Probiotics in infancy induce protective immune profiles that are characteristic for chronic low-grade inflammation

Background Probiotics are widely studied both in the treatment and prevention of allergic diseases, but their mode of action is poorly known. Objective Our aim was to examine the effect of probiotic bacteria on in vivo cytokine, antibody, and inflammatory responses in allergy‐prone infants. Methods In a randomized double‐blind study, probiotic bacteria or placebo were given for 1 month before delivery to mothers and for 6 months to infants with a family history of allergy. Plasma samples were analysed for C‐reactive protein (CRP), total IgA and IgE, food‐specific IgA, IgG, and IgE, IL‐2, IL‐4, IL‐6, IL‐10, TNF‐α, and IFN‐γ. We analysed the associations of immunological and inflammatory parameters at age 6 months with probiotic treatment and allergic phenotype at 2 years. Results Infants receiving probiotic bacteria had higher plasma levels of CRP (P=0.008), total IgA (P=0.016), total IgE (P=0.047), and IL‐10 (P=0.002) than infants in the placebo group. Increased plasma CRP level at age 6 months was associated with a decreased risk of eczema [odds ratio (OR) 0.41 [95% confidence interval (CI) 0.17–0.99], P=0.046], and with a decreased risk of allergic disease [OR 0.38 (95% CI 0.16–0.87), P=0.023] at age 2 years, when adjusted with probiotic use. Conclusion The association of CRP with a decreased risk of eczema at 2 years of age in allergy‐prone children supports the view that chronic, low‐grade inflammation protects from eczema. Probiotic‐induced low‐grade inflammation was characterized by elevation of IgE, IgA, and IL‐10, the changes typically observed in helminth infection‐associated induction of regulatory mechanisms. The findings emphasize the role of chronic microbial exposure as an immune modulator protecting from allergy.     

肾炎患者血中C3d水平及CD16+单核巨噬细胞膜补体调节蛋白的表达

目的 :探讨肾炎患者补体激活时活化单核巨噬细胞 (CD16 Mo MΦ)膜辅因子蛋白 (MCP)、促衰变因子 (DAF)及同种限制因子 2 0 (HRF 2 0 )表达水平。方法 :采用流式细胞术测定 136例肾小球肾炎患者血中CD16 Mo MΦMCP、DAF和HRF 2 0表达水平 ,采用ELISA法测定血清C3d及荷C3d 免疫复合物的 (C3d IC)水平。结果 :MC病人血清C3d、C3d IC水平及血中CD16 Mo MΦMCP、DAF、HFR 2 0表达水平与正常组无显著差异 (P >0 0 5 ) ,GS、MN及PGN病人血清C3d水平、血中CD16 Mo MΦMCP、DAF、HRF 2 0表达水平及MN、PGN病人C3d IC水平均显著高于正常组 (P <0 0 1) ,且MCP、DAF、HRF 2 0表达水平与血清C3d水平呈显著正相关 (P <0 0 1)。结论 :肾小球肾炎补体激活时血中CD16 Mo MΦMCP、DAF、HRF 2 0表达水平显著上调 ,以保护CD16 Mo MΦ不被激活的补体损伤。从而 ,CD16 Mo MΦ浸润肾组织并产生促炎作用 ,参于肾小球肾炎的发病及发展。     

Immune privilege in the gut: the establishment and maintenance of non-responsiveness to dietary antigens and commensal flora

Summary:  Immune privilege in the gut is the result of a complex interplay between the gut microbiome, gut luminal antigens, and the intestinal epithelial barrier. Composed of both physical and immunochemical components, the intestinal barrier secretes immunoregulatory mediators that promote the generation of tolerogenic antigen-presenting cells, phagocytic innate immune cells characterized by 'inflammatory anergy', and regulatory cells of the adaptive immune system. Innate immune cells mediate controlled transepithelial transport of luminal antigens as far as the mesenteric lymph nodes, where the intestinal and peripheral immune systems intersect. This promotes the generation of adaptive regulatory lymphocytes that actively suppress effector cell responses against gut luminal antigens and flora. The net result is the generation of tolerance to dietary antigens and the maintenance of gut homeostasis. Dysregulation of this complex immunoregulatory network leads to diseases such as food allergy and inflammatory bowel disease. Future therapies for these diseases will likely involve the functional restoration of the barrier and regulatory cell functions at the epithelial/luminal interface.     

