The brain-gut axis is an important pathway for the interaction between the central nervous system and the gastrointestinal tract. Ischemic stroke can promote the imbalance and displacement of intestinal flora, and the intestinal flora and its metabolites in turn can affect the occurrence, development and outcome of ischemic stroke. This article reviews the related literature on ischemic stroke and intestinal flora, in order to review the relationship between the two and related mechanisms, and to prospect the stroke treatment of targeting intestinal flora.

Objective:To systematically review the qualitative researches on patients′ lived experiences of being mechanically ventilated in intensive care unit.Methods:The Cochrane Library, PubMed, Web of Science, Ovid, CNKI, VIP and Wanfang database were searched to collect qualitative studies on patients′ lived experiences of being mechanically ventilated in intensive care unit, from October 2009 to October 2019. Two reviewers independently screened the literature against the pre-determined inclusion and exclusion criteria, extracting the data, and evaluated the included studies according to JBI Critical Appraisal Tool for qualitative studies in Australia.Results:A total of fourteen studies were included. Thirty-eight complete results were grouped according to their similarities to form seven categories. These categories led to three synthesized findings: results 1: patients suffered from both physical and mental distress; results 2: they were eager for supports; results 3: patients achieved personal growth through self-adjustment and reflection.Conclusion:Discomfort experience during mechanical ventilation reduces patients′ comfort, and to a certain extent, has negative impacts on their physical or mental health and clinical outcome. As the main caregiver of patients with mechanical ventilation, not only should nurses alleviate patients′ physical distress by strengthening communication but also give them adequate psychological support. Eventually, promote the physical and mental recovery of patients.

Objective    To systematically evaluate the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Methods    We searched the CNKI, Wanfang Database, VIP, PubMed, Web of science, Cochrane Library (from inception to January 2019) to identify studies about the risk factors of acute kidney injury after surgery for acute type A aortic dissection. Quality of the included studies was evaluated by Kars-Ottawa scale. The meta-analysis was performed by RevMan 5.3 software. Results    A total of 16 case-control studies were included  involving 1 728 patients. The results of meta-analysis showed that gender (OR=1.58, 95% CI 1.31 to 1.89, P<0.001), body mass index (OR=1.05, 95%  CI 0.66 to 1.45, P<0.001), hypertension (OR=1.58, 95% CI 1.10 to 2.26, P=0.010), smoking history (OR=1.71, 95% CI 1.12 to 2.61, P=0.010), preoperative serum creatinine level (OR=30.26, 95% CI 20.17 to 40.35, P<0.000 01), preoperative white blood cell (OR=1.73, 95% CI 0.26 to 3.20, P=0.020), extracorporeal circulation time (OR=25.60, 95% CI 21.13 to 30.08, P<0.000 01), aortic occlusion time (OR=13.24, 95% CI 10.27 to 16.22, P<0.001), deep hypothermic circulatory arrest (DHCA) time (OR=2.58, 95% CI 0.86 to 4.29, P=0.003), arch replacement (OR=2.31, 95% CI 1.31 to 4.07, P=0.004), intraoperative blood transfusion (OR=1.27, 95% CI 0.29 to 2.24, P=0.010), postoperative mean arterial pressure (OR=–2.41, 95% CI –4.59 to –0.24, P=0.030), reoperation due to postoperative hemorrhage (OR=4.19, 95% CI 2.04 to 8.63, P<0.001), postoperative acute respiratory insufficiency (OR=6.61, 95% CI 3.21 to 13.60, P<0.001), postoperative mechanical ventilation time (OR=48.51, 95% CI 21.94 to 75.09, P<0.001) were associated with acute kidney injury after surgery for acute type A aortic dissection. Conclusion    Current evidence shows that gender, body mass index, hypertension, smoking history, preoperative serum creatinine level, preoperative white blood cell, extracorporeal circulation time, aortic occlusion time, deep hypothermic circulatory arrest (DHCA) time, arch replacement, intraoperative blood transfusion, postoperative mean arterial pressure, postoperative hemorrhage reoperation, postoperative acute respiratory insufficiency and postoperative mechanical ventilation time were risk factors for acute kidney injury after surgery for type A aortic dissection. Medical staff can strengthen perioperative management of patients with acute type A aortic dissection combined with the above factors, so as to reduce the incidence of acute kidney injury after operation and improve the clinical prognosis of patients.

