ObjectiveTo explore the influence of enhanced recovery after surgery (ERAS) on intestinal flora in patients with colorectal cancer.MethodsBy convenient sampling method, 60 patients with colorectal cancer were selected from August 2018 to December 2019 in the Department of Gastrointestinal Surgery of West China Hospital of Sichuan University and randomly divided into ERAS group and traditional treatment group (traditional group). Among them, the perioperative clinical management was carried out according to the ERAS management and traditional treatment process in the the ERAS group and in the traditional group, respectively. The fresh fecal samples were collected within 24 h after admission and the first natural defecation after operation. The bacterial 16 Sr DNA V3–V4 region was sequenced by Illumina MiSeq sequencer, and the results were analyzed by bioinformatics.ResultsA total of 60 patients with colorectal cancer were included, 30 cases in the traditional group and 27 cases in the ERAS group (3 people temporarily withdrew from the study). There were no significant differences in the basic informations between the two groups (P>0.05). ① Before or after operation, there were no significant differences in Shannon index and Simpson index between the two groups. The difference between preoperative and postoperative comparison in the same group was also not statistically significant (P>0.05). ② Beta diversity analysis showed that there was no significant difference in community composition between the traditional group and the ERAS group before operation, and there was a clear boundary between the traditional group and the ERAS group after operation. ③ At the phylum level, compared with the preoperative abundance, the postoperative abundance Firmicutes decreased by 26.5% and 5.5% in the traditional and ERAS group, respectively; Bacteroidetes increased by 21.6% and 4.7% in the traditional and ERAS group, respectively; Proteobacteria increased by 7.2% and 2.2% in the traditional and ERAS group, respectively. At the genus level, compared with the preoperative abundance, the postoperative abundance of Bacteroides in the traditional group increased by 17.6% and in the ERAS group decreased by 1.6%; Bifidobacterium decreased by 1.8% and 1.3% in the traditional group and in the ERAS group, respectively.ConclusionsERAS does not affect species diversity of intestinal flora. Although ERAS has some damage to structure of intestinal flora, it is weaker than traditional process, so it is more conducive to reconstruction and restoration of intestinal microecological environment.
ObjectiveTo review the association of gut microbiota and postoperative gastrointestinal dysfunction (GID) in patients after abdominal surgery and to provide a new idea for the pathogenesis, prevention, and treatment of postoperative GID in patients after abdominal surgery.MethodThe related and latest literatures were reviewed by searching the literatures on “intestinal flora” “gut microbiota” “intestinal microbial population” “brain-gut axis” “gastrointestinal function” “gastric paralysis” “intestinal paralysis” and “ileus” from January 1, 2000 to April 2, 2021 in Chinese and English databases.ResultsGut microbiota diversity was closely related to postoperative GID symptoms in patients after abdominal surgery. Gut microbiota regulated gastrointestinal motility and mucosal barrier function by metabolizing food to produce metabolites such as 5-hydroxytryptamine, melatonin, short-chain fatty acid, succinic acid, lactic acid, and so on.ConclusionsThe imbalance of gut microbiota is closely related to postoperative GID in patients after abdominal surgery. However, the relevant bacterial metabolites that have been found are limited at present, and the relevant mechanism needs to be further investigated.
Diabetic neuropathic pain (DNP) is one of the most common and complex complications of diabetes. In recent years, studies have shown that gut microbiota can regulate inflammatory response, intestinal permeability, glucose metabolism, and fatty acid oxidation, synthesis, and energy consumption by regulating factors such as lipopolysaccharides, short chain fatty acids, bile acids, and branched chain amino acids, achieving the goal of treating DNP. This paper summarizes the relevant mechanisms of gut microbiota in the treatment of DNP, the relevant intervention measures of traditional Chinese and western medicine, in order to provide new ideas for clinical treatment of DNP.
