乳酸杆菌联合甲硝唑治疗妊娠合并滴虫性阴道炎的临床分析

目的:探讨甲硝唑联合乳酸杆菌治疗妊娠期滴虫性阴道炎患者的临床疗效。方法:将本院妇科门诊收治的88例妊娠期滴虫性阴道炎患者分为联合组和对照组各44例,两组患者均给予甲硝唑片口服治疗,联合组加用乳酸杆菌胶囊治疗,比较两组患者治疗1个疗程(甲硝唑连用7d,乳酸杆菌胶囊连用10d为1个疗程)后的临床疗效差异。结果:联合组的治疗总有效率为90.91%显著高于对照组的75.00%且差异具有统计学意义(P0.05)。治疗后两组患者的IL-8、IL-13较治疗前均显著降低(P0.05),联合组降低更加显著(P0.05),治疗前后两组患者的IL-2变化不显著(P0.05)。治疗1个疗程结束时,联合组的阴道滴虫转阴率97.73%高于对照组的93.18%但差异不具有统计学意义(P0.05)。治疗结束1个月后,联合组的滴虫转阴率95.45%显著的高于对照组的81.82%且差异具有统计学意义(P0.05)。治疗1个疗程结束时,联合组的乳酸杆菌菌落数≥1/2面积率为75%显著高于对照组的22.73%且差异具有统计学意义(P0.05),联合组的产H2O2阳性率47.73%显著的高于对照组的15.91%且差异具有统计学意义(P0.05)。结论:甲硝唑联合乳酸杆菌治疗妊娠期滴虫性阴道炎患者对于恢复患者阴道微生态环境、提高治疗效果具有显著作用。     

Guidance on the use of probiotics in clinical practice in children with selected clinical conditions and in specific vulnerable groups

Aim

The use of probiotics has been covered by many guidelines, position papers and evidence‐based recommendations, but few have referred to specific patient groups or clinical indications. This review summarises recommendations and scientifically credited guidelines on the use of probiotics for children with selected clinical conditions and provides practice points.

Methods

An expert panel was convened by the European Paediatric Association in June 2017 to define the relevant clinical questions for using probiotics in paediatric health care and review and summarise the guidelines, recommendations, position papers and high‐quality evidence.

Results

The panel found that specific probiotic strains were effective in preventing antibiotic‐associated and nosocomial diarrhoea, treating acute gastroenteritis and treating infantile colic in breastfed infants. However, special caution is indicated for premature infants, immunocompromised and critically ill patients and those with central venous catheters, cardiac valvular disease and short‐gut syndrome. This review discusses the safety of using probiotics in selected groups of paediatric patients and the quality of the available products providing practice points based on proved findings.

Conclusion

Efficacy of probiotics is strain specific. Their benefits are currently scientifically proven for their use in selected clinical conditions in children and not recommended for certain patient groups.     

Efficacy profiles for different concentrations of Lactobacillus acidophilus in experimental colitis

AIM:To determine the efficacy profiles of different concentrations of Lactobacillus acidophilus(L.acidophilus)for treating colitis using an experimental murine model.METHODS:Colitis was established in 64 BALB/c mice by adding 5%dextran sodium sulfate(DSS)to the drinking water and allowing ad libitum access for 7 d.The mice were then randomly divided into the following control and experimental model groups(n=8 each;day 0):untreated model control;negative-treatment model control(administered gavage of 1 mL/10 g normal saline);experimental-treatment models C4-C8(administered gavage of 104,105,106,107,or 108CFU/10 g L.acidophilus,respectively);positive-treatment model control(administration of the anti-inflammatory agent prednisone acetate at 45 g/10 g).Eight mice given regular water(no DSS)and no subsequent treatments served as the normal control group.Body weight,fecal traits,and presence of fecal occult blood were assessed daily.All animals were sacrificed on post-treatment day7 to measure colonic length,perform histological scoring,and quantify the major bacteria in the proximal and distal colon.Intergroup differences were determined by one-way ANOVA and post-hoc Student-Newman-Keuls comparison.RESULTS:All treatments(L.acidophilus and prednisone acetate)protected against colitis-induced weight loss(P<0.05 vs model and normal control groups).The extent of colitis-induced colonic shortening was significantly reduced by all treatments(prednisone acetate>C4>C5>C7>C8>C6;P<0.05 vs untreated model group),and the C6 group showed colonic length similar to that of the normal control group(P>0.05).The C6 group also had the lowest disease activity index scores among the model groups.The bacterial profiles in the proximal colon were similar between all of the experimental-treatment model groups(all P>0.05).In contrast,the bacterial profile in the distal colon of the C6 group showed the distinctive features(P<0.05 vs all other experimental-treatment model groups)of Lactobacillus sp.and Bifidobact     

