Chemokine profiling in children and adults with symptomatic and asymptomatic respiratory viral infections

Molecular diagnosis; Viral infection; Chemokines; Disease prognosis; CXCL10; CXCL11; CCL3; CCL4; CCL5; Random forest.

Intestinal immune maturation is accompanied by temporal changes in the composition of the microbiota

In animals establishment of the intestinal microbial ecosystem is influenced by mucosal immune functions. As mucosal immune functions dynamically change during development of juvenile layer chicken, this study focused on dynamics in the ileal microbiota composition in relation to intestinal immune development. In addition, the levels of immunoglobulin (Ig) in serum and amount of bacteria coated with IgA, a hallmark of intestinal immune maturation, were analysed. The composition of the intestinal microbiota transiently changed at the age of 14-42 days compared to the microbiota composition before and after this period. This temporal deviation in microbiota composition was associated to a temporal increase in transcriptional activity of pro-inflammatory cytokine genes. Furthermore, before week two limited amounts of faecal bacteria were bound by IgM and from week two increasing amounts of bacteria were bound by IgA, reaching a maximal level of 70% of IgA-coated bacteria at 6 weeks of age. These data could indicate that prior to achievement of intestinal homeostasis at 6-10 weeks post hatch, activation of inflammatory pathways cause a temporal disturbance of the microbiota composition. This period of imbalance may be essential for adequate immune development and establishment of intestinal homeostasis.

A randomized trial of polyurethane and silicone percutaneous endoscopic gastrostomy catheters

BACKGROUND

No data are available on differences in complication rate and long-term functioning between polyurethane and silicone percutaneous endoscopic gastrostomy (PEG) catheters.

METHODS

We randomized patients who qualified for PEG placement to receive either a polyurethane or silicone PEG catheter. Patients were prospectively monitored for 28 days after placement for the occurrence of complications. Data on long-term PEG survival were obtained retrospectively from the Hospital and general practitioner's medical records.

RESULTS

One hundred and six patients were randomized (polyurethane 50, silicone 56). During the first four weeks of follow-up, major complications occurred twice with both polyurethane and silicone PEGs (relative risk 1.1, 95% confidence interval: 0.11-11). Overall complications occurred four times with polyurethane and 17 times with silicone PEGs (relative risk 3.8, 95% confidence interval: 1.37-10.5). Long-term follow-up was available in 96 patients. Seven polyurethane PEGs and 10 silicone PEGs were removed because of PEG malfunctioning, the remainder functioned well until death or the reinstitution of oral feeding. The median complication-free survival was 916 days for the polyurethane PEG and 354 days for the silicone PEG (Log rank test: P=0.24).

CONCLUSION

Polyurethane PEG catheters were associated with less short-term complications than silicone catheters, but major complications and long-term function were comparable.

Eradication of Helicobacter pylori does not decrease the long-term use of acid-suppressive medication

BACKGROUND

Many patients are not symptom-free after eradication therapy for Helicobacter pylori and continue to use proton pump inhibitors or H2-receptor antagonists (H2-RAs).

AIM

To ascertain whether a cohort of patients treated for H. pylori were still taking either proton pump inhibitors or H2-RAs more than 4 years after H. pylori eradication therapy.

METHODS

In 1993-94, a cohort of 167 patients were given eradication therapy for their H. pylori infection. By means of questionnaires to the patient, general practitioner and pharmacist we were able to retrieve data from 151 patients. The use (at the time of questionnaire) of proton pump inhibitors or H2-RAs was noted.

RESULTS

Indications for eradication therapy were peptic ulcer disease: 28 patients (19%) or functional dyspepsia: 123 patients (82%). Mean time of follow-up was 1466 +/- 21 days. In this group, 77 patients (51%) still used acid-suppressive medication (proton pump inhibitors 44% and H2-RAs 7%) at the time of the survey (mean follow-up more than 4 years after eradication). In the group treated for peptic ulcer disease (n=28), only nine patients still used proton pump inhibitors or H2-RAs. In contrast, 68 patients who were treated for functional dyspepsia (total number 123) still used proton pump inhibitors or H2-RAs (55%) (P < 0.05).

CONCLUSION

Even after successful H. pylori eradication, < 50% of patients stop acid-suppressive therapy. This contributes significantly to economic cost and raises doubts about the practice of routinely eradicating H. pylori in patients with functional dyspepsia. In contrast, the majority of peptic ulcer patients are able to stop acid-suppressive medication.