Multidrug resistance (MDR) is one of the major obstacles limiting the ef¿ cacy of cancer chemotherapy. Identi¿ cation of new and effective MDR reversal agents is needed. In this study, the effects of polyoxyethylene 40 stearate (PS40) on MDR were evaluated via the transport of the P-glycoprotein (P-gp) substrate vinblastine sulfate (VBL) through Caco-2 cell monolayers and rat intestine tissue. The effects of PS40 on the antitumor activity of VBL were examined through 3-(4,5)-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) cytotoxicity assay and multidrug-resistant tumor-bearing mice. Results of the transport experiments showed that PS40 reduced VBL efÀ ux. The cytotoxicity of vinblastine to K562/ADR cells was signi¿ cantly enhanced when the cells were cotreated with 100 or 150 P g/mL PS40. In vivo data revealed that average tumor volume and average tumor weight were signi¿ cantly less in the VBL+PS40 group than in the VBL group. The inhibition rate for tumor growth was increased from 0.06 (VBL group) to 0.84 (VBL+PS40 group). These results suggest that PS40 may be a potentially useful adjuvant to enhance the therapeutic effects of P-gp substrates.
K EYWORDS:Polyoxyethylene 40 stearate , P-glycoprotein , vinblastine sulfate , Caco-2 , nude mice , K562/ADR
Background
The Diegoa antigen commonly occurs in certain Asian and South American Indian populations. In general, hemolysis caused by anti-Diegoa antigen is not severe, and exchange transfusion is rarely needed. Here, we report a neonate with moderate hemolytic disease caused by anti-Diegoa antigen in the Baoji area of China.
Case presentation
A 39-week gestation male newborn of Han nationality was delivered by second cesarean section because of scarred uterus. The newborn’s birth weight was 3700 g with an Apgar score of 9. Four hours after delivery, transcutaneous bilirubin test revealed a level of 17 mg/dl. After 23 hours, the neonate developed anemia and hyperbilirubinemia. Bacterium, virus and other pathogens, as well as tests for arcuate and glucose-6-phosphate dehydrogenase, were all negative. Direct antiglobulin test of the neonate was positive. Diegoa antigens of the baby and his father were positive, while his mother was negative. The newborn was successfully cured with phototherapy and one-dose intravenous injection of human albumin.
Conclusions
It is important to consider and test for the anti-Diegoa antibody in cases of hemolytic disease of the newborn of the Han ethnicities of China.
Background
Infants with rule-out infections are responsible for the majority of empirical antibiotics treatment (EAT) in neonatal intensive care units (NICUs), particularly very preterm infants (VPIs). Antibiotic overuse has been linked to adverse outcomes. There is a paucity of data on the association between EAT and clinical outcomes (containing the nutritional outcomes) of VPIs without infection-related morbidities.
Methods
Clinical data of VPIs admitted in 28 hospitals in 20 provinces of China from September 2019 to December 2020 were collected. EAT of VPIs was calculated as the number of days with initial usage in the first week after birth, and then categorized into 3 groups (antibiotic exposure: none, 1-4 days, and > 4 days). Clinical characteristics, nutritional status , and the short-term clinical outcomes among 3 groups were compared and analyzed.
Results
In total, 1834 VPIs without infection-related morbidities in the first postnatal week were enrolled, including 152 cases (8.3%) without antibiotics, 374 cases (20.4%) with EAT ≤4 days and 1308 cases (71.3%) with EAT > 4 days. After adjusting for the confounding variables, longer duration of EAT was associated with decreased weight growth velocity and increased duration of reach of full enteral feeding in EAT > 4 days group (aβ: -4.83, 95% CI: − 6.12 ~ − 3.53; aβ: 2.77, 95% CI: 0.25 ~ 5.87, respectively) than those receiving no antibiotics. In addition, the risk of feeding intolerance (FI) in EAT > 4 days group was 4 times higher than that in non-antibiotic group (aOR: 4.14, 95%CI: 1.49 ~ 13.56) and 1.8 times higher than that in EAT ≤4 days group (aOR: 1.82, 95%CI: 1.08 ~ 3.17). EAT > 4 days was also a risk factor for greater than or equal to stage 2 necrotizing enterocolitis (NEC) than those who did not receive antibiotics (aOR: 7.68, 95%CI: 1.14 ~ 54.75) and those who received EAT ≤4 days antibiotics (aOR: 5.42, 95%CI: 1.94 ~ 14.80).
Conclusions
The EAT rate among uninfected VPIs was high in Chinese NICUs. Prolonged antibiotic exposure was associated with decreased weight growth velocity, longer duration of reach of full enteral feeding, increased risk of feeding intolerance and NEC ≥ stage 2. Future stewardship interventions to reduce EAT use should be designed and implemented.
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