Background: Nowadays, the number of elderly has steadily increased annually. Elderly patients with ischemic stroke often have worse outcomes than younger patients. However, there has not been a study of ischemic stroke in the elderly in Thailand. A better knowledge of the risk factors, subtypes, and outcomes of strokes in the elderly may have significant practical implications for the aged society in the future. The objective of the study was to assess the risk factor, stroke subtypes, and outcome of stroke in the elderly compared to the younger patients. Method: All patients presented with acute ischemic stroke and transient ischemic attack (TIA) aged over 45 years who were admitted in the Stroke unit between November 1st, 2016 and December 31st, 2017 were retrospectively studied. Result: Five hundred forty-two patients were included. The average age was 68.78 ± 12.03, 44.8% of them were male. 186 (34.3%) patients were 75 or older. Cardioembolism was found to be the most common cause of ischemic stroke in 156 patients (28.8%) and was associated with poor outcome. Patients who were 75 or older had significantly worse outcomes in all categories including NIHSS at discharge, modified Rankin scale, length of stay and the number of deaths compared to the younger group. Atrial fibrillation was the risk factors associated with older age with OR 3.861 (p value< 0.001). Aged 75 years or older, atrial fibrillation, more NIHSS score on admission and history of the previous stroke were the risk factors associated with a patient’s death. Conclusion: The elderly who are 75 years or older accounts for more than one-third of ischemic stroke in our study. Stroke in the elderly correlates with higher mortality and poorer outcome. Cardioembolism related to atrial fibrillation is the major cause of stroke in this population.

Background: Pharmacologic and non-pharmacologic treatments for stroke are essential but can be costly or harmful, whereas probiotics are a promising alternative. This scoping review aimed to synthesize the in vitro and in vivo evidence of probiotics on stroke-related neurological, biochemical, and histochemical outcomes. Methods: A systematic review was conducted in PubMed, Embase, and Cochrane Central Register of Clinical Trials (CENTRAL) up to 7 May 2021. Titles and abstracts were screened and assessed by two independent reviewers. The initial screening criteria aimed to include studies using probiotics, prebiotics, and symbiotics both in vitro and in vivo for the prevention and/or treatment of stroke. Results: Of 6293 articles, 4990 passed the initial screen after excluding duplication articles, of which 36 theme-related full texts were assessed and 13 were included in this review. No in vitro studies passed the criteria to be included in this review. Probiotics can ameliorate neurological deficits and show their anti-inflammation and anti-oxidative properties. Decreased loss of cerebral volume and inhibition of neuronal apoptosis were revealed in histopathological evidence. Conclusions: There are potential cognitive benefits of probiotic supplementation, especially among animal models, on decreasing cerebral volume, increasing neurological score, and decreasing the inflammatory response. However, further investigation is needed to validate these conclusions in various populations.

Introduction: Fecal microbiota transplantation (FMT) has been proposed as a potential treatment for irritable bowel syndrome (IBS); however, the consensus regarding its efficacy and safety is limited.Materials and Methods: We performed a systematic search of the literature using PubMed, EMBASE, Ovid MEDLINE, and Cochrane. Meta-analyses were conducted in relative risk (RR) or standard mean difference (SMD) using 95% confidence intervals (CI). Cochrane risk-of-bias 2 tool (RoB2) was employed to evaluate the study quality.Result: Of 2,589 potential records, 7 studies with 9 cohorts involving 505 participants were included. Meta-analyses showed no significant difference in the short-term (12 weeks) and long-term (12 months) global improvement of IBS symptoms of FMT vs. placebo (RR 0.63, 95% CI 0.39–1.00 and RR 0.88, 95% CI 0.53–1.45, respectively). There were statistically significant differences of short-term IBS-SSS improvement (SMD –0.58, 95% CI –1.09 to –0.88) and short-term IBS-QoL improvement (SMD 0.67, 95% CI 0.43–0.91). Eight from 9 studies (88.9%) had a low risk of bias. The subgroup analysis revealed the short-term global symptoms improvement in studies with low-risk of bias (RR 0.53, 95% CI 0.35–0.81), studies with well-defined donors (RR 0.31, 95% CI 0.14–0.72), and studies with FMT using colonoscopy (RR 0.66, 95% CI 0.47–0.92). Major FMT adverse events are transient and rapidly self-limiting.Conclusion: FMT significantly improved IBS-SSS and IBS-QoL in the short-term period in IBS patients. However, global symptom improvement showed no significance. Well-defined donors and appropriate fecal administration routes appear to be important factors for the successful outcomes of FMT in IBS.Systematic review registration: [www.crd.york.ac.uk/prospero], identifier [CRD42021246101].