【摘要】 目的 探讨强化益生元膳食纤维的肠内营养在腹部外科术后患者中的临床应用。 方法 2008年7月-2010年11月30例接受腹部外科中等以上手术的患者术前随机分为研究组和对照组，每组15例。研究组患者于术后接受肠内营养，并予以强化益生元膳食纤维；对照组只接受相同的肠内营养支持。观察指标为术后感染并发症、胃肠道并发症、住院时间、抗生素治疗时间、C反应蛋白水平和病死率等。 结果 研究组术后住院时间为（10±5） d，对照组为（15±7） d，两组差异有统计学意义（t=2.251，P=0.033）；研究组C反应蛋白水平为（6.6±3.2） mg/L，对照组为（9.8±2.1） mg/L，两组差异有统计学意义（t=3.238，P=0.003）；研究组抗生素治疗时间为（5.0±3.5） d，对照组为（6.0±4.8） d，两组差异无统计学意义（t=0.652，P=0.520）。两组均无死亡病例；术后研究组2例发生感染并发症，对照组3例，两组感染并发症发生率差异无统计学意义（P=1.000）。两组患者均能耐受经肠内补充营养素。 结论 与常规肠内营养比较，给予强化益生元膳食纤维的肠内营养能减少腹部外科术后患者的住院时间，降低急性期炎症反应。【Abstract】 Objective To investigate the effect of early enteral supply of prebiotic fiber in patients undergoing major abdominal surgery. Methods Between July 2008 and November 2010, 30 patients undergoing major gastrointestinal surgery were randomized into the study group and the control group before operation with 15 patients in each group. Prebiotic fiber was administered combined with enteral nutrition support for patients in the study group. Patients in the control group only received conventional enteral nutrition without fiber. The main endpoints included the development of bacterial infection, the duration of hospital stay, antibiotic therapy, the serum level of C-reaction protein (CRP), side effects of the enteral nutrition and morbidity. Results Compared with the control group, the median duration of hospital stay was shorter in the study group [(15±7) days in the control group vs. (10±5) days in the study group; t=2.251, Plt;0.05]. The mean level of CRP was also lower in the study group [(6.6±3.2) mg/L] than that in the control group [(9.8±2.1) mg/L] (t=3.238, Plt;0.05). The enteral nutrition and fibers were well tolerated. The incidence of infectious complications (3 cases in the control group vs. 2 cases in the study group) and the median duration of antibiotic therapy [(6.0±4.8) days in the control group vs. (5.0±3.5) days in the study group] were not significantly different between the two groups (t=0.652, Pgt;0.05). No patients died in both the two groups. Conclusion Compared with the conventional enteral nutrition, early enteral supply of prebiotic fiber can reduce the duration of hospital stay and acute phase response.
Gastroparesis is a gastrointestinal motility disorder that refers to delayed gastric emptying in the absence of mechanical obstruction. Clinical manifestations include postprandial fullness and epigastric discomfort, abdominal distension, nausea, and vomiting. According to its etiology, it can be divided into three categories: surgery-related gastroparesis, non-surgery-related gastroparesis and idiopathic gastroparesis. Non-surgery-related gastroparesis is common clinically. At present, the exact pathogenesis of gastroparesis remains to be unclear. The intestinal flora is huge and abundant. It participates in a variety of physiological functions of the host. Studies have confirmed that the intestinal flora is related to perioperative treatment measures, surgical stress, and various system diseases (endocrine and metabolic system diseases, nervous system diseases, and immune system diseases), especially the weakening of gastrointestinal motility, and gastrointestinal motility. Attenuation can further promote the occurrence and development of gastroparesis. Based on the current research, this article reviews the research on the correlation between gastroparesis and intestinal flora.
In order to study the influence of biliary tract obstruction on enteromicroflora,we ligate the canine biliary tract to observe the acrobic and anerobic bacteria in the duodenum and ileum at intervals of post-ligation(the 10th,20th,30th days),and to study the pathogenesis and ultramicroscopic of the ileal mucosa at the same intervals.The results showed that:the population and species of enteroflora in small intestine gradually increased after biliary obstruction.Bacteria(especialy E.coli) ascended to the upper part of small intestine,from their normal habitant of lower part of small intestine.Therefore the radio of general aerobia and E.coli risen obviously in duodenum.The longer the obstruction,the more pathologic changes were observed in ileal mucosa.such as edema,leukocytes infiltration and destruction of epithelial villi.All of those changed may be the causative factor of biliary tract infection.So that,in the programs of preventing enterogenic infection at the state of biliary tract obstruction,the protection and adjusting of normal enteroflora should be adventently considered.
