human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To compare intradermal ( ID ) and intramuscular ( IM ) booster doses , which have been used in healthy and high risk subjects , such as healthcare workers , haemodialysis patients , human immunodeficiency virus patients , and renal transplant recipients unresponsive to initial hepatitis B vaccination , in celiac individuals . METHODS We conducted our study on 58 celiac patients , vaccinated in the first year of life , whose blood analysis had showed the absence of protective hepatitis B virus ( HBV ) antibodies . All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year . In all patients we r and omly performed an HBV vaccine booster dose by ID or IM route . Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine ( Engerix B ) 2 μg by the ID route , while 28 celiac patients  were revaccinated with Engerix B 10 μg by the IM route . Four weeks after every booster dose , the anti-hepatitis B surface ( HBs ) antibody titer was measured by an enzyme-linked immune-adsorbent assay . We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose . The cut off value for a negative anti-HBs antibody titer was 10 IU/L. Patients with values between 10 and 100 IU/L were considered " low responders " while patients with an antibody titer higher than 1000 IU/L were considered " high responders " . RESULTS No significant difference in age , gender , duration of illness , and years of gluten intake was found between the two groups . We found a high percentage of " responders " after the first booster dose ( ID = 76.7 % , IM = 78.6 % ) and a greater increase after the third dose ( ID = 90 % , IM = 96.4 % ) of vaccine in both groups . Moreover we found a significantly higher number of high responders ( with an anti-HBs antibody titer > 1000 IU/L ) in the ID ( 40 % ) than in the IM ( 7.1 % ) group , and this difference was evident after the first booster dose of vaccination ( P < 0.01 ) . No side effects were recorded in performing delivery of the vaccine by either the ID or IM route . CONCLUSION Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients . However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio Are meta-analyses the brave new world , or are the critics of such combined analyses right to say that the biases inherent in clinical trials make them uncombinable ? Negative trials are often unreported , and hence can be missed by meta-analysts . And how much heterogeneity between trials is acceptable ? A recent major criticism is that large r and omised trials do not always agree with a prior meta- analysis . Neither individual trials nor meta-analyses , reporting as they do on population effects , tell how to treat the individual patient . Here we take a more rounded approach to meta-analyses , arguing that their strengths outweigh their weaknesses , although the latter must not be brushed aside A defective production of protective levels of antibodies to Hepatitis B ( HB ) vaccine is reported to occur in 4–10 % of healthy subjects and a correlation with the presence of specific human leukocyte antigen ( HLA ) molecules , including DQ2 , which also confers genetic predisposition to celiac disease ( CD ) and type I diabetes mellitus ( T1DM ) , has been suggested . The aim of this study was to analyze the serological response to HB vaccine and measles-containing vaccines in 69 diabetic patients ( T1DM ) , 42 patients with celiac disease ( CD ) and 79 healthy control subjects ( CT ) . The median interval between the third dose of HB vaccine and serum collection was 6.8 , 3.5 , and 4.7 years for T1DM , CD and CT groups , respectively . 50/69 ( 72 % ) T1DM patients , 32/42 ( 76 % ) CD patients and 61/79 ( 77 % ) CT subjects showed protective anti-HBs antibodies after vaccination , with no statistically significant difference . On the contrary , a lower statistically significant difference was found in the mean HBsAb level of T1DM subjects when compared with the other two groups . No correlation between HLA DQ2 expression in T1DM and vaccine response was detected . The comparison of serological response to measles after vaccination also showed no statistically significant differences in the three groups . Contrasting results between these data and those reported in the literature might be due to differences in the time intervals between vaccination and testing . Prospect i ve studies in pathological and healthy groups with the same age at HBV vaccination and with the same time interval for blood sample collection to determine antibody titers are necessary in order to provide more conclusive data Abnormal immune response to gliadin , genetic , and environmental factors play a role in the pathogenesis of celiac disease ( CD ) . Non-responsiveness to hepatitis B virus ( HBV ) vaccination  is related to genetic features . Certain human leukocyte antigen ( HLA ) genotypes are more prevalent among non-responders to HBV vaccination . There is also a strong relationship between CD and these HLA genotypes . This study investigates the relationship between CD and non-responsiveness to  HBV vaccination  , with an emphasis on genotypic co-incidence . No statistically significant difference was noted between the ages and gender of CD patients and control subjects .  