Gut microbiota intervention by pre and probiotics can induce regulatory T cells and reduce the risk of severe acute GVHD following allogeneic hematopoietic stem cell transplantation

BackgroundAcute graft-versus-host disease (aGVHD) is one of the leading causes of limitation and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Numerous studies have shown that changes in the gut microbiome diversity increased post-transplant problems, including the occurrence of aGVHD. Probiotics and prebiotics can reconstitute the gut microbiota and thus increase bacterial metabolites such as short-chain fatty acids (SCFAs) that have immunomodulatory effects preventing aGVHD in recipients of allo-HSCTs.Methods/Study DesignWe conducted a pilot randomized clinical trial to investigate whether oral synbiotics are associated with the prevention or reduction in occurrence/severity and mitigate complications of aGVHD following allo-HSCT. A commercially available synbiotic mixture containing high levels of 7 safe bacterial strains plus fructo-oligosaccharides as a prebiotic was administered to allo-HSCT recipients. Out of 40 allo-HSCT patients, 20 received daily a synbiotic 21 days prior to transplantation (days −21 to day 0). In contrast, in the control group 20 recipients of allo-HSCT did not receive a symbiotic therapy.ResultsWithin first 100 days of observation, the incidence of severe (grade III/IV) aGVHD in the a synbiotic-therapy group was 0% (0 out of 20 patients), whereas it was 25% (5 out of 20 patients) in the control group (P = 0.047). The median percentage of CD4 + CD25 + Foxp3+ regulatory T cells (Tregs) among CD4+ lymphocytes on day 28 after HSCT in the synbiotic group was higher (2.54%) than in control group (1.73%; P = 0.01). There was no difference in Treg cells on day 7 after HSCT between two groups. However, the median percentage and the absolute count of Tregs in patients who experience aGVHD was significantly lower on days 7 and 28 after HSCT (both P < 0.05). The overall 12-month survival (OS) rate was higher (90%) in the symbiotic-treated patients than in the control group (75%), but the difference was not statistically significant (P = 0.234).ConclusionOur preliminary findings suggest that synbiotic intake before and during the conditioning regimen of allo-HSCT patients may lead to a reduction in the incidence and severity of aGVHD through the induction of CD4 + CD25 + Foxp3+ regulatory T cells, thus contributing to the improvement of transplant outcomes. Much larger studies are needed to confirm our observations.     

Principles of extramural health care for chronic wounds in China

Development of extramural health care for chronic wounds is still in its infancy in China, and thus it is urgent and vital to establish a correct concept and practicable principles. The authors reviewed recent domestic and international literature and summarized the following treatment procedures and principles for extramural health care of chronic wounds. (1) The patient needs to do self-assessment of the wound by using available simple methods; (2) The patient consults with professional physicians or nurses on wound care to define the severity and etiology of the non-healing wound; (3) Professionals evaluate the existing treatment strategies; (4) Etiological treatments are given by professionals; (5) Patients buy needed dressings via the more convenient ways from pharmacies, e-commerce platform or others; (6) Professionals provide a standardized and reasonable therapeutic plan based on the patient's wound conditions; (7) Both professionals and the patient pay attention to complications to prevent adverse outcomes; (8) Professionals strengthen the public education on wound care and integrated rehabilitation. This review expected to provide new perspectives on the therapeutic strategies for chronic wounds in an extramural setting.     

Ⅳ型胶原α5链基因突变致奥尔波特综合征两家系遗传学分析

目的: 分析奥尔波特（Alport）综合征的遗传学特征。方法: 对原因不明的反复尿检异常的2名先证者进行基于高通量测序技术的全外显子组测序,通过基因突变的致病性、孟德尔遗传规律和临床表型的综合分析,筛选出致病的基因突变,最后通过Sanger测序在家系成员中验证基因突变。结果: 两个家系中分别鉴定出COL4A5基因上的2个杂合性剪接位点突变：c.2147-2A > T（IVS27）和c.646-2A > G（IVS11）（NM_033380）,且这2个杂合突变分别与2个家系的患病成员呈现共分离关联。结论: Alport综合征主要通过女性直系患者遗传,临床上可以通过有效的遗传咨询进行产前诊断。     

