Early use of probiotics might prevent antibiotic-associated diarrhea in elderly (>65 years): a systematic review and meta-analysis.

BACKGROUND: Antibiotic-associated diarrhea (AAD) is diarrhea associated with consuming antibiotics that cannot be explained by other causes. AAD prolongs admission time and increases mortality and financial costs. Elderly individuals are more prone to receive antibiotic treatment and develop AAD. The finding that living probiotic microorganisms decrease AAD incidence in adults (<65 years) has been clarified. However, it is controversial among elderly individuals. METHODS: We aimed to explore whether probiotics could prevent AAD in elderly individuals. We searched three electronic databases (PubMed, EMBASE, and The Cochrane Library), and two reviewers independently screened and assessed the studies. RevMan5.4 software was used to perform a meta-analysis according to the PRISMA guidelines. RESULTS: Eight RCTs of 4691 participants were included. We excluded two large studies because probiotics were used 48 hours after the first dose of antibiotics, and there was no effect. Subgroup analysis of 6 RCTs showed that probiotics given within two days of antibiotic treatment produced a lower AAD prevalence rate in elderly individuals. CONCLUSION: We recommend that elderly individuals could be routinely distributed probiotics to prevent AAD development when receiving antibiotic treatment. TRIAL REGISTRATION: The review was not registered.

Predictive value of frailty in the mortality of hospitalized patients with COVID-19: a systematic review and meta-analysis.

Background: The present study aimed to analyze the impact of frailty on mortality risk among hospitalized patients with coronavirus disease 2019 (COVID-19). Methods: Literature searches were conducted using the MEDLINE, Embase, and Cochrane databases for articles reporting the association between frailty and mortality in hospitalized patients with COVID-19. The quality of the included studies was assessed using the Newcastle-Ottawa scale (NOS). A random-effects meta-analysis was performed to calculate the pooled effects. Results: A total of 21 studies with 26,652 hospitalized patients were included. Sixteen studies used the Clinical Frailty Score (CFS), and five used other frailty assessment tools. The pooled estimates of frailty in hospitalized patients with COVID-19 were 51.4% [95% confidence interval (CI): 39.9-62.9%]. In the CFS group, frail patients experienced a higher rate of short-term mortality than non-frail patients [odds ratio (OR) =3.0; 95% CI: 2.3-3.9; I2=72.7%; P<0.001]. In the other tools group, frail patients had a significantly increased short-term mortality risk compared with non-frail patients (OR =2.4; 95% CI: 1.4-4.1; P=0.001). Overall, a higher short-term mortality risk was observed for frail patients than non-frail patients (OR =2.8; 95% CI: 2.3-3.5; P<0.001). In older adults, frail patients had a higher rate of short-term mortality than non-frail patients (OR =2.3; 95% CI: 1.8-2.9; P<0.001). Conclusions: Compared to non-frail hospitalized patients with COVID-19, frail patients suffered a higher risk of all-cause mortality, and this result was also found in the older adult group.

The Impact of Frailty on Outcomes of Elderly Patients After Major Vascular Surgery: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the quality of published evidence of all frailty tools in major vascular surgery and to determine the effect of frailty on short and long-term outcomes after vascular procedures. METHODS: MEDLINE, Embase, Cochrane Database and Scopus (updated on May 12, 2018) were searched for studies evaluating the effect of frailty in vascular surgery and data were extracted from the included studies. A modified Newcastle-Ottawa scale was used to assess the quality of the included studies. The impact of frailty on outcomes was expressed as odds ratios (OR) or hazard ratios (HR) using a random effects model. RESULTS: A total of 22 cohort studies and one RCT were included. Overall frailty was found to be associated with a significantly increased risk of 30 day mortality in patients who underwent vascular surgery (OR 3.83, 95% CI 3.08-4.76), with similar effects in both patients who underwent abdominal aortic aneurysm (AAA) repair (OR 5.15, 95% CI 3.91-6.77) and lower extremity revascularisation (OR 3.29, 95% CI 2.53-4.28). Functional status remained the only tool with high quality of evidence predicting 30 day mortality after vascular surgery (OR 4.49, 95% CI 3.81-5.30). As for long-term outcomes, frailty was associated with a significantly increased risk of long-term all cause mortality in the overall studied population (HR 2.22, 95% CI 1.81-2.73), as well as in patients with AAA repair (HR 2.10, 95% CI 1.59-2.79) and lower extremity revascularisation (HR 2.46, 95% CI 1.73-3.49). Central muscle mass was found to be the only tool with moderate quality of evidence predicting long-term survival after major vascular surgery (HR 2.48, 95% CI 1.76-3.49). Other single domain tools were generally scored as low quality, and the modified Frailty Index was the only multi-domain tool with moderate quality while others were scored as low or very low. CONCLUSION: Frailty, assessed by functional status, can predict short-term mortality in elderly patients after vascular surgery; while central muscle mass may help determine long-term survival in abdominal aortic repair. As frailty is associated with both worse short and long-term outcomes, frailty assessment may be considered in patients scheduled for vascular surgery.

