BackgroundInfections and graft-vs-host disease (GvHD) still represent major, not easily predictable complications in allogeneic hematopoietic stem cell transplant (allo-HSCT). Both conditions have been correlated to altered enteric microbiome profiles during the peritransplant period. The main objective of this study was to identify possible early microbiome-based markers useful in pretransplant risk stratification.MethodsStool samples were collected from 96 consecutive patients at the beginning of the pretransplant conditioning regimen (T0) and at 10 (T1) and 30 (T2) days following transplant. When significant in univariate analysis, the identified microbiome markers were used in multivariate regression analyses, together with other significant clinical variables for allo-HSCT-related risk stratification. Four main outcomes were addressed: (1) septic complications, (2) GvHD, (3) relapse of the underlying disease, and (4) mortality.ResultsThe presence of >5% proinflammatory Enterobacteriaceae at T0 was the only significant marker for the risk of microbiologically confirmed sepsis. Moreover, ≤10% Lachnospiraceae at T0 was the only significant factor for increased risk of overall mortality, including death from both infectious and noninfectious causes.Finally, a low bacterial alpha-diversity (Shannon index ≤ 1.3) at T1 was the only variable significantly correlating with an increased risk of GvHD within 30 days.ConclusionsMicrobiome markers can be useful in the very early identification of patients at risk for major transplant-related complications, offering new tools for individualized preemptive or therapeutic strategies to improve allo-HSCT outcomes.
Antenna-coupling group delay limits the cancellation bandwidth of conventional self-interference cancellers (SICs), making it difficult to ensure isolation in both transmit (TX) and receive (RX) bands. Isolation over both bands is achieved in the dual-path receiver architecture proposed in this paper. The main path consists of a highly linear current-mode RX with a passive RF SIC. The auxiliary path implements a notch in the TX band followed by an adaptive digital equalizer whose output is used to suppress the TX noise leakage in the RX band. The main and auxiliary receiver prototypes, implemented in 28-nm CMOS technology, operate between 1 and 2 GHz, occupy an area of 0.51 and 0.12 mm 2 , and have a power dissipation of 32-40 and 26-64 mW, respectively. The stand-alone RX has a noise figure (NF) of 4-5 dB and an out-of-band IIP3 of 18 dBm. Turning on the passive canceller results in an effective IIP3 of 25-29 dBm and a degradation of the NF of less than 0.8 dB. Thanks to its high dynamic range, the auxiliary path suppresses the TX noise by >29 dB while degrading the RX NF by only 1 dB at 23-dBm TX output power.
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