Objective    To systematically evaluate the risk factors for perioperative blood transfusion in patients undergoing coronary artery bypass grafting (CABG). Methods    PubMed, Web of Science, The Cochrane Library, EMbase, CNKI, WanFang and VIP Database were electronically searched to collect case-control and cohort studies about the risk factors for perioperative blood transfusion in patients undergoing CABG from inception to February 2020. Two reviewers screened and evaluated the literatures according to the inclusion and exclusion criteria, and meta-analysis was performed by using RevMan 5.3 software. Results    A total of 26 articles were collected, involving 84 661 patients. The results of meta-analysis showed that age (OR=1.06, 95%CI 1.03 to 1.08, P<0.001), age≥70 years (OR=2.14, 95%CI 1.77 to 2.59, P<0.001), female (OR=1.85, 95%CI 1.55 to 2.22, P<0.001), body mass index (OR=0.94, 95%CI 0.90 to 0.98, P=0.003), weight (OR=0.95, 95%CI 0.93 to 0.96, P<0.001), body surface area (OR=0.19, 95%CI 0.10 to 0.39, P<0.001), smoking (OR=0.80, 95%CI 0.69 to 0.93, P=0.003), diabetes (OR=1.15, 95%CI 1.09 to 1.20, P<0.000 01), chronic heart failure (OR=1.59, 95%CI 1.26 to 1.99, P<0.001), number of diseased coronary arteries (OR=1.17, 95%CI 1.01 to 1.35, P=0.030), reoperation (OR=2.12, 95%CI 1.79 to 2.51, P<0.001), preoperative hemoglobin level (OR=0.60, 95%CI 0.43 to 0.84, P=0.003), preoperative ejection fraction <35% (OR=2.57, 95%CI 1.24 to 5.34, P=0.010), emergency surgery (OR=4.09, 95%CI 2.52 to 6.63, P<0.001), urgent operation (OR=2.28, 95%CI 1.25 to 4.17, P=0.007), intra-aortic balloon pump (OR=3.86, 95%CI 3.35 to 4.44, P<0.001), cardiopulmonary bypass (OR=4.24, 95%CI 2.95 to 6.10, P<0.001), cardiopulmonary bypass time (OR=1.01, 95%CI 1.01 to 1.01, P<0.000 01) and minimum hemoglobin during cardiopulmonary bypass (OR=0.42, 95%CI 0.23 to 0.77, P=0.005) were the risk factors for perioperative blood transfusion in patients undergoing CABG. Conclusion    Current evidence shows that age, age≥70 years, female, body mass index, weight, body surface area, smoking, diabetes, chronic heart failure, number of diseased coronary arteries, reoperation, preoperative hemoglobin level, preoperative ejection fraction<35%, emergency surgery, urgent operation, intra-aortic balloon pump, cardiopulmonary bypass, cardiopulmonary bypass time and minimum hemoglobin during cardiopulmonary bypass are risk factors for perioperative blood transfusion in patients who undergo CABG. Medical staff should formulate and improve the relevant perioperative blood management measures according to the above risk factors, in order to reduce the perioperative blood utilization rate and improve the clinical prognosis of patients.

Objective:To systematically evaluate the qualitative research on experience of nurses in participating in treatment of acute respiratory infectious diseases, so as to provide evidence-based basis for subsequent formulation of intervention strategies and practices.Methods:Databases including PubMed, EMbase, Web of Science, The Cochrane Library, CNKI, Wanfang, and VIP databases for related qualitative research.The retrieval time was from the construction of databases to February 13, 2020. The 2017 version of JBI Critical Appraisal Tool for qualitative studies of Australian Evidence-Based Health Care Center was used for literature quality evaluation, and the collection and integration methods were adopted for Meta integration.Results:A total of 8 studies were included, 30 research results were refined, 8 new categories were formed and 3 integrated results were obtained. At the beginning of the epidemic, nursing staff volunteered themselves and showed a series of positive psychological experiences. As the treatment progressed, the nursing staff were under tremendous physical and psychological pressure and heavy workload. Through self-adjustment and encouragement and support from all parties of the society, the nursing staff finally realized their professional value, gained growth and put forward expectations and suggestions to the hospital management staff.Conclusions:The nurses are under great psychological pressure during the treatment and it should be taken seriously. In the process of participating in the treatment, it is necessary to dynamically evaluate psychological condition of nursing staff and timely provide support, guidance and encouragement to improve their psychological coping ability.

