Gut dysbiosis in cutaneous T-cell lymphoma is characterized by shifts in relative abundances of specific bacterial taxa and decreased diversity in more advanced disease.

BACKGROUND: Cutaneous T-cell lymphoma (CTCL) patients often suffer from recurrent skin infections and profound immune dysregulation in advanced disease. The gut microbiome has been recognized to influence cancers and cutaneous conditions; however, it has not yet been studied in CTCL. OBJECTIVES: To investigate the gut microbiome in patients with CTCL and in healthy controls. METHODS: A case-control study was conducted between January 2019 and November 2020 at Northwestern's busy multidisciplinary CTCL clinic (Chicago, Illinois, USA) utilizing 16S ribosomal RNA gene amplicon sequencing and bioinformatics analyses to characterize the microbiota present in fecal samples of CTCL patients (n = 38) and age-matched healthy controls (n = 13) from the same geographical region. RESULTS: Gut microbial α-diversity trended lower in patients with CTCL and was significantly lower in patients with advanced CTCL relative to controls (P = 0.015). No differences in ß-diversity were identified. Specific taxa were significantly reduced in patient samples; significance was determined using adjusted P-values (q-values) that accounted for a false discovery rate threshold of 0.05. Significantly reduced taxa in patient samples included the phylum Actinobacteria (q = 0.0002), classes Coriobacteriia (q = 0.002) and Actinobacteria (q = 0.03), order Coriobacteriales (q = 0.003), and genus Anaerotruncus (q = 0.01). The families Eggerthellaceae (q = 0.0007) and Lactobacillaceae (q = 0.02) were significantly reduced in patients with high skin disease burden. CONCLUSIONS: Gut dysbiosis can be seen in patients with CTCL compared to healthy controls and is pronounced in more advanced CTCL. The taxonomic shifts associated with CTCL are similar to those previously reported in atopic dermatitis and opposite those of psoriasis, suggesting microbial parallels to the immune profile and skin barrier differences between these conditions. These findings may suggest new microbial disease biomarkers and reveal a new angle for intervention.

Growing up in the hospital: Part II, Nurturing the philosophy of family-centered care.

This article is the second in a series that addresses the issues of "growing up in the hospital." Whereas the first article focused on the child and the complex growth and development issues surrounding indefinite hospitalization, this article will focus on the family, the philosophy of family-centered care, and how nursing practice can nurture this ideal when working with children who must "grow up in the hospital."

Growing up in the hospital: Part I, Let's focus on the child.

Major advances in medical research and technology have made it possible for many children with complex chronic illnesses to survive, including those who just a few years ago would have died (Hobbs & Perrin, 1985). One goal of health care professionals who care for these children is, and continues to be, discharge of the child to the family and community whenever possible. Complex medical and nursing care, elusive diagnoses, complicated psychosocial issues, and inconsistent community resources often mean discharge must be prolonged. Focusing on the creation of innovative methods for integrating the growth and developmental needs of these special children is a challenging and often overlooked aspect of our pediatric nursing practice. This article is one of a series that will address the issues of growing up in the hospital. What are the implications for the child, family, and professional nurse? What strategies can we devise to assist our patients through what may be a very lengthy and complex hospital course?