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Diabetes can significantly increase the risk of post-stroke cognitive impairment (PSCI). Previous studies have shown that diabetes can be involved in the occurrence of cognitive impairment by insulin resistance, blood-brain barrier damage, low level inflammation, β-amyloid deposition and tau phosphorylation, aggravation of ischemic brain injury and oxidative stress. In recent years, the role of diabetes in the pathophysiology of PSCI is attracting increasing attention. This article reviews the correlation between diabetes mellitus and PSCI and the possible pathophysiological mechanisms, hoping to provide reference for prevention and treatment strategies of PSCI in diabetics.
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The intestinal flora and the intestinal environment in which it resides together constitute the intestinal microecosystem, it is significantly disturbed in neurocritical ill patients, as manifested by the decrease of bacterial diversity, an increase of pathogen, and the destruction of the intestinal barrier. Appropriate enteral nutrition is effective in maintaining intestinal barrier stability, regulating intestinal immune function, inhibiting intestinal inflammation, and regulating specific intestinal microbiota and intestinal function. It is important for sustaining intestinal microecological balance, reducing clinical complications in patients, and is a new target for the treatment of neurocritical ill patients. This review elaborates the alteration of intestinal microecology and treatment options recommended by current clinical guidelines in neurocritical ill patients and summarizes the research progress of the effects of enteral nutrition and several nutritional additives on intestinal flora and intestinal functions, to provide a reference for the follow-up research.
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Objective:To investigate the metabolic disorder of gut microbiota and short-chain fatty acids (SCFAs) in patients with hypertensive intracerebral hemorrhage and their correlations with the poor outcomes.Methods:Thirty-eight patients with hypertensive intracerebral hemorrhage within 7 d of onset and 32 healthy controls were enrolled prospectively. Fecal samples were collected for 16S rRNA sequencing and SCFAs levels detection. The outcome was evaluated by the modified Rankin Scale at 90 d after the onset, and >2 points were defined as a poor outcome. Multivariate logistic regression model was used to determine the correlations between the gut microbiota and the fecal SCFAs levels and outcomes. Results:The gut microbiota of patients with hypertensive intracerebral hemorrhage was significantly different from that of healthy control group. It is manifested as a decrease in α diversity, a difference in β diversity, an increase in the abundance of potential undesirable bacteria, a decrease in the abundance of common SCFA-producing bacteria and a decrease in the fecal SCFAs levels. In patients with hypertensive intracerebral hemorrhage, compared with the good outcome group, the α diversity of the gut microbiota, the abundance of SCFA-producing bacteria such as Lacetospirillum and Bacteroides, and the total SCFAs, acetic acid and propionic acid levels decreased in the poor outcome group. Multivariate logistic regression analysis showed that after adjusting for potential confounding factors, the decrease of fecal SCFAs levels after log2 conversion was significantly and independently correlated with the poor outcomes. Conclusion:Patients with hypertensive intracerebral hemorrhage have gut microbiota and SCFAs metabolic disorder, the latter is significantly correlated with the poor outcomes. Gut microbiota and SCFAs may become an outcome marker and treatment target for patients with hypertensive intracerebral hemorrhage
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Objective To investigate the gut microbial characteristics and risk factors in people with mild cognitive impairment. Methods Twenty-eight people with mild cognitive impairment and 65 age-, gender- as well as education-matched controls were recruited. Carotid artery ultrasonography was conducted and fasting anticoagulant blood and fresh fecal samples were collected on all subjects. Total bacterial DNA was extracted from the stool samples and amplified through real-time quantitative polymerase chain reaction (qPCR). Next generation analysis of 16S rRNA was performed to achieve genomic sequences using the Illumina Hiseq 2500 platform. Results Compared with the control group, mild cognitive impairment group exhibited greater microbial diversity (Bray Curtis distance, Adonis test, P<0.05), which were characterized by enrichment of proteobacteria, Synergistetes, lactobacillus, and depletion of Epulopiscium. Age, creatinine, average CCAIMT, Crouse score, and plaque numbers were associated with cognitive impairment. Multiple logistic regression analysis revealed that the number of hyperechoic plaques (OR=11.511, 95%CI:1.406~94.226, P=0.023) and the abundance of lactobacillus (OR=4.894, 95%CI: 1.090~21.966, P=0.038) were the important risk factors for mild cognitive impairment. Conclusion Higher abundance of lactobacillus in the gut holds potential as novel risk factor of people with mild cognitive impairment.
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Objective To investigate the gut microbial characteristics in patients with acute ischemic stroke and resilience of the gut microbiota after a stroke. Methods Ninety-five fecal samples from 28 ischemic stroke patients and 28 fecal samples from 28 healthy volunteers were collected.DNA was extracted from these samples and the bacterial 16S rRNA were amplified through real-time quantitative polymerase chain reaction (qPCR). All PCR products were mixed together and then sequenced using the Illumina Hiseq 2500 platform. Microbiome analysis was implemented in QIIME. Results Patients with acute ischemic stroke showed significantly higher diversity than controls (phylogenetic diversity, P=0.002). The overall composition of the gut microbial communities also differed significantly between acute ischemic stroke patients and healthy controls as indicated by the clear separation in principle coordinate analysis (Adonis test on Bray-Curtis, P<0.001). Stroke patients' intestines had more opportunistic pathogens, such as Enterobacteriaceae, Veillonellaceae and Streptococcaceae, fewer commensal or beneficial genera including Bacteroides and Prevotella. Four weeks after onset, the gut microbiota in stroke patients began to restore, but the alpha diversity declined (P<0.05). Conclusion The present study has revealed the characteristic of gut microbial dysbiosis and recovery in acute ischemic stroke patients.However,the significance of the dynamic gut microbiota in stroke patients needs further study.
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In physiological conditions, a diverse microbiota might enhance host defense. However, the gut microbiota of critically ill patients is characterized by lower diversity, lower abundances of key commensal genera, and overgrowth by one bacterial generation, a state known as dysbiosis. Increasing evidences indicate that microbiota-derived components can reach the systemic circulation from the gut and modulate immune homeostasis. Dysbiosis could have greater consequences for the critically ill patients and might contribute to poor outcome. In this review, we highlighted the crucial role of intestinal microbiota in systemic homeostasis in the critically ill patients and summarized emerging evidence in the field of microbiota-targeted therapies. This would provide new perspective for further establishing the causes and consequences of dysbiosis found in the critically ill patients as well as developing new strategies of intervention.
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Objective To explore the feasibility of high-frequency electric welding systemin cholecyste-ctomy when compared with ultrasound scalpel , Ligasure and traditional scalpel. Methods Ninety-six rabbits were enrolled in the study and divided into high-frequency electric welding system group , ultrasound scalpel group , Ligasure group and traditional scalpel group. The working temperature was recorded. Eight rabbits of each group were killed to observe the occlusion at 1st, 4th, 7th day postoperatively. Tissues were collected for observation under HE staining. Results High-frequency electric welding system group excelled in operative time , bleeding, working temperature, granulation tissue and inflammatory reaction. No significant difference was found in preope-rative and postoperative liver function test. Conclusion High-frequency electric welding system in cholecyste-ctomy has similar effect as ultrasound scalpel and Ligasure.