Objective: To investigate the effect of the time from onset to recanalization on the outcomes after endovascular treatment (EVT) in patients with acute stroke due to posterior circulation large vessel occlusion. Methods: From May 2015 to May 2019, patients with acute ischemic stroke due to posterior circulation large vessel occlusion receiving EVT in the Department of Neurology, Nanjing First Hospital, Nanjing Medical University were enrolled retrospectively. According to the modified Rankin Scale (mRS) score at 90 d after procedure, they were divided into good outcome group (≤2) and poor outcome group (>2). Demographic and clinical data were compared between the two groups. Multivariate logistic regression analysis was used to determine the independent correlation between the time from onset to recanalization and the outcomes. Results: A total of 64 patients with acute ischemic stroke due to posterior circulation large vessel occlusion treated by EVT were enrolled in this study. There were 50 males (78.0%) and 14 females (22.0%). The age was 67.52±10.30 years. The National Institutes of Health Stroke Scale (NIHSS) score was 22.04±4.17, and the time from onset to recanalization was 370.53±78.59 min. Thirty-one patients (48.0%) were in the good outcome group and 33 (52.0%) were in the poor outcome group. There were significant differences in baseline NIHSS score, systolic blood pressure, time from onset to revascularization, and the proportions of patients with tandem lesion and symptomatic intracranial hemorrhage between the two groups (all P<0.05). Multivariate logistic regression analysis showed that the longer time from onset to recanalization (odds ratio [OR] 1.317, 95% confidence interval [CI] 1.001-3.034; P=0.041) and symptomatic intracranial hemorrhage (OR 4.207, 95% CI 1.931-10.761; P=0.004) were the independent predictors of poor outcomes, while the lower baseline NIHSS score (OR 0.302, 95% CI 0.056-0.743; P=0.047) was the independent protective factor of poor outcomes. Conclusions The longer time from onset to recanalization is an independent risk factor for poor outcomes after EVT in patients with acute ischemic stroke caused by posterior circulation large vessel occlusion.

Objective To investigate the predictive value of serum lipoprotein (a) (Lp [a]) levels for short-term functional outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.Methods Elderly patients with acute ischemic stroke and type 2 diabetes mellitus admitted to Nanjing First Hospital from June 2016 to December 2016 were enrolled retrospectively.The modified Rankin scale was used to assess the outcomes at 90 d after onset;0-2 was defined as good outcome and ＞2 were defined as poor outcome.Multivariate logistic regression analysis was used to determine independent risk factors for poor outcomes,and the receiver operator characteristic (ROC) curve analysis was used to evaluate the predictive value of serum Lp(a) levels for poor outcomes.Results A total of 231 patients were enrolled,with an average age of 69.7 years and males accounting for 65.4％.The median serum Lp(a) was 166 mg/L (interquartile range 78-331 mg/L).At 90 d after onset,140 patients (60.6％) had good outcomes and 91 (39.4％) had poor outcomes.After adjustment for other confounding variables,multivariate logistic regression analysis showed that elevated serum Lp(a) (referenced to the lowest quartile,the 3rd quartile:odds ratio[OR]2.899,95％ confidence interval[CI] 1.154-7.285,P =0.024;the 4th quartile:OR 3.334,95％ CI 1.329-8.361,P =0.010),the baseline National Institute of Health Stroke Scale score (OR 1.224,95％ CI 1.143-1.310;P＜ 0.001),and complicated with coronary heart disease (OR 2.504,95％ CI 1.196-5.243;P =0.015) were the independent risk factors for poor outcomes.ROC curve analysis showed that the area under the curve of serum Lp(a) level in predicting the poor outcome was 0.775 (95％ CI 0.696-0.854;P=0.04).The optimal cut-off value was 119 mg/L,the sensitivity was 71.15％,the specificity was 75.90％,the positive predictive value was 38.52％,and the negative predictive value was 61.48％.Conclusion Serum Lp(a) level has certain predictive value for the short-term poor outcomes in elderly patients with acute ischemic stroke and type 2 diabetes mellitus.

Objective: To investigate the correlations of serum uric acid with outcomes and symptomatic intracranial hemorrhage (sICH) after intravascular mechanical thrombectomy bridged with intravenous thrombolysis in patients with ischemic stroke. Methods: From January 2015 to January 2019, patients with acute ischemic stroke admitted to Nanjing First Hospital, Nanjing Medical University and underwent intravascular mechanical thrombectomy bridged with intravenous thrombolysis were analyzed retrospectively. Demographic characteristics, vascular risk factors, laboratory findings, National Institutes of Health Stroke Scale (NIHSS) scores, onset to treatment time, and whether sICH occurred were recorded. The modified Rankin Scale was used to evaluate the outcomes at 90 d after onset, and 0 to 2 was defined as good outcome. Multivariate logistic regression models were used to determine the independent factors for outcomes and sICH. Results: A total of 144 patients were included, 54 (37.5%) had a good outcome, 90 (62.5%) had a poor outcome (including 28 deaths), and 29 (20.1%) had sICH. Serum uric acid was significantly higher in the good outcome group than in the poor outcome group (P<0.05). Serum uric acid was significantly higher in the non-sICH group than in the sICH group (P<0.05). Multivariate logistic regression analysis showed that higher serum uric acid were the independent protective factors of good outcome (odds ratio 0.82, 95% confidence interval 0.66-0.93; P<0.001) and sICH (odds ratio 0.97, 95% confidence interval 0.93-0.99; P=0.004). Conclusion High serum uric acid level is independently associated with good outcome after intravascular mechanical thrombectomybridged with intravenous thrombolysis in patients with acute ischemic stroke.