Effect of PLCε gene silencing on inhibiting the cancerous transformation of ulcerative colitis.

The aim of the present study was to investigate the effect of phosphoinositide-specific phospholipase Cε (PLCε) gene silencing on the inhibition of cancer development in ulcerative colitis (UC) and to explore the pathogenesis and carcinogenic mechanism of UC, in order to facilitate the establishment of novel strategies for the treatment of UC, prevent the cancerous transformation of UC and discern the association between inflammation and cancer. A pGenesil-PLCε RNA interference vector was constructed and transfected into HEK293 cells (pGenesil-PLCε group). HEK293 cells transfected with pGenesil empty plasmid were set as the negative control (pGenesil-NC group). The expression of PLCε was observed, and molecules associated with the PLC signaling pathway were detected using a reverse transcription-quantitative polymerase chain reaction and western blotting. ELISA was used to determine the expression of serum interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) of mice in which the PLCε gene had been silenced. Compared with the pGenesil-NC group, the mRNA and protein levels of PLCε were significantly decreased in the pGenesil-PLCε group. In addition, the mRNA levels of K-ras, NF-κB, Fas and Bcl-2 were markedly reduced, while P53 mRNA level was notably enhanced, in the pGenesil-PLCε group, and these changes were accompanied by similar changes in the corresponding protein levels. The serum IL-1 and TNF-α expression in the PLCε gene-silenced mice was significantly reduced compared with that in the control mice. In conclusion, PLCε RNA silencing can effectively inhibit the cancerous transformation of UC by regulating the colorectal cancer-related cell proliferation and cell cycle in vivo. In addition, PLCε RNA silencing can suppress the expression of inflammatory factors in vitro.

A Pilot Study of the FRAIL Scale on Predicting Outcomes in Chinese Elderly People With Type 2 Diabetes.

OBJECTIVE: To determine the prevalence of frailty in older diabetic inpatients using the FRAIL scale and to evaluate the association of frailty with physical function and diabetic vascular complications, as well as its relationship to hospitalization and mortality. METHODS: This pilot study was conducted at the Center of Gerontology and Geriatrics, West China Hospital. A total of 146 inpatients aged 60 years or older with type 2 diabetes were enrolled between December 2011 and October 2012, and participants were followed until December 2013. Frailty, functional status, diabetic nephropathy, and macroangiopathy were assessed at enrollment. The longitudinal outcomes were hospitalization and mortality. Frailty was determined by the 5-item FRAIL scale. Functional status was determined using activities of daily living (ADLs), instrumental activities of daily living (IADLs), and timed "Up and Go" test (TUG). RESULTS: At baseline, 47.2% of participants were robust, 37.7% were prefrail, and 15.1% were frail. After adjusting for age, gender, MMSE score, body mass index (BMI), and the duration and severity of diabetes, both prefrailty and frailty were significantly associated with ADL disability (odds ratio [OR] 2.84 and 6.58, respectively), mobility impairment (OR 3.89 and 22.15, respectively), and diabetic nephropathy (OR 4.31 and 4.46, respectively). In the year after enrollment, the proportion of participants with 3 or more hospitalizations was 16.0% among robust participants, 23.6% among prefrail participants, and 40.9% among frail participants. Being frail predicted a greater number of hospitalizations (OR 5.99). There was no cumulative mortality for robust participants, whereas 3.6% of prefrail participants and 22.7% of frail participants died during follow-up (P < .001). CONCLUSION: In older diabetic inpatients in China, frailty is an independent risk factor for adverse health outcomes. Clinicians could use the FRAIL scale to regularly identify individuals who are frail or who are at risk of becoming frail.