Baseline serum IgA , IgM , and IgG levels of all CD patients were normal . Responsiveness to HBV vaccination  was observed in 17 ( 68 % ) CD patients and all ( 100 % ) control subjects ( P = 0.006 ) . In conclusion , CD should also be sought in unresponders to HBV vaccine who are not immunosuppressed OBJECTIVE . Patients with celiac disease , who often carry human leukocyte antigen-DR3;DQ2 , are prone to inadequate response to hepatitis B immunization . We evaluated vaccine response in relation to disease activity and whether previous treatment with a gluten-free diet influences the achievement of protective antibody titers . PATIENTS AND METHODS . We studied 128 children and adolescents with celiac disease and 113 age-matched control subjects . Twenty-two patients with celiac disease were prospect ively immunized after diagnosis during dietary treatment ( group 1 ) . A total of 106 ( group 2 ) and the  control subjects received vaccination by mass immunization in schools at 14 years of age regardless of diet status and when celiac disease was still undiagnosed in 27 of these children . Diet compliance and celiac disease activity were monitored by measurement of antibodies against transglutaminase and endomysium . Vaccine response was determined by measuring antihepatitis B antibodies from serum . RESULTS . The seroconversion after hepatitis B vaccination was 95.5 % in group 1 . All of these patients carried human leukocyte antigen DQ2 . The response rate in group 2 was 50.9 % and correlated with gluten intake ( untreated patients : 25.9 % , non-strict diet : 44.4 % , strict diet : 61.4 % ) . Treated and compliant patients did not significantly differ from control subjects ( 75.2 % ) . Thirty-seven antihepatitis B – negative patients with celiac disease received a booster during a controlled gluten-free diet , and 36 ( 97.3 % ) seroconverted , irrespective of the presence of human leukocyte antigen DQ2 . CONCLUSIONS . Nonresponse to recombinant hepatitis B surface antigen may be a sign of undiagnosed celiac disease . However , there is a good vaccine response in adequately treated patients . Human leukocyte antigen DQ alleles do not seem to have a primary role . Revaccination is recommended during a controlled gluten-free diet BACKGROUND / AIMS We aim ed to compare the response rates to hepatitis B virus vaccination in the first year of life , using two different immunization protocol s , in children with celiac disease . METHODS Study Group 1 included patients with celiac disease who received 10 μg of hepatitis B vaccine intramuscularly at birth ( 0 ) , 2 and 9 - 12 months of life . Group 2 included those who received hepatitis B vaccine at 0 , 1 and 6 months of life . Healthy children were divided into two control groups according to the above schedules . RESULTS The total study group included 64 patients and 49 healthy controls . Celiac patients were found to have lower response rates with respect to controls ( 78.1 % vs. 95.9 % , respectively ) . The difference in response rates in the two patient groups was not statistically significant . CONCLUSIONS The response rates of celiac patients to the two different hepatitis B vaccination schedules showed no statistically significant difference Objectives : To determine whether children with celiac disease ( CD ) fail to show a response to  hepatitis B virus ( HBV ) vaccine  more frequently than children without CD . Patients and Methods : This was a prospect i ve study that compared the response to HBV , tetanus , rubella , and Haemophilus influenzae type b ( Hib ) vaccines between children with CD and age- and sex-matched control subjects . Results : The study population included 26 patients with CD and 18 age- and sex-matched controls . All had received the full complement of childhood vaccinations .  A significantly higher proportion of subjects in the CD group ( 14 of 26 ) failed to respond to HBV vaccine  compared with controls ( 2 of 18 ; 53.9 % vs 11.1 % ; P < 0.05 ) . Patients with CD were 8.33 times more likely to test negative for hepatitis B surface antigen than control subjects ( 95 % CI , 1.5–46.5 ) . By contrast , all of the subjects in both groups tested positive for rubella antibodies ; only 1 subject in the CD group tested negative for tetanus antibody versus none in the control group ( 3.9 % vs 0 % ; P = 1.0 ) . The percentage of subjects who tested negative for Hib antibodies was similar in the 2 groups ( CD , 33.3 % ; control , 44.4 % ; P = 0.53 ) . Conclusions : More than 50 % of children with CD do not show a response to st and ard vaccination regimens for HBV . Given the large number of children with CD throughout