新生儿环状胰腺的临床诊治分析

目的: 总结新生儿环状胰腺的病例特点、诊断要点及治疗方法。方法: 回顾性分析浙江大学医学院附属儿童医院2009年1月至2018年12月收治的114例新生儿环状胰腺病例的临床资料,收集患儿的出生情况（胎龄、出生体质量）、临床症状、发病时间、产前检查结果、并发畸形、影像学检查、手术方法、术后并发症等信息,并进行系统分析。结果: 114例患儿中,102例行腹部超声检查,提示十二指肠梗阻68例、环状胰腺4例;113例行腹部立位X线摄片检查,提示双泡征76例、单泡征12例、高位肠梗阻5例;103例行上消化道造影检查,提示十二指肠梗阻102例。所有患儿均行手术治疗,其中十二指肠侧侧吻合术110例、十二指肠空肠吻合术4例;开腹手术45例,腹腔镜手术69例（术中中转开腹1例）。术后平均禁食时间为（7.8±2.7）d,平均住院时间为（16.9±10.1）d,出现并发症5例。产前检查异常组术后并发症的发生率较产前检查无异常组低（P < 0.05）;腹腔镜手术组术后平均禁食时间较开腹手术组缩短（P < 0.05）。结论: 出生后早期反复呕吐者需考虑环状胰腺可能。环状胰腺合并畸形率高,产前筛查异常患儿建议常规行胎儿染色体检查。手术为唯一确诊及治疗方法,腹腔镜手术可作为有经验医生的首选手术方式。     

MR Lymphangiography for Focal Disruption of the Thoracic Duct in Chylothorax of an Infant: a Case Report and Literature Review

Chylothorax is a rare cause of pleural effusion in children, and it is usually difficult to identify the location of chyle leakage due to the small size of the thoracic duct in children. Herein we report an infant case with chylothorax whose leakage of the thoracic duct was successfully located by magnetic resonance lymphangiography (MRL) using pre-contrast MR cholangiopancreatography (MRCP) and gadodiamide-enhanced spectral presaturation inversion recovery (SPIR) T1-weighted imaging, which demonstrate the imaging method is easy and effective for detecting the focal disruption of the thoracic duct in children with chylothorax and younger than 8 months old.     

HPLC测定绞股蓝中七叶胆苷XLVI和人参皂苷Rb3含量

目的 建立HPLC测定绞股蓝中七叶胆苷XLVI和人参皂苷Rb₃含量的方法。方法 采用Ultimate XB-C₁₈色谱柱（250 mm×4.6 mm，5 μm），以乙腈（A）-水（B）线性梯度洗脱，检测波长203 nm，流速1 mL·min^-1，柱温30℃。结果 七叶胆苷XLVI在3.30~39.62 μg·mL^-1范围内线性良好（r²=0.999 7），平均回收率为113%，RSD为1.84%；人参皂苷Rb₃在3.27~39.26 μg·mL^-1范围内线性良好（r²=0.999 7），平均回收率为102%，RSD为2.82%。结论 该方法有较好的分离效果，准确性、精密度和重复性良好，为绞股蓝的研究和质量控制提供了科学依据。     

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??OBJECTIVE To establish a method of on-line matrix elimination together with ion chromatographic for determination of residual tetraethylammonium bromibde(TEAB) which acts as phase transfer catalyst in clopidogrel sulfate. METHODS An ion excluding column Dionex IonPac NG1 was used for the separation of TEAB from clopidogrel sulfate, using 20 mmol??L^-1 MSA as eluent. A pre-concentration column Dionex CG17 was used to enrich the trace TEAB. After being switched to analytical system, the separation was performed on Dionex ICS3000 using Dionex IonPac CS17 as analytical column, and suppressor was not required. 5 mmol??L^-1 MSA containing 35% acetonitrile was used as mobile phase. RESULTS The RSDs of retention time and peak area were good. The recoveries of TEAB were between 97.8%-103.3%. The calibration curves of analytes were linear in the range between 0.4 and 10.0 ??g??mL^-1. The limit of detection reached 0.2 ??g??mL^-1. CONCLUSION This method can be applied to detect trace kation in pharmaceutical chemicals.     

10种常见中药饮片微生物污染相关因素研究

目的 探究中药饮片的品种、药用部位和炮制方法与微生物污染之间的关系。方法 依照中国药典方法进行需氧菌总数计数、霉菌和酵母菌总数计数,采用SNK检验进行数据分析。采用生化分析及ABI3500基因测序对中药饮片中的嗜热菌进行鉴定分析。结果 需氧菌总数、霉菌和酵母菌总数的lg值分析显示,中药饮片的不同品种、不同药用部位和不同炮制方法之间存在显著性差异,分别以芫花、合欢皮品种,花类药用部位,净制的炮制方法染菌程度最大。中药饮片100℃水浴30 min后基本能够去除耐热菌微生物,但麦冬与芫花中仍能鉴定出嗜热菌。结论 中药饮片的品种、药用部位和炮制方法的差异与微生物污染紧密相关。麦冬与芫花经过煎煮,依然不能完全杀灭嗜热菌。