Analysis of fecal microbiota and related clinical indicators in ICU patients with sepsis.

Background: To analyze the characteristics of fecal microbiota disturbance in the intensive care unit (ICU) patients with sepsis and the correlation with related clinical indicators. Methods: This study included 31 patients with sepsis admitted to the emergency ICU ward between September 2019 and December 2021. They were divided into Group without septic shock (ND_NS group, 7 cases) and Group with septic shock (ND_S group, 24 cases) according to the presence or absence of septic shock. Furthermore, we divided these 31 sepsis patients into Clinical Improvement group (21 cases) and Death or DAMA group (10 cases) based on clinical outcome, 15 cases of Physical Examiner recruited in the same period were included as control group: ND_HC group (15 cases). The fecal samples of the patients with sepsis within 24 h of admission and random fecal samples of the control group were collected and analyzed by 16S rDNA gene sequencing used for the analysis of fecal microbiota. At the same time, the relevant clinical data of these patients with sepsis were also collected for analysis. Results: There were 15 cases with drug-resistant bacteria in the ND_S group and only 2 cases in the ND_NS group (P = 0.015). There were significant differences in APACHE II score, length of ICU stay, lactate level, and oxygenation index of patients between the Death or DAMA group and Clinical Improvement group (all P < 0.05). For phylum level, the abundance of Firmicutes, Actinobacteria, and Bacteroidetes decreased in the ND group compared with the ND_HC group, while the abundance of Proteobacteria increased (P < 0.05). For genus level, the relative abundance of Escherichia-Shigella and Klebsiella were significantly increased in the ND group compared with the ND_HC group (P < 0.05). The top six genera in relative abundance in the ND_S group were Escherichia-Shigella, Enterococcus, Bifidobacterium, Lactobacillus, Akkermansia, and Klebsiella. Compared with the Clinical Improvement group, the relative abundance of Escherichia-Shigella and Klebsiella in the Death or DAMA group showed an increasing trend with no significant significance, while the relative abundance of Enterococcus and Faecalibacterium decreased in the Death or DAMA group (P < 0.05). Alpha diversity analysis showed that compared with the ND_HC group, the alpha diversity of the fecal microbiota in the ND group decreased. There were significant differences in the Observed_species index, Chao1 index, and ACE index of patients between the ND_HC group and ND group (all P < 0.05). Moreover, compared with the ND_NS group, the Alpha diversity of the ND_S group was more abundant. PCoA analysis showed significant differences in microbial community structure between the ND group and ND_HC group (P = 0.001). There also were significant differences in microbial community structure between the ND_S group and ND_NS group (P = 0.008). LEfSe analysis showed that compared with the ND_HC group, there were significant differences in the species of the ND group, including Enterobacteriaceae, Escherichia-Shigella, Enterococcus, Elizabethkingia, and Family_XIII_AD3011_group. Conclusions: ICU patients with sepsis suffered intestinal microecological disturbances with significantly decreased abundance of fecal microbiota, diversity, and beneficial symbiotic bacteria. For these patients, the ratio of pathogenic bacteria, including Escherichia-Shigella and Klebsiella increased and became the main bacterial genus in some samples. Moreover, the increasing trend of these two pathogenic bacteria may be correlated with the development of septic shock and the risk of death in patients with sepsis.

Blood Purification for Hypertriglyceridemia-Induced Acute Pancreatitis: A Meta-analysis.

OBJECTIVES: The purpose of our study is to investigate the efficacy and safety of blood purification (BP) therapy in hypertriglyceridemia-induced acute pancreatitis. METHODS: We searched PubMed, Embase, Cochrane Library, and Web of Science databases for articles published. RESULTS: The analysis included 13 studies with 934 patients (263 in BP group, 671 in control group). There was no difference in efficacy and safety between the BP group and the control group (all P > 0.05). Compared with conventional treatment, BP had shorter hospital stay (mean difference, -4.96; 95% confidence interval [CI], -8.81 to -1.11; P = 0.01) in the case of similar mortality and complications. Meanwhile, insulin treatment showed similar mortality to BP, but fewer local complications (odds risk, 2.18; 95% CI, 1.13-4.20; P = 0.02) and shorter hospital stay (mean difference, 5.46; 95% CI, 0.64-10.29; P = 0.03). CONCLUSIONS: In the treatment of hypertriglyceridemia-induced acute pancreatitis, BP methods are effective in accelerating triglyceride level reduction and shortening hospital stay but do not affect the efficacy or reduce mortality significantly compared with conventional treatment. Insulin therapy has the same effect as BP but decreases incidence of complications and cost.