the world , this observation suggests that there is a large HBV-susceptible population despite widespread vaccination . Current immunization strategies may need to be reassessed to protect this population and achieve the goal of universal protection Objectives There is a relationship between nonresponsiveness to hepatitis B virus ( HBV ) vaccine  and certain human leukocyte antigen ( HLA ) genotypes . In healthy population , 4–10 % vaccine recipients fail to produce protective levels of antibodies to the HBV vaccine  after st and ard immunization depending upon age and the presence of various underlying diseases . Celiac disease ( CD ) is an HLA-associated immunological disease . It has been suggested that certain HLA haplotypes which are linked to CD are associated with nonresponse to HBV  vaccine as well . The aim of this study is to assess the response to HBV vaccine  prospect ively in a group of CD and to explore the potential link between CD and HBV vaccine nonresponse by study ing shared HLA haplotypes . Patients and methods Sixty-three previously diagnosed celiac patients who were on a strict gluten-free diet ( GFD ) and 54 healthy children were evaluated serologically for anti-HBs status . Celiac children who were anti-HBs negative at baseline were fully vaccinated prospect ively , and reevaluated for the response to HBV vaccine . To estimate the role of HLA type in HBV vaccine response in celiac patients , a subgroup of both patients and control participants had HLA genotypes performed . Results At enrollment , 27 ( 67.5 % ) children with CD and 48 ( 85.2 % ) healthy children were anti-HBs positive  , and the difference between patients and controls was statistically significant ( P<0.05 ) . However , failure to respond to HBV vaccine was only 3.6 % ( response rate 96.4 % ) in prospect ively vaccinated celiac patients . There was no relationship between HLA type and vaccine nonresponse in our study group . Conclusion The response to HBV vaccine in celiac children who were compliant to GFD is not different from a healthy population . CD may be one of the immune diseases associated with a high rate of HBV vaccine nonresponse but it might not be permanent and treatment with GFD and compliance to the treatment may ameliorate the immune response to HBV vaccine in celiac children 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: AIM To compare intradermal ( ID ) and intramuscular ( IM ) booster doses , which have been used in healthy and high risk subjects , such as healthcare workers , haemodialysis patients , human immunodeficiency virus patients , and renal transplant recipients unresponsive to initial hepatitis B vaccination , in celiac individuals . METHODS We conducted our study on 58 celiac patients , vaccinated in the first year of life , whose blood analysis had showed the absence of protective hepatitis B virus ( HBV ) antibodies . All patients had received the last vaccine injection at least one year before study enrolment and they had been on a gluten free diet for at least 1 year . In all patients we r and omly performed an HBV vaccine booster dose by ID or IM route . Thirty celiac patients were revaccinated with recombinant hepatitis B vaccine ( Engerix B ) 2 μg by the ID route , while 28 celiac patients  were revaccinated with Engerix B 10 μg by the IM route . Four weeks after every booster dose , the anti-hepatitis B surface ( HBs ) antibody titer was measured by an enzyme-linked immune-adsorbent assay . We performed a maximum of three booster doses in patients with no anti-HBs antibodies after the first or the second vaccine dose . The cut off value for a negative anti-HBs antibody titer was 10 IU/L. Patients with values between 10 and 100 IU/L were considered " low responders " while patients with an antibody titer higher than 1000 IU/L were considered " high responders " . RESULTS No significant difference in age , gender , duration of illness , and years of gluten intake was found between the two groups . We found a high percentage of " responders " after the first booster dose ( ID = 76.7 % , IM = 78.6 % ) and a greater increase after the third dose ( ID = 90 % , IM = 96.4 % ) of vaccine in both groups . Moreover we found a significantly higher number of high responders ( with an anti-HBs antibody titer > 1000 IU/L ) in the ID ( 40 % ) than in the IM ( 7.1 % ) group , and this difference was evident after the first booster dose of vaccination ( P < 0.01 ) . No side effects were recorded in performing delivery of the vaccine by either the ID or IM route . CONCLUSION Our study suggests that both ID and IM routes are effective and safe options to administer a booster dose of HBV vaccine in celiac patients . However the ID route seems to achieve a greater number of high responders and to have a better cost/benefit ratio Are meta-analyses the brave new world , or are the critics of such combined analyses right to say that the biases inherent in clinical trials make them