Introduction Following the discovery of various effects on skin function by modifying endocannabinoid systems, multiple preclinical studies have revealed the promise of cannabis and cannabinoids in the treatment of a variety of skin diseases. However, its clinical efficacy is still debated. Methods and analysis The protocol has been prepared using the Preferred Items for Systematic Review and Meta-analysis Protocols guidelines. A systematic search will be conducted using PubMed, EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials and Web of Science. We will include randomised controlled trials and observational studies investigating alterations to dermatological characteristics following administration of cannabis and cannabinoids for dermatological diseases and disorders. The two reviewers will perform both the title and abstract and full-text screenings. The Cochrane Risk-of-Bias 2 and ROBINS-1 tools will be used to evaluate the risk of bias. If a group of comparable studies for each quantitative outcome can be discovered, we will conduct a random effects meta-analysis. We will investigate heterogeneity using a combination of visual inspection of the forest plot, the Cochran’s Q test and Higgins’ test [I2]. Sensitivity analyses will be performed to assess the statistical robustness of the primary outcome. To evaluate a publication bias, the Egger’s regression asymmetry test and funnel plots will be considered. Ethics and dissemination This study does not require ethical approval because no original data will be collected. The findings will be presented at conferences and published in peer-reviewed journals. PROSPERO registration number CRD42023397189.

Objective Evidence on the association between the gut microbiome and metabolic conditions has been increasing during the past decades. Unlike the straightforward identification of beneficial non-pathogenic bacteria as a potential probiotic for clinical use, the analysis of gut microbiome diversity is more complex and required a better understanding of various measures. We aim to summarize an elaborated list of gut microbiome diversity measures. Design Systematic search was conducted in three databases: PubMed, Embase, and Cochrane Central Register of Clinical Trials for randomized controlled trials, quasi-experimental and observational studies for the relationship between gut microbiota and metabolic diseases published in 2019 with the English language. Results The measurement methods of alpha diversity and beta diversity were explored. Of 5929 potential studies, 47 were included in the systematic review (14632 patients). Of 13 alpha diversity measures, the Shannon index was the most commonly used in 37 studies (78.7%), followed by Chao1 index (19 studies), Operational Taxonomic Unit (OTU) richness (15 studies), Simpson index (13 studies), and Abundance-based Coverage Estimators (ACE) index (10 studies). Of 2 beta diversity measures, the UniFrac was the most commonly used in 24 studies (unweighted 17 studies and weighted 16 studies), followed by Bray-Curtis dissimilarity (16 studies). Conclusion Various measurement of gut microbiome diversity have been used in the literature. All measurements have unique characteristics, advantages, and disadvantages which lead to different usage frequency. The measures were chosen considering cost, simplicity, and types of research. What is already known on this subject? ▸ Alpha diversity, including Shannon index diversity, chao1 diversity, etc., is the average species diversity within a habitat type at a local scale while beta-diversity, such as Bray-Curtis dissimilarity and UniFrac, indicates the differentiation between microbial communities from different environments. ▸ Alpha- and beta-diversity are the two most diverse measures of gut microbiota diversity with no consensus on which measurement methods should be used in metabolic condition study. What are the new findings? ▸ Distinct characteristics, advantages, and disadvantages of each microbiome diversity measurement method lead to a variety of usage frequencies in metabolic condition studies. Shannon diversity is the most widely used alpha diversity while there is no predilection for beta diversity. How might it impact on clinical practice in the foreseeable future? ▸ Further researchers on metabolic condition with microbiome diversity measurement will have impartial evidence on which measurement methods are most rationally appropriate for their studies regarding simplicity, cost, and efficacy.

Introduction: Increasing data demonstrate an association between gut microbiome in brain diseases via the gut-brain axis. However, few studies have evaluated the association between gut microbiome and large-artery atherosclerotic ischemic stroke patients. Method: A cross-sectional pilot study was conducted among 15 patients with large-artery atherosclerotic ischemic stroke and 15 asymptomatic persons. Large-artery atherosclerotic stroke were diagnosed using TOAST classification. The control group was selected based on age- and sex-match with the patient group. Participants provided a stool sample profiled by 16S-ribosomal gene-specific methods Next-generation sequencing. The Mann-Whitney U test was used to compare the differences in gut microbiota profile between stroke and control groups. Alpha (Shannon diversity index) and beta diversity (Bray-Curtis dissimilarity) were used to evaluate gut microbial diversity. Generalized linear mixed effects models were used to relate gut microbial genus and stroke which were adjusted for age, BMI, underlying disease (diabetes, hypertension and dyslipidemia), and alcohol use. Result: The average age of stroke patients was 61.1±7.1 and 59.2±8.2 in the control group. Beta-diversity (Bray-Curtis dissimilarity) of the gut microbiome was statistically significant in order, family and genus level (P-value=0.017, 0.011 and 0.003, respectively) between stroke and control groups; however, there was no statistically significant difference in alpha-diversity (Shannon diversity index; P-value=0.852). The relative abundance of Class Bacteriodia increased in stroke group. Using generalized linear mix effect model, we found 6 genera was significantly associated with stroke after multivariate adjustment. Ruminococcus spp .(P-value=0.017), Streptococcus spp .(P-value=0.019), Actinomyces spp .(P-value=0.02) and Dorea spp .(P-value=0.021) showed positive association while Bifidobacterium spp .(P-value=0.04) and Faecalibacterium spp .(P-value=0.041) showed negatively association with stroke. Conclusion: Patients with large-artery atherosclerotic stroke had a decreased microbiome beta-diversity and certain gut microbiota genera may be related to large-artery atherosclerotic stroke. Future implications of this study could include the development of targeted interventions to modulate gut microbiota in order to improve outcomes for patients with large-artery atherosclerotic stroke.