Preventing pediatric antibiotic-associated diarrhea and Clostridium difficile infections with probiotics: A meta-analysis

AIM: To assess the efficacy and safety of probiotics for preventing pediatric: (1) antibiotic associated diarrhea and (2) Clostridium difficile (C. difficile) infections. METHODS: On June 3, 2013, we searched PubMed (1960-2013), EMBASE (1974-2013), Cochrane Database of Systematic Reviews (1990-2013), CINAHL (1981-2013), AMED (1985-2013), and ISI Web of Science (2000-2013). Additionally, we conducted an extensive grey literature search including contact with National Institutes of Health Clinical Trials Registry, abstracts from annual infectious disease and gastroenterology meetings, experts in the field and correspondence with authors. The primary outcomes were the incidence of antibiotic-associated diarrhea (AAD) and C. difficile infections (CDI). Dichotomous outcomes (e.g., incidence of AAD or CDI) were pooled using a random-effects model to calculate the relative risk and corresponding 95% confidence interval (95%CI) and weighted on study quality. To explore possible explanations for heterogeneity, a priori subgroup analysis were conducted on probiotic strain type, daily dose, quality of study and safety of probiotics. The overall quality of the evidence supporting each outcome was assessed using the grading of recommendations, assessment, development and evaluation criteria. RESULTS: A total of 1329 studies were identified with 22 trials (23 treatment arms and 4155 participants) meeting eligibility requirements for our review of prevention of AAD and 5 trials (1211 participants) for the prevention of CDI. Trials in adult populations, trials of uncertain antibiotic exposure or studies which did not provide incidence of AAD were excluded. We found 12 trials testing a single strain of probiotic and 10 trials testing a mixture of probiotic strains. Probiotics (all strains combined) significantly reduced the incidence of pediatric AAD (pooled RR = 0.42, 95%CI: 0.33-0.53) and significantly reduced pediatric CDI (pooled RR = 0.35, 95%CI: 0.13-0.92). Of the two strains with multiple trials, both significantly reduced pediatric AAD: Saccharomyces boulardii lyo (pooled RR = 0.43, 95%CI: 0.32-0.60) and Lactobacillus rhamnosus GG (pooled RR = 0.36, 95%CI: 0.19-0.69). There was no significant effect by type of antibiotic, or by duration or dose of probiotic. No adverse events associated were found in the 22 controlled trials relating to the use of probiotics. CONCLUSION: This meta-analysis found that probiotics significantly prevented pediatric antibiotic associated diarrhea and pediatric CDI, but the efficacy varies significantly by the strain of the probiotic.     