uncombinable ? Negative trials are often unreported , and hence can be missed by meta-analysts . And how much heterogeneity between trials is acceptable ? A recent major criticism is that large r and omised trials do not always agree with a prior meta- analysis . Neither individual trials nor meta-analyses , reporting as they do on population effects , tell how to treat the individual patient . Here we take a more rounded approach to meta-analyses , arguing that their strengths outweigh their weaknesses , although the latter must not be brushed aside A defective production of protective levels of antibodies to Hepatitis B ( HB ) vaccine is reported to occur in 4–10 % of healthy subjects and a correlation with the presence of specific human leukocyte antigen ( HLA ) molecules , including DQ2 , which also confers genetic predisposition to celiac disease ( CD ) and type I diabetes mellitus ( T1DM ) , has been suggested . The aim of this study was to analyze the serological response to HB vaccine and measles-containing vaccines in 69 diabetic patients ( T1DM ) , 42 patients with celiac disease ( CD ) and 79 healthy control subjects ( CT ) . The median interval between the third dose of HB vaccine and serum collection was 6.8 , 3.5 , and 4.7 years for T1DM , CD and CT groups , respectively . 50/69 ( 72 % ) T1DM patients , 32/42 ( 76 % ) CD patients and 61/79 ( 77 % ) CT subjects showed protective anti-HBs antibodies after vaccination , with no statistically significant difference . On the contrary , a lower statistically significant difference was found in the mean HBsAb level of T1DM subjects when compared with the other two groups . No correlation between HLA DQ2 expression in T1DM and vaccine response was detected . The comparison of serological response to measles after vaccination also showed no statistically significant differences in the three groups . Contrasting results between these data and those reported in the literature might be due to differences in the time intervals between vaccination and testing . Prospect i ve studies in pathological and healthy groups with the same age at HBV vaccination and with the same time interval for blood sample collection to determine antibody titers are necessary in order to provide more conclusive data Abnormal immune response to gliadin , genetic , and environmental factors play a role in the pathogenesis of celiac disease ( CD ) . Non-responsiveness to hepatitis B virus ( HBV ) vaccination  is related to genetic features . Certain human leukocyte antigen ( HLA ) genotypes are more prevalent among non-responders to HBV vaccination . There is also a strong relationship between CD and these HLA genotypes . This study investigates the relationship between CD and non-responsiveness to  HBV vaccination  , with an emphasis on genotypic co-incidence . No statistically significant difference was noted between the ages and gender of CD patients and control subjects .  Baseline serum IgA , IgM , and IgG levels of all CD patients were normal . Responsiveness to HBV vaccination  was observed in 17 ( 68 % ) CD patients and all ( 100 % ) control subjects ( P = 0.006 ) . In conclusion , CD should also be sought in unresponders to HBV vaccine who are not immunosuppressed OBJECTIVE . Patients with celiac disease , who often carry human leukocyte antigen-DR3;DQ2 , are prone to inadequate response to hepatitis B immunization . We evaluated vaccine response in relation to disease activity and whether previous treatment with a gluten-free diet influences the achievement of protective antibody titers . PATIENTS AND METHODS . We studied 128 children and adolescents with celiac disease and 113 age-matched control subjects . Twenty-two patients with celiac disease were prospect ively immunized after diagnosis during dietary treatment ( group 1 ) . A total of 106 ( group 2 ) and the  control subjects received vaccination by mass immunization in schools at 14 years of age regardless of diet status and when celiac disease was still undiagnosed in 27 of these children . Diet compliance and celiac disease activity were monitored by measurement of antibodies against transglutaminase and endomysium . Vaccine response was determined by measuring antihepatitis B antibodies from serum . RESULTS . The seroconversion after hepatitis B vaccination was 95.5 % in group 1 . All of these patients carried human leukocyte antigen DQ2 . The response rate in group 2 was 50.9 % and correlated with gluten intake ( untreated patients : 25.9 % , non-strict diet : 44.4 % , strict diet : 61.4 % ) . Treated and compliant patients did not significantly differ from control subjects ( 75.2 % ) . Thirty-seven antihepatitis B – negative patients with celiac disease received a booster during a controlled gluten-free diet , and 36 ( 97.3 % ) seroconverted , irrespective of the presence of human leukocyte antigen DQ2 . CONCLUSIONS . Nonresponse to recombinant hepatitis B surface antigen may be a sign of