Pilot study investigating the effect of enteral and parenteral nutrition on the gastrointestinal microbiome post-allogeneic transplantation

Nutrition support is frequently required post-allogeneic haematopoietic progenitor cell transplantation (HPCT); however, the impact of mode of feeding on the gastrointestinal microbiome has not been explored. This study aimed to determine if there is a difference in the microbiome between patients receiving enteral nutrition (EN) and parenteral nutrition (PN) post-allogeneic HPCT. Twenty-three patients received either early EN or PN when required. Stool samples were collected at 30 days post-transplant and analysed with shotgun metagenomic sequencing. There was no difference in microbial diversity between patients who received predominantly EN (n = 13) vs. PN (n = 10) however patients who received predominantly EN had greater abundance of Faecalibacterium (P < 0·001) and ruminococcus E bromii (P = 0·026). Patients who had minimal oral intake for a longer duration during provision of nutrition support had a different overall microbial profile (P = 0·044), lower microbial diversity (P = 0·004) and lower abundance of faecalibacterium prausnitzii_C (P = 0·030) and Blautia (P = 0·007) compared to patients with greater oral intake. Lower microbial diversity was found in patients who received additional beta lactam antibiotics (P = 0·042) or had a longer length of hospital stay (P = 0·019). Post-HPCT oral intake should be encouraged to maintain microbiota diversity and, if nutrition support is required, EN may promote a more optimal microbiota profile.     

Affective School Engagement and Self-Concept: How are Irish Boys and Girls Faring?

Internationally and in Ireland, much of the research around gender and educational engagement has centred on the academic differences between boys and girls (Warrington and Younger 2000; Francis 2009; O’Connor 2007). Less is known however about the factors shaping affective school engagement and student self-concept and how this can affect participation in learning. Children and young people emphasise the affective or emotional as much as the learning aspects of school life (Alexander 2008). Drawing on data from the 9-year cohort of the Growing Up in Ireland study, this paper examines self-concept among boys and girls in Irish primary schools. The findings show important differences in terms of the affective elements of school engagement, with boys more likely than girls to score significantly lower levels on measures of ‘good’ behaviour and intellectual school status, while girls score significantly lower on freedom from anxiety than boys. The findings also illustrate that predictors of disengagement are about more than the child’s gender – in that working class children and students with special educational needs are faring less well in terms of affective engagement in school.     

CCK对孤束核中胃扩张相关神经元电活动的影响

目的：研究胆囊收缩素对孤束核中胃扩张相关神经元电活动的影响。方法：记录乌拉坦麻醉大鼠孤束核内胃扩张相关神经元的电活动,观察胃扩张以及静脉注射CCK对神经元电活动的影响。结果：外周静脉注射CCK对孤束核内胃扩张相关神经元自发电活动的影响是多样的,既具有兴奋效应（9／14）,也具有抑制效应（5／14）。但对于胃扩张诱发的孤束核神经元放电,不管是胃扩张兴奋性神经元还是胃扩张抑制性神经元,CCK均表现为抑制效应。结论：外周CCK可以影响孤束核内胃扩张相关神经元的活动。     

Intercostal nerve blockade with liposomal bupivacaine reduces length of stay after video assisted thoracic surgery (VATS) lobectomy

BackgroundIntercostal nerve blockade (INB) for thoracic surgery analgesia has gained popularity in practice, but evidence demonstrating its efficacy remains sparse and inconsistent. We investigated the effect of INB with standard bupivacaine (SB) with epinephrine versus liposomal bupivacaine (LB) versus a mixed solution of the two on postoperative pain control and outcomes in video assisted thoracoscopic lobectomy patients.MethodsSince 2014, our practice has shifted from using INBs with SB with epinephrine, to LB, to a mix of the two as the central component of multimodal analgesia after video assisted thoracoscopic surgery. The blocks are performed in a standardized fashion under thoracoscopic visualization consecutively from two rib spaces above to two below the outermost incisions. We retrospectively compared all minimally invasive lobectomies performed at our institution between January 2014 and July 2018 by type of local anesthetic used for INB. We examined median length of stay (LOS), opioid utilization, and subjective pain scores [0–10].ResultsOut of 302 minimally invasive lobectomy patients, 34 received SB with epinephrine, 222 received LB alone, and 46 received the mixed solution. LOS was almost a full day shorter in the LB group than in the SB group (34.8 vs. 56.5 hours, P=0.01). There was nearly 25% lower median total morphine equivalent utilization in the mixed solution cohort compared to the LB cohort (−7.1 mg, P=0.02). Additionally, IV morphine equivalent utilization was over 50% lower in the mixed solution group than in the SB with epinephrine group (−10.0 mg, P=0.03).ConclusionsOur study is by far the largest (N=302) to compare types of local anesthetic used for INB within a uniform case population. The reductions in LOS and opiate utilization observed in our study among patients receiving LB-based formulations were both statistically and clinically significant.     