Specific probiotics alleviate allergic rhinitis during the birch pollen season

AIM： To investigate whether birch pollen allergy symptoms are linked with gut microbiota changes and whether probiotics have an effect on these.
METHODS： Forty seven children with confirmed birch pollen allergy were randomized to receive either a probiotic combination of Lactobacillus acidophilus （L. acidophilus） NCFM^TM （ATCC 700396） and Bifidobacterium lactis （B. lactis） BI-04 （ATCC SD5219） or placebo in a double-blind manner for 4 mo, starting prior to onset of the birch pollen season. Symptoms were recorded in a diary. Blood samples were taken for analysis of cytokines and eosinophils. Fecal samples were analysed for microbiota components, calprotectin and IgA. Nasal swabs were taken for analysis of eosinophils.
RESULTS： The pollen season induced a reduction in Bifldobacterium , Clostridium and Bacteroides which could not be prevented by the probiotic intervention. During the intervention, significantly higher numbers ofB. lactis 11.2 × 10^7 ± 4.2 ×10^7 vs 0.1 × 10^7 ± 0.1 × 10^7 bacteria/g feces （P 〈 0.0001） and L. acidophilus NCFMTM 3.5 × 10^6 ± 1.3 × 10^6 vs 0.2 × 10^6 ±0.1 × 10^6 bacteria/g feces （P 〈 0.0001） were observed in the probiotic group compared to the placebo group.During May, there was a tendency for fewer subjects, （76.2% vs 95.2%, P = 0.078） to report runny nose, while during June, fewer subjects, 11.1% vs 33.3%, reported nasal blocking in the probiotics group （P = 0.101）. Concomitantly, fewer subjects in the probiotic group had infiltration of eosinophils in the nasal mucosa compared to the placebo group, 57.1% vs 95% （P = 0.013）. Eye symptoms tended to be slightly more frequent in the probiotic group, 12.5 d [interquartile range （IQR） 6-18] vs 7.5 d （IQR 0-11.5） （P = 0.066） during May. Fecal IgA was increased in the placebo group during the pollen season; this increase was prevented by the probiotics （P = 0.028）.
CONCLUSION： Birch pollen allergy was shown to be associated with changes in fecal microbiota composition. The specific combination of probiotics used was shown to prevent the pollen-induced infiltration of eosinophils into the nasal mucosa, and indicated a trend for reduced nasal symptoms.     

Impact of oral probiotics on neurodevelopmental outcomes in preterm infants

Objective: The aim of the study was to evaluate the neurodevelopment outcomes of very low birth weight (VLBW) preterm infants supplemented with oral probiotics for the prevention of necrotizing enterocolitis (NEC).

Methods: A prospective follow-up study was performed in a cohort of VLBW preterm infants enrolled in a single center randomized controlled clinical trial to evaluate the efficacy of oral probiotics for the prevention of NEC. Cognitive and neuromotor developments were assessed by using the Bayley scales of infant development II. Sensory and neurological performance was evaluated by standard techniques. The primary outcome was neurodevelopmental impairment at 18–24 months’ corrected age.

Results: A total of 400 infants completed the trial protocol. Of the 370 infants eligible for follow-up, 249 infants (124 in the probiotics group and 125 in the control group) were evaluated. There was no significant difference in any of the neurodevelopmental and sensory outcomes between the two groups.

Conclusion: Oral probiotic given to VLBW infants to reduce the incidense and severity of NEC started with the first feed did not affect neuromotor, neurosensory and cognitive outcomes at 18–24 months’ corrected age.     

The intestinal microflora in allergic Estonian and Swedish 2-year-old children

BACKGROUND: The prevalence of allergic diseases seems to have increased particularly over the past 35-40 years. Furthermore, allergic disease is less common among children in the formerly socialist countries of central and Eastern Europe as compared with Western Europe. It has been suggested that a reduced microbial stimulation during infancy and early childhood would result in a slower postnatal maturation of the immune system and development of an optimal balance between TH1- and TH2-like immunity. AIMS: To test the hypothesis that allergic disease among children may be associated with differences in their intestinal microflora in two countries with a low (Estonia) and a high (Sweden) prevalence of allergy. METHODS: From a prospective study of the development of allergy in relation to environmental factors, 29 Estonian and 33 Swedish 2-year-old children were selected. They were either nonallergic (n = 36) or had a confirmed diagnosis of allergy (n = 27) as verified by typical history and at least one positive skin prick test to egg or cow's milk. Weighed samples of faeces were serially diluted (10-2-10-9) and grown under anaerobic conditions. The counts of the various genera and species were calculated for each child. In addition, the relative amounts of the particular microbes were expressed as a proportion of the total count. RESULTS: The allergic children in Estonia and Sweden were less often colonized with lactobacilli (P < 0.01), as compared with the nonallergic children in the two countries. In contrast, the allergic children harboured higher counts of aerobic micro-organisms (P < 0. 05), particularly coliforms (P < 0.01) and Staphylococcus aureus (P < 0.05). The proportions of aerobic bacteria of the intestinal flora were also higher in the allergic children (P < 0.05), while the opposite was true for anaerobes (P < 0.05). Similarly, in the allergic children the proportions of coliforms were higher (P < 0. 05) and bacteroides lower (P < 0.05) than in the nonallergic children. CONCLUSIONS: Differences in the indigenous intestinal flora might affect the development and priming of the immune system in early childhood, similar to what has been shown in rodents. The role of intestinal microflora in relation to the development of infant immunity and the possible consequences for allergic diseases later in life requires further study, particularly as it would be readily available for intervention as a means for primary prevention of allergy by the administration of probiotic bacteria.     