ObjectiveTo explore the composition of intestinal microbiota between patients with fixed airflow obstruction asthma, reversible airflow obstruction asthma, and healthy control, and analyze the correlation between key differential bacterial distribution and clinical characteristics. MethodsFifteen patients with fixed airflow obstruction asthma (FAO) and 13 patients with reversible airflow obstruction asthma (RAO) were included, along with 11 matched healthy control subjects. Clinical data were collected, and lung function tests and induced sputum examination were performed. Blood and stool samples were tested to compare the gut microbiota status among the groups, and analyze the relationship between gut microbiota abundance and patients' blood routine, IgE levels, lung function, and induced sputum. Results The dominant bacterial compositions were similar in the three groups, but there were differences in the abundance of some species. Compared to the RAO group, the FAO group showed a significant increase in the genera of Bacteroides and Escherichia coli, while Pseudomonas was significantly decreased. The phylum Firmicutes was negatively correlated with the course of asthma, while the phylum Bacteroidetes and genus Bacteroides were positively correlated with the asthma course. Bacteroidetes was negatively correlated with Pre-BD FEV1/FVC, Pseudomonas was positively correlated with Pre-BD FEV1, Escherichia coli was negatively correlated with Post-BD FEV1/FVC, and Bacteroides was negatively correlated with Post-BD MMEF. The class Actinobacteria and the order Actinomycetales were negatively correlated with peripheral blood EOS%, while the order Enterobacteriales and the family Enterobacteriaceae were positively correlated with peripheral blood IgE levels. Furthermore, Actinobacteria and Actinomycetales were negatively correlated with induced sputum EOS%. Conclusions There are differences in the gut microbiota among patients with fixed airflow obstruction asthma, reversible airflow obstruction asthma, and healthy individuals. Bacteroides and Escherichia coli are enriched in the fixed airflow obstruction asthma group, while the Firmicutes are increased in the reversible airflow obstruction asthma group. These three microbiota may act together on Th2 cell-mediated inflammatory responses, influencing the process of airway remodeling, and thereby interfering with the occurrence of fixed airflow obstruction in asthma.
ObjectiveTo investigate the effect of Roux-en-Y gastric bypass (RYGB) on the composition of intestinal microbiota among the biliopancreatic limb, the Roux limb, and the common channel in normal Sprague-Dawley (SD) rats. MethodsSixteen SD rats were randomly divided into sham surgery group (Sham group) and RYGB group, each group enrolled 8 rats. Rats in Sham group underwent sham surgery of end to end anastomosis in situ after cutting off the stomach and jejunum, and rats in RYGB group underwent RYGB. Then quantitative real-time PCR (RT-PCR) method was used to detect the expression of total bacteria, Bifidobacterium, Bacteroides, and Lactobacillus mRNA at biliopancreatic limb, the Roux limb, and the common channel. At last the comparison of mRNA in 4 kinds of bacteria was performed. ResultsCompared with Sham group, the weight of rats in RYGB group was lower at 8 weeks after surgery (P<0.01). RT-PCR results showed that, expression levels of total bacteria, Bifidobacterium, and Bacteroides mRNA at the Roux limb and the common channel in RYGB group were higher than corresponding site of rats in Sham group (P<0.05), but there was no significant difference at biliopancreatic limb between the 2 groups (P>0.05). Expression level of Lactobacillus mRNA at the Roux limb in RYGB group was higher than corresponding site of rats in Sham group (P<0.05), but there was no significant difference at biliopancreatic limb and the common channel between the 2 groups (P>0.05). ConclusionRYGB can significantly improve expression levels of the total bacteria, Bifidobacterium, and Bacteroides mRNA at Roux limb and the common channel, increase the level of Lactobacillus mRNA at Roux limb, while has no influence on biliopancreatic limb.
Objective To explore the causal relationship between gut microbiota and urinary tract infections (UTI) using data from genome-wide association studies. Methods The gut microbiota data were sourced from the MiBioGen consortium, comprising genetic variables from 18 340 individuals. UTI data (ieu-b-5.65) were derived from the UK Biobank. Six methods including inverse variance weighted (IVW), Mendelian randomization (MR)-Egger, maximum likelihood, simple mode, weighted mode, and weighted median were employed for two-sample MR analysis on these datasets. Additionally, MR-PRESSO was used to detect and correct for heterogeneity and outliers in the analysis. Cochran’s Q test and leave-one-out analysis were applied to assess potential heterogeneity and multiple effects. Furthermore, reverse MR analysis was conducted to investigate causal relationships between UTI and gut microbiota. Results According to IVW method analysis results, bacterial genera Eggerthella (OR=1.08, 95%CI 1.01 to 1.16, P=0.034) and Ruminococcaceae (UCG005) (OR=1.10, 95%CI 1.01 to 1.20, P=0.022) were found to increase the risk of UTI, while Defluviitaleaceae (UCG011) (OR=0.90, 95%CI 0.82 to 0.99, P=0.022) appeared to decrease it. Reverse MR analysis did not reveal a significant effect of UTI on these three bacterial genera. Our study found no evidence of heterogeneity or pleiotropy based on the results of Cochran’s Q test, MR-Egger, and MR-PRESSO global test. Conclusion In this MR study, we demonstrate a causal association between Eggerthella, Ruminococcaceae, Defluvitalaceae and the risk of urinary tract infections.