of their renal disease. Although vaccinating patients before dialysis makes immunological sense, there are substantial cost implications

in vaccinating Alanine-glyoxylate transaminase much larger numbers of patients: Many pre-dialysis patients will never progress to renal replacement therapy, succumbing instead to their comorbidities. Vaccine adjuvants have been studied in HD patients. The addition of granulocyte-macrophage colony-stimulating factor and interleukin-2 has not been consistently successful in improving response rates.63,64 Likewise, studies have failed to show a significant, durable benefit of interferons or thymopentin.65–67 Alternatively, a more recent vaccine formulation (HBV-AS04) consisting of standard Engerix B YDV with adjuvant 3-O-desacyl-40-monophosphoryl lipid A, has shown the ability to provide earlier and greater anti-HBs responses than the standard vaccine.