undiagnosed celiac disease . However , there is a good vaccine response in adequately treated patients . Human leukocyte antigen DQ alleles do not seem to have a primary role . Revaccination is recommended during a controlled gluten-free diet BACKGROUND / AIMS We aim ed to compare the response rates to hepatitis B virus vaccination in the first year of life , using two different immunization protocol s , in children with celiac disease . METHODS Study Group 1 included patients with celiac disease who received 10 μg of hepatitis B vaccine intramuscularly at birth ( 0 ) , 2 and 9 - 12 months of life . Group 2 included those who received hepatitis B vaccine at 0 , 1 and 6 months of life . Healthy children were divided into two control groups according to the above schedules . RESULTS The total study group included 64 patients and 49 healthy controls . Celiac patients were found to have lower response rates with respect to controls ( 78.1 % vs. 95.9 % , respectively ) . The difference in response rates in the two patient groups was not statistically significant . CONCLUSIONS The response rates of celiac patients to the two different hepatitis B vaccination schedules showed no statistically significant difference Objectives : To determine whether children with celiac disease ( CD ) fail to show a response to  hepatitis B virus ( HBV ) vaccine  more frequently than children without CD . Patients and Methods : This was a prospect i ve study that compared the response to HBV , tetanus , rubella , and Haemophilus influenzae type b ( Hib ) vaccines between children with CD and age- and sex-matched control subjects . Results : The study population included 26 patients with CD and 18 age- and sex-matched controls . All had received the full complement of childhood vaccinations .  A significantly higher proportion of subjects in the CD group ( 14 of 26 ) failed to respond to HBV vaccine  compared with controls ( 2 of 18 ; 53.9 % vs 11.1 % ; P < 0.05 ) . Patients with CD were 8.33 times more likely to test negative for hepatitis B surface antigen than control subjects ( 95 % CI , 1.5–46.5 ) . By contrast , all of the subjects in both groups tested positive for rubella antibodies ; only 1 subject in the CD group tested negative for tetanus antibody versus none in the control group ( 3.9 % vs 0 % ; P = 1.0 ) . The percentage of subjects who tested negative for Hib antibodies was similar in the 2 groups ( CD , 33.3 % ; control , 44.4 % ; P = 0.53 ) . Conclusions : More than 50 % of children with CD do not show a response to st and ard vaccination regimens for HBV . Given the large number of children with CD throughout the world , this observation suggests that there is a large HBV-susceptible population despite widespread vaccination . Current immunization strategies may need to be reassessed to protect this population and achieve the goal of universal protection Objectives There is a relationship between nonresponsiveness to hepatitis B virus ( HBV ) vaccine  and certain human leukocyte antigen ( HLA ) genotypes . In healthy population , 4–10 % vaccine recipients fail to produce protective levels of antibodies to the HBV vaccine  after st and ard immunization depending upon age and the presence of various underlying diseases . Celiac disease ( CD ) is an HLA-associated immunological disease . It has been suggested that certain HLA haplotypes which are linked to CD are associated with nonresponse to HBV  vaccine as well . The aim of this study is to assess the response to HBV vaccine  prospect ively in a group of CD and to explore the potential link between CD and HBV vaccine nonresponse by study ing shared HLA haplotypes . Patients and methods Sixty-three previously diagnosed celiac patients who were on a strict gluten-free diet ( GFD ) and 54 healthy children were evaluated serologically for anti-HBs status . Celiac children who were anti-HBs negative at baseline were fully vaccinated prospect ively , and reevaluated for the response to HBV vaccine . To estimate the role of HLA type in HBV vaccine response in celiac patients , a subgroup of both patients and control participants had HLA genotypes performed . Results At enrollment , 27 ( 67.5 % ) children with CD and 48 ( 85.2 % ) healthy children were anti-HBs positive  , and the difference between patients and controls was statistically significant ( P<0.05 ) . However , failure to respond to HBV vaccine was only 3.6 % ( response rate 96.4 % ) in prospect ively vaccinated celiac patients . There was no relationship between HLA type and vaccine nonresponse in our study group . Conclusion The response to HBV vaccine in celiac children who were compliant to GFD is not different from a healthy population . CD may be one of the immune diseases associated with a high rate of HBV vaccine nonresponse but it might not be permanent and treatment with GFD and compliance to the treatment may ameliorate the immune response to HBV vaccine in celiac children 
    Output:
    