“Aggressive” Feeding of Very Preterm Neonates and Body Mass Index at School Age

Introduction: The effects of “aggressive” neonatal feeding policies of very preterm neonates (VPN) and the risk of metabolic syndrome later in life remain questionable. We aimed to evaluate the effect of our “aggressive” nutrition policies of VPN during hospitalisation on body mass index (BMI) at ages 2 and 8 years. Materials and Methods: Eighty four VPN, who received “aggressive” nutrition during hospitalisation in an effort to minimise postnatal growth restriction (PGR) (group A), and 62 term neonates, as controls (group B), were enrolled in the study. Group A was further divided in four subgroups depending on the type (A1: fortified expressed breast milk and preterm formula; A2: exclusively preterm formula) and quantity of milk received (A3: maximum feeds 180–210 mL/kg/day; A4: maximum feeds 210 and up to 260 mL/kg/day). BMI was calculated at ages 2 and 8 years and plotted on the centile charts. Results: There was no significant difference in BMI between groups A and B at 2 and 8 years, respectively, in both absolute BMI values and their centile chart distribution. There was no significant difference in BMI at 2 and 8 years either between subgroups A1 and A2 or between subgroups A3 and A4. Conclusions: “Aggressive” and individualised feeding policy for VPN did not affect the BMI and obesity rates at ages of 2 and 8 years in our study population. The type and quantity of milk feeds had no impact on their BMI at school age. Further larger studies are needed to confirm our results.     

The associations of medical marijuana policies with opioid‐related health care utilization

ObjectiveTo examine the associations between medical marijuana policies and opioid‐related hospitalizations and emergency department visits.Data SourcesWe utilized quarterly rates of hospital discharge data from the Healthcare Cost and Utilization Project''s (HCUP) Fast Stats Database from 2005 to 2016 along with state‐level sociodemographic data from US Census Bureau and Bureau of Labor Statistics and opioid‐related state health policy data from publicly available sources for the analysis.Study DesignAnalyses were carried out using a difference‐in‐differences regression approach. We estimate heterogeneous effects of medical marijuana policies such as initial policy, presence of active dispensary, and home cultivation on opioid‐related hospitalizations and emergency department visits related to opioids.Data Collection/Extraction MethodsPublicly available secondary data were collected, linked, and analyzed. Observations with missing values for explanatory variables were excluded from the analysis.Principal FindingsRegression results indicate that type of medical marijuana policy has varying effects on opioid‐related hospitalizations and emergency department visits. States that allow home cultivation of medical marijuana experienced significant positive associations with opioid‐related hospitalizations and emergency department visits, while no effect was observed with medical marijuana dispensaries. Moreover, recreational marijuana policies were positively associated with opioid‐related hospitalizations.ConclusionsThe findings indicate that the effects of medical marijuana policies on opioid‐related hospitalizations and emergency department visits vary depending on the type of medical marijuana policy. Our findings indicate that the implementation of home cultivation of marijuana is positively associated with hospitalizations and emergency department visits related to opioids, suggesting that easier access to marijuana among opioid users may result in adverse health conditions that need treatment.     

Mapa de las políticas nutricionales escolares en España

ObjectiveTo systematically describe the school nutritional policies of the 17 autonomous communities of Spain.MethodThrough a search of bibliographic databases, web pages and other official information systems, 183 documents of interest were identified. Information was systematically collected with the SNIPE (school nutrition index of programme effectiveness) questionnaire, adapted to Spain, and validated by reference staff of the regional government's health and education ministries.ResultsThe main objective of the policies is to prevent obesity and improve the nutrition of schoolchildren. The 17 autonomous communities cover the school canteen service, 11 cafeteria and vending machines, and 9 the breakfast service. All communities use the Consensus Document on School Food as a reference for the content of the menu and the nutritional quality of the products offered at the school; however, only 4 of them have regulated these aspects. The evaluation of policy objectives ranges from 58.8% of the autonomous communities for food supply to 5.9% for rotation and menu quality.ConclusionAlthough all the autonomous communities have standards for the school menu, the standards for the rest of the food supply vary across them; also, evaluation of objectives is scarce and only 4 communities have approved mandatory regulations. Nutritional standards should be reviewed according to current scientific knowledge and enacted by law, in compliance with the current legislation (Act 17/2011).