Objective To compare the effects of intensive blood pressure (BP) lowering and guideline-recommended standard BP lowering on the early reperfusion and prognosis after intravenous thrombolysis in patients with acute ischemic stroke. Methods This is a randomised controlled trial consisting of 118 consecutive patients who came from Department of Neurology, Nanjing First Hospital from July 2012 to April 2016, accepting intravenous recombinant tissue plasminogen activator thrombolysis with the systolic blood pressure (SBP) being 150-185 mmHg(1 mmHg=0.133 kPa). The patients with ischemic stroke were diagnosed by multi-mode MRI and confirmed to have ischemic penumbra. The SBP of patients randomly assigned to intensive BP lowering group and guideline BP lowering group was maintained in 140-150 mmHg or below 180 mmHg respectively for 72 h and all patients needed to reexamine multi-mode MRI at 24 h. The primary endpoints were the neurologic function at early stage, modified Rankin Scale (mRS) score and the mortality at 90 d;the secondary endpoints were the volume of infarction and hypoperfusion area, the rate of reperfusion, hemorrhagic transformation (HT) and syptomatic intracerebral hemorrhage (sICH). Results Forty-nine cases in intensive BP lowering group and 56 cases in guideline BP lowering group acquired the available images. The volume of infarction was increased both in these two groups, and there was no statistically significant difference in the increased values ((13.21±9.51) cm3 vs (12.95±9.68) cm3). There were no statistically significant differences in the volume of hypoperfusion, reperfusion rate, neurologic function at early stage, the mRS scores and mortality at 90 d, the incidence of sICH except the rate of HT (9.4%, 5/53 vs 23.1%, 15/65, χ2=3.860, P=0.049) between the two groups.Conclusion Early intensive BP-lowering treatment has no adverse effects on the transformation of ischemic penumbra and prognosis after intravenous thrombolysis in patients with acute ischemic stroke and may decrease the the rate of HT in some degree.

ABSTRACT:Objective To explore the role of PTEN in the suppression of neural stem cells so as to clarify whether neural stem cell proliferation can be promoted by regulating the PI3K-Akt/PTEN expression level. Methods We removed the hippocampus from neonatal 24 h Kunming mice,isolated and cultured the generation of neural stem cells,which were then identified by immunofluorescence test.We randomly grouped the cultured neural stem cells into normal group,ischemia model group,hypoxia group (hypoxia + ischemia model group),Lip2000 group (hypoxia+ ischemia model group + Lip2000 null transfection group,PTEN transfection group (hypoxia +ischemia model group+Ad5-PTEN transfection group),and PTEN interference group (hypoxia+ ischemia model group+Lip2000+PTENsiRNA interference group).We detected the proliferation of neural stem cells in the groups at different time points,and PTEN protein expression of neural stem cells in each group after PTEN transfection,
and the effect on iconic protein on Akt-PI3K signaling pathway.Results (1 )Nestin identification of the neural stem cells was tested by immunofluorescence.We observed green bright and typical cell spheroids under fluorescence microscope;the clear structure could be seen within spheroids.(2)We determined the proliferation of neural stem cells at different time points by MTT.After 36 h of culture,the neural stem cells had obvious proliferation in the hypoxia group and Lip2000 group compared with the model group, the PTEN transfection group and PTEN interference group (P <0.05),including the cell proliferation of PTEN interference group compared to that of the model group,and PTEN transfection group obviously,the differences were also significant (P < 0.05 );(3 ) Compared with the cells in the normal group,PTEN expression increased in the model group and PTEN gene transfection group (P <0.05);it was all lower in other groups than in the normal group (P <0.05).The trend of decrease was similar in hypoxia group,Lip2000 group,and PTEN interference group (P >0.05);(4)After PTEN plasmid transfection,there were no apparent changes in the total Akt and bad in the groups,but compared with the normal group,PI3K,p-Akt,and p-bad expressions in model group and PTEN gene transfection group reduced (P <0.05),with the more obvious changes in the PTEN transfection group.PI3K,p-Akt,and p-bad expressions in the hypoxia group, Lip2000 group and PTEN interference group increased (P < 0.05 ). Conclusion Hypoxia contributes to promoting the proliferation of neural stem cells,and the inhibition of PTEN on PI3K/Akt might be the key factor for blocked proliferation of adult neural stem cells.