AIM To evaluate factors associated with Clostridium difficile infection(CDI)and outcomes of CDI in the myelodysplastic syndrome(MDS)and acute myeloid leukemia(AML)population.METHODS After IRB approval,all MDS/AML pati...AIM To evaluate factors associated with Clostridium difficile infection(CDI)and outcomes of CDI in the myelodysplastic syndrome(MDS)and acute myeloid leukemia(AML)population.METHODS After IRB approval,all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were identified.Medical charts were reviewed for demographics,clinical information,development of CDI,complications of CDI,and mortality.Patients with CDI,defined as having a positive stool PCR done for clinical suspicion of CDI,were compared to those without CDI in order to identify predictors of disease.A t-test was used for comparison of continuous variables and chisquare or Fisher's exact tests were used for categorical variables,as appropriate.RESULTS Two hundred and twenty-three patients(60.1%male,mean age 61.3 years,13%MDS,87%AML)had 594 unique hospitalizations during the study period.Thirtyfour patients(15.2%)were diagnosed with CDI.Factors significantly associated with CDI included lower albumin at time of hospitalization(P<0.0001),prior diagnosis of CDI(P<0.0001),receipt of cytarabine-based chemotherapy(P=0.015),total days of neutropenia(P=0.014),and total days of hospitalization(P=0.005).Gender(P=0.10),age(P=0.77),proton-pump inhibitor use(P=0.73),receipt of antibiotics(P=0.66),and receipt of DNA hypomethylating agent-based chemotherapy(P=0.92)were not significantly associated with CDI.CONCLUSION CDI is common in the MDS/AML population.Factors significantly associated with CDI in this population include low albumin,prior CDI,use of cytarabine-based chemotherapy,and prolonged neutropenia.In this study,we have identified a subset of patients in which prophylaxis studies could be targeted.展开更多
Multiple sclerosis(MS)is a demyelinating autoimmune disease of the central nervous system(CNS).We have shown that oral administration of Bowman-Birk inhibitor(BBI),a soybean-derived serine protease inhibitor,suppresse...Multiple sclerosis(MS)is a demyelinating autoimmune disease of the central nervous system(CNS).We have shown that oral administration of Bowman-Birk inhibitor(BBI),a soybean-derived serine protease inhibitor,suppresses disease in experimental autoimmune encephalomyelitis(EAE),1 a model of MS.We show here that the suppression is dependent on stimulator of interferon genes(STING)and the production of interferon-β(IFN-β)by F4/80+macrophages.Furthermore,we show that the absence of type I IFN receptor-α(IFNAR1)in myeloid cells precludes EAE suppression by BBI,demonstrating that IFN-βsignaling in these cells is relevant for the beneficial effect of BBI.BBI also induces IFN-βproduction by human macrophages and monocytes in a STING-dependent manner,suggesting that BBI could have a therapeutic effect in MS similar to the one in EAE.展开更多
文摘AIM To evaluate factors associated with Clostridium difficile infection(CDI)and outcomes of CDI in the myelodysplastic syndrome(MDS)and acute myeloid leukemia(AML)population.METHODS After IRB approval,all MDS/AML patients hospitalized at the University of Maryland Greenebaum Comprehensive Cancer Center between August 2011 and December 2013 were identified.Medical charts were reviewed for demographics,clinical information,development of CDI,complications of CDI,and mortality.Patients with CDI,defined as having a positive stool PCR done for clinical suspicion of CDI,were compared to those without CDI in order to identify predictors of disease.A t-test was used for comparison of continuous variables and chisquare or Fisher's exact tests were used for categorical variables,as appropriate.RESULTS Two hundred and twenty-three patients(60.1%male,mean age 61.3 years,13%MDS,87%AML)had 594 unique hospitalizations during the study period.Thirtyfour patients(15.2%)were diagnosed with CDI.Factors significantly associated with CDI included lower albumin at time of hospitalization(P<0.0001),prior diagnosis of CDI(P<0.0001),receipt of cytarabine-based chemotherapy(P=0.015),total days of neutropenia(P=0.014),and total days of hospitalization(P=0.005).Gender(P=0.10),age(P=0.77),proton-pump inhibitor use(P=0.73),receipt of antibiotics(P=0.66),and receipt of DNA hypomethylating agent-based chemotherapy(P=0.92)were not significantly associated with CDI.CONCLUSION CDI is common in the MDS/AML population.Factors significantly associated with CDI in this population include low albumin,prior CDI,use of cytarabine-based chemotherapy,and prolonged neutropenia.In this study,we have identified a subset of patients in which prophylaxis studies could be targeted.
基金supported by a grant from the National Institutes of Health(5R01AI106026)to A.R.
文摘Multiple sclerosis(MS)is a demyelinating autoimmune disease of the central nervous system(CNS).We have shown that oral administration of Bowman-Birk inhibitor(BBI),a soybean-derived serine protease inhibitor,suppresses disease in experimental autoimmune encephalomyelitis(EAE),1 a model of MS.We show here that the suppression is dependent on stimulator of interferon genes(STING)and the production of interferon-β(IFN-β)by F4/80+macrophages.Furthermore,we show that the absence of type I IFN receptor-α(IFNAR1)in myeloid cells precludes EAE suppression by BBI,demonstrating that IFN-βsignaling in these cells is relevant for the beneficial effect of BBI.BBI also induces IFN-βproduction by human macrophages and monocytes in a STING-dependent manner,suggesting that BBI could have a therapeutic effect in MS similar to the one in EAE.