Impaired secretory immunity in dystrophic epidermolysis bullosa

Dystrophic epidermolysis bullosa is a congenital disorder characterized by blistering of the skin and oral mucosa. This study investigated the hypothesis that children with dystrophic epidermolysis bullosa have impaired oral secretory immunity. Immunoglobulin A (IgA), secretory IgA and IgG concentrations, and IgA and secretory IgA antibody levels to Candida albicans, Lactobacillus casei and Streptococcus mutans were measured in whole saliva from 22 children with dystrophic epidermolysis bullosa and 22 matched controls. Salivary total IgA and total IgG concentrations were significantly raised in dystrophic epidermolysis bullosa due to serum leakage from oral blistering, but the converse was seen with secretory IgA. This suggestion of a mucosal immune defect was supported by decreased secretory IgA antibody responses to all three microorganisms tested. This apparent defect in secretory immunity in dystrophic epidermolysis bullosa may be due to mucosal involvement and damage resulting in impaired antigen sampling in mucosal associated lymphoid tissue or to impaired transport of secretory IgA across the salivary gland mucosa.     

Genotypic and phenotypic characterization of Lactobacillus plantarum strains isolated from Thai fermented fruits and vegetables

Ten Lactobacillus strains originally isolated from Thai fruits and vegetables fermentation were characterized by various phenotypic and genotypic methods. The phenotypic analysis using the method of carbohydrate fermentation patterns (API50CHL) revealed that the isolates belonged to the L. plantarum species. This was further confirmed by 16S rRNA gene sequencing. Multilocus sequence typing (MLST) revealed a strongly clonal population structure and a low genotypic diversity in this collection. However, the analyzed L. plantarum population demonstrated a higher level of diversification after API50CHL that reflects the role of available carbohydrate sources in bacterial evolution. Our results support the postulate that a combination of conventional biochemical and genotyping methods allows a thorough characterization and identification of isolates. We propose that genotypic characterization could be complemented by biochemical characterization to discriminate L. plantarum strains. (© 2009 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

高效表达幽门螺杆菌黏附素Hp0410的嗜酸乳杆菌重组菌株的构建

目的构建高效表达幽门螺杆菌黏附素Hp0410的嗜酸乳杆菌重组菌株。方法从幽门螺杆菌标准株NCTC11639中扩增出幽门螺杆菌黏附素基因Hp0410,克隆入穿梭质粒pMG36e中,通过电穿孔将重组质粒转入嗜酸乳杆菌,表达的目的蛋白经SDS聚丙烯酰胺凝胶电泳与硝酸银染色及Western blotting鉴定,并检测重组质粒的稳定性。结果扩增的黏附素Hp0410基因与基因库公布的一致,构建的重组质粒成功转入嗜酸乳杆菌中,表达出分子量约34kD的目的蛋白,Western blotting证实该蛋白可被幽门螺杆菌感染患者血清所识别。重组质粒pMG36e-Hp0410在含有红霉素和不含有红霉素的环境下均稳定。结论成功构建了高效组成型表达幽门螺杆菌黏附素Hp0410的重组嗜酸乳杆菌菌株。