[Role of p38 mitogen-activated protein kinase pathway in pathogenesis of ulcerative colitis].

OBJECTIVE: To elucidate the role of p38 mitogen-activated protein kinase (p38MAPK) in the pathogenesis of ulcerative colitis (UC) and DSS-induced colitis in mice. METHODS: (1) 27 Balb/c mice were divided randomly into three groups: DSS-induced colitis group, normal control group and SB203580 treatment group. In DSS-induced colitis group, mice were feed with 5% DSS solution. In SB203580 treatment group, mice were feed with 5%DSS solution for 72 hours, then treated with intraperitoneal injection of SB203580 (1 mg/kg) once daily. Disease activity index (DAI) was record to evaluate the severity of colitis. The mice were executed after 7 days. The levels of TNF-alpha and IL-1beta were measured by ELISA. (2) A total of 54 cases were included in the study. 36 cases were patients with active ulcerative colitis, 18 cases were normal mucosa from 18 colon cancer cases served as control. Effects of SB203580 (a selective p38MAPK inhibitor) on expression of TNF-alpha and IL-1beta in intestinal mucosal biopsy specimens from patients with ulcerative colitis were determined on condition of tissue culture. RESULTS: (1) The DAI scores, the levels of TNF-alpha and IL-1beta in SB203580 group were lower significantly compared with DSS group (P < 0.05), and were increased significantly compared with normal control group (P < 0.05). (2) The levels of TNF-alpha and IL-1beta in intestinal mucosal biopsy specimens in SB203580 treatment group were lower significantly than those in UC group (P < 0.05). CONCLUSION: SB203580 can inhibit p38MAPK signal transduction pathway, then reduce the expression of pro-inflammatory cytokine TNF-alpha and IL-1beta.

Occurrence and risk factors of mild cognitive impairment in the older Chinese population: a 3-year follow-up study.

OBJECTIVE: To investigate the occurrence and risk factors of mild cognitive impairment (MCI) and the conversion rates to dementia in Chinese people over 80 years of age. METHODS: Two hundred and two participants (>80 years old) without dementia were assessed clinically using neuropsychological tests; they were re-assessed at 1, 2, and 3 years. RESULTS: The results revealed that 30.2% of the study population was classified as having MCI at baseline. Multivariate linear regression analysis showed that coronary heart disease, hypertension, and stroke were risk factors of MCI. During the 3 years follow-up, the occurrence of MCI increased, and 21.8% of the participants with MCI progressed to dementia. CONCLUSIONS: These results suggest that in the older elderly, prevention and early treatment of cardiovascular and cerebrovascular diseases may be effective in lowering the risk of MCI. MCI is a high risk factor for dementia.

[Study on esophageal motor function against reflux after esophagogastric anastomosis with mucosal valve].

OBJECTIVE: To find an effective operative procedure against reflux after esophagogastric anastomosis with mucosal valve. METHODS: Four hundred and sixty-four patients with esophageal or cardiac cancer were randomly divided into three groups according to anastomosis modes. Group A underwent esophagogastric anastomosis with mucosal valve (175 cases), group B with mechanical stapler (151 cases) and group C one layer anastomosis with handcraft suture (138 cases). The gastroesophageal reflux index (GERI) was examined by isotope,and 24 h esophageal pH was also monitored. The esophageal motor function was compared among three groups. RESULTS: The reflux rates were 0, 33.3%, and 6.7% in group A, B, C respectively. The esophageal motor function and the 24 h esophageal pH monitoring indicated that the various indexes were approaching to the normal level in group A, but the various indexes in group B and C were significantly different from the normal values (P< 0.05). CONCLUSION: The esophagogastric anastomosis with mucosal valve has better antireflux effect and can prevent the reflux esophagitis after esophageal or cardiac cancer eradication.