Evidence indicates that the metabolic inflammation induced by gut microbiota dysbiosis contributes to diabetic kidney disease. Prebiotic supplementations to prevent gut microbiota dysbiosis, inhibit inflammatory responses, and protect the renal function in DKD. Qing-Re-Xiao-Zheng formula (QRXZF) is a Traditional Chinese Medicine (TCM) formula that has been used for DKD treatment in China. Recently, there are growing studies show that regulation of gut microbiota is a potential therapeutic strategy for DKD as it is able to reduce metabolic inflammation associated with DKD. However, it is unknown whether QRXZF is effective for DKD by regulating of gut microbiota. In this study, we investigated the reno-protective effect of QRXZF by exploring its potential mechanism between gut microbiota and downstream inflammatory pathways mediated by gut-derived lipopolysaccharide (LPS) in the kidney. High-fat diet (HFD) and streptozotocin injection-induced DKD mice model was established to assess the QRXZF effect in vivo. Mice treated with QRXZF for 8 weeks had significantly lower levels of urinary albumin, serum cholesterol and triglycerides. The renal injuries observed through histological analysis were attenuated as well. Also, mice in the QRXZF group had higher levels of Zonula occludens protein-1 (ZO-1) expression, lower levels of serum fluorescein-isothiocyanate (FITC)-dextran and less-damaged colonic mucosa as compared to the DKD group, implying the benefit role for the gut barrier integrity. QRXZF treatment also reversed gut dysbiosis and reduced levels of gut-derived LPS. Notably, the expression of toll-like receptor 4 (TLR4) and nuclear factor-κB (NF-κB), which are important inflammation pathways in DKD, were suppressed in the QRXZF groups. In conclusion, our results indicated that the reno-protective effects of QRXZF was probably associated with modulating gut microbiota and inhibiting inflammatory responses in the kidney.
ObjectivesTo evaluate the association between anxiety, depression and resilience with overall health and functioning in axial spondyloarthritis (axSpA).DesignCross-sectional evaluation of baseline data from a prospective cohort study, with recruitment from January 2018 to March 2021.SettingOutpatient clinic in a tertiary hospital in Singapore.ParticipantsPatients aged 21 years and above who were diagnosed with axSpA.Outcome measuresThe Hospital Anxiety and Depression Scale (HADS) was used for assessing anxiety and depression, 10-item Connor Davidson Resilience Scale (CD-RISC-10) for resilience, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) for disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) for functional limitation and Assessment of SpondyloArthritis International Society Health Index (ASAS HI) for overall health and functioning. Univariable and multivariable linear regression analyses were performed to assess the association between anxiety, depression and resilience with health and functioning.ResultsWe included 296 patients in this study. The median (IQR) score for HADS-Anxiety was 5.0 (2.0–8.0), with 13.5% and 13.9% having borderline abnormal and abnormal anxiety, respectively. The median (IQR) score for HADS-Depression was 3.0 (1.0–7.0), with 12.8% and 8.4% having borderline abnormal and abnormal depression, respectively. The median (IQR) CD-RISC-10 score was 29.0 (23.0–32.0) while the median (IQR) ASAS HI score was 4.0 (2.0–7.0). Apart from BASDAI, BASFI and disease duration, anxiety and depression were associated with overall health and functioning (β: 0.12, 95% CI 0.03, 0.20; β: 0.20, 95% CI 0.09, 0.31) in the multivariable linear regression. Level of resilience was not associated with health and functioning.ConclusionAnxiety and depression, but not resilience, were associated with poorer health and functioning. Clinicians could consider routinely screening for anxiety and depression in their patients, especially in patients with more severe symptoms.
Background Despite therapeutic advances, treatment of patients with axial spondyloarthritis (axSpA) continue to pose as a challenge as many do not respond well to conventional Western medications, such as nonsteroidal anti‐inflammatory drugs (NSAIDs) and biologic disease‐modifying antirheumatic drugs (bDMARDs). Hence, acupuncture is a possible alternative. Some studies found electroacupuncture to be better than manual acupuncture, though no trials have been conducted in patients with axSpA. This clinical trial aims to evaluate the clinical efficacy, safety, and cost‐effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA. Methods/Design This randomized controlled trial will recruit 100 patients diagnosed with axSpA, who have active disease despite NSAIDs and bDMARDs. Eligible patients will be randomized to receive either electroacupuncture or manual acupuncture in a 1:1 ratio. All participants will receive standard rheumatologic care in addition to 20 acupuncture sessions. The mean difference in Bath Ankylosing Spondylitis Disease Activity Index score between the 2 groups over 12 weeks will serve as the primary outcome. Secondary outcomes include improvements in other clinical, quality of life, and economic outcomes over 24 weeks. All adverse events will be recorded. Discussion Results from this trial may provide evidence regarding the clinical effectiveness, safety, and cost‐effectiveness of electroacupuncture compared to manual acupuncture for patients with axSpA, and guide implementation into clinical practice. Limitations of this trial include the lack of patient blinding, use of a repeated measures design, and possible variation in acupuncture technique amongst the various Traditional Chinese Medicine practitioners.
BACKGROUND The use of social media in healthcare may serve as a beneficial tool for education, information dissemination, telemedicine, research, networking and communications. To better leverage on the benefits of social media, it is imperative to understand the patterns of use and potential barriers to its implementation in healthcare. A previous study in 2016 which investigated social media use among young clinical rheumatologists (45 years and younger) and basic scientists showed that there was substantial use of social media among them for social and professional reasons9. However, there is limited inquiry on social media use amongst different areas in Rheumatology, such as spondyloarthritis. OBJECTIVE To explore motivations, barriers and patterns of social media use among an international group of clinicians and researchers with an interest in spondyloarthritis. METHODS We distributed an online survey via email from March 2021 to June 2021 to 198 members of the Assessment of SpondyloArthritis international Society (ASAS). It contained 24 questions about demographic characteristics, patterns of current social media usage and perceptions of utility. Univariable and multivariable logistic regression analyses were performed to identify characteristics associated with usage patterns. RESULTS The response rate was 78.8% (n=156). Of these, 146 (93.6%) used at least one social media platform. Apart from online shopping and entertainment, usage of social media for clinical updates (OR: 6.25, 95% CI: 2.43 – 16.03) and research updates (OR: 3.45, 95% CI: 1.35 – 8.78) were associated with higher social media consumption. Among the respondents, 103 (66.0%) utilised it in a work-related manner. Usage of social media for new online resources (OR: 6.55, 95% CI: 2.01 – 21.37), interaction with international colleagues (OR: 4.66, 95% CI: 1.21 – 17.90) and establishing an online presence (OR: 4.05, 95% CI: 1.25 – 13.13) were associated with higher levels of consumption for work-related purposes. Time investment, confidentiality concerns and security concerns were the top 3 challenges to a wider adoption of social media. CONCLUSIONS Majority of respondents (66.0%) utilise social media in a work-related manner. Professional development, establishing an online presence and international collaboration were associated with higher usage. Challenges to social media adoption should be addressed to maximise its benefits.
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