Low-Density Lipoprotein Cholesterol and Alzheimer's Disease: A Systematic Review and Meta-Analysis.

Objective: To assess the association between low-density lipoprotein cholesterol (LDL-c) and risk of Alzheimer's disease (AD). Methods: Embase, Pubmed, and Web of Science were searched until June 2019. Standard mean difference (SMD) with 95% confidence intervals (CI) was estimated using random-effects models. Results: Our meta-analysis of 26 studies revealed higher levels of LDL-c in AD than that of non-dementia controls (SMD = 0.35, 95% CI 0.12-0.58, p < 0.01). The meta-regression analysis on confounders showed that age (p < 0.01, Adj R-squared = 92.41%) and cardiovascular disease (p = 0.01, Adj R-squared = 85.21%), but not the body mass index, education, smoking, hypertension and diabetes mellitus, exerted an impact on the relationship between LDL-c and risk of ICH. Further subgroup analysis of age showed LDL-c levels in AD patients aged 60-70 were higher than that of non-dementia (60 ≤ age < 70: SMD = 0.80, 95% CI 0.23-1.37, p < 0.01); but no association between the SMD of AD in LDL-c and age over 70 was noted across the studies (70 ≤ age < 77: SMD = -0.02, 95% CI -0.39~0.34, p = 9.0; 77 ≤ age < 80: SMD = 0.15, 95% CI -0.17~0.47, p = 0.35; ≥80: SMD = 0.53, 95% CI -0.04~1.11, p = 0.07). The concentrations of LDL-c during the quintile interval of 3~4 were positively associated with AD (121 ≤ concentration < 137: SMD = 0.98, 95% CI 0.13~1.82, p = 0.02; ≥137: SMD = 0.62, 95% CI 0.18~1.06, p < 0.01); whereas there was no correlation between AD and LDL-c within the quintile interval of 1~2 (103.9 ≤ concentration < 112: SMD = 0.08, 95% CI -0.20~0.35, p = 0.59; 112 ≤ concentration < 121: SMD = -0.26, 95% CI -0.58~0.06, p = 0.11). Conclusions: Elevated concentration of LDL-c (>121 mg/dl) may be a potential risk factor for AD. This association is strong in patients aged 60-70 years, but vanishes with advancing age.

Fibrinogen and risk of dementia: A systematic review and meta-analysis.

BACKGROUND: The aim of this meta-analysis is to evaluate the association of fibrinogen with risk of dementia and its subtypes. METHODS: Embase, Pubmed and Web of Science were retrieved systematically up to February 2019. Standard mean difference (SMD) with 95 % confidence intervals was estimated using random-effects models. RESULTS: Sixteen studies involving 3,649 participants were summarized. Patients with all-cause dementia exhibited higher fibrinogen levels than those in non-dementia controls (SMD = 0.90 [0.43;1.36] p < 0.01). Further subgroup analysis revealed a positive association of fibrinogen with vascular dementia (VaD) (SMD = 1.11 [0.45;1.78] p < 0.01) rather than Alzheimer's disease (AD) (SMD = 0.01 [-0.17;0.19]) p = 0.92) and Parkinson's disease dementia (PDD) (SMD = 0.35 [-0.23;0.93] p = 0.24). This correlation was significant in Europeans (SMD = 0.92 [0.34;1.49] p < 0.01), but probably not in Asian based populations (SMD = 1.04 [-0.09;2.17] p = 0.07), and gradually declined with advancing age (60 ≤ age < 70: SMD = 1.22 [0.38;2.06] p < 0.01; 70 ≤ age < 80: SMD = 0.29 [0.04;0.53] p = 0.02; age ≥ 80: SMD = 0.01 [-0.12;0.15] p = 0.84). CONCLUSIONS: Plasma fibrinogen is a potential risk factor for all-cause dementia and VaD under the age of 80, and is more obvious in cohorts with people of European descent.

The expression and biological function of chemokine CXCL12 and receptor CXCR4/CXCR7 in placenta accreta spectrum disorders.

OBJECTIVES: Investigation of mechanism related to excessive invasion of trophoblast cells in placenta accreta spectrum disorders (PAS) provides more strategies and ideas for clinical diagnosis and treatment. MATERIALS AND METHODS: Blood and placental samples were collected from included patients. The distribution and expression of CXCL12, CXCR4 and CXCR7 proteins in the paraffin of placental tissue in the included cases were analysed, and we analyse the downstream pathways or key proteins involved in cell invasion. RESULTS: Firstly, our results determined that CXCL12 and CXCR4/CXCR7 were increased in extravillous trophoblastic cell (CXCL12: P < .001; CXCR4: P < .001; CXCR7: P < .001), and the expression levels were closely related to the invasion depth of trophoblastic cells. Secondly, CXCL12 has the potential to become a biochemical indicator of PAS since the high expression of placental trophoblast CXCL12 may be an important source of blood CXCL12. Using lentivirus-mediated RNA interference and overexpression assay, it was found that both chemokine CXCL12 and receptor CXCR4/CXCR7 are associated with regulation of trophoblast cell proliferation, migration and invasion. Further results proved that through the activating the phosphorylation and increasing the expression of MLC and AKT proteins in the Rho/rock, PI3K/AKT signalling pathway, CXCL12, CXCR4 and CXCR7 could up-regulate the expression of RhoA, Rac1 and Cdc42 proteins to promote the migration and invasion of extravillous trophoblastic cell and ultimately formate the placenta accrete compare to the normal placenta. CONCLUSIONS: Our research proved that trophoblasts may contribute to a PAS-associated increase in CXCL12 levels in maternal blood. CXCL12 is not only associated with biological roles of PAS, but may also be potential for prediction of PAS.

Endovascular therapy versus intravenous thrombolysis in cervical artery dissection-related ischemic stroke: a meta-analysis.

BACKGROUND: The purpose of our meta-analysis is to evaluate the endovascular therapy (EVT) in patients with cervical artery dissection (CAD)-related acute ischemic stroke (AIS) by comparing its efficacy and safety with the ones of intravenous thrombolysis (IVT). METHODS: A systematic search on EVT to CAD-related ischemic stroke is performed. The meta-analysis models are applied to calculate either the risk ratio (RR) with 95% confidence interval (CI) or pooled proportions with 95% CI of favorable functional outcome (mRS = 0-2), excellent functional outcome (mRS = 0-1), symptomatic intracranial hemorrhage (SICH), mortality and recurrent stroke between EVT and IVT in CAD-related stroke. The differences between the two treatment groups are analyzed by the pooled odds ratio value and Chi-squared test. RESULTS: A total of 190 patients given EVT and 139 IVT-alone patients are included. By comparing EVT alone and IVT alone, patients treated with EVT alone are more likely to experience favorable outcomes than those treated with IVT alone (71.2% vs 53.4%). Besides, there is no significant difference in excellent functional outcome, SICH, mortality and recurrent stroke between the EVT-alone and IVT-alone groups (all P > 0.05). Towards general EVT (EVT with or without IVT), the outcomes are not significantly different from those of IVT alone except for a higher mortality rate (10.2% vs 3.2%). CONCLUSION: Based on our findings, EVT is considered to be more efficacious than IVT for CAD-related AIS patients. Although EVT alone tends to be safe and promising, its safety needs to be further evaluated, particularly for EVT separating from IVT therapy.

Study on compositions of FCC flue gas and pollutant precursors from FCC catalysts.

Fluid catalytic cracking (FCC) unit emits a large amount of flue gas, which is a major issue of environmental protection supervision. A spent FCC catalyst from a typical FCC unit was characterized by NMR, XPS, EA TGA and TPD-MS methods. XPS results presented that the nitrogen compounds in coke were pyridine nitrogen, pyrrole and quaternary nitrogen. Sulfur compounds in coke are in the form of thiophene and thiols. TGA and TPD-MS results indicated that the soft coke in the spent catalyst may decompose to small molecular such as NOx, SO2 and HCN. NH3 and HCN are mainly emitted due to the incomplete combustion. The flue gas from the FCC unit is monitored by different on-line monitoring instruments. Results showed that the existence of ammonia greatly affected the value of SO2 during the venting process or instruments' inlet piping system, where saturated vapor in flue gas is partially condensed. The concentration of NH3 and HCN is more than 100 ppm, which should be paid more attention to. Taken together, fourier transform infrared method was more applicable for monitoring FCC flue gas than non-dispersed infrared method and ultraviolet fluorescence method.

Cerebral Microbleeds and the Safety of Anticoagulation in Ischemic Stroke Patients: A Systematic Review and Meta-Analysis.

OBJECTIVES: The objective of this study was to investigate the safety of anticoagulation in ischemic stroke (IS) patients with cerebral microbleeds (CMBs). METHODS: PubMed, Web of Science, Elsevier Clinical Key, Google Scholar, and Cochrane Library from 1996 to July 2018 were searched to identify relevant studies that included IS patients, underwent T2*-weighted gradient recalled echo, or susceptibility-weighted imaging for detection CMBs and used anticoagulants during follow-up. Primary outcome of interest was intracerebral hemorrhage (ICH). Secondary outcomes were hemorrhage transformation, IS, total mortality, and new developed CMBs. We critically appraised studies and conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. RESULTS: We included 7 observational studies. Cerebral microbleeds were associated with a significantly elevated risk of anticoagulation-related ICH (odds ratio, 4.01; 95% confidence interval, 1.82-8.81; P = 0.001). It was significant for warfarin (odds ratio, 8.02; 95% confidence interval, 1.51-42.62; P = 0.015). New developed CMBs in patients on warfarin treatment were associated with baseline CMBs, and the appearance of hemorrhagic transformation did not have a significant relationship with baseline CMBs. CONCLUSIONS: The presence of CMBs increases the risk of ICH during anticoagulant treatment (especially warfarin) in IS patients. Further studies with larger numbers of patients are needed to confirm our conclusions.

Serum uric acid concentrations and risk of intracerebral hemorrhage: A systematic review and meta-analysis.

BACKGROUND AND AIMS: The relationship between serum uric acid (UA) and the risk of intracerebral hemorrhage (ICH) remains controversial. The aim of our systematic review and meta-analysis was to ascertain the association between serum UA concentrations and the risk of ICH. METHODS: We systematically searched databases of Embase, Pubmed, Web of Science and Cochrane Library up to December 30, 2017, and additional papers were identified through a manual search. Mean difference (MD) for serum UA levels with 95% confidence intervals (CI) was calculated. Six studies, including 345 ICH patients, 574 ischemic stroke patients and 535 healthy controls, were identified for meta-analysis. RESULTS: Our results revealed no statistically significant differences in the comparison of UA between ICH and healthy controls (95% CI = -9.04-15.61); UA levels in patients with ischemic stroke were significantly higher than those in healthy controls (95% CI = 3.91-56.32); further subgroup analysis of age showed higher UA levels in ICH patients over 65 years than healthy controls (age≥65: 95% CI = 1.44-35.96). Subgroup of ethnicity (Asians: CI = -9.06-21.00; Caucasians: 95% CI = -68.43-8.43), gender (Men: 95% CI = -56.08-4.73; Women: 95% CI = -27.19-35.91) and sample size (large samples: 95% CI = -20.54-41.05; small samples: 95% CI = -25.41-13.78) with respect to UA levels between ICH and healthy controls did not change these results. CONCLUSIONS: This meta-analysis showed that serum UA levels did not increase the risk of ICH probably because of the dual roles of UA, i.e. pro-oxidant and antioxidant, in the progression of atherosclerosis. However, serum UA may be a potential risk factor for ICH in the elderly. There were no race-specific differences in UA levels between Asians and Caucasians as well as gender-related differences between men and women in the risk of ICH.

Comparative efficacy and acceptability of antidepressant treatment in poststroke depression: a multiple-treatments meta-analysis.

OBJECTIVE: The aim of this study is to create a rank order of the comparative efficacy and acceptability (risk of all-cause discontinuation) of antidepressant treatment in poststroke depression (PSD) by integrating direct and indirect evidence. DESIGN: Multiple-treatments meta-analysis of randomised controlled trials. PARTICIPANTS: Patients with depression following stroke. INTERVENTIONS: 10 antidepressants and placebo in the acute treatment of PSD. OUTCOME MEASURES: The primary outcomes were the overall efficacy, defined as the mean change of the total depression score. The secondary outcome was the acceptability, defined as risk of all-cause discontinuation. These estimates as standardised mean differences or ORs with 95% CIs. RESULTS: We identified 12 suitable trials, with data from 707 participants. All drugs were significantly more effective than placebo apart from sertraline, nefiracetam and fluoxetine. Most of the comparisons for acceptability revealed no significant differences except that paroxetine had significantly lower all-cause discontinuation than doxepin, citalopram and fluoxetine. Standardised mean differences compared with placebo for efficacy varied from -6.54 for the best drug (reboxetine) to 0.51 for the worst drug (nefiracetam). ORs compared with placebo for acceptability ranged from 0.09 for the best drug (paroxetine) to 3.42 for the worst drug (citalopram). For the efficacy rank, reboxetine, paroxetine, doxepin and duloxetine were among the most efficacious treatments, the cumulative probabilities of which were 100%, 85.7%, 83.2%, 62.4%, respectively. With respect to the acceptability rank, paroxetine, placebo, sertraline and nortriptyline were among the most acceptable treatments, the cumulative probabilities of which were 92.4%, 63.5%, 57.3%, 56.3%. CONCLUSION: After weighing the efficacy and acceptability, we conclude that paroxetine might be the best choice when starting acute treatment for PSD, and fluoxetine might be the worst choice. TRIAL REGISTRATION NUMBER: This systematic review has been registered in the Prospective Register of Systematic Review Protocols (PROSPERO) public database (CRD42017054741; http://www.crd.york.ac.uk/PROSPERO).

Nephrolithiasis and Osteomalacia associated with adefovir-induced Fanconi syndrome in a patient with hepatitis B.

BACKGROUND: An increasing number of case reports suggest that acquired renal Fanconi syndrome may be associated with prolonged use of adefovir against hepatitis B virus. Renal Fanconi syndrome is an uncommon disease, and its complication with nephrolithiasis is quite rare. Herein, we report a rare coexistence of nephrolithiasis and acquired renal Fanconi syndrome in a chronic hepatitis B-positive patient with prolonged adefovir therapy. CASE PRESENTATION: The patient presented with osteomalacia and nephrolithiasis. Consequently, extracorporeal shock-wave lithotripsy and left double-J ureteral stent insertion were considered for obstructive nephropathy, which was caused by nephrolithiasis. However, osteomalacia had been misdiagnosed as osteoporosis before admission to our hospital. On admission, a complexity of multiple fractures, hypophosphataemia, glycosuria without hyperglycaemia and non-anion-gap metabolic acidosis indicated a diagnosis of acquired renal Fanconi syndrome induced by adefovir. After switching from adefovir to entecavir, the patient's symptoms and laboratory findings improved significantly. CONCLUSIONS: The mechanism responsible for nephrolithiasis in renal Fanconi syndrome is still unclear. We recommend regularly monitoring renal function and serum calcium and serum phosphate to prevent renal Fanconi syndrome during the prolonged use of adefovir for hepatitis B virus.

Safety and Efficacy of Thrombolysis in Cervical Artery Dissection-Related Ischemic Stroke: A Meta-Analysis of Observational Studies.

BACKGROUND: Although thrombolysis is considered to be the first-line treatment for ischemic stroke, there remains an ongoing controversy on the safety and efficacy of thrombolysis in cervical artery dissection (CAD). The aim of this meta-analysis was to assess observational data related to the safety and efficacy of thrombolysis in CAD-related ischemic stroke. METHODS: We performed a systematic search of the efficacy of thrombolysis treatment in CAD-related ischemic stroke with appropriate observational studies identified for the study. The meta-analysis models in Comprehensive Meta-Analysis V2 software were applied to calculate the merged rates of favorable outcome (modified Rankin Scale, mRS 0-2), excellent outcome (mRS 0-1), intracranial hemorrhage (ICH), symptomatic ICH (SICH), mortality and recurrent stroke between thrombolysis and non-thrombolysis in CAD-related stroke. The difference of outcomes and adverse events between the 2 groups was compared by analyzing the pooled OR value and chi-square test using the software SPSS. RESULTS: A total of 846 patients were identified from 10 studies (174 with thrombolysis; 672 with non-thrombolysis). The meta-analysis detected no significant statistical difference in the proportion of CAD-related stroke patients enjoying a favorable outcome at the 3 months' follow-up between the thrombolysis and non-thrombolysis groups (53.7 vs. 58.2%, OR 0.782, x03C7;2 = 0.594, p > 0.05); non-thrombolysis was slightly superior than thrombolysis in terms of excellent outcome (52.4 vs. 34.4%, OR 0.489, x03C7;2 = 9.143, p = 0.002). There was no significant difference in SICH, mortality and recurrent stroke rates between the 2 groups (all p > 0.05). ICH rate was higher in the thrombolysis group of CAD-related stroke patients compared to that in the non-thrombolysis group (12.3 vs. 7.4%, OR 2.647, x03C7;2 = 4.127, p = 0.042). CONCLUSION: Thrombolysis seems to be equally safe and will achieve an efficacy similar to the efficacy of non-thrombolysis in patients with acute ischemic stroke due to CAD. It is also as effective as thrombolysis in stroke from miscellaneous causes. Therefore, CAD patients experiencing a stroke should not be denied thrombolysis therapy. However, this will need to be confirmed in large-scale randomized studies, especially involving intravenous thrombolysis treatment.