尖锐湿疣皮损中的微卫星DNA不稳定性

目的：探讨微卫星不稳定性在尖锐湿疣及其癌变中的作用及意义。方法：采用聚合酶链-单链构象多态性分析(PCR-SSCP)检测28例尖锐湿疣皮损中的微卫星DNA改变。结果：28例尖锐湿疣皮损中8例存在微卫星不稳定性。而且其主要出现在尖锐湿疣癌变中，未发现杂合性丢失。结论：尖锐湿疣及其癌变与微卫星不稳定性有关，临床上通过对尖锐湿疣患者微卫星不稳定性的检测，有可能对尖锐湿疣癌变作出可能性预测及早期诊断，为发现癌变高危人群提供新的依据。     

脑血管病急性期MMP-9、IL-6和IL-10水平变化的研究

目的：探讨基质金属蛋白酶‐9（MMP‐9）、白细胞介素‐6（IL‐6）和白细胞介素‐10（IL‐10）与脑动脉粥样硬化斑块不稳定性以及脑梗死的关系。方法选择急性脑血管病患者56例,其中反复短暂性脑缺血发作（TIA）16例,急性脑梗死40例。对照组为21例健康体检者。所有缺血性脑血管病患者均经头CT血管造影（CTA）检查或颈部血管超声证实存在不稳定斑块,且发病机制考虑与不稳定斑块破裂有关。采用ELISA方法检测各组血清MMP‐9、IL‐6和IL‐10水平并进行比较。结果急性脑梗死组患者血清中MMP‐9、IL‐10水平分别为（137.10±69.38）ng/mL和（39.16±32.82）pg/mL,TIA组患者血清中MMP‐9、IL‐10水平分别为（119.79±65.54）ng/mL和（33.00±21.36）pg/mL,均明显高于对照组〔分别为（65.42±36.81）ng/mL和（19.83±12.16）pg/mL〕;脑梗死组患者血清MMP‐9及IL‐10水平均高于TIA组（均P＜0.05）。各组间IL‐6水平差异无统计学意义（均P＞0.05）。结论MMP‐9和IL‐10水平升高可能与动脉粥样硬化不稳定斑块破裂以及脑梗死灶形成有关。     

胃底折叠术治疗胃食管反流病对高血压的影响

[目的]观察胃底折叠术治疗胃食管反流病对高血压的影响。[方法]回顾性分析2011-06—2012-08期间20例行腹腔镜胃底折叠术的胃食管反流病合并高血压患者的临床资料,依照反流病诊断问卷在手术前和手术后进行反流症状评分。[结果]20例均成功实施腹腔镜手术并于术后第12个月随访。反流总积分(Sc)由术前20.0±9.5降至术后0.5±0.9(P0.05),术后收缩压下降了(11.0±12.0)mm Hg(1mmHg=0.133kPa),舒张压下降了(9.0±11.5)mm Hg(均P0.05)。术后随访12个月11例血压恢复正常,停药时间均在9个月以上;2例减少2种降压药,1例减少1种降压药;6例无效,仍用术前降压药物。[结论]胃食管反流病与部分高血压密切相关,腹腔镜胃底折叠术治疗胃食管反流病合并高血压安全、有效。     

Mediation of serotonin-induced analgesia by the 5HT2 receptor in the pentobarbital anesthetized mouse model

Serotonin can induce analgesia when injected directly into the brain, but analgesia after peripheral administration has been more difficult to show. The pentobarbital anesthetized mouse (PAM) model, developed to alleviate some of the problems involved in the measurement of tail flick latency, was used to assess the action of peripherally administered serotonin. Mice were anesthetized with about 65 mg/kg of sodium pentobarbital IP and their tail flick latencies measured while they were in stage III anesthesia. In these anesthetized mice, IP serotonin induced a significant analgesia that was much more robust than that found in awake mice. The analgesic effect was dose-dependent from 0.25 mg/kg to 10 mg/kg but was not blocked by the antiopiate naltrexone. Of several psychotropic agents tested, only amitriptyline, mianserin, and trazodone had significant effects on analgesia in the PAM model. The analgesic effect of serotonin was reproduced by the 5HT2 agonist DOI and totally blocked by the 5HT2 antagonist NPP. These results show the utility of the PAM model in studying nonopiate analgesia and suggest that the analgesic action of serotonin is mediated primarily through